POS Core Plans - Only for plans with a renewal date prior to Sept. 1, 2008
| Plan Code | Plan | Deductible | Coinsurance | Out of Pocket | Copay | |||||||
| 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 | OV | ||
| POS1019 | POS 1 | $250 | $500 | $250 | $500 | N/A | 80-20% | $250 | $500 | $1,250 | $2,500 | $10 |
| POS1020 | POS 2 | $250 | $500 | $500 | $1,000 | 90-10% | 70-30% | $500 | $1,000 | $1,500 | $3,000 | $15 |
| POS1021 | POS 3 | $500 | $1,000 | $1000 | $2,000 | 80-20% | 70-30% | $2,000 | $4,000 | $3,000 | $6,000 | $20 |
| POS1023 | POS 4 | $750 | $2,250 | $1,750 | $5,250 | 70-30% | 70-30% | $3,000 | $6,000 | $4,000 | $8,000 | $20 |
| POS1025 | POS 5 | $1,000 | $3,000 | $2,000 | $6,000 | 70-30% | 70-30% | $4,000 | $8,000 | $5,000 | $10,000 | $30 |
| POS1026 | POS 6 | $1,500 | $4,500 | $3,500 | $10,500 | 70-30% | 70-30% | $6,000 | $12,000 | $9,500 | $19,000 | $30 |
| POS1016 | CDPOS 1 | $1,500 | $3,000 | $3,000 | $6,000 | 90-10% | 70-30% | $2,000 | $4,000 | $4,000 | $8,000 | D/C |
| POS1017 | CDPOS 2 | $2,500 | $5,000 | $3,500 | $7,000 | 90-10% | 70-30% | $3,500 | $7,000 | $5,500 | $11,000 | D/C |
| POS1018 | CDPOS 3 | $3,500 | $7,000 | $5,000 | $10,000 | 90-10% | 70-30% | $5,000 | $10,000 | $8,000 | $16,000 | D/C |
| POS1007 | POS 250 CO-CHOICE | $250 | $500 | $500 | $1,000 | 80-20% | 60-40% | $1,250 | $2,500 | $2,500 | $5,000 | $20/$45 |
| POS1009 | POS 500 CO-CHOICE | $500 | $1,000 | $1,000 | $2,000 | 80-20% | 60-40% | $1,500 | $3,000 | $3,000 | $6,000 | $20/$45 |
| POS1010 | POS 750 CO-CHOICE | $750 | $1,500 | $1,500 | $3,000 | 80-20% | 60-40% | $1,750 | $3,500 | $3,500 | $7,000 | $20/$45 |
| POS1011 | POS 1000 CO-CHOICE | $1,000 | $2,000 | $2,000 | $4,000 | 80-20% | 60-40% | $2,000 | $4,000 | $4,000 | $8,000 | $20/$45 |
| POS1012 | POS 1500 CO-CHOICE | $1,500 | $3,000 | $3,000 | $6,000 | 80-20% | 60-40% | $2,500 | $5,000 | $5,000 | $10,000 | $20/$45 |
| POS1014 | POS 2000 CO-CHOICE | $2,000 | $4,000 | $4,000 | $8,000 | 80-20% | 60-40% | $3,000 | $6,000 | $6,000 | $12,000 | $20/$45 |
| POS1056 | POS 2500 CO-CHOICE | $2,500 | $5,000 | $5,000 | $10,000 | 80-20% | 60-40% | $3,500 | $7,000 | $7,000 | $14,000 | $20/$45 |
| POS1057 | POS 3000 CO-CHOICE | $3,000 | $6,000 | $6,000 | $12,000 | 80-20% | 60-40% | $4,000 | $8,000 | $8,000 | $16,000 | $20/$45 |
| POS1058 | POS 3500 CO-CHOICE | $3,500 | $7,000 | $7,000 | $14,000 | 80-20% | 60-40% | $4,500 | $9,000 | $9,000 | $18,000 | $20/$45 |
| POS1059 | POS 4000 CO-CHOICE | $4,000 | $8,000 | $8,000 | $16,000 | 80-20% | 60-40% | $5,000 | $10,000 | $10,000 | $20,000 | $20/$45 |
| POS1060 | POS 4500 CO-CHOICE | $4,500 | $9,000 | $9,000 | $18,000 | 80-20% | 60-40% | $5,500 | $11,000 | $11,000 | $22,000 | $20/$45 |
