Atlantis Health Plan10/27/08

History

Atlantis Health Systems Inc., was incorporated on April 17, 1995 by healthcare professionals living and practicing in New York City.

Atlantis Health Plan was licensed in 2000 by the Department of Insurance and Department of Health to conduct business in New York City.

Mission Statement

Our mission is to re-establish the partnership that once existed between the doctor and the patient.

Atlantis Health Plan accomplishes this by having only you and the doctors in charge of the management and delivery of your healthcare.

Atlantis Health Plan

The only doctor owned health plan in the tri-state area. Atlantis gives you many advantages over other health plans:

It saves you money.

You get an automatic second opinion on all procedures. Over-treatment is one of the primary causes of rate increases and medical abuse.

Doctors “call the shots”, putting your medical care into the hands of experts.

You can count on quality care at a cost you can afford.

95% of complete claims are processed within 45 days of receipt.

The Best Plan for You: HMO or POS?

All plans include:• No referrals required to see specialists

• Over 33,000 in-network provider locations

• 24/7 telephone hotline answered by our own physicians

• Second opinions provided

• $0 Co-pay for well-child exams

• $0 Co-pay for emergency room visit if admitted to hospital

HMO In-Network

Deductible $0

Co-Insurance $0

Co-Pay $20

Emergency Room

$50

Worldwide

Hospital $0 or $500

POS In-Network Out-of-Network

Deductible $0 $1,000 or $2,000

Co-Insurance $0 30% up to

$2,000 or $3,000

Co-Pay $10 or $20 Deductible/

Co-Insurance

Emergency Room

$50 Worldwide

$50

Worldwide

Hospital $0 or $500 Deductible/

Co-Insurance

Which HMO or POS Plan is Best for You?

HERE ARE YOUR

OPTIONS:

L-HMO 20 HMO 20E L-POS F20 POS A10E

In Network

In Network

In Network

Out of Network

In Network

Out of Network

Deductible*Single/Family

$0 $0 $0 $2,000/$4,000 $0 $1,000/$2,500

Co-Insurance*Single/Family

0% 0% 0%30% up to

$3,000/6,000 0%

30% up to $2,000/$5,000

Max Out of Pocket*Single/Family

N/A N/A N/A $5,000/$10,000 N/A $3,000/$7,500

Co-PayDoctor & Lab

$20 $20 $20 Deductible/

Co-insurance$10

Deductible/Co-Insurance

Outpatient Surgery/ Delivery of Child

Lesser of 20% or $200

$0Lesser of 20% or $200/ $0

Deductible/Co-insurance

$0Deductible/

Co-insurance

Emergency Room** $50 $50 $50 $50 $50 $50

Hospital Co-pay / Deductible

$500 $0 $500 Deductible/

Co-Insurance$0

Deductible/Co-Insurance

Outpatient Physical Therapy (Max 20 visits/ diagnosis/yr)

$20 (only following inpatient stay)

$0$20

(only following inpatient stay)

Deductible/Co-insurance

$10Deductible/

Co-insurance

Outpatient Mental Health (max 20 visits/Calendar Yr)

$20 $20 $20Deductible/

Co-insurance $10

Deductible/Co-insurance

Lifetime Maximum No Limit No Limit No Limit $1,000,000 No Limit $1,000,000

* Deductibles, Co-Insurance, and Maximum Out-of-Pockets apply per Calendar Year** Emergency Coverage is worldwide and the co-pay is waived if there is an inpatient admission

Prescription Drug Options

HERE ARE

YOUR OPTIONS:RX M

(Mandatory Generic)RX G RX A

Generic Co-Pay $10 $7 $10

Preferred Brand NameCo-Pay

$25If there is no generic drug available within an entire

class of drugs

$30 $20

Non-Preferred Brand Name Co-Pay

$25If there is no generic drug available within an entire

class of drugs

$50 $30

Annual Deductible per

Person per Calendar Yr$0 Generic$250 Brand

$0 $0

Annual Maximum per Person per Calendar Yr

No Limit for Generic drugs; $2,000 limit for

brand name drugsNo Limit No Limit

• Atlantis Health Plan prescription benefits are available through CatalystRx .

• Catalyst network includes all major pharmacies and supermarkets.

• Many independent pharmacies are also in the plan.

• You are provided a detailed list of all participating pharmacies.

• All plans include Mail Order:90 day supply of maintenance drugs at 1 ½ the co-pay for: anti-diabetics, anti-hypertensives, anti-hyperlipidemics, beta-blockers, calcium blockers, diuretics, thyroid medication and birth control pills.

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