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| Benefit Provision | Basic Option | Plus Option |
|---|---|---|
| Deductible WVUH-East Facility In-Network Out-of-Network |
Individual/Family 0 $300/$900 $600/$1800 |
Individual/Family 0 $100/$300 $600/$1800 |
| Coinsurance WVUH-East Facility In-Network Out-of-Network |
Individual/Family 85%Employer/ 15% Employee 70%Employer/ 30% Employee 60%Employer/ 40% Employee |
Individual/Family 95%Employer/ 5% Employee 80%Employer/ 20%Employee 60%Employer/ 40%Employee |
| Patient Copay Primary Care Specialist Urgent Care Out-of-Network |
$20 $35 $30 Coinsurance |
$20 $35 $30 Coinsurance |
| Out-of-Pocket Max WVUH-East Facility In-Network Out-of-Pocket |
Individual/Family $1500/$4500 $3000/$9000 N/A |
Individual/Family $1000/$3000 $2000/$6000 N/A |
| Preventive Care — Examples of services
covered are: Pap smear, mammogram, prostate screening, gynecological exam, routine physical examination, x-rays, designated laboratory blood tests, immunizations, hearing tests and vision tests. |
100% Employer (No employee deductible) | |
| Emergency Room | Emergent care: $50 patient copay (waived if admitted) Non-emergent care: Deductible (if applicable) and coinsurance |
|
| Individual Lifetime Maximum Benefit | $2,000,000 | |
Full-time and part-time status employees are eligible for WVUH-East Group Health Plan. Coverage will begin the first day of the pay period following 30 days of employment.