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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