Health Care Plan Design and Cost Trends - 1988 through 1998
APPENDIX A Typical Plan Design 1988 and 1998
Typical Plan Designs
Dollars have not been updated for inflation.
Feature 1988 (FFS - 92% of plans)
1998 (FFS- 14% of plans)
Deductible Individual: $100 Family: $300
Individual: $200 Family: $400
Hospitalization Maximum Number of Days: Unlimited Inpatient Hospital Coinsurance: 80%
Inpatient Surgery Coinsurance: 80%
General Coinsurance: 80%
Maximum Number of Days: Unlimited Inpatient Hospital Coinsurance: 80%
Inpatient Surgery Coinsurance: 80%
General Coinsurance: 80%
Physician Visits Inpatient Physician Visits Coinsurance: 80% Outpatient Physician Visits Coinsurance: 80%
Inpatient Physician Visits Coinsurance: 80% Outpatient Physician Visits Coinsurance: 80%
Outpatient x-ray & lab Coinsurance: 80% Subject to General Deductible
Coinsurance: 80% Subject to General Deductible
Prescription Drugs Covered Co-pay: $2 per prescription (brand name or generic)
Covered Co-pay: $5 generic; $10 brand name
Purchase of generic is NOT required
Voluntary mail order pharmacy service available
Out-of-pocket Limits Individual: $1,000 Family: $3,000
Individual: $1,000 Family: $3,000
Vision Care Not Covered Not Covered Dental Care Separate Dental Deductible: $50/person Deductible waived for preventive care
Preventive Care Coinsurance: 100%
Basic Restorative Care Coinsurance: 80%
Major Restorative Care Coinsurance: 50%
Maximum Annual Dental Benefit: $1,000
Orthodontia Coinsurance: 50%
Max. Lifetime Orthodontia Benefit: $1,000
Separate Dental Deductible: $50/person Deductible waived for preventive care
Preventive Care Coinsurance: 100%
Basic Restorative Care Coinsurance: 80%
Major Restorative Care Coinsurance: 50%
Maximum Annual Dental Benefit: $1,000
Orthodontia Coinsurance: 50%
Max. Lifetime Orthodontia Benefit: $1,000
Under PPO and POS plans, the coinsurance for out of network services is reduced by 20%.
Feature 1998 (PPO – 40% of plans)
1998 (POS- 21% of plans)
Deductible In network: None Out of network: $100 Ind/ $200 Family
In network: None Out of network: $150 Ind/$300 Family
Hospitalization Maximum Number of Days: Unlimited Inpatient Hospital and Surgery Coinsurance:
90% In network
Maximum Number of Days: Unlimited Inpatient Hospital and Surgery Coinsurance:
100% In network
Physician Visits Inpatient Physician Visits: 90% In network Outpatient Physician Visits: 100% In network
Inpatient Physician Visits: 100% In network Outpatient Physician Visits: 100% In network
Outpatient x-ray & lab Coinsurance: 90% In network Subject to General Deductible
Coinsurance: 100% In network Subject to general deductible (out of network)
Prescription Drugs Covered Copay: $5 generic/$10 brand name
Purchase of Generic is NOT required
Voluntary mail order pharmacy service available
Covered Copay: $5 generic/$10 brand name
Purchase of Generic is NOT required
Voluntary mail order pharmacy service available
Out-of-pocket Limits In network: $1,000 Ind/ $2,000 Family Out of network: $2,000 Ind/ $4,000 Family
In network: $1,000 Ind/ $2,000 Family Out of network: $2,000 Ind/ $4,000 Family
Vision Care Not Covered Not Covered Dental Care Separate Dental Deductible: $50/person Deductible waived for preventive care
Preventive Care Coinsurance: 100%
Basic Restorative Care Coinsurance: 80%
Major Restorative Care Coinsurance: 50%
Maximum Annual Dental Benefit: $1,000
Orthodontia Coinsurance: 50%
Max. Lifetime Orthodontia Benefit: $1,000
Separate Dental Deductible: $50/person Deductible waived for preventive care
Preventive Care Coinsurance: 100%
Basic Restorative Care Coinsurance: 80%
Major Restorative Care Coinsurance: 50%
Maximum Annual Dental Benefit: $1,000
Orthodontia Coinsurance: 50%
Max. Lifetime Orthodontia Benefit: $1,000
Feature 1998 (HMO - 26% of plans)
Deductible None Hospitalization Unlimited No Copay
Physician Visits Inpatient Physician Visits: 100% Outpatient Physician Visits: $10 Copayment
Outpatient x-ray & lab No Copay Emergency Room $25 Copay Prescription Drugs Covered Copay: $5 Generic/$10 Brand
Generic Required if available
Mail order pharmacy service is available
Out-of-pocket Limits None Vision Care Not Covered Dental Care Separate Dental Deductible: $50/person Deductible waived for preventive care
Preventive Care Coinsurance: 100%
Basic Restorative Care Coinsurance: 80%
Major Restorative Care Coinsurance: 50%
Maximum Annual Dental Benefit: $1,000
Orthodontia Coinsurance: 50%
Max. Lifetime Orthodontia Benefit: $1,000
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