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Comparison of Illinois FIT Plans* and Saver 2000 Plan* |
Amounts shown are UniCare's payment for participating providers after applicable deductibles are met, unless otherwise noted. |
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| Plan Features for PPO Providers | FIT 500 Plan FIT 1000 Plan |
FIT 1500 / FIT 2000 FIT 3000 / FIT 5000 |
Saver 2000 | |||||
| Annual Deductible1 Per member, two member maximum |
$500 $1,000 |
$1,500, $2,000 $3,000, $5,000 |
$2,000 | |||||
| Annual Out-of-Pocket Maximum1 (amounts shown plus deductibles) |
$3,000 (Individual) $6,000 (Family) |
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| Lifetime Maximum Benefit | UniCare pays up to $5,000,000 per member | |||||||
| Office Visits Exam only for any covered illness or injury, and certain preventive care services for adults |
You pay a $30 copay, unlimited visits, deductible waived | You pay a $30 copay, deductible waived
Limited to two office visits per member, per year, participating and nonparticipating providers combined. |
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| Well Baby/Children (through age 6) | ||||||||
| Immunizations | 100%, deductible waived
Maximum payment of $300 per member, per year
After maximum payment has been met, 80%, deductible applies |
100%, deductible waived
Maximum payment of $300 per member, per year
After maximum payment has been met, 70%, deductible applies |
Not Covered | |||||
| Office Vists | You pay a $30 copay, unlimited visits, deductible waived | Not Covered | ||||||
| Adult Preventive Care Screenings Surgery, anesthesia, radiation therapy and in-hospital doctor visits |
100%, deductible waived
Maximum payment of $300 per member, per year
After maximum payment has been met, 80%, deductible applies |
100%, deductible waived
Maximum payment of $300 per member, per year
After maximum payment has been met, 70%, deductible applies |
70% | |||||
| Professional Services Surgery, anesthesia, radiation therapy and in-hospital doctor visits |
80% | 70% | 70% - for limited services only | |||||
| Lab Work and X-rays | 80% | 70% | 70%
Maximum payment of $300 per member, per year, deductible waived, participating and nonparticipating providers combined |
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| Inpatient Hospital Services | 80% | 70% | 70% | |||||
| Outpatient Hospital or Surgical Center |
80% | 70% | 70% | |||||
| Physical Therapy, Occupational Therapy, and Acupuncture |
Maximum payment of $30 per visit, up to 12 visits per member, per year for all of these services combined | Not Covered | ||||||
| Retail Pharmacy Per prescription (up to a 30-day supply) |
A $250 Brand Name Drug Deductible applies to FIT 500 and to FIT 1000 |
A $250 Brand Name Drug Deductible
A $500 Brand Name Drug Deductibleapplies to FIT 1500 and to FIT 2000 applies to FIT 3000 and to FIT 5000 |
$200 Brand Name Deductible
UniCare pays a maximum of $500 per member, per year. Includes generic and brand, participating and nonparticipating pharmacies, retail and mail service combined. |
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| Generic Drugs Not subject to deductible(s) |
You pay a $10 copay | You pay a $10 copay | ||||||
| Brand Name Drugs Brand Name Deductible applies |
You pay a $30 copay for formulary drugs, or a $50 copay for nonformulary drugs | You pay a $25 copay | ||||||
| Self Injectable Drugs Subject to a Brand Name Deductible when applicable |
80% | 70% | 70% | |||||
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