Apex+Rx and Apex

The following are the changes for Apex+Rx and Apex plans.

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Our  Apex+Rx plan has had the following benefit changes effective January 1, 2011:

Benefit 2010 2011
Out-of-Pocket Maximum $1000 out-of-pocket maximum excluding Part D pharmacy  $1200 out-of-pocket maximum excluding Part D pharmacy
Inpatient Hospital Care  $100 Copay per day for days 1-5; $0 Copay for additional days $125 Copay per day for days 1-5; $0 Copay for additional days 
Inpatient Mental Health Care  $100 Copay per day for days 1-5; $0 Copay for additional days $125 Copay per day for days 1-5; $0 Copay for additional days 
Skilled Nursing Facility $0 Copay per day for days 1-10; $100 Copay per day for days 11-21; $0 Copay per day for additional days $0 Copay per day for days 1-10; $100 Copay per day for days 11-22; $0 Copay per day for additional days
Diagnostic Tests $0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, CT, PET scans & nuclear medicine; $0 Copay for therapeutic radiology services $0 Copay for lab services, diagnostic procedures tests & x-rays; $130 Copay for MRI, MRA, CT, CTA, PET & SPECT scans; $15 Copay for therapeutic radiology services. 
ESRD   20% Coinsurance, $5 Copay for nutrition therapy for ESRD  20% Coinsurance, $0 Copay for nutrition therapy for ESRD 
Routine Vision $15 Copay for 1 routine eye exam every year; $100 limit for eye wear every two years  $0 Copay for 1 routine eye exam every 12 months from a VSP provider; $120 allowance toward the purchase of vision hardware from a VSP provider every 12 months with a $15  Copay
Part D
Deductible  $0 Deductible  $0 Deductible
Initial Coverage Limit  $2830  $2840
Drug Tier Labels

 Tier I - Preferred Generics
Tier II - Preferred Brand
Tier III - Specialty Drugs

Tier IV - Non-Preferred Brand

Tier I - Generic Drugs

Tier II - Brand Drugs

Tier III - Non-Preferred Brand Drugs

Tier IV - Specialty Drugs

Retail Copays

 

     Tier I

     Tier II

     Tier III

     Tier IV

30/90 Day Supply

 

$5/$15 Copay

$29/$87 Copay

20% Coinsurance 

$59/$177 Copay

30/90 Day Supply

 

$8/$20 Copay

$32/$80 Copay

$64/$160 Copay

33% Coinsurance

Mail Order Copays

 

     Tier I

     Tier II

     Tier III

     Tier IV

 30/90 Day Supply

 

$5/$10 Copay

$29/$58 Copay

20% Coinsurance 

$59/$118 Copay

 30/90 Day Supply

 

$8/$16 Copay

$32/$64 Copay

$64/$128 Copay

33% Coinsurance
Coverage Gap

$4550

$5 Copay - Tier I Drugs

$4550

$8 Copay - Tier I Drugs 


Our  Apex plan, which is now called Alpine, has had the following changes effective January 1, 2011:

Benefit 2010 2011
Out-of-Pocket Maximum $1000 out-of-pocket maximum excluding Part D pharmacy  $2250 out-of-pocket limit excluding Part D pharmacy
Inpatient Hospital Care  $100 Copay per day for days 1-5; $0 Copay for additional days $200 Copay per day for days 1-5; $0 Copay for additional days
Inpatient Mental Health Care  $100 Copay per day for days 1-5; $0 Copay for additional days $200 Copay per day for days 1-5; $0 Copay for additional days
Skilled Nursing Facility $0 Copay per day for days 1-10; $100 Copay per day for days 11-21; $0 Copay per day for additional days $0 Copay per day for days 1-10; $100 Copay per day days 11-33; $0 Copay per day for additional days
Primary Care Visits  $5 Copay  $15 Copay
Specialist Visits $15 Copay $30 Copay
Outpatient Mental Health & Substance Abuse $15 Copay $30 Copay
Outpatient Surgery/Services $50 Copay at ambulatory surgery center or outpatient hospital facility; $15 Copay for outpatient clinic services $150 Copay at ambulatory surgery center or outpatient hospital facility; $30 Copay for outpatient clinic services
Ambulance  $100 Copay  $150 Copay
Urgently Needed Care $15 Copay $30 Copay
Outpatient Rehabilitation Services $0 Copay per visit for visits 1-5; $15 Copay for subsequent visits  $30 Copay per visit for visits 1-5; $30 Copay for subsequent visits 
Diagnostic Tests $0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, CT, PET scans & nuclear medicine; $0 Copay for therapeutic radiology services $0 Copay for lab services, diagnostic procedures, tests & x-rays; $130 Copay for MRI, MRA, CT, CTA, PET, SPECT scans; $30 Copay for therapeutic radiology services 
ESRD   20% Coinsurance, $5 Copay for nutrition therapy for ESRD  20% Coinsurance, $0 Copay for nutrition therapy for ESRD 
Routine Vision $15 Copay for 1 routine eye exam every year; $100 limit for eye wear every two years  $0 Copay for 1 routine eye exam every 12 months from a VSP provider; $120 allowance toward the purchase of vision hardware from a VSP provider every 12 months with a $15  Copay
Medicare-covered Dental $15 Copay $30 Copay