Friday, December 15, 2017
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HEALTH BENEFITS
<span class="redactor-invisible-space"></span><span class="redactor-invisible-space"></span>Untitled Document



Culpeper County Government 2017-2018 Benefit Plan Options

 

                   

 
HealthKeepers 25/1000
Lumenos HSA 4
Deductible
$1000 (Individual) /$2000 (Family)
$1500 (Individual) / $3000 (Family)
Preventative Care
Check-ups, GYN exam and pap test
100 %
100 %
Prostate Exam and PSA
100 %
100 %
Mammogrpahy screenings
100 %
100 %
Screenings/Immunizations
100 %
100 %
Colorectal cancer screenings
100 %
100 %
Well Baby Care
Check-ups, Visits
100 %
100 %
Screening tests
100 %
100 %
Immunizations
100 %
100 %

Annual Vision Exam

$15.00 co-pay
$30.00 OON allowance
$15.00 co-pay
$30.00 OON allowance
 
Diagnostic Tests
Advanced Diagnostic Imaging
After Plan Deductible
$25.00 PCP/$50.00 Specialist
After Plan Year Deductible $150.00
10% after Plan Year Deductible
10% after Plan Year Deductible
PT/OT/ST
After Plan Deductible
$25.00 co-pay
10% after Plan Year Deductible
Outpatient Surgery
After Plan Deductible
$150.00 co-pay
10% after Plan Year Deductible
Pre/Post Natal Care
After Plan Deductible
$300.00 co-pay
10% after Plan Year Deductible
Outpatient Mental Health/Substance Abuse Visits
After Plan Deductible
$300.00 co-pay
10% after Plan Year Deductible
Inpatient Hospital Services

After Plan Year Deductible

$300.00 day/not to exceed $1500.00 per admission

10% after Plan Year Deductible
Skilled Nursing
After Plan Year Deductible 20%
10% after Plan Year Deductible
Durable Medical Equipment
After Plan Year Deductible $0
10% after Plan Year Deductible