RULES FOR NETWORK USE. A member is considered to have access to the network based on the type of services required, if there are: Primary Care -Two Primary Care Physicians (PCP) within 15 miles; Specialty Care -Two Specialty Care Physicians (SCP) within 20 miles; and Hospital - One hospital within 25 miles. The distance between the member and provider is the center-point of one zip code to the center-point of the other. Deductible $200/individual $500/individual $400/family $1,000/family Effective 1-1-09 $300/Individual $600/Individual $600/Family $1,200/Family Co-payments Office Visits $10 Most services 10% Effective 10-1-08 Office Visits $15 Services 0% or 10% (See 2. below) Emergency 0% Effective 10-1-08 Emergency room visit Emergency room visit $50 co-pay if not admitted $50 co-pay if not admitted Preventive Services Covered at 100% Not covered Limited to $1500 per Calendar year per person. Out-of-Pocket Maximum $1,000/individual $2,000/individual $2,000/family $4,000/family
Appears in 1 contract
Sources: Collective Bargaining Agreement
RULES FOR NETWORK USE. A member is considered to have access to the network based on the type of services required, if there are: Primary Care -Two Primary Care Physicians (PCP) within 15 miles; Specialty Care -Two Specialty Care Physicians (SCP) within 20 miles; and Hospital - One hospital within 25 miles. The distance between the member and provider is the center-point of one zip code to the center-point of the other. Deductible $200/individual $500/individual $400/family $1,000/family Effective 1-1-09 $300/Individual $600/Individual $600/Family $1,200/Family Co-payments Office Visits $10 Most services 10% Effective 10-1-08 Office Visits $15 Services 0% or 10% Emergency 0% (See 2. belowBelow) Emergency 0% Effective 10-1-08 Emergency room visit Emergency room visit $50 co-pay if not admitted $50 co-pay if not admitted Preventive Services Covered at 100% Not covered Limited to $1500 per Calendar year per person. Out-of-Pocket Maximum $1,000/individual $2,000/individual $2,000/family $4,000/family
Appears in 1 contract
Sources: Collective Bargaining Agreement