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Comparison of UniCare HSA-Compatible Plans for Illinois Residents* |
Amounts shown below are the member's share of costs. |
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| Plan Features | HSA-Compatible Variable-Contrib |
HSA-Compatible Variable-Deductible |
HSA-Compatible Plan 2 |
HSA-Compatible Plan 3 |
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Annual Deductible - Network Single Family |
$2,850 for 2007 $5,650 for 2007 |
$1,100 for 2007 $2,200 for 2007 |
$2,600 $5,200 |
$5,000 $10,000 |
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Out-of-Pocket Max - Network1 Single Family |
$5,000 $10,000 |
$5,000 $10,000 |
$5,000 $10,000 |
$5,000 $10,000 |
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Annual Deductible - Non-Network Single Family |
$6,850 $13,650 |
$5,050 $10,100 |
$6,600 $13,200 |
$9,000 $18,000 |
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Out-of-Pocket Max - Non-Network1 Single Family |
$15,000 $20,000 |
$15,000 $20,000 |
$15,000 $20,000 |
$15,000 $20,000 |
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Amounts shown below are UNICARE's payment after applicable deductibles are met. |
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| Plan Features | HSA-Compatible Variable-Contrib |
HSA-Compatible Variable-Deductible |
HSA-Compatible Plan 2 |
HSA-Compatible Plan 3 |
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Coinsurance Network Non-Network |
100% 60% |
80% 60% |
80% 60% |
100% 60% |
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Retail Prescriptions (30 days) Co-pays apply after satisfaction of annual deductible • Generic • Brand-name Formulary • Generic Non-formulary |
100% after insured pays $10 co-pay $30 co-pay $50 co-pay |
100% after insured pays $10 co-pay $30 co-pay $50 co-pay |
100% after insured pays $10 co-pay $30 co-pay $50 co-pay |
100% after insured pays $10 co-pay $30 co-pay $50 co-pay |
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Mail Order Prescriptions (60 days) Co-pays apply after satisfaction of annual deductible • Generic • Brand-name Formulary • Generic Non-formulary |
100% after insured pays $20 co-pay $60 co-pay $100 co-pay |
100% after insured pays $20 co-pay $60 co-pay $100 co-pay |
100% after insured pays $20 co-pay $60 co-pay $100 co-pay |
100% after insured pays $20 co-pay $60 co-pay $100 co-pay |
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