ERIE's Health Protection Plan Comparison
A side-by-side comparison of ERIE's health protection plan offerings.
In-Network or Out-of-Network: What’s the Difference?
In-network: A national network of health care providers and facilities that accept pre-negotiated, discounted rates. You will typically save money when you receive care and services from in-network providers.
Out-of-network: Providers or facilities that do not offer discounted rates. You can visit these providers, but they will likely charge you more for care and services and can charge you for the difference between their price and the amount the plan will cover.
Before you choose a health plan option for the upcoming year, consider your options. The choice that you made in the past may not be right for you today.
ERIE’s three health plan options—Consumer-Directed Health Plan (CDHP ), Health2 and Health1—offer you a choice of contribution levels, deductibles and tax-advantaged strategies for paying out-of-pocket medical expenses. The access to coverage is the same; the differences are your contributions and how you pay for out-of-pocket expenses.
Which option is right for you? Let’s take a look at the differences—and benefits—of each.
| CDHP | Health2 | Health1 |
|---|
Your contribution per paycheck: | Lowest | Moderate | Highest |
Your deductible: | Highest | Moderate | Lowest |
Before your deductible is reached, you pay: | 100% of prescription and medical expenses Enroll in the HSA and use ERIE's contribution of $750 or $1,500 to help offset out-of-pocket expenses. | Copays for office visits and certain services, and prescriptions 100% of medical expenses Enroll in Health Care FSA and pay for out-of-pocket expenses with pre-tax dollars. | Copays for office visits and certain services, and prescriptions 100% of medical expenses Enroll in Health Care FSA and pay for out-of-pocket expenses with pre-tax dollars. |
After your deductible is reached: | Plan pays 80%
You pay 20% of eligible costs | Plan pays 80%
You pay 20% of eligible costs | Plan pays 90%
You pay 10% of eligible costs |
Annual Deductible
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
Individual | | $4,000 | | $1,000 | | $500 |
Family | $4,000 | $8,000 | $1,000 | $2,000 | $500 | $1,000 |
ERIE HSA Contribution | $750/individual or $1,500/family | $750/individual or $1,500/family | N/A | N/A | N/A | N/A |
Annual Deductible: The amount you pay out of pocket until the plan begins to pay a portion of covered expenses. For CDHP, the deductible includes both medical and prescription drug expenses. Health1 and Health2 have only medical deductibles.
PPO Plans’ Annual Out-of-Pocket Maximum—Medical only
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
Individual | N/A | N/A | | $4,000 | | $2,000 |
Family | N/A | N/A | $4,000 | $6,000 | $2,000 | $4,000 |
PPO Plans’ Annual Out-of-Pocket Maximum—Medical only: Once you pay this amount out of pocket (through your deductible, coinsurance or copayments) for medical expenses, the plan pays further eligible expenses at 100% for the rest of the calendar year.
PPO Plans’ Annual Out-of-Pocket-Maximum—Prescription Drugs only
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
Individual | N/A | N/A | | N/A | | N/A |
Family | N/A | N/A | $9,200 | N/A | $11,200 | N/A |
PPO Plans’ Annual Out-of-Pocket-Maximum—Prescription Drugs only: Once you pay this amount out of pocket (through in-network prescription drug copayments and coinsurance), the plan pays further eligible prescription expenses at 100% for the rest of the calendar year.
CDHP Annual Out-of-Pocket Maximum—Medical and Prescription Drugs
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
Individual | $3,750 | $7,500 | N/A | N/A | N/A | N/A |
Family | | $15,000 | N/A | N/A | N/A | N/A |
CDHP Annual Out-of-Pocket Maximum—Medical and Prescription Drugs: Once you pay this amount out of pocket, the plan pays further eligible expenses at 100% for the rest of the calendar year.
