Nursing Facility / Home Health Care 0%* 30%* Hospice Care 0%* Not Covered Nursing Facility / Covered Home Health Care Co-pay Covered Hospice Care Co-pay Covered Nursing Facility / Hawaii Employer-Union Health Benefits Trust Fund City Financial Tower / Hospice Care No Charge Not Covered Nursing Facility / Hospice Care No Charge No / Charge Nursing Facility / Hospice Care / Hospice Care No Charge No Charge Nursing Facility / Pharmacy Non-Participating Pharmacy Generic / Home Health Care No Charge Hospice Care No Charge Nursing Facility / /
IndustryTerm
out-of-network / printing / in-network / /
MedicalTreatment
Radiation Therapy / Immunizations / surgery / /
Organization
Diagnostic Lab / Bargaining Unit / Except Bargaining Unit / ASC Diagnostic Lab / Bargaining Units Except Bargaining Unit / HDHP NOTE ALL DEVIATIONS IN YOUR COMPANY’S PROPOSED BENEFITS Carrier HMSA General In-Network Out-of-Network OUTPATIENT SERVICES Chemotherapy/Radiation Therapy 10%* 30%* Surgery 10%* 30%* Diagnostic Lab / N/A N/A N/A Two-Party N/A N/A N/A Family N/A N/A N/A Administration / Medicare / /
Person
Care Visits / Natal Care / Deductible Single / / /
Position
Physician Services / PROPOSED BENEFITS Carrier ROYAL STATE General / PROPOSED BENEFITS Carrier Provided byHMSA General / Office Visit Co-pay Covered Specialist Office / Policy Year Benefit Maximum None PHYSICIAN SERVICES / Specialist Office / PROPOSED BENEFITS Carrier HMSA General / PROPOSED BENEFITS Carrier Kaiser General / PROPOSED BENEFITS Carrier Kaiser Comprehensive General / No Charge Physician / PROPOSED BENEFITS General / PROPOSED BENEFITS Carrier HMA General / General / / Board Co-pay Covered Ancillary Services Co-pay Covered Physician Services / No Charge Physician Services / PROPOSED BENEFITS Carrier Kaiser Basic General / /
hawaii employer-union health benefits trust fund SECTION v