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2011 RECOMMENDED HEALTH INSURANCE PLANS <br />VA <br />RNs � 1 <br />this is a general product comparison only. The products listed may not cover all of your health care expenses. For exact terms and conditions, refer to the Group I <br />nembership Contract to determine which expenses are covererd. <br />-!11!- <br />8/17/2010 nam-. HealthPartnerse <br />Three for Free Plan <br />Qualified HDHP <br />Qualified HDHP <br />Health Service <br />Embedded Deductible <br />Embedded Deductible <br />In- Network <br />In- Network <br />In- Network <br />Lifetime maximum <br />Unlimited <br />Unlimited <br />Unlimited <br />Calendar Year Deductible <br />$1,500 per person <br />$2,500 per person <br />$5,000 per person <br />(applies to Medical OOP Max) <br />$3,000 per family <br />$5,000 per family <br />$10,000 per family <br />Calendar Year <br />Out of Pocket Maximum <br />$3,750 per person <br />$2,500 per person <br />$5,000 per person <br />(once OOP Max is met coverage is <br />$7,500 per family <br />$5,000 per family <br />$10,000 per family <br />100 %) <br />Preventive Health Care <br />100% coverage <br />100% coverage <br />100% coverage <br />Office Visits <br />Three free <br />Illness or Injury <br />then <br />100% after deductible <br />10 % after deduc le <br />Urgent Care <br />70% after deductible <br />Physical Therapy <br />Occupational Therapy <br />Speech Therapy <br />70% after deductible <br />100% after deductible <br />100% er de uctible <br />Chiropractic Services <br />Urgent Care <br />La' i Diagnostic Services <br />70% after deductible <br />100% after deductible <br />100% aft eductible <br />Inpatient Hospital Care <br />70% after deductible <br />100% after deductible <br />100% aft eductible <br />Outpatient Hospital Care <br />MRI /CT <br />70% after deductible <br />100% after deductible <br />100% a er d ductible <br />Emergency Care <br />Hospital ER <br />70% coverage after deductible <br />100% coverage after deductible <br />100% cove ge aft deductible <br />Ambulance <br />$12 preferred generic <br />Prescription Drugs <br />$45 preferred brand <br />100% after deductible <br />10 /° after dedu 'ble <br />$90 non preferred <br />Specialty Drugs <br />80% coverage up to <br />100% after deductible <br />1 % after deducts le <br />$200 copay <br />Out of Network Benefits <br />Out of Network Benefits <br />ut of Network Benefi <br />ifetime maximum <br />$1 million <br />$1 million <br />$1 million <br />�alendar Year Deductible <br />$3,000 per person <br />$2,500 per person <br />$5,00 per person <br />$9,000 per family <br />$5,000 per family <br />$10, 00 per family <br />krmual Out of Pocket Maximum <br />$9,000 per person <br />$2,500 per person <br />$5, 0 per person; <br />$5,000 per family <br />$1 ,000 per family <br />Routine Physicals <br />50% after deductible <br />100% after deductible <br />1 % after deductible <br />Prenatal Postnatal Care <br />50% after deductible <br />100% after deductible <br />0% after deductible <br />k11 other Services <br />50% after deductible <br />100% after deductible <br />00% after deductible <br />this is a general product comparison only. The products listed may not cover all of your health care expenses. For exact terms and conditions, refer to the Group I <br />nembership Contract to determine which expenses are covererd. <br />-!11!- <br />8/17/2010 nam-. HealthPartnerse <br />