DESCRIPTION OF BENEFIT PLANS
ACHIA PLAN OPTIONS
- ACHIA offers six different comprehensive PPO plans. The primary differences between the plans are the annual deductible and the associated out-of-pocket expense limitations. All plans pay 80% of the allowed charges once you have satisfied the annual deductible for that plan, as long as you receive treatment either from a preferred hospital or from a hospital that is not preferred when you do not have reasonable access to a preferred hospital. If you have reasonable access to a preferred hospital and choose to receive treatment from a hospital that is not preferred, ACHIA will pay only 60% of the usual and customary charges. Once your deductible and out of pocket maximum have been satisfied,
ACHIA will pay your claims at 100%.
- ACHIA also offers a Traditional non-PPO plan. This plan pays 80% of the allowed charges after the $1,000 annual deductible has been satisfied. Once your deductible and out of pocket maximum have been satisfied, ACHIA will pay your claims at 100%.
ACHIA MEDICARE PLAN OPTIONS
- For those covered under Medicare, ACHIA offers two Medicare supplement plans. The two Medicare supplement plans are standardized Plan A and Plan F. If you are not enrolled in Part B of Medicare, benefits under these plans will not include benefits normally paid by Medicare. These plans do not cover basic prescription drugs, but do cover drugs that are covered by Medicare Part B.
- For those under 65 and covered under Medicare, ACHIA offers a Medicare carveout plan. The plan coordinates the benefits of the ACHIA Traditional non-PPO plan with Medicare. The Medicare carveout plan pays 80% of the charges not covered by Medicare (but covered under the ACHIA plan) once the $1,000 deductible has been satisfied, and pays 100% of the charges not covered by Medicare (but covered under the ACHIA plan) after you have paid charges equal to the out-of-pocket expense limit including deductible. this plan differs from the non-PPO plan in that it does not cover drugs whether you have Medicare Part D or not. However, drugs covered under Medicare Part B are covered under this plan.