Medical Coverage Comparison Chart

Plan Feature	PPO 1	PPO 2	PPO 3	High Deductible PPO with HRA	HMO	Comprehensive
Carrier Options	Highmark, UPMC, HealthAmerica	Highmark, UPMC, HealthAmerica	Highmark, UPMC, HealthAmerica	Highmark, UPMC, HealthAmerica	Highmark, HealthAmerica	Highmark
Annual Deductible (Indiv/Family)
In-Network Providers	$250 / $500	$250 / $500	$500 / $1,000	$1,000 / $2,000	$0 / $0	$500 / $1,000
Out-of-Network Providers	$500 / $1,000	$500 / $1,000	$1,000 / $2,000	$2,000 / $4,000	Not Covered	$500 / $1,000
Annual Out-of-Pocket Maximum (Indiv/Family)
In-Network Providers	Deductible Only	$1,500 / $3,000	$3,000 / $6,000	$4,500 / $9,000	$0	$2,500 / $5,000
Out-of-Network Providers	$3,000 / $6,000	$3,000 / $6,000	$4,500 / $9,000	Unlimited	Not Covered	$2,500 / $5,000
Plan Coinsurance Responsibility
In-Network Providers	100%	80%	80%	80%	100%	80%
Out-of-Network Providers	60% of UCR	60% of UCR	60% of UCR	60% of UCR	Not Covered	80% of UCR
Carnegie Mellon HRA Contribution
Individual / Family	N/A	N/A	N/A	$250 / $500	N/A	N/A
Physician Visit (Copay/Plan Coinsurance)
In-Network
Primary Care Office Visit	$15 in 2009 $20 in 2010	$15 in 2009 $20 in 2010	$15 in 2009 $20 in 2010	80%	$10 in 2009 $15 in 2010	80%
Specialist Office Visit	$25 in 2009 $35 in 2010	$25 in 2009 $35 in 2010	$25 in 2009 $35 in 2010	80%	$20 in 2009 $30 in 2010	80%
Preventive Care (per schedule)	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0
ER Visit (waived if admitted)	$50	$50	$50	80%	$35 in 2009 $50 in 2010	80%
Out-of-Network
Primary and Specialist Office Visit	60% of UCR	60% of UCR	60% of UCR	60% of UCR	Not Covered	80%
Preventive Care	60% of UCR	60% of UCR	60% of UCR	60% of UCR	Not Covered	80%
ER Visit (waived if admitted)	$50	$50	$50	80%	$35 in 2009 $50 in 2010	80%
Primary Care Physicial Required?	No	No	No	No	Yes	No