Traditional Plans

Comparison of University Health Care Plans
Chart Effective July 1, 2008

Health Benefits For University of Delaware Employees

This Summary of Benefits is intended as a HIGHLIGHT of the health plans available.
After your health plan selection, you will receive a Summary Plan Booklet at your home address.

Allergy Service	Hospital Service	Short Term Therapy Service
Ambulance Service	Maternity Service	Specialist Service
Chiropractic Service	Mental Health Service	Urgent Care Service
Emergency Service	Other Service	Vision and Hearing Service
Home Care Service	Preventive Service	X-Ray and Lab Service
Benefits Rate Chart (Medical, Dental, Vision and Dependent Life

*Description of Benefit*	*First State Basic*		Aetna⁵ Doctor Locator	BlueCARE⁵ Doctor Locator	*Comprehensive - Preferred Provider Organization (PPO)*
	*In-Network Benefits^1,4*	*Out-of-Network Benefits^1,4*			*In-Network Benefits¹*	*Out-of-Network Benefits*^1,4
Deductible	$500 Single $1,000 Family²	$1,000 Single $2,000 Family²	None	None	None	$300 Single $600 Family
Out-of-Pocket Maximum	$2,000 Single⁶ $4,000 Family^3,6	$4,000 Single⁶ $8,000 Family^3,6	None	None	None	$1,800 Single⁶ $3,600 Family ⁶
In-patient Semiprivate Room & Board (includes intensive care, if medically appropriate)	90%	70%	$100 co-pay per day with max. of $200 per admission	$100 co-pay per day with max. of $200 per admission	$100 co-pay per day with max. of $200 per admission	80%
In-patient Physicians’ and Surgeons’ Services	90%	70%	100%	100%	100%	80%
Skilled Nursing Facility	90% up to 120 days per confinement	70% up to 120 days per confinement	100%	100%	100% up to 120 days per confinement	80% up to 120 days per confinement
Outpatient Surgery-doctor's office	90%	70%	$20 co-pay	$20 co-pay	100%	80%
Outpatient Surgery-ambulatory surg ctr	90%	70%	$30 co-pay	$30 co-pay	100%	80%
Outpatient Surgery-OR dept hospital	90%	70%	$75 co-pay	$75 co-pay	100%	80%
Prenatal and Postnatal Care	90%	70%	$20 initial co-pay(In-patient room & board co-pays apply)	$20 initial co-pay (In-patient room & board co-pays apply)	100% (In-patient room & board co-pays do apply to hospital deliveries/birthing centers)	80%
Delivery Fee	90%	70%	100%	100%	100%	80%
Hospice	90% up to 240 days	70% up to 240 days	100%	100%	100% up to 240 days	80%
Home Care Services	90% up to 240 visits per plan year	70% up to 240 visits per plan year	100% up to 240 visits per plan year	100% up to 240 visits per plan year	100% up to 240 visits per plan year	80% up to 240 visits per plan year
Emergency Ambulance	90%	70%	$50 co-pay	$50 co-pay	100%	100% no ded
Emergency Services	90%	70%	$135 co-pay (waived if admitted)	$135 co-pay (waived if admitted)	$125 co-pay (waived if admitted) Physician - 100%	$125 co-pay (waived if admitted) Physician - 80%
Urgent Care Services	$25 co-pay⁵	$25 co-pay⁵	$20 co-pay	$20 co-pay	$25 co-pay⁵	80%
Mental Health Care						Return To Top
In-patient Acute	90% up to 60 days (subject to authorization)	70% up to 60 days	80% up to 30 days per plan year	80% up to 31 days per plan year	100% up to 60 days (subject to authorization & co-pays)	80% up to 60 days
Partial Hospitalization/Residential	90% up to 120 partial days (subject to authorization)	70% up to 120 partial days	80%	80% up to 31 days per plan year	100% up to 120 days (subject to authorization)	80% up to 120 days
Outpatient	90% (subject to authorization)	70%	$20 co-pay per visit 20 visits per plan year	$20 co-pay per visit 20 visits per plan year	100% after $25 co-pay (subject to authorization)	80%
