POS Core Plans - Only for plans with a renewal date of Sept. 1, 2008 or later
| Plan Name | Deductible | Coinsurance | Out of Pocket | Office Visit Copay | Prescription Benefits | ||||||||
| In Network | Out of Network | NHP - Member | In Network | Out of Network | In Network | ||||||||
| Single | Family | Single | Family | In Network |
Out of Network |
Single | Family | Single | Family | PCP | Specialist | ||
| POS 1 | $250 | $500 | $250 | $500 | N/A | 80-20% | $250 | $500 | $2,500 | $5,000 | $15 | $30 | Options |
| POS 2 | $250 | $500 | $500 | $1,000 | 80-20% | 70-30% | $1,500 | $3,000 | $3,000 | $6,000 | $20 | $40 | Options |
| POS 3 | $500 | $1,000 | $1,000 | $2,000 | 80-20% | 70-30% | $2,500 | $5,000 | $5,000 | $10,000 | $25 | $50 | Options |
| POS 4 | $750 | $2,250 | $1,750 | $5,250 | 80-20% | 70-30% | $3,000 | $6,000 | $6,000 | $12,000 | $25 | $50 | Options |
| POS 5 | $1,000 | $3,000 | $2,000 | $6,000 | 80-20% | 70-30% | $4,000 | $8,000 | $8,000 | $16,000 | $25 | $50 | Options |
| POS 6 | $1,500 | $4,500 | $3,500 | $10,500 | 80-20% | 70-30% | $5,000 | $10,000 | $10,000 | $20,000 | $25 | $50 | Options |
| CDPOS 1 | $1,500 | $3,000 | $3,000 | $6,000 | 100-0% | 70-30% | $1,500 | $3,000 | $4,500 | $9,000 | D/C | D/C | Options |
| CDPOS 2 | $2,500 | $5,000 | $5,000 | $10,000 | 100-0% | 70-30% | $2,500 | $5,000 | $6,500 | $13,000 | D/C | D/C | Options |
| CDPOS 3 | $3,500 | $7,000 | $7,000 | $14,000 | 100-0% | 70-30% | $3,500 | $7,000 | $8,500 | $17,000 | D/C | D/C | Options |
| P250 COCHOICE | $250 | $500 | $500 | $1,000 | 80-20% | 60-40% | $2,250 | $4,500 | $4,500 | $9,000 | $30 | $60 | Options |
| P500 COCHOICE | $500 | $1,000 | $1,000 | $2,000 | 80-20% | 60-40% | $2,500 | $5,000 | $5,000 | $10,000 | $30 | $60 | Options |
| P750 COCHOICE | $750 | $1,500 | $1,500 | $3,000 | 80-20% | 60-40% | $2,750 | $5,500 | $5,500 | $11,000 | $30 | $60 | Options |
| P1000 COCHOICE | $1,000 | $2,000 | $2,000 | $4,000 | 80-20% | 60-40% | $3,000 | $6,000 | $6,000 | $12,000 | $30 | $60 | Options |
| P1500 COCHOICE | $1,500 | $3,000 | $3,000 | $6,000 | 80-20% | 60-40% | $3,500 | $7,000 | $7,000 | $14,000 | $30 | $60 | Options |
| P2000 COCHOICE | $2,000 | $4,000 | $4,000 | $8,000 | 80-20% | 60-40% | $4,000 | $8,000 | $8,000 | $16,000 | $30 | $60 | Options |
| P2500 COCHOICE | $2,500 | $5,000 | $5,000 | $10,000 | 80-20% | 60-40% | $4,500 | $9,000 | $9,000 | $18,000 | $30 | $60 | Options |
| P3000 COCHOICE | $3,000 | $6,000 | $6,000 | $12,000 | 80-20% | 60-40% | $5,000 | $10,000 | $10,000 | $20,000 | $30 | $60 | Options |
| P3500 COCHOICE | $3,500 | $7,000 | $7,000 | $14,000 | 80-20% | 60-40% | $5,500 | $11,000 | $11,000 | $22,000 | $30 | $60 | Options |
| P4000 COCHOICE | $4,000 | $8,000 | $8,000 | $16,000 | 80-20% | 60-40% | $6,000 | $12,000 | $12,000 | $24,000 | $30 | $60 | Options |
| P4500 COCHOICE | $4,500 | $9,000 | $9,000 | $18,000 | 80-20% | 60-40% | $6,500 | $13,000 | $13,000 | $26,000 | $30 | $60 | Options |