| POS1061 | POS 5000 CO-CHOICE | $5,000 | $10,000 | $10,000 | $20,000 | 80-20% | 60-40% | $6,000 | $12,000 | $12,000 | $24,000 | $20/$45 |
| HSAPOS1000 | HSAPOS 1500 - 100% | $1,500 | $3,000 | $2,500 | $5,000 | N/A | 80-20% | $1,500 | $3,000 | $4,500 | $9,000 | D |
| HSAPOS1001 | HSAPOS 1500 - 90% | $1,500 | $3,000 | $2,500 | $5,000 | 90-10% | 70-30% | $2,000 | $4,000 | $5,500 | $11,000 | D/C |
| HSAPOS1002 | HSAPOS 1500 - 80% | $1,500 | $3,000 | $2,500 | $5,000 | 80-20% | 60-40% | $2,500 | $5,000 | $6,500 | $13,000 | D/C |
| HSAPOS1003 | HSAPOS 2000 - 100% | $2,000 | $4,000 | $3,000 | $6,000 | N/A | 80-20% | $2,000 | $4,000 | $5,000 | $10,000 | D |
| HSAPOS1004 | HSAPOS 2000 - 90% | $2,000 | $4,000 | $3,000 | $6,000 | 90-10% | 70-30% | $2,500 | $5,000 | $6,000 | $12,000 | D/C |
| HSAPOS1005 | HSAPOS 2000 - 80% | $2,000 | $4,000 | $3,000 | $6,000 | 80-20% | 60-40% | $3,000 | $6,000 | $7,000 | $14,000 | D/C |
| HSAPOS1006 | HSAPOS 2500- 100% | $2,500 | $5,000 | $3,500 | $7,000 | N/A | 80-20% | $2,500 | $5,000 | $5,500 | $11,000 | D |
| HSAPOS1008 | HSAPOS 2500 - 90% | $2,500 | $5,000 | $3,500 | $7,000 | 90-10% | 70-30% | $3,000 | $6,000 | $6,500 | $13,000 | D/C |
| HSAPOS1009 | HSAPOS 2500 - 80% | $2,500 | $5,000 | $3,500 | $7,000 | 80-20% | 60-40% | $3,500 | $7,000 | $7,500 | $15,000 | D/C |
| HSAPOS1010 | HSAPOS 3000 - 100% | $3,000 | $6,000 | $4,000 | $8,000 | N/A | 80-20% | $3,000 | $6,000 | $6,000 | $12,000 | D |
| HSAPOS1011 | HSAPOS 3000 - 90% | $3,000 | $6,000 | $4,000 | $8,000 | 90-10% | 70-30% | $3,500 | $7,000 | $7,000 | $14,000 | D/C |
| HSAPOS1012 | HSAPOS 3000 - 80% | $3,000 | $6,000 | $4,000 | $8,000 | 80-20% | 60-40% | $4,000 | $8,000 | $8,000 | $16,000 | D/C |
| HSAPOS1020 | HSAPOS 3500 - 100% | $3,500 | $7,000 | $4,500 | $9,000 | N/A | 80-20% | $3,500 | $7,000 | $6,500 | $13,000 | D |
| HSAPOS1024 | HSAPOS 3500 - 80% | $3,500 | $7,000 | $4,500 | $9,000 | 80-20% | 60-40% | $4,500 | $9,000 | $9,000 | $18,000 | D/C |
| HSAPOS1021 | HSAPOS 4000 - 100% | $4,000 | $8,000 | $5,000 | $10,000 | N/A | 80-20% | $4,000 | $8,000 | $7,000 | $14,000 | D |
| HSAPOS1025 | HSAPOS 4000 - 80% | $4,000 | $8,000 | $5,000 | $10,000 | 80-20% | 60-40% | $5,000 | $10,000 | $10,000 | $20,000 | D/C |
| HSAPOS1022 | HSAPOS 4500 - 100% | $4,500 | $9,000 | $5,500 | $11,000 | N/A | 80-20% | $4,500 | $9,000 | $7,500 | $15,000 | D |
| HSAPOS1026 | HSAPOS 4500 - 80% | $4,500 | $9,000 | $5,500 | $11,000 | 80-20% | 60-40% | $5,500 | $11,000 | $11,000 | $22,000 | D/C |
| HSAPOS1023 | HSAPOS 5000 - 100% | $5,000 | $10,000 | $6,000 | $12,000 | N/A | 80-20% | $5,000 | $10,000 | $8,000 | $16,000 | D |
| HSAPOS1027 | HSAPOS 5000 - 80% | $5,000 | $10,000 | $5,600 | $11,200 | 80-20% | 60-40% | $5,600 | $11,200 | $11,200 | $22,400 | D/C |
