Comparison of health plans, benefits, copayments and deductibles

Massachusetts businesses know that health insurance is a valued part of a benefit package. With FCHP, you'll get flexible and innovative product designs, a strong network of leading doctors and hospitals, and easy plan administration.

Benefit Premium Saver Basic I Premium Saver 1000 Premium Saver 2000 with $500 inpatient copay I Premium Saver 65/35 Care Choice 1250 Office visits—routine exams $0 $0 $0 $0 $0 Office visits—other primary care $25 $25 $25 $25 $25 per visit after deductible Office visits—specialty care $40 $40 $40 $40 $40 per visit after deductible Annual vision exams $0 $0 $0 $0 $0 Prescriptions (up to a 30-day supply)  $15/$30/$50 $15/$40/$75 $15/$50/$100 $10/$30/$50 $15/$30/$50 after deductible Emergency room (waived if admitted) $150 $150 copayment after deductible $200 copayment after deductible 35% coinsurance $100 per visit after deductible Inpatient hospital $1,200 $500 after deductible $500 after deductible 35% coinsurance Covered in full after deductible Same day surgery $800 $250 after deductible $250 after deductible 35% coinsurance Covered in full after deductible Chiropractic care (12 visits) $25 $25 $25 $25 $25 per visit after deductible Diagnostic services (Lab, X-ray, EKG, etc.)* Covered in full Covered in full after deductible Covered in full after deductible Covered in full after deductible Covered in full after deductible Imaging (CAT, PET, MRI scans, nuclear Cardiology) $150 $150 copayment after deductible $150 copayment after deductible Covered in full after deductible Covered in full after deductible Preventive services* Covered in full Covered in full Covered in full Covered in full Covered in full Deductible (ind/fam) None $1,000/$2,000 $2,000/$4,000 None $1,250/$2,500 Out-of-pocket maximum** (ind/fam) $3,000/$6,000 $3,000/$6,000 $5,000/$10,000 $5,000/$10,000 $4,000/$8,000

* Diagnostic services are those tests and services that are intended to diagnose, check the status of or treat a disease or condition. Preventive services are services, tests and immunizations that are intended to screen for diseases orconditions and to improve early detection of disease when there is no diagnosis or symptoms. This excludes routine physical exams.

** Items that count toward the out-of-pocket maximum vary by plan design.