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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:

For PPO (Preferred Provider Organization) plans, you generally pay a copay for office visits, and a deductible and coinsurance for hospital/facility services. Be sure to review the complete Certificate of Coverage before enrolling.

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Certificate of Coverage

Costs:

$497/mo	(member)
$894/mo	(plus child(ren))
$1,043/mo	(plus spouse)
$1,391/mo	(plus family)

Insurance Company:

Network:

In-network Deductible / Coinsurance / Maximums

In-network medical deductible and coinsurance
How it works	Applies to most facility services and certain treatments (see below for details)
Individual	$1,500 deductible, then 20% coinsurance, up to out-of-pocket max
Family	Two $1,500 individual deductibles, then 20% coinsurance, up to out-of-pocket max
In-network out-of-pocket maximum
How it works	Maximum you pay for deductible and coinsurance
Individual	$6,000
Family	$12,000
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 most out-of-network services; emergencies treated as in-network
Individual	$3,000 deductible, then 50% coinsurance, up to out-of-pocket max
Family	Two $3,000 individual deductibles, then 50% coinsurance, up to out-of-pocket max
Out-of-network out-of-pocket maximum
How it works	Maximum you pay for deductible and coinsurance
Individual	$15,000
Family	$30,000
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	$25 copayment
Specialist office visits	$50 copayment (no referrals required for specialists)
Physical / occupational therapy visits (30 per year)
Chiropractor visits
Allergy consultation/testing
All other specialists
Included services	Included in office visit copayment.
Surgical procedures
Anesthesia
Diagnostic tests
Additional Services
Lab tests in a provider's office or freestanding lab	$10 copayment
Imaging tests	20% coinsurance (no out-of-pocket max)
Allergy shot	$0 copayment

Preventive Care

Services	$0 copayment (subject to age limitations and other guidelines)
Annual physical exam
Colorectal cancer screenings (age 50-74)
Routine gynecological services
Mammography screenings (age 35 and up)
Prostate cancer screenings
Adult immunizations
Well child visits and immunizations (to age 19)
Pre- and post-natal office visits (office visit copay applies for initial office visit)

Outpatient Hospital / Facility

Facility services	Subject to the $1,500 individual deductible (two indiv. deductibles for family coverage), then 20% coinsurance (up to $6,000 indiv / $12,000 family out-of-pocket max)
Physician services
Ambulatory surgery
Anesthesia
Diagnostic tests
Lab tests
Imaging
Imaging tests	20% coinsurance (no out-of-pocket max)

Inpatient Hospital / Facility

Facility services	Subject to the $1,500 individual deductible (two indiv. deductibles for family coverage), then 20% coinsurance (up to $6,000 indiv / $12,000 family out-of-pocket max)
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)

Deductible	$200 individual deductible
Drug types
Generic drugs	$15 copayment
Brand formulary drugs	$50 copayment
Brand non-formulary drugs	$100 copayment
Brand specialty drugs obtained through the pharmacy program	$100 copayment
Mail order prescriptions	3 copayments for a 3-month supply

Treatments and Supplies

Treatments	Subject to the $1,500 individual deductible (two indiv. deductibles for family coverage), then 20% coinsurance (up to $6,000 indiv / $12,000 family out-of-pocket max) *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	30% coinsurance (no out-of-pocket max)
Medical supplies
Durable medical equipment (no out-of-network coverage)
Prosthetics/orthotics ($15,000 benefit limit per year)

Mental Health

Outpatient
Mental health visits (30 per year, unless biologically-based)	$50 copayment
Inpatient
Mental health (30 days per year, unless biologically-based)	Subject to the $1,500 individual deductible (two indiv. deductibles for family coverage), then 20% coinsurance (up to $6,000 indiv / $12,000 family out-of-pocket max)

Chemical Dependency

Outpatient
Chemical dependency visit (60 per year)	$50 copayment
Inpatient	Subject to the $1,500 individual deductible (two indiv. deductibles for family coverage), then 20% coinsurance (up to $6,000 indiv / $12,000 family out-of-pocket max)
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

Services
Ambulance and pre-hospital emergency services	Subject to the $1,500 individual deductible (two indiv. deductibles for family coverage), then 20% coinsurance (up to $6,000 indiv / $12,000 family out-of-pocket max)
Visits
Emergency room visit	$250 copayment
Urgent care center visit	$100 copayment

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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