|Plan A||Plan B||PlanC|
|Preventive and diagnostic services*||No charge||20%|
|Basic restorative services||20%||50%||50%|
|Oral surgery, endodontics, and periodontics||50%||75%||75%|
|Major restorative services||50%||75%||75%|
|Orthodontics (for children and adults)||75%||75%||75%|
*Not subject to the deductible
|Subscriber + spouse/domestic partner||
|Subscriber + child(ren)||$100.67||$103.69||$106.71|
|Subscriber, spouse, + child(ren)||$151.01||$157.05||$163.09|
|Subscriber + spouse/domestic partner||$93.54||$99.15||$104.77|
|Subscriber + child(ren)||$193.54||$96.35||$99.15|
|Subscriber, spouse, + child(ren)||$140.31||$145.92||$145.92|
|Subscriber + spouse/domestic partner||$77.14||$81.77||$86.40|
|Subscriber + child(ren)||$77.14||$79.46||$81.77|
|Subscriber, spouse, + child(ren)||$115.72||$120.34||$124.97|
10 Essential Benefits
Healthcare reform says all health plans must include ten essential benefits. The basic benefits include:
- Outpatient Care - the kind you get without being admitted to a hospital
- Emergency Services - for issues that could lead to death or disable you if you do not treat them.
- Inpatient Care - covers room and board, tests, drugs, and care from doctors and nurses while admitted, which may include organ and tissue transplants, and hospice and respite care.
- Maternity and Newborn Care - care before and after your baby is born
- Mental Health and Substance Use Disorder Services - this includes behavioral health treatment, counseling, and psychotherapy.
- Prescription Drugs - covers retail, mail order, and specialty drugs.
- Rehabilitative and Habilitative Services - services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Laboratory Services - covers lab tests, X-ray services, and pathology, and imaging and diagnostics such as MRI, CT scan, and PET scan.
- Preventive and Wellness Services - including mammograms, colonoscopies, vaccines. Covered in full if you use in-network providers for care such as routine physicals, screening, and immunizations. Disease management coordinates care for diabetes, asthma, and other conditions.
- Pediatric Services - including dental care (preventive, basic, major) and vision care (eye exam, lenses, and eyewear).