Available Plans HealthChoice High Option HealthChoice Basic
HealthChoice S-Account HealthChoice USA 2 Using a HealthChoice
Network Provider will lower your out-of-pocket costs.
Slide 3
When using a Network Provider: $30 copay for PCP office visits
$50 copay for specialist office visits Annual deductible
$500/individual or $1,500/family Plan pays 80%/member pays 20% of
Allowed Charges $2,800 individual out-of-pocket maximum HIGH OPTION
3
Slide 4
When using a Network Provider: Office visit copays do not apply
Plan pays first $500/member pays next $500 as deductible; $1,000
deductible for family Plan then pays 50% until $5,500/individual or
$11,000/family out-of-pocket is met Plan pays 100% of Allowed
Charges BASIC 4
Slide 5
Health Savings Account (HSA) Combined $1,500
deductible/individual and $3,000/family Entire deductible must be
met before claims are paid (including prescriptions) $50 copay for
office visits The calendar year out-of-pocket max is
$4,000/individual or $8,000/family S-Account 5
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For members who live and work outside of Oklahoma and Arkansas
for more than three months Benefits are the same as High Option
Plan Members have access to the USA Plans nationwide provider
network USA 6
Slide 7
Network Pharmacy Benefits 7 No lifetime maximum *NEW*
HealthChoice offers certain prescription tobacco cessation
medications for a $5 copay *NEW* A separate $2,500 annual out-of-
pocket maximum applies (does not apply to S-Account Plan) Benefits
are the same for the High Option, Basic, USA, and S-Account plans
once the annual deductible is met
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Network Pharmacy Benefits 8 For Preferred medications: You pay
$30 or actual cost of medications costing up to $100 You pay 25% up
to $60 for medications costing more than $100 May cover the greater
of a 34-day supply or 100 units (tablets/capsules) Benefits are the
same for the High Option, Basic, and USA plans and for the
S-Account plan once the annual deductible is met