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Health Insurance: 2010 Plans

In New York, Freelancers Union offers eligible members PPO or high-deductible plans through Freelancers Insurance Company (FIC). Freelancers Union also offers health insurance in other states through United Healthcare's Golden Rule Insurance Company.

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Plan Summary

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The plan summary provides a more detailed view of the selected coverage, but don't forget to read the Certificate of Coverage. All benefits presented on this page are for services received from in-network providers unless otherwise noted.

Overview:

Until you meet your deductible, you pay for most services out of pocket. Once you reach your deductible, the plan pays 100% for medical services. The plan can be used with a Health Savings Account (HSA). Be sure to review the complete Certificate of Coverage before enrolling.

*HSA Compatible

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Certificate of Coverage

Costs:

$324/mo	(member)
$583/mo	(plus child(ren))
$680/mo	(plus spouse)
$907/mo	(plus family)

Insurance Company:

Network:

In-network Deductible / Coinsurance / Maximums

In-network medical and prescription deductible and coinsurance
How it works	Applies to all in-network medical services (except preventive) and prescriptions
Individual	$5,000 deductible, then 30% pharmacy coinsurance, up to out-of-pocket max
Family	$10,000 deductible, then 30% pharmacy coinsurance, up to out-of-pocket max
In-network out-of-pocket maximum
How it works	Maximum you pay for deductible and coinsurance
Individual	$5,950
Family	$11,900
Maximum plan benefit
How it works	Maximum amount plan will pay for all in- and out-of-network services
Annual	$2,000,000 per individual
Lifetime	$5,000,000 per individual

Out-of-network Deductible / Coinsurance / Maximums

Out-of-network medical deductible and coinsurance
How it works	Applies to out-of-network medical services; emergencies treated as in-network
Individual	$10,000 deductible, then 50% coinsurance, no out-of-pocket max
Family	$20,000 deductible, then 50% coinsurance, no out-of-pocket max
Out-of-network out-of-pocket maximum
How it works	Maximum you pay for deductible and coinsurance
Individual	Not applicable
Family	Not applicable
Maximum plan benefit
How it works	Maximum amount plan will pay for all in- and out-of-network services
Annual	$2,000,000 per individual
Lifetime	$5,000,000 per individual

Doctor Visits

Primary care office visits	Subject to the $5,000 individual / $10,000 family deductible
Specialist office visits	Subject to the $5,000 individual / $10,000 family deductible
Physical / occupational therapy visits (30 per year)
Chiropractor visits
Pre- and post-natal office visits (office visit copay applies for initial office visit)
Allergy consultation/testing
All other specialists
Services	Subject to the $5,000 individual / $10,000 family deductible
Surgical procedures
Anesthesia
Diagnostic tests
Lab tests in a provider's office or freestanding lab
Imaging tests
Allergy shot

Preventive Care

Services	Deductible waived, covered 100% (subject to age limitations and other guidelines)
Annual physical exam
Routine gynecological services
Mammography screenings (age 35 and up)
Prostate cancer screenings
Adult immunizations
Well child visits and immunizations (to age 19)

Outpatient Hospital / Facility

Facility services	Subject to the $5,000 individual / $10,000 family deductible
Physician services
Ambulatory surgery
Anesthesia
Diagnostic tests
Lab tests
Imaging tests

Inpatient Hospital / Facility

Facility services	Subject to the $5,000 individual / $10,000 family deductible
Physician services
Pre-admission testing
Surgery
Anesthesia
Maternity delivery
Diagnostic tests
Lab tests
Imaging tests
Physical rehabilitation (21 days per year)
Skilled nursing facility (30 days per year)

Pharmacy (no out-of-network coverage)

Preventive medications	Deductible waived, then 30% coinsurance (up to $5,950 individual / $11,900 familiy out-of-pocket max)
Drug types	Subject to the $5,000 individual / $10,000 family deductible, then 30% coinsurance (up to $5,950 / $11,900 out-of-pocket max)
Generic drugs
Brand formulary drugs
Brand non-formulary drugs
Brand specialty drugs obtained through the pharmacy program
Mail order prescriptions

Treatments and Supplies

Treatments	Subject to the $5,000 individual / $10,000 family deductible *Certain specialty drugs are covered only through Accredo, Medco's specialty mail order pharmacy.
Chemotheraphy infusion (see Pharmacy section for oral)
Radiation therapy
Hemodialysis
Specialty drugs provided and administered by a health care provider*
Equipment and Supplies	Subject to the $5,000 individual / $10,000 family deductible
Medical supplies
Durable medical equipment (no out-of-network coverage)
Prosthetics/Orthotics ($15,000 benefit limit per year)

Mental Health

Outpatient	Subject to the $5,000 individual / $10,000 family deductible
Mental health visits (30 per year, unless biologically-based)
Inpatient	Subject to the $5,000 individual / $10,000 family deductible
Mental health (30 days per year, unless biologically-based)

Chemical Dependency

Outpatient	Subject to the $5,000 individual / $10,000 family deductible
Chemical dependency visits (60 visits per year)
Inpatient	Subject to the $5,000 individual / $10,000 family deductible
Chemical dependency detox (7 days per year)
Inpatient rehabilitation (30 days per year)

Vision

Exams (1 every 2 years)
Eye exam	$10 copayment per visit (out-of-network varies)
Eyewear (every 2 years)	$10 copayment (additional copays for designer frames, specialty lenses, or non-formulary contact lenses; out-of-network varies)
1 pair of glasses OR
2 boxes of conventional contact lenses OR
4 boxes of disposable contact lenses

Urgent and Emergency Care

Ambulance
Ambulance and pre-hospital emergency services	Subject to the $5,000 individual deductible / $10,000 family deductible
Visits	Subject to the $5,000 individual deductible / $10,000 family deductible
Emergency room visit
Urgent care center visit

The information on this Website about insurance benefits is a summary of applicable terms and conditions that is provided for general informational purposes only. The terms of any insurance products are governed solely by the applicable Certificate of Coverage. In the event of any inconsistency between information provided on this Website and the provisions of the Certificate of Coverage, the Certificate of Coverage shall govern.

The group insurance plans displayed may not be available in your county or state. Please check our eligibility requirements to confirm what plans are available in your area.

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