Diagnostic Services, Durable Medical Equipment, Orthotics & Prosthetics, Home Health Care & Hospice, In- & Outpatient Hospital Expenses, Maternity, Inpatient Mental Health & Substance Abuse Rehab or Detox, Other Therapy Services, Medical/Surgical Expenses
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| Plan: 80%
You: 20% | Plan: 60%
You: 40% | Plan: 80%
You: 20% | Plan: 60%
You: 40% | Plan: 90%
You: 10% | Plan: 70%
You: 30% |
Occupational & Speech Therapy, Spinal Manipulation — Combined In- & Out-of-Network Limit: 25 visits/calendar year
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| Plan: 80%
You: 20% | Plan: 60%
You: 40% | Plan: 80%
You: 20% | Plan: 60%
You: 40% | Plan: 90%
You: 10% | Plan: 70%
You: 30% |
Physical Therapy — Combined In- & Out-of-Network Limit: 35 visits/calendar year
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| Plan: 80%
You: 20% | Plan: 60%
You: 40% | Plan: 80%
You: 20% | Plan: 60%
You: 40% | Plan: 90%
You: 10% | Plan: 70%
You: 30% |
Preventive Care — Adult & Pediatric Physical Exams and Adult & Pediatric Immunizations, per preventive schedule
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| 100%, no deductible | | 100%, no deductible | 60% | 100%, no deductible | |
Physician Office Visits, Outpatient Mental Health & Substance Abuse
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| | | 100% after $20 copay | 60% | 100% after $20 copay | |
Specialist Office Visit
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| 80% | 60% | 100% after $35 copay | 60% | 100% after $35 copay | 70% |
Urgent Care Center & Retail Clinic Visit
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| 80% | 60% | 100% after $40 copay | 60% | 100% after $40 copay | 70% |
Teladoc General Medicine
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| You pay a $45 fee or $10 copay after deductible is met. | You pay a $45 fee or $10 copay after deductible is met. | 100% after $10 copay | 100% after $10 copay | 100% after $10 copay | 100% after $10 copay |
Teladoc Dermatology
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| You pay $75 fee or $35 copay after deductible is met. | You pay $75 fee or $35 copay after deductible is met. | 100% after $35 copay | 100% after $35 copay | 100% after $35 copay | 100% after $35 copay |
Emergency Room Services
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| 80%, network deductible applies | 80%, network deductible applies | 100% after $100 copay (waived if admitted) | 100% after $100 copay (waived if admitted) | 100% after $100 copay (waived if admitted) | 100% after $100 copay (waived if admitted) |
Ambulance
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| 80%, network deductible applies | 80%, network deductible applies | 80%, network deductible applies | 80%, network deductible applies | 90%, network deductible applies | 90%, network deductible applies |
Hearing Aid Exam & Hearing Aids
Benefits | CDHP In-Network | CDHP Out-of-Network | Health2 In-Network | Health2 Out-of-Network | Health1 In-Network | Health1 Out-of-Network |
|---|
| Limit: $3,000 max. per ear (including fitting and testing) every 3 years | Limit: $3,000 max. per ear (including fitting and testing) every 3 years | Limit: $3,000 max. per ear (including fitting and testing) every 3 years | Limit: $3,000 max. per ear (including fitting and testing) every 3 years | Limit: $3,000 max. per ear (including fitting and testing) every 3 years | Limit: $3,000 max. per ear (including fitting and testing) every 3 years |
| 100% deductible applies | 100% deductible applies | 100% deductible does not apply | 100% deductible does not apply | 100% deductible does not apply | 100% deductible does not apply |
Pre-certification requirements: Member or provider should contact UnitedHealthcare prior to a planned inpatient admission or within 48 hours of an emergency or
maternity-related admission. If this does not occur and it is later determined that all or part of the inpatient stay was not medically necessary or appropriate, the patient is
responsible for any non-covered costs.
Copayments are not subject to the deductible. You may also be responsible for a facility fee, clinic charge or similar fee/charge (in addition to any professional fees) if your
office visit or service is provided at a location that qualifies as a hospital department or a satellite building of a hospital.