ORDER N0.28473 EMPLOYEE HEALTH INSURANCE On this 22"d day of December 2003 upon motion made by Commissioner Letz, Seconded by Commissioner Williams the Court approved by vote of 3-1-0 to award the Employee Health Insurance to EBA. COMMISSIONERS' COURT AGENDA REQUEST ~ ~ w 13 PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS REQUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT. MADE BY: Pat Tinley OFFICE: Coup Jud MEETING DATE: December 22, 2003 TIl~1E PREFERRED: SUBJECT: (PLEASE BE SPECIFIC) Consider and discuss acceptance, rejection or other appropriate action on Employee Health Insurance Bids. EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON) NAME OF PERSON ADDRESSING THE COURT ESTIMATED LENGTH OF PRESENTATION: IF PERSONNEL MATTER -NAME OF EMPLOYEE: Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and 552, Government Code, is as follows: Meeting scheduled for Mondays: THIS REQUEST RECEIVED BY: THIS REQUEST RECEIVED ON: County Jude 5:00 P.M. previous Tuesday. All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been prepared for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be appreciated and contribute towards you request being addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners' Court. p-an Name Funding Method Stop-Loss Insurer Coverage Basis O tional Coverage Basis on P Quotes S ecific) Covered Benefits ( P Covered Benefits (A99) Specific SIR Specific SIR on Optional Quotes Lazering? Guarantees Specific Stop"Loss Rate (Employee) & Specific Stop-Loss Rate (EmP pependent(s) Loss Rate Aggregate Stop" (Employee) Claim Adrn'nistration CtOB tRA1H PPA Ne~ork Monthly Fixed Cost NCE.FUNDING OPTIONS.. TY MEpICA~ INSURA TAC KEFtR COON Greentree & 1100 Expiring plans A, B & C Self-Funded Clarendon 12:12 nta Medical Medical$&40 0 nla No nta 57.4 124.21 EBA Plans A, B ~` C Self-F Se unity Fidelity 12:12 0 14.75 1.95 3 $24,440 Medical & RX Medical & RX $40,000 Plans A, B ~ C $elf_Funded Mutual of Omaha 12:12 12:12, 8:8,11:8,12:15 Medical Medical & RX $40,000 Plan 300 Self-Funded Blue Cross 12:15 9:12 Medical Medical & RX $40,000 $50,000, $75,000, $100,000 $50,000,$60,000 $50,000 ~'~ ~U~ ~ u~1~ Yes ($75,000 0 ~ ~ person) (e°'~t toward aggregate I.lo attachment point?) No 3 year TPA fee, all other one Year 46.35 107.49 6.g 14 1.95 0,5 3 $22,934 3 year TPA fee, all One year other one year 36.26 94.09 3.12 31.5 0 0 $22,253 aha Mutual 1 & 2 3 & 4, Classes5 & 6 Self-Funded Mutual of Omaha 12:12 12:15,15:12 Medical & ~ Medical & RX $40,000 Yes ($75,000 specific on 1 person, does not count toward ae gt poan attachm One Year 37.97 51.62 96.94 51.62 9.49 46.18 0 0 $28,432 6.25 24.3 2~ a.s 2.95 $23,32f . ,~ t 4 Annual Fixed Cost $293,281 $275,207 $267,036 $341,182 $279,909 Claim Factors for "Maximum" Claim Levels (High Plan) 392 94 271.96 