Untitled Document

Frank Cafaro
26 Railroad Avenue #300
Babylon, New York 11702
office phone: 631-321-6165
cell phone: 516-480-2396
fax: 631-321-6175
Email: info@cafaroinsurance.com

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EMBLEM HSA PPO/EPO
Downstate Rate and Plan Design Comparison for
Sole Proprietors - 1st Quarter 2010

	EMBLEM PPO HSA-Compatible		EMBLEM EPO HSA-Compatible
	In-Network	Out-of-Network	In-Network
Allowed charges	GHI fee schedule	80th%ile HIAA/Ingenix	GHI fee schedule
Deductible individual/family	$5,000 / $10,000	$10,000 / $20,000	$5,8000 / $11,600
Coinsurance	100%	80%	100%
Out-of-pocket maximum	$5,000 / $10,000	$12,000 / $24,000	$5,8000 / $11,600
Annual physical check-up (adult)	Covered in full	Deductible and coinsurance	Covered in full
Diagnostic/lab fees	Deductible and coinsurance	Deductible and coinsurance	Deductible and coinsurance
Inpatient hospital coverage and inpatient medical services*	Deductible and coinsurance	Deductible and coinsurance	Deductible and coinsurance
Drug card	Covered in full after deductible	In-network only	Covered in full after deductible
Lifetime maximum	Unlimited	Unlimited	Unlimited
Downstate Rates for 4th Quarter 2009
Employee	$295.00		$218.14
Family	$733.00		$534.56