| P5000 COCHOICE | $5,000 | $10,000 | $10,000 | $20,000 | 80-20% | 60-40% | $7,000 | $14,000 | $14,000 | $28,000 | $30 | $60 | Options |
| HSAP1500 - 0% | $1,500 | $3,000 | $2,500 | $5,000 | 100-0% | 80-20% | $1,500 | $3,000 | $4,500 | $9,000 | D | D | Options |
| HSAP1500 - 10% | $1,500 | $3,000 | $2,500 | $5,000 | 90-10% | 70-30% | $2,000 | $4,000 | $5,500 | $11,000 | D/C | D/C | Options |
| HSAP1500 - 20% | $1,500 | $3,000 | $2,500 | $5,000 | 80-20% | 60-40% | $2,500 | $5,000 | $6,500 | $13,000 | D/C | D/C | Options |
| HSAP2000 - 0% | $2,000 | $4,000 | $3,000 | $6,000 | 100-0% | 80-20% | $2,000 | $4,000 | $5,000 | $10,000 | D | D | Options |
| HSAP2000 - 10% | $2,000 | $4,000 | $3,000 | $6,000 | 90-10% | 70-30% | $2,500 | $5,000 | $6,000 | $12,000 | D/C | D/C | Options |
| HSAP2000 - 20% | $2,000 | $4,000 | $3,000 | $6,000 | 80-20% | 60-40% | $3,000 | $6,000 | $7,000 | $14,000 | D/C | D/C | Options |
| HSAP2500 - 0% | $2,500 | $5,000 | $3,500 | $7,000 | 100-0% | 80-20% | $2,500 | $5,000 | $5,500 | $11,000 | D | D | Options |
| HSAP2500 - 10% | $2,500 | $5,000 | $3,500 | $7,000 | 90-10% | 70-30% | $3,000 | $6,000 | $6,500 | $13,000 | D/C | D/C | Options |
| HSAP2500 - 20% | $2,500 | $5,000 | $3,500 | $7,000 | 80-20% | 60-40% | $3,500 | $7,000 | $7,500 | $15,000 | D/C | D/C | Options |
| HSAP3000 - 0% | $3,000 | $6,000 | $4,000 | $8,000 | 100-0% | 80-20% | $3,000 | $6,000 | $6,000 | $12,000 | D | D | Options |
| HSAP3000 - 10% | $3,000 | $6,000 | $4,000 | $8,000 | 90-10% | 70-30% | $3,500 | $7,000 | $7,000 | $14,000 | D/C | D/C | Options |
| HSAP3000 - 20% | $3,000 | $6,000 | $4,000 | $8,000 | 80-20% | 60-40% | $4,000 | $8,000 | $8,000 | $16,000 | D/C | D/C | Options |
| HSAP3500 - 0% | $3,500 | $7,000 | $4,500 | $9,000 | 100-0% | 80-20% | $3,500 | $7,000 | $6,500 | $13,000 | D | D | Options |
| HSAP3500 - 20% | $3,500 | $7,000 | $4,500 | $9,000 | 80-20% | 60-40% | $4,000 | $8,000 | $9,000 | $18,000 | D/C | D/C | Options |
| HSAP4000 - 0% | $4,000 | $8,000 | $5,000 | $10,000 | 100-0% | 80-20% | $4,000 | $8,000 | $7,000 | $14,000 | D | D | Options |
| HSAP4000 - 20% | $4,000 | $8,000 | $5,000 | $10,000 | 80-20% | 60-40% | $5,000 | $10,000 | $10,000 | $20,000 | D/C | D/C | Options |
| HSAP4500 - 0% | $4,500 | $9,000 | $5,500 | $11,000 | 100-0% | 80-20% | $4,500 | $9,000 | $7,500 | $15,000 | D | D | Options |
| HSAP4500 - 20% | $4,500 | $9,000 | $5,500 | $11,000 | 80-20% | 60-40% | $5,500 | $11,000 | $11,000 | $22,000 | D/C | D/C | Options |
| HSAP5000 - 0% | $5,000 | $10,000 | $6,000 | $12,000 | 100-0% | 80-20% | $5,000 | $10,000 | $8,000 | $16,000 | D | D | Options |
| HSAP5000 - 20% | $5,000 | $10,000 | $5,600 | $11,200 | 80-20% | 60-40% | $5,600 | $11,200 | $11,200 | $22,400 | D/C | D/C | Options |
D/C = Deductible and Coinsurance
Please note: These plans are effective Sept. 1, 2008. This summary is intended to highlight and give a general description of some of the benefits available. For a complete description of benefits, limitations and exclusions, please refer to the Member Responsibility Tables and Certificate of Coverage.