Employee Only 324.13 280.47 267.35 849.73 735.25 637.47 392.94 601.23 Employee & Child(ren) 392.94 601.23 Employee & Spouse 849.73 735.25 637.47 849.73 735.25 637.47 392.94 601.23 Employee & Family Claim Factors for "Maximum" Claim Levels (Mid Plan) 362.48 223.56 Employee Only 324.13 250.8 267.35 849.73 657.49 637.47 362.48 492.52 Employee 8~ Child(ren) 362.48 492.52 Employee & Spouse 849.73 657.49 637.47 849.73 657.49 637.47 362.48 492.52 Employee & Family Claim Factors for "Maximum" Claim Levels (Low Plan) 362.48 201.28 Employee Only 324.13 229.23 267.35 849.73 600.93 637.47 362.48 442.83 Employee & Child(ren) 442.83 Employee & Spouse 849.73 600.93 637.47 362.48 849.73 600.93 637.47 362.48 442.83 Employee & Family Monthly Maximum Claims 1 409165 $1,177,969 $1,116,659 $1,226,520 $1,043,473 Annual Maximum Clams $ > Monthly Admin. & Maximum Claims $141,871 $121,098 $115,308 $130,642 $110,282 Annual Admin. ~ Maximum Claims $1,702,447 $1,453,176 $1,383,695 $1,567,704 $1,323,382 Terminal Stop-Loss Run-Off $191,176 n/a Liability n/a n/a n/a Based On... Employee Only (High Plan) 164 Emp/child (High Plan) 13 Emp/Spouse (High Plan) 14 Emp/Family (High Plan) 11 Employee Only (Mid Plan) 30 Emp/Child (Mid Plan) ~ Emp/Spouse (Mid Plan) ~ Emp/Family (Mid Plan) 3 Employee Only (Low Plan) 11 Emp/Child (Low Plan) 2 Emp/Spouse (Low Plan) 2 Emp/Family (Low Plan) 1 Total 265 Note: The figures above include retirees. Also, since TAC is quoting only 2 plans, this illustration assumes that all Plan C enrolles would be covered under TAC Plan 1 moves away from EBA, EBA will charge $12 per run-off claim for servicing. "High" Benefit Level Plans Current Plan (Plan A) EBA Proposal Greentree Proposal TAC proposal' (Plan A) . (Plan A) (Plan 3tJtij Network Non-Network Neti~rvrk N4t~--.. Network Non- Network - Ncin-~tetwark N N.etvvOrlt: Network ~ i r ~. - ,. .s ~' i , ~t P... ~ <. 1 ~e i :c~y~ ClT x r r ~ a ~ . ~~ ~:,}. '~ .1 ° ~ .,. .. , Network Hill Country Alliance, !-lilt ` ` Hill Co untry E31ue CrQSe T~ Texas True Choice C©untry Alliance, ~ C At~ance, . !*~' Texts . ~~j ~' " :True Ct'tC>it~: Deductible $400 $800 S~rt1e 85 Same.es. Same as Same as $2~0.. `$500 .. $~ Family Deductible $1,200 $2,400 Expiring .,, Expiring Expiring Expiring $750 $'1`,500 ~' $~ B~tiB'Frts. BeneSts Benefits Benefits 3 Month Ded. yes yes yes _ dyes nc Carr over Coinsurance $2,000 plus ded. $4,000 plus ded. $'1,500 .:. $~,SttO $~ Maximum (i~ individual dE Coinsurance $6,000 plus deds. $12,000 plus deds. $4,5t}0 $'[4,5t}0 $~ Maximum (family) (ir dE Total out of Pocket $2,400 (including $4,800 (including ~«~ $1,750 $4,OOU $ (individual) deductibles) deductibles) ~ ~~ ~p (i d Total out of Pocket $7,200 (including $14,400 (including $5,250 ; $`I;24t~'l $' (family) deductibles) deductibles) '.: .. ; (ii di Lifetime $1 M $1 M $2M $2M' ; $~ Maximums && ;(%~~; ~' i,3 n # t. '4: .. „, ' "~a. ^x ~ ~ Z• " ,,. "X. ~ :. .. ,..,~; •,;.» a n::~,, ~~"i.,si* ':a~g ~.: '",Y.,''.. $84 '"$ ~ 'f^sA , k „am.