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AUG 2 0 1911 <br />Mrs. Stanford emphasized that the health care industry has <br />changed significantly in the last few years; for example, <br />out-patient services are almost as expensive as in-patient cost. <br />After determining that IRMH and Doctors Clinic received approxi- <br />mately $800,000 of the claim dollars paid in this program last <br />year, they went to those providers and negotiated significant <br />discounts in behalf of the County. Those discounts are included <br />in the plan design and are significant enough to support enhanced <br />benefits. <br />PLAN A - PRESENT TRADITIONAL INDEMNITY <br />HEALTH PLAN <br />Indian River County <br />PRESENT PLAN <br />RECOMMENDED PLAN <br />---------------------- <br />------------- <br />IRMH/DOCTORS <br />HUMANA HOSPITAL/ <br />CLINIC <br />FLA. HEALTH NET - <br />Eligible Charges <br />PPO <br />NON -PPO <br />PPO <br />WORK PPO <br />NON -PPO <br />Individual Annual Deductible <br />$200 <br />0 <br />$200 <br />5300 - <br />Family Annual Deductible <br />$400 (Cum.) <br />0 <br />2 x Ind. <br />2 x Ind. <br />Co -Ins. Max. OOP (Excl. Ded.) <br />$1,000 (1)(5) <br />----------------------$1,000 <br />(1)(5) ---------------------- <br />Family Co -Ins. Maximum <br />No Limit <br />2 x Ind. <br />2 x Ind. <br />2 x Ind. <br />Maximum Lifetime Benefit (1) <br />$5,000,000 <br />----------------------$1,000,000 <br />---------------------- <br />Pre -Admission Certification <br />Required (3) <br />Required (3) <br />Required (3) <br />Hospital Services (In -Patient) <br />90% <br />80% <br />80% <br />80% <br />60% <br />Per Admission Deductible <br />$200 (4) <br />0 <br />$200 <br />5500 <br />Hospital Services (Out -Patient) <br />90% <br />80% <br />$50 Co -Pay, then 80% <br />80% After Ann. Ded. <br />60% After Ann. Ded. <br />Out -Patient Surgery <br />100% <br />$50 Co -Pay, then 80% <br />80% After Ann. Ded. <br />60% After Ann. Ded. <br />Supplemental Accident <br />100% to $300 <br />N/A <br />N/A <br />N/A <br />(Before Deductible Applies) <br />Physician and Other Services 90% 80% <br />(Except office Visits - See Below) <br />Second Surgical Opinion 100% <br />Office Visits 90% 80% <br />Other Services <br />80% <br />90%, No Ded. <br />100% (6) <br />100% After <br />$20 Co -Pay <br />80% <br />100% (6) 100% (6) <br />80% After 60% After <br />Annual Ded. Annual Ded. <br />80% 60% <br />(1) $25,600 for retirees under provisions of S.B. 153. Co-insurance waiver does not apply. <br />(2) 80% co-insurance will be 90% for use of preferred providers. <br />(3) Benefits reduce to 50% for non-compliance. <br />(4) Waived if admission is certified. <br />(5) Does not apply to Alcohol/Drug and per admission deductibles. (Also Mental Nervous for recommended plan.) <br />(6) Mandatory for certain procedures; 50% co-insurance for non-compliance <br />32 <br />