UNIVERSITY OF OKLAHOMA PROPOSED DRAFT BENEFITS SUMMARY FEBRUARY 5, 2001

1.) All coinsurance is after contract year deductible - unless otherwise noted.

2.) Out-of-pocket maximum excludes deductibles and copays unless otherwise noted.

3.) POS in-network out-of-pocket maximum includes co-pays except Rx, out-of-network out-of-pocket excludes deductibles

Current PPO (bcbc)

Proposed PPO Option (bcbs)

Current POS (Prudential)

Proposed PPO (OU/Schaller)

In network Out of Network

In Network Out of Network

In Network Out of Network

In-Network Out of Network

Lifetime Maximum

$2 million combined

$2 million combined

Unlimited

$1 million

$2 million combined

Physician Office Visits - PCP

$10 copay

70% coins.

$10 copay

70% coins.

$10 copay

60% coins.

$10 copay

70% coins.

Physician Office Visits - Specialist

85% coins

85% coins.

$10 co-pay

$20 copay

70% coins.

Diagnostics, X-ray and lab billed

85% coins.

70% coins.

85% coins.

70% coins.

100% coverage

60% coins.

$10 copay

70% coins.

from free-standing lab/x-ray facility

Allergy injections and

85% coins.

70% coins.

85% coins.

70% coins.

$10 copay

60% coins.

$10 copay

70% coins.

Benefit Highlights

Individual

$100

$300

$150

$400

None

$500

None

$500

Family

$250

$750

$375

$900

None

$1,250

None

$1,250

Hospitalization - Facility

85% coins.

70% coins.

85% coins.

70% coins.

80% coins.

60% coins.

$200 copay

70% coins.

$300 deduct.

Outpatient Services - Facility

85% coins.

70% coins.

85% coins.

70% coins.

100% coverage

60% coins.

$100 copay

70% coins.

Maximum Out-of-Pocket

Excluding Co-pays

Excluding Co-pays

Excluding Co-pays

Excluding Co-pays

Excluding Rx

Individual

$1,000

$5,000

$1,000

$5,000

$1,000

$4,000

$1,000

$4,000

Family

$3,000

$15,000

$3,000

$10,000

Prescription Drug

Retail

85% coins.

70% co-ins.

$10 generic

not covered

$5 generic

Separate $100

$7 generic

not covered

$20 pref. brand

$10 pref. Brand

deductible, then

$14 pref. brand

$30 non-pref.

$25 non-pref.

70% coins.

$28 non-pref.

Mail Order**

NA

NA

NA

NA

$10 generic

$14 generic

not covered

(90 day supply)

$20 pref. Brand

$28 pref. brand

$50 non-pref.

$56 non-pref.

Preventive Care (annual)

Routine Physical

$10 copay

70% coins.

$10 copay

70% coins.

$10 copay

60% coins.

$10 copay

70% coins.

Pap Smear

under RP copay

70% coins.

Under RP copay

70% coins.

100% coverage

60% coins.

100% coverage

70% coins.

Prostate Screening

under RP copay

Not covered

Under RP copay

not covered

100% coverage

not covered

100% coverage

70% coins.

1 screen 40-49

1 screen 40-49

1 per year 50+

1 per year 50+

Gynecological Exam

$10 copay

70% coins.

$10 copay

70% coins.

$10 copay

60% coins.

$10 copay

70% coins.

Mammogram

$75/screen max

70% coins.

$75/screen max

70% coins.

100%

60% coins.

100%

70% coins.

1 mammo 35-39

1 mammo 35-39

1 mammo/yr 40+

1 mammo/yr 40+

Well Child Care

$10 copay

70% coins.

$10 copay

70% coins.

$10 copay

60% coins.

$10 copay

70% coins.

Immunizations

100% allowed chg

100% allowed chg

100% allowed chg

100% allowed chg

100% allowed chg

60% coins.

100% allowed chg

70% coins.

Emergency Care

$50 copay off top

$50 copay off top

$50 copay off top

$50 copay off top

$50 copay

60% coins.

$75 copay

70% coins.

(waived

(waived if admit)

(waived

(waived if admit)

(waived

(waived if admit)

(waived if

if admitted)

Add'l $300 ded.

if admitted)

add'l $300 ded.

if admitted)

admit)

85% coins.

85% coins.

85% coins.

70% coins.

100% thereafter

Maternity

85% coins.

70% coins.

85% coins.

70% coins.

80% coins

60% coins.

$200 inpat copay

70% coins.

$10 for only first

off.visit copay

Mental Health

Inpatient - 30 days/contract yr

80% coins.

70% coins.

80% coins.

70% coins.

80% coins.

50% coins.

$25 copay/day

70% coins.

Outpatient - severe

80% coins.

70% coins.

80% coins.

70% coins.

80% coins.

50% coins.

70% coins.

Outpatient

80% coins. & 24

70% coins.

80% coins. & 24

70% coins.

80% coins. & 24

50% coins.