>7 d ~-.. o~ ~'.;. %.: ~ ;~ .... ": ,., y.i" t, ~ s 5• 7 • - ''w~'i .~rs'4,S '": `ra ;'~ rk~., ~.„ <$$~ ~'~/ v ~ ury" .;?r'~F ,g,,. <. "-ebb. .s'..x .~ ti . ~ " "w ~ ' ' P > S?"d~ q• r.: 1~`, ~; ms`s ~ {~.b ! ~. rte.,.. .. ~ fi ~ ` ` ~ vim, r 'i~,'~i;. d... & ,,.~.Z.. . '~'° g ~~ p [ < $' ,? .Y G i d' 'm'M»•.' ' a$~?.'s$?r~~; ryse p' ~~1~y~,,>1 i +~1!5 -•~, nF '~ .. $ s ~, e'y~ +"s ..N~',. • , r> .xT~`... ,X:.,. 4 '?",2,.~°,~„ ~.."'°,li',~,~_~ ~ ; ~ t. ; p~~ e ~ '.. .~a Aa'~ry .. ...~. ~ ~ ~J g ,~,~~.o r;k... . ~$°4's °~':...s.: o =~. yt~ ; w ' s :nr" ` • y, ;. . „ . a. ~ ve m iA '"%'; w /.. >`§f' 9. 3 ~` .. ~g a ~ ~ ,ge ~ ~ '? : ' o-' .. fi~yy . mz ~ ~'. g ~ ~~~~,~, , ~y x•,' a y,,,, ~UGfib~E t pp„~ ~,,C~' E~ .~. `.(,~~1G,~w~~°i.+ • ~ ~Qt r~~ 't~ ~.~ .. n'yt~+~f`.t~. ' ~~ ~ ~ ..8 , , c.u,„xv,7s ' -n t;~,~y 3 w>s=.'.~"r:.', 3 •,dF~ ~.° . ' r .•i x Y f s. ~• k .» p "... "4 .. i N ~ ~?,y"m ,~~ '"¢~b":.. x,6h>vy~-. aq~ ~~„"A Y.. e4,', ~' ~ ~ ~ Generic retail $5 co a * $5 co a * Same as Same as Same as Same as $5 co a * $5 co a * $' Generic mail order $10 copay* (90 $10 copay* (90 Expiring Expiring Expiring Expiring $10 copay* (90 $10 ecapay* (90 $; "~ ~ da s da s Sene€its Benefits Benefits Benefits da s da s d< n ~ ~.,. Name Brand retail $20 copay* $20 copay* $35 copay* $35 Copay" $: (single source) fc Name brand mail $25 copay* (90 $25 copay* (90 $7t3 copey* `$70 capay*' ." $~ order (single days) days) - ,. fc source ,: :, d. Name Brand retail $35 copay* $35 copay* $20 cc~pay* . $Ztl copay~ . " $~ (multiple source) ° . , ': fc Name brand mail $40 copay* (90 $40 copay* (90 $40 copay* $4Q capay* $~ order (multiple days) days) fc source) d, ~ may" Dedu~tEble a'r lies unless`not ~ ,, ~ ,~ ~~ - f' ~ , `' Hospital None None S~rne s Same: Same as Same as None None , ,. N Deductible Expi ' g , ~ Expiring Expiring Transplants $250,000 $250,000 B fits `efs` Benefits Benefits None N©ne N lifetime max. Trans lants 90% 70% ~ 9t}°fo T€}°k 91 Transplant $10,000 ($200/day) Not covered N transportation, lod in ,meals Organ 100% up to $10,000 100% up to $10,000 $ Procurement for lung, heart, liver, for lung, heart, liver, kidney/pancreas, kidney/pancreas, heart lung, allogenic heart/lung, allogenic ' BMT BMT Emergency Room 90°lo after $75 . 90°fo: after $75 $~ Facility charges for copay cbpay true emergencies Emergency room 90°l0 90% 91 Physician charges for true emer encies Emergency Room 90% after $75 ~ 7`(~%n after $75 ,,, 91 Facility charges for copay, copay non-emergencies , , Emergency room `9(}~la' :.. 7Q°!