AlaskaCare Medical Plan Comparison
| Premium | Standard | Economy | |
|---|---|---|---|
| Benefit Year† | July 1 - December 31 | July 1 - December 31 | July 1 - December 31 |
| Deductible† | $150 Individual $300 Family No carryover or waivers |
$150 Individual $300 Family No carryover or waivers |
$250 Individual $500 Family No carryover or waivers |
| Coinsurance** † | 90% of first $1,750 100% after **30% as secondary to State employee health trust plan |
80% of first $3,000 100% after **30% as secondary to State employee health trust plan |
70% of first $3,333 100% after **30% as secondary to State employee health trust plan |
| Annual Out-of-Pocket Maximum † | $175/person after deductible | $600/person after deductible | $1,000/person after deductible |
†For only 2013, the benefit year is shortened. Amount will double for full plan year starting January 2014.
**coinsurance will be 30% of covered charges for dependents that are covered by a State employee health trust and that coverage: has been waived, pays less than 70% of covered expenses, or has an individual out-of-pocket maximum, including deductibles, of more than $3,500 (this applies to any dependent covered by Select Benefits as the secondary plan).
| Premium, Standard, and Economy | |
|---|---|
| Lifetime Maximum | Unlimited |
| Preferred Hospital | Anchorage & outside Alaska Penalty - 20% additional coinsurance plus double out of pocket maximum |
| Prescription Drugs Card Program (up to 30-day supply) |
20% copay for all prescriptions Minimum $13 Maximum $61 |
| Prescription Drugs Card program (31-90 day supply) |
20% copay for all prescriptions Minimum $21 Maximum $122 |
| Prescription Drugs Without card |
60% reimbursement after medical deductible |
| Prescription Drugs Mail order (90-day supply) |
$20 copay brand name $8 copay generic |
| Prescription Drugs Annual maximum copay |
Individual = $1,000 Family = $2,000 |
| Emergency Room Copayment | $100 each incident for nonemergency use |
| OP Surgery, Preop Testing, 2nd Opinions, Skilled Nursing Facilities | Same coinsurance as other expenses, after deductible |
| Nurse Line | Available |
| Preventive Care | 100% with no deductible for one routine office visit and related tests* |
| Newborn Care & Immunizations | 100% with no deductible for one routine office visit and related tests* |
| Travel | Round trip subject to coinsurance and deductible. Must be pre-authorized. |
| Substance Abuse Inpatient (IP) | IP w/plan referral, medically necessary—normal coinsurance IP w/o referral, medically necessary—$400 penalty, normal coinsurance, limited to DOI set limits |
| Substance Abuse Outpatient (OP) | OP w/plan referral, medically necessary—normal coinsurance OP w/o referral, medically necessary—$200 penalty, normal coinsurance, limited to DOI set limits |
| Mental/Nervous Inpatient (IP) | IP w/plan referral, medically necessary—normal coinsurance IP w/o referral, medically necessary—50% up to 30 visits/yr |
| Mental/Nervous Outpatient (OP) | OP w/referral, medically necessary—normal coinsurance OP w/o referral, medically necessary—50% up to 30 visits/yr |
| Employee Assistance Program | Available |
| Spinal Disorders | Coinsurance as noted above; yearly maximum $750 |
| Dependent Children Coverage | Up to age 26 |
| Premiums | See premiums. |
*effective July 1, 2013
(Effective 2013)