The Hay Group Study
Health Care Plan Design and
Cost Trends--1988 through 1997
APPENDIX A
Typical Plan Design 1988 and 1997
Typical Plan Designs
Dollars have not been updated for inflation.
| Feature | 1988 |
1997 |
| 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 | 1997 |
1997 |
| Deductible | In network: $200 Ind/$400 Family Out of network: $400 Ind/ $800 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: 100% 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 | 1997 (HMO - 24% 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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