~` 9( Physician charges for non- emergencies Kerrville roviders P $10 co a * pY $20 co a * pY ~ $~O co '~ i~i~: ;, 70%.: ;.., $' Out of Kerrville $20 copay* $20 copay* ;: ,:;; .... . ..., .. - ,.$20 c©p~y'*:..; 7th°Ic~ ` ' , ; . $, roviders , , .. .. Physician Inpatient 90% 70% .. _,: .: .; ... ;. Physician Surgery 90% 70% 9tl°lo ~`n% _ 9( (inpatient) Anesthesiology 90% 70% ; .: - ` :' > 90°~ 7th°I° ~ 9( in atient Allergy tests, 90% 70% 90°~ 7C1~1a ::. 9( serums and infections X-ray, Radiologist 90% 70% 90% 70% 9( Lab, Patholo ist 70% 70% 100%'` 70Q~ . 9( Preferred Lab 100%* Not covered 1001°fo* 713% 1( Accidental Injuries 100%* to $300 Not covered 90°I° 70% 9( Outpatient 90% 70% 90%" 7q°fo 9 Services Outpatient Surgery 90%" 70%'` 90°fa . ' 70% .~ .... 9 Home Health care 90% ($10,000 70% ($10,000 ~ 10C!#/o": ~ `' ' ~ 70°la",($7,0401yr} 9~ max./lifetime) max./lifetime) {$'ia,01)fi~lyr)" P' Skilled Nursing 90% (7 days) 70% (7days) ,.. , 1t}0°fo. > ""~©~lo ($7,C3t~t~{ye) 9~ Hospice Care 90% ($20,000 70% ($20,000 109°l0-. ,_ 7Q„°!o ;, " ..; Ir lifetime max.) lifetime max.) ($2Q,41101itfe}; .~,, , ($'t"4,f3t}t~ilife} 1i d. t....:;, ,.,, 9i ~" ": , ... ~" ., ; '" d; . ...., . 0 . ~.., ...:.... ~..:.,. . : .:. :. ~ gi . ,.; . d, Chiropractic Care 90% ($1,500 yearly 70% ($1,500 yearly 9d°!o ($"f,541tI" ~7t1°I~r,(~i'1,~t30 9i max. max. ea!' max. "", ~~1... tri~c. ' i Physical Therapy 90% ($1,500 yearly 70% ($1,500 yearly 94°l0 7t1% :: 9i max. max. Speech Therapy 90% 70% , ~: 90°to,: ', 7{3%. ,. N Ambulance 90% 70% 9{1°~ 7f1%_ 8i Routine Newborn 90%'` 70%" $20 copay~` 7(}°l0. 9i Care Sick Bab care 90% 70% 911°la 7fl°lo 9i Maternity initial 90% (dependent 70% (dependent 90% 7t3°I° 9i office visit, delivery daughters not daughters not related fees, other covered) covered) OB related fees Preventative Care 100%` to $200 Not covered $2t? c~pay* 70% 1 i $; Durable Medical 90% 70% 90% 70% 9 Equipment Mental Disorders - Same as an other Same as an other Satri~: ~~ an Same as an Serious Illness illness illness other illness other illness o Other Mental 50%, 7 days /year 50%, 7 days /year COQ/o*~ 3f~ days 70°la*, 30 days, 9 Disorders - atxl 30 dr, and 30.dr. d inpatient ~risits/yr. , uisitsJyr, d {physician (physician Ghat~es subject charges "suhje~t tt~ tied::- tt> deft.. Other Mental 50%, 20 visits /year 50%, 20 visits /year Ot', $20 dr. @ 70°I°* _ 5 Disorders - cppay*, facility ct~pay*t facility, ~ a outpatient ~ 9d%* after 70%* after v $70 copay {30 $7A ccapay (30 visits/ r, visits! r: Substance Abuse 50%, 7 days /year 50%, 7 days /year Saiirie as other Same as etf~er .' 