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<br /> InCumbonl{i\<ItI1a) FinlIHealthPPO _ Open _P1uo U.ile<l~PPO
<br /> 0
<br /> NtA NtA $4,000 annual plan cOst artd a one time $3, waNed NtA NtA In<IUded
<br /> setuplimplemenlation fee
<br /> NtA NtA NlA Dra1Iing of tfleSPD is inCluded at cost at cost at cost inClUded included iodUded
<br />
<br /> iocIuded tnctuded ioduded N/A NtA NtA N/A N/A N/A NtA NlA N/A
<br /> ineIUded iodUded iodUded fncfuded InclUded Included included inclUded inClUded included ' inClUded inclUded
<br /> , . " , .
<br /> $43,67 $45,85 $17,00 $17.00 $17,00 $15.30 $1M4 $16.47 $13,00 $13.2\1 RQ more than:
<br /> $41-59 $13.91
<br /> $41-59 $43.67 $45.85 $34.00 $34,00 $34,00 $15,30 $15.84 $16.47 $13.00 $13,2\1 ;01) more than
<br /> $13.91
<br /> $40.65 $42.68 $44.82 $17.00 $17.00 $17.00 $15.30 $15.84 $16.47 $13.00 $13.25 ,no more: than
<br /> $13.91
<br /> $42.68 $44.82 $34.00 $34.00 $34,00 $15,30 $15,84 $16.47 $13.00 $13.25 nO mot.than
<br /> $40.85
<br /> SO.60 $0.60 $0.60 Not Appfeable included, if no litigation invofved InclUded ioduded includl>d
<br /> lndUded ioClUded inCluded inCluded Ineluded Induded $0.15 SO.15 $0.15 included iodUded inCluded
<br /> 25%of~ tncIuded, but if sent to an outsi:fe firm, 29% of saYings $2501 clalm 15% of ~C
<br /> 25% of savings
<br /> 30%' of recoverfes 30% of recoveries 29'1!>of~ ~ of recoveiie&
<br />
<br /> In<:luded ineIUded inch,llfed N1A N1A NtA $1.20 $1.20 $1.20 - ioduded ioduded
<br /> .
<br /> iloIuded - - $2,50 $2.50 $2.50 ineJOcJed included included $2,75 $2.75 no more than
<br /> $2.89
<br /> ,_ Induded included $135 Per Hr. $135 Per Hr. $135 Per Hr. included inclUded included ioduded included IndUded
<br /> ioduded - Induded $135 Per Hr. $135 PerHr. $135 Per Hr. included incfuded inclUded IndUded iodUded IndUded
<br /> lndUded IndUded ioduded $135 Per Hr. $135 Per Hr. $135 Per Hr. included induded included ioduded included IncfUded
<br /> IndUded inclUded - Included Included Included included included included SO.50 SO.50 $0.50
<br /> add'1 cost add'1 cost add'1 cost N1A NlA NtA Wa n1a nIa
<br /> .
<br /> $420 $4.20 $4.20 ioduded inCluded InclUded ,ih(:lUded i1 Network access fee $1.50 $f.50 M'mwe than
<br /> $1,59
<br /> SO.80 SO.80 $0.80 Not Applicable Not available not avalable
<br /> $0,00 SO.OO $0,00 Entrust recommends $0.00 $0.00 $0.00 $0.00 $0,00 $0.00
<br /> World Doc at $3.95 PEPM
<br /> $4,000 None $10,000 - - -.
<br /> ... . "
<br /> - included ioduded $4.50 $4.50 $4,50 $17.30 $17.91 $18.63 $11.25 $11.25 tJomore1bil1
<br /> $11.81
<br /> iodUded included included $4.50 $4,50 $4.50 $17.30 $17.91 $18.63 $11.25 $11.25 no more than
<br /> $11.81
<br /> _a_$I.85 Free Online i1tdUded iodUded IndUded
<br /> IndUded IndUded inclUded IndU<fed Included ioduded included included ioduded lnduded inclUded iodUded
<br /> . ' . .
<br /> . $47." $49,27 $5'.45 $24.00 $24.00 $24.00 $39.89 $35.10 $38.45 $35.20 $35.45 ~"".&4
<br /> . . . .
<br /> $47.19 $49.27 $.51.45 $41.00 $41.00 $41.00 $39.89 $35.10 $38.45 $35.20 $35.45 $39.84
<br />. ' . ... 0 .
<br /> $48.25 $48.28 $50.42 $24.00 $24.00 $24.00 $33.95 $35.'0 $38.45 $31.50 $31.75 $38.'4
<br /> . ' . ...
<br /> $46.25 $48.28 $50.42 $41.00 $41.00 $41.00 533.95 $35.10 $38.45 $31.50 $31.75 $36.14
<br /> Entrust Will handle the complete Matches current plan design
<br /> COBRA/HlPAA/MEOtCARE PART DAdmlnistratlon for $5.94 HRA fee added to the fund cost:
<br /> the City for $3.95 PEPM, Charps that are not $2.00 of network fee includes PHS plus which fee iodudelo onlt$ ErllOllmenl.,.,mm
<br /> eonsidated eJJsible for reimbursement unded.t;e: works v&h precert on High cost services such as
<br /> reinsuranee contract. include, but are not limited to, a imaging. this can be .removed but does help self HRA
<br /> . fee of$4.95 pet'"transadfon. tt ~ important to review funded plans (2%) . $1500 finlIyear
<br /> the administration service a~ent provided by The OM program in included in the network Online fie$1500/$175hr
<br /> Entrust in order to have a complete understand Of aU access fees. stop-toes fee is based on $145 sptm custom programming
<br /> administrative expeDS:eS prior to the pia,. effectflfe deductible
<br /> date,
<br /> , , $283200 ~ ~
<br />.. $5617.00 ~ ~
<br />.. .., , $1 080.00 ~ ~
<br />.. " "' $4 715.00 ~ ~
<br />.. $14244,00 ImmEiII IIIID!1liE!JIi
<br /> $170928.00 ImimZl!II ~
<br />
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