Group
Health
Plans.com
Statewide
Hmo Plan
1-888-456-1858
/
504-456-1858
Click here
to request
quotes
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TO
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(Actual
Client
Rates)
Single
employee
175.78
Employee +spouse 386.32
Employee +child(ren) 326.53
Employee + Family 543.42
BENEFITS
HMO
In-Network
Physician Services
Office Visits • Prenatal
& Postnatal Maternity Care’
$20 copayment
Specialist
Services • Allergy
Treatments
Routine Gynecological Exam & Pap Test
•
$35 copayment
Well Child Care •
Immunizations • Newborn
Care
Inpatient Hospital Care
Unlimited Hospital Days (Semi-Private).
$150 copayment
Private Room When Medically Necessary •
per day (maximum
3 days)
Medication & Drugs ‘ Nursing
Care •
Professional Services’ X-rays &
Laboratory . Intensive/Coronary
Care
Radiation Therapy/Administrative
of Blood
Rx
Card
$10/25/45
Outpatient
Facility Services
X-ray & Laboratory
$0 copayment
Ambulatory Surgery
$150 copayment
Short-Term Therapies
Physical ‘Speech
• Occupational
•
20% coinsurance
Respiratory . Cardiac
Rehabilitation
(Short-term therapies are covered from their
original onset up to 60
days.)
Voluntary
Family Planning
Elective Sterilization, Male or Female
$100 copayment
Infertility Services for the diagnosis of infertility
50% coinsurance
Skilled
Nursing Facility
Facility, supplies, and equipment authorized
2O% coinsurance
in lieu of acute care hospitalization within
the service area
Home
Health Care
Authorized in lieu of acute care hospitalization
20% coinsurance
within the service area
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