9 - inpatient non-serious nc~ti-serious d mental itfness manta[ illness d except subject except subject ~ to 3 treatment, to 3 treatment a set3es per series. per $ fifefirr~e lifefime Substance Abuse 50%, 20 visits /year 50%, 20 visits /year ` Same es other Same es other 5 -outpatient ,:mitt-S@Cfpu$ ~ . non-5erigtlS '' 2 mental illness mental illness v except subject except subject _ u to 3 treatment to 3 treatment g series per series per a lifetime lifetime g Dental Oral 90%" Not covered I` Sur er plan Na Method Funding Stop-Losslnsurer Coverage Basis Coverage Basis on Optional Quotes S ecific) Covered Benefits ( P Covered Benefits (A99) Specific SIR Specific SIR on Optional Quotes Lazering? Guarantees Specific Stop-Loss Rate (Emp-oyee) Specific Stop-Loss Rate (Emp & pependent(s) Aggregate Stop-Loss Rate (gmployee) Claim Administration Utilizatio F11PPA COBRA/ Network Monthly Fixed Cost DING pPTIONS'~ INSURANCE "FUN AL KERB COUNTY MEDIC TAG EBA Greentree p-an 300 & 1100 Expiring plans A, B ~ C Self-Funded Plans A, B ~ C Self-Funded Blue Cross Plans A, B & C Self-Funded Mutual of Omaha 12:15 Self-Funded Fidelity Security 12:12 Clarendon 12:12 12:12 $;8,11:8, 121 12:12, g:12 5 Medical Medical Medical & RX nla Medical & RX Medical & RX $40,000 Medical Medical & RX $40,000 Medical & RX $40,000 $50,000, $75,000, $40,000 ~10Q,000 $50,000, $60,000 $50,000 nla No No 3 year TPA fee, all other one year n/a 57.4 124.21 0 14.75 1.95 0 3 $24,440 46.35 107.49 6.9 14 1.95 0.5 3 $22,934 Yes ($75,000 on 1 person) (count toward aggregate attachment point?) 3 year TPA fee, all other one year 36.26 94.09 3.12 31.5 0 0 $22,253 No One year Mutual of Om3 ~ 4, Classes 1 & 2, 5&6 Self-Funded Mutual of Omaha 12:12 12:15, 15:12 Medical & RX Medical & RX $40,000 Yes ($75,000 erson, specific on P does not count toward a99reoint} attachment P pne year 37.97 51.62 96.94 51.62 6.25 9.49 24.3 46.18 2.4 0 0.8 0 2.95 0 $23,326 $28,432 Annual Fixed Cost Claim Factors for "Maximum" Claim Levels (High Plan) Employee Only Employee & Child(ren) Employee & Spouse Employee & Family Claim Factors for "Maximum" Claim Levels (Mid Plan) Employee Only Employee & Child(ren) Employee & Spouse Employee & Family Claim Factors for "Maximum" Claim Levels (Low Plan) Employee Only Employee & Child(ren) Employee & Spouse Employee & Family Monthly Maximum Claims Annual Maximum Claims Monthly Admin. & Maximum Claims Annual Admin. & Maximum Claims Terminal Stop-Loss Run-Off Liability Based On... Employee Only (High Plan) Emp/Child (High Plan) $293,281 $275,207 $267,036 $341,182 $279,909 324.13 280.47 267.35 392.94 271.96 849.73 735.25 637.47 392.94 601.23 849.73 735.25 637.47 392.94 601.23 849.73 735.25 637.47 392.94 601.23 324.13 250.8 267.35 362.48 223.56 849.73 657.49 637.47 362.48 492.52 849.73 657.49 637.47 362.48 492.52 849.73 657.49 637.47 362.48 492.52 324.13 229.23 267.35 362.48 201.28 849.73 600.93 637.47 362.48 442.83 849.73 600.93 637.47 362.48 442.83 849.73 600.93 637.47 362.48 442.83 $117,430 $98,164 $93,055 $102,210 $86,956 $1,409,165 $1,177,969 $1,116,659 $1,226,521 $1,043,473 $141,871 $121,098 $115,308 $130,642 $110,282 $1,702,447 $1,453,176 $1,383,695 $1,567,704 $1,323,382 n/a n/a n/a $191,176 n/a 164 13 EmpJSpouse (High Plan) 14 EmplFamily (High Plan) 11 Employee Only (Mid Plan) 30 Emp/Child (Mid Plan) ~ Emp/Spouse (Mid Plan) ~ Emp/Family (Mid Plan) 3 Employee Only (Low Plan) 11 EmplChild (Low Plan) 2 Emp/Spouse (Low Plan) 2 Emp/Family (Low Plan) 1 Total 265 Note: The figures above include retirees. Also, since TAC is quoting only 2 plans, this illustration assumes that all Plan C enrolles would be covered under TAC Plan 11 moves away from EBA, EBA will charge $12 per run-off claim for servicing. "Mid" B enefit Level Plan s l asat ro TAC M Current Plan (Plan A) EBA Proposa! Greentree Proposa p p (PI~n B} (Plan B) (Plan 1.~tflQ} , rk Netw 1~-N~twt~tlt Nt Netwokl Network Non-Network "N~twrark Nan=< - Network Non- o N Netrtit~rk Network .~` 1 ~ r~r ~ ~` r~,.~,:z 3Y . r ~ rt ~ c wY p'. y ~~ 1'Y t Y.. ~ z ~ I F~ ~ k .~ - 7 ~ i f T ~ C C Network Hill Country . Nib ~ Hill Country s .. :: (IueYCrvss Texas 1 Alliance, Texas Country Alliance, Choice True Choice Alliance, ???????? T~axas True Cha~ice 7at} $'I tk3Q $750 500 1 Same as Same Same as Same $ , Deductible $750 , $ .. . ` QC~C? $3 $2 250 Family 250 $2 $4,500 Expiring ds Expiring as $2,25a , , , 13ene~its -Expiring Benefits Expiring Deductible Benefits No Benefits Ye$ yes 3 Month Ded. yes yes Car over flClC} 6 750 $3 Coinsurance $3,000 plus ded. $5,000 plus ded. $3,C1E?t3° $ , , (includi Maximum deducti individual ~ $1$ Q(}CI 25 $11 $9,(~l , , Coinsurance $9,000 plus deds. $15,000 plus (includi Maximum deds. deduct (family) _ '- 750 $3 $7 000 750 $3 Total out of $3,750 (including $6,500 (including , , , (includii Pocket deductibles) deductibles) deductil (individual) 0!E3fI - ' 19 25 $11 Total out of $11,250 $19,500 $11,25q , $ , , (includi Pocket (family) (including (including deduct tibl d d deductibles es uc e $2M $2M $1 M Lifetime $1 M $1 M Maximums .. . .,.. ,, .. v ...., .e .... .., ,.,f2.. .•:. x: ...:.. s ...... / ,~' ,. ..... ..~ R# 6~ .} M, a 4 v... ?§.. . ,>... r,,..t~. .>.za ..., f; .... A., ,:Y .v. ,.., x ~.;, , :na ''r.'`~ Xr„~ o ..n.^ ,, a,,, e. ,:•~-~ t. g.~.>a„ys Yt. .. ~a~' ~. y`".:.{~::a~° a~% ~. `$~, ~`t'.: s~ ~t 'a" u~.: ~ ~~1 '~ ~ 'X :°4, X~..,• E . q~ .~,i :A;°a'%'"'c' ;~~: f ~~ ~ Y;?1 °<< _ , ~ ~~~.w•=a~~;-, ~-: ~. ~~'r'.3•' ' .~ .! cx ~ ,.. ~y~~" ~ .~ 'r~';~",^~,.~ ~:.. Y'7~ •~~vtT" ~ ~~`~~•4.~;" ~ }~~.r ,~.3~, ~S~ ~Q¢. y 'p~~y+{w '~ p,"Y;Yayr~„ y~~.