Mental Health Care Substance Abuse	(defined by Delaware Code, Title 18, Chapter 33, Section 3343)					Return To Top
In-patient Acute	90%	70% up to 30 days for substance abuse and up to 60 days for serious MH	$100 co-pay/day with max. of $200/hospitalization	$100 co-pay/day with max. of $200/hospitalization	$100co-pay/day with max. of $200/adm.	80% up to 60 days (120 days for serious MH)
Outpatient	90% (subject to authorization)	70%	$20 co-pay per visit for up to 20 visits	$20 co-pay per visit for up to 20 visits	100% after $25 co-pay (suject to authorization)	80%
Other Services						Return To Top
Durable Medical Equipment	90%	70%	80% limited to $5,000 per member per plan year	80%	100%	80%
Physician Home/Office Visits (sick)	90%	70%	$10 co-pay per office visit $25 co-pay per home visit or after hours visit	$10 co-pay per office visit $25 co-pay per home visit	$15 co-pay	80%
Specialist Care	90%	70%	$20 co-pay per visit	$20 co-pay per visit	$25 co-pay	80%
Allergy Testing & Treatment	90%	70%	$20 co-pay per visit - allergy testing $5 co-pay per visit – allergy treatment	$20 co-pay per visit - allergy testing $5 co-pay per visit – allergy treatment	$25 co-pay/$5 co-pay per visit	80%
X-ray, Mammogram & other Diagnostic Services	90%	70%	$15 co-pay per visit	$15 co-pay per visit	$15 co-pay per visit	80%
Lab	90%	70%	$5 co-pay per visit	$5 co-pay per visit	$5 co-pay per visit	80%
MRI, CT or PT scans	90%	70%	$25 co-pay per visit	$25 co-pay per visit	$15 co-pay per visit	80%
Chiropractic Care	90% up to 30 visits per plan year	70% up to 30 visits per plan year	$20 co-pay per visit	$20 co-pay first visit, then 80% up to 60 consecutive visits per acute condition	85% up to 30 visits per plan year	80% up to 30 visits per plan year
Short-Term Therapies: Physical, Speech, Occupational	90% (subject to authorization)	70% (subject to authorization)	80%, 45 visits per condition for physical and occupational therapy combined. (45 visits per condition for speech therapy) (80%/45 visits per condition for for speech therapy)	80%, 60 consecutive days except for physical therapy. Physical therapy - 45 visits per condition	85%	80%
Annual Pap Smear & GYN Exam	100% no deductible	70% no deductible	$10 co-pay per exam Pap - $5 co-pay	$10 co-pay per exam Pap - $5 co-pay	$15 co-pay Pap - $5 co-pay	80%
Periodic Physical Exams, Immunizations, Diabetes Education	100% no deductible	70% no deductible	$10 co-pay per visit 100% Diabetes Education	$10 co-pay per visit 100% Diabetes Education	100% after $15 co-pay	80%
Routine Vision Care	Not covered	Not covered	100% after $15 co-pay (one exam every 24 months)	100% after $15 co-pay (one exam every 24 months)	Not covered	Not covered
Hearing Tests Hearing Aids	100%, no ded 90% after deductible, under age 18	70%, no ded 70% after deductible, under age 18	100% after office visit co-pay 80% under age 18	100% after office visit co-pay 80% under age 18	100% after office visit co-pay 100% under age 18	80% 80%after deductible, under age 18

1 All percentages listed above refer to Blue Cross Blue Shield of Delaware's allowable charges.
2 Two individuals must meet the deductible each plan year in order for the family deductible to be met.
3 Two individuals must meet the coinsurance expense limit in order for benefits to be paid at 100% of the allowable charge for the rest of the family members.      Includes deductible amounts but not prescription cost.
4  Coinsurance is after deductible.
5  100% after co-pay.
6  Includes deductible.

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