HEALTH BENEFITS

Untitled Document

Culpeper County Government 2018-2019 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

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