~~ psG,.y: Z *~ k s yt 1„~ € S~iR7./ . i. ?i 'W d . ~ °.R•q ~ _ • a Generic retail $5 co a $5 co a " Sarne as i Same Same as irin Ex a Same $5 co as $10 copay* $5 co a * $1Q eopay*` $10* $20 (1i Generic mail $10 copay~` (90 (90 $10 copay ng Expir Benefits as Expiring g p Benefits Expiring 90 da s 90 da s da s " order days)_ da s Name Brand $20 copay'` $20 copay* Benefits Benefits $35 copay* $35 copay* $30 on retail (single formula source Name brand $25 copay* (90 $25 copay* (90 - $7Q copay* `$7q copay* $60 on mail order days) days) formula sin le source 100 da Name Brand $35 copay" $35 copay" $2t3 cnpay"~ -~24`copay* $45 no retail (multiple formula source Name brand $40 copay* (90 $40 copay* (90 ' $4i~ ~t~pay* ~4q'ccapay* $90 no mail order days) days) formul< (multiple 100 da source ~ ,~ ';, , ,, ~ E De~cluctibte~ a mess rioted with an asterisl< I ~ Hospital None None Same as. Same , Same as Same Norte Norte None Deductible Expiring 'as -" Expiring as Transplants $250,000 $250,000 Bene~tts" ;.expiring . Benefits Expiring None, Node None lifetime max. ' Benefits Benefits Trans lants 90% 60% ' 8d% . -;;;.;.;° _ .. o~~. -. 80% Transplant $10,000 Not covered . `??'~'???. ??'~??, '. None transportation, (200/day) . ,. ,. meals lod in , Organ 100% up to 100% up to '~?'~'??? ????? $50,00 Procurement $10,000 for lung, $10,000 for lung, heart, liver, heart, liver, kidney/pancreas, kidney/pancreas, heart/lung, heart/lung, alto enic BMT allo epic BMT Emergency ?????? 80°!° after 80°!° after 80% Room Facility $1 OD copay ~~~ ~paY charges for true emer encies Emergency ?????? 8p°!° 80°!0: 870% room Physician charges for true emer encies Emergency ?????? 80% after 8f?°!o after 80% Room Facility $1Qq CApey $'t00. cti#~ay charges for non- emer encies Emergency ?????? 80°!° 6C1~lo 80% room Physician charges for non- emer encies Kerrville $20 copay" $30 copay* $~5 Giipay~` 7p°!° $20 co roviders Out of Kerrville $20 copay* $30 copay* $25 ~pay~' 7C}°!°: , " $20 co roviders Physician 80% 60% 8Q°!o 6t3~k 80% In atient Physician 80% 60% 80°!0 60°la 80% Surgery " in atient Anesthesiology 80% 60% 80°~ 6Q°l° 80% in atient Allergy tests, 80% 60% 8q°!° 60?!° 80% serums and infections X-ray, 80% 60% 80°l0 ~ fit?% 80% Radiolo ist Patholo ist Lab 70% 60% 100%'~ , .; fia°!o, 80% , Preferred Lab 100%* Not covered ~t~t}~/o* Tt}°~~ ` 100%* Accidental 100%" to $300 Not covered ``8th°I° ~€~°To 80% In'uries Outpatient 80% 60% 80°!°" 60°fo 80% Services Outpatient 80%* 60%* $t3°I°';:": . ; 6>. except ;.` <: , ; exaep# $10,OC sibect to 3~ ° ~,t~je~ tc~ ~. ` and . ..., tr-eatnttent ' #rea#men#- .. . $30,0C ~~ series `per ' , series per t~e#irn~ `Ii~~e Substance 50%, 20 visits 50%, 20 visits ,, .:~ Same:;; i `' ° , `t`ree as ... 50%, ~ Abuse - /year /year . :; -.. , , dtl~e~' r~dn-; €~tFter ncr~ $70 outpatient ' ser~aus -serous allowa ,-; ~ me~ite i(tn+~s~;">; rrter~f[ itlr~es~' 50 visi `except. -:> ~ ,.. ,ex~ep# ~ yr. , uG . ;: , subject tci `. subjec# to 3 . $10,OC :,, ,' treatirieri# :#~ea#ment and ,::.::;.:: .: ,.... ; .. a. ,. seres~per ,";: , manes er p, ,. 30,OC Dental Oral 80%'` Not covered 80°!a 60°k Not co Sur e