$25 copay/visit, 24

70% coins.

visits/contract yr

Visits/contract yr

visits/contract yr

visits/contract yr

Inpatient Hospital

80% coins.

60% coins.

Physician Outpatient

$10 copay

60% coins.

Chemical Dependency

$2,500 annual max

$2,500 annual max

Inpatient - 30 days/contract yr

80% coins.

70% coins.

80% coins.

70% coins.

80% coins.

50% coins.

$25 copay/day

70% coins.

Outpatient

80% coins. & 25

50% coins.

80% coins. & 25

50% coins.

100% first 3 visits

50% coins.

$25 copay/visit, 24

70% coins.

visits/contract yr

Visits/contract yr

then 80% coins.

visits/contract yr

Ambulance

85% coins.

70% coins.

85% coins.

70% coins.

100% coverage

60% coins.

100% coverage

70% coins.

TMJ

$1,500 lifetime max

$1,500 lifetime max

$1,500 lifetime max

$1,500 lifetime max

85% coins.

70% coins.

85% coins.

70% coins.

85% coins.

60% coins.

$100 copay

70% coins.

Home Health

85% coins.

70% coins.

85% coins.

70% coins.

100% coverage*

60% coins.

100% coverage

70% coins.

Hospice

85% coins.

70% coins.

85% coins.

70% coins.

100% coverage*

60% coins.

100% coverage

70% coins.

**Looking into BC mail-order options

*With Case Mgmt.

**

still investigating a BC mail-order option

* With Case Mangmt.

 

 

 

 

CHANGE IN COSTS TO EMPLOYEE

PROPOSED RATES FY 2001-2002, February 9, 01

07/00-6/01

7/01-6/02

Employee's

7/00-6/01

07/01-06-02

Employee's

Current Prudential

Proposed BC/BS

Added Cost

Current Prudential

Proposed Schaller

Added Cost

Active Employees

Employee Only

$ 0.16

$ 7.10

$ 6.94

$ 0.16

0.00

$ (0.16)

Employee & Spouse

$ 204.24

$ 221.62

$ 17.38

$ 204.24

$ 223.65

$ 19.41

Employee & Child(ren)

$ 184.64

$ 184.85

$ 0.21

$ 184.64

$ 187.31

$ 2.67

Employee & Family

$ 329.92

$ 327.88

$ (2.04)

$ 329.92

$ 328.66

$ (1.26)

2 Employees & Child(ren)

N/A

$ 59.51

N/A

N/A

$61.43

N/A

07/00-06/01

07/01-06/02

Employee's

07/00-06/01

7/01-6/02

Employee's

Current BC/BS

Proposed Schaller

Added Costs

Current BC/BS

Proposed BC/BS

Added Cost

Active Employees

Employee Only

0.00

0.00

0.00

0.00

$ 7.10

$ 7.10

Employee & Spouse

$ 189.42

$ 223.65

$ 34.23

$ 189.42

$ 221.62

$ 32.20

Employee & Child(ren)

$ 158.00

$ 187.31

$ 29.31

$ 158.00

$ 184.85

$ 26.85

Employee & Family

$ 280.24

$ 328.66

$ 48.42

$ 280.24

$ 327.88

$ 47.64

2 Employees & Child(ren)

$ 50.86

$ 61.43

$ 10.57

$ 50.86

$ 59.51

$ 8.65

07/00-06/01

07/01-06/02

Employee's

07/00-06/01

7/01-6/02

Employee's

Current Prudential

Same Benefit Blue Cross

Added Cost

CurrentBC/BS

Same Benefit Blue Cross

Added Cost

Active Employees

Employee Only

$ 0.16

$ 16.57

$ 16.41

0.00

$ 16.57

$ 16.57

Employee & Spouse

$ 204.24

$ 231.66

$ 27.42

$ 189.42

$ 231.66

$ 42.24

Employee & Child(ren)

$ 184.64

$ 193.22

$ 8.58

$ 158.00

$ 193.22

$ 35.22

Employee & Family

$ 329.92

$ 342.73

$ 12.81

$ 280.24

$ 342.73

$ 62.49

2 Employees & Child(ren)

NA

$ 62.20

$ 50.86

$ 62.20

$ 11.34

07/01-06/02

07/01-06/02

Employee's

07/00-06/01

7/01-6/02

Employee's

Proposed Schaller

Same Benefit Blue Cross

Added Cost

Proposed BC

Same Benefit Blue Cross

Added Cost

Active Employees

Employee Only

0.00

$ 16.57

$ 16.57

$ 7.10

$ 16.57

$ 9.47

Employee & Spouse

$ 223.65

$ 231.66

$ 8.01

$ 221.62

$ 231.66

$ 10.04

Employee & Child(ren)

$ 187.31

$ 193.22

$ 5.91

$ 184.85

$ 193.22

$ 8.37

Employee & Family

$ 328.66

$ 342.73

$ 14.07

$ 327.88

$ 342.73

$ 14.85

2 Employees & Child(ren)

$ 61.43

$ 62.20

$ 0.77

$ 59.51

$ 62.20

$ 2.69