County of Albemarle       Attachment  A
Proposed Medical Plan Options Effective October 1, 2004 -- Triple Option Plans  
       
  CURRENT (10/02 - 9/03)    
  POS - High Plan POS - Middle Plan POS - Low Plan
Coinsurance Paid By Plan 100% 90% 80%  
Maximum Out-of-Pocket (Individual/Family) $1,000/$2,000 $2,000/$4,000 $2,500/$5,000  
Inpatient Hospital $100/admission 10% coinsurance 20% coinsurance  
Physician Services        
 PCP office visit $15 $15 $20  
 Specialist visit $25 $25 $35  
Preventive Services        
 Physical Exams $15 $15 $20  
 Well Child Care $15 $15 $20  
Outpatient Services        
Outpatient Surgery 0% facility, $15/$25 physician 10% facility, $15/$25 physician 20% facility, $20/$35 physician  
 Urgent Care Center $15 $35 $35  
 Emergency Room $75 $100 20% coinsurance  
X-rays, MRIs and Lab Services 100% covered after applicable copay 10% coinsurance 20% coinsurance  
 Prescription Drugs        
Retail $8/$18/$33, 30-day supply $10/$20/$35, 30-day supply $10/$30/$50, 30-day supply  
OUT OF NETWORK        
  Deductible: $500/$1,000
Coinsurance: 70%/30%
Deductible: $750/$1,500
Coinsurance: 70%/30%
Deductible: $1,000/$2,000
Coinsurance: 70%/30%
 
         
   

Go to Atttachment B Proposed Employee Premiums for Medical and Dental Plans for 2004-2005