Medical Plan Quick Guide
The medical plan chart below illustrates the differences in costs for Emory's POS medical plan within the three networks:
| POS Plan | |||
|---|---|---|---|
| Earned Incentives | $425/$8251 | ||
| Tier 1 | Tier 2 | Tier 32 | |
| Annual Deductible - Single | $850 | $1,000 | $2,000 |
| Annual Deductible - Family | $2,550 | $3,000 | $6,000 |
| Out-of-Pocket Maximum3 - Single | $3,000 | $4,500 | $11,250 |
| Out-of-Pocket Maximum3 - Family | $6,000 | $9,000 | $22,500 |
| Out-of-Pocket Maximum3 - Aggregate | Yes | Yes | Yes |
| Primary Care Office Visits4 | $25 copay | $35 copay | 50% after deductible |
| Pediatrician Office Visits | $25 copay | $25 copay | 50% after deductible |
| Specialist Office Visits5 | $35 copay | $50 copay | 50% after deductible |
| Diagnostic Labs | 15% coinsurance | 25% coinsurance | 50% coinsurance |
| X-Ray | 15% after deductible | 25% after deductible | 50% after deductible |
| Durable Medical Equipment | 15% coinsurance | 25% coinsurance | 50% after deductible |
| Routine Preventive Care6 | $0 copay | $0 copay | 50% after deductible |
| Emergency Room Visits7 | $250 copay | $250 copay | $250 copay |
| Hospitalizations: Inpatient/Outpatient Coverage | 15% after deductible | 25% after deductible | 50% after deductible |
| Behavioral Health Inpatient | 15% after deductible | 25% after deductible | 50% after deductible |
| Behavioral Health Outpatient | $25 copay | $25 copay | $25 copay |
- 1 An annual maximum of $425 in incentives can be earned (for Single level coverage) or $825 (for Employee+Spouse or Family level coverage).
- 2 Amounts applied to deductible and out-of-pocket maximums are limited to the Reasonable and Customary charges.
- 3 Out-of-Pocket maximum includes copays.
- 4 Includes services of an internist, general physician, family practitioner, dermatologist, and/or allergist.
- 5 An additional facility fee may be charged for your specialist visit which may apply to your deductible or co-insurance.
- 6 Routine Preventive Care services ONLY are covered at 100% under the plan at the Tier 1 and Tier 2 Network levels. Diagnostic services are subject to the deductible and co-insurance.
- 7 Copay waived if admitted.
Disclaimer
Every attempt has been made to ensure the chart and information above accurately reflects the details of the plan. Should there be any errors, the terms and conditions of the Summary Plan Description (SPD) prevail.