ERIE's Health Protection Plan Comparison

A side-by-side comparison of ERIE's health protection plan offerings.

Download Health Plan Comparison Table

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.

Health Plan Comparison Table

Annual Deductible 

Benefits
CDHP In-Network
CDHP Out-of-Network
Health2 In-Network
Health2 Out-of-Network
Health1 In-Network
Health1 Out-of-Network
Benefits
Individual
CDHP In-Network
$2,000[1]  
CDHP Out-of-Network
$4,000
Health2 In-Network
$500[1]  
Health2 Out-of-Network
$1,000
Health1 In-Network
$250[1]
Health1 Out-of-Network
$500
Benefits
Family
CDHP In-Network
$4,000  
CDHP Out-of-Network
$8,000  
Health2 In-Network
$1,000
Health2 Out-of-Network
$2,000
Health1 In-Network
$500
Health1 Out-of-Network
$1,000
Benefits
ERIE HSA Contribution
CDHP In-Network
$750/individual or $1,500/family
CDHP Out-of-Network
$750/individual or $1,500/family  
Health2 In-Network
N/A
Health2 Out-of-Network
N/A
Health1 In-Network
N/A
Health1 Out-of-Network
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
Benefits
Individual
CDHP In-Network
N/A  
CDHP Out-of-Network
N/A  
Health2 In-Network
$2,500[2]
Health2 Out-of-Network
$4,000
Health1 In-Network
$1,000[2]  
Health1 Out-of-Network
$2,000
Benefits
Family
CDHP In-Network
N/A  
CDHP Out-of-Network
N/A  
Health2 In-Network
$4,000
Health2 Out-of-Network
$6,000
Health1 In-Network
$2,000
Health1 Out-of-Network
$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
Benefits
Individual
CDHP In-Network
N/A
CDHP Out-of-Network
N/A
Health2 In-Network
$4,100[2]
Health2 Out-of-Network
N/A  
Health1 In-Network
$5,600[2]
Health1 Out-of-Network
N/A  
Benefits
Family
CDHP In-Network
N/A
CDHP Out-of-Network
N/A
Health2 In-Network
$9,200
Health2 Out-of-Network
N/A  
Health1 In-Network
$11,200
Health1 Out-of-Network
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
Benefits
Individual
CDHP In-Network
$3,750  
CDHP Out-of-Network
$7,500
Health2 In-Network
N/A
Health2 Out-of-Network
N/A
Health1 In-Network
N/A
Health1 Out-of-Network
N/A
Benefits
Family
CDHP In-Network
$7,500[3]  
CDHP Out-of-Network
$15,000
Health2 In-Network
N/A
Health2 Out-of-Network
N/A
Health1 In-Network
N/A
Health1 Out-of-Network
N/A
CDHP Annual Out-of-Pocket Maximum—Medical and Prescription Drugs: These amounts are defined by the IRS. 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
Benefits
CDHP In-Network
Plan: 80% You: 20%
CDHP Out-of-Network
Plan: 60% You: 40%
Health2 In-Network
Plan: 80% You: 20%
Health2 Out-of-Network
Plan: 60% You: 40%
Health1 In-Network
Plan: 90% You: 10%
Health1 Out-of-Network
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
Benefits
CDHP In-Network
Plan: 80% You: 20%
CDHP Out-of-Network
Plan: 60% You: 40%
Health2 In-Network
Plan: 80% You: 20%
Health2 Out-of-Network
Plan: 60% You: 40%
Health1 In-Network
Plan: 90% You: 10%
Health1 Out-of-Network
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
Benefits
CDHP In-Network
Plan: 80% You: 20%
CDHP Out-of-Network
Plan: 60% You: 40%
Health2 In-Network
Plan: 80% You: 20%
Health2 Out-of-Network
Plan: 60% You: 40%
Health1 In-Network
Plan: 90% You: 10%
Health1 Out-of-Network
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
Benefits
CDHP In-Network
100%, no deductible  
CDHP Out-of-Network

60%

Health2 In-Network
100%, no deductible  
Health2 Out-of-Network
60%
Health1 In-Network
100%, no deductible  
Health1 Out-of-Network

70%

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
Benefits
CDHP In-Network

80%

CDHP Out-of-Network

60%

Health2 In-Network
100% after $20 copay  
Health2 Out-of-Network
60%
Health1 In-Network
100% after $20 copay  
Health1 Out-of-Network

70%

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
Benefits
CDHP In-Network
80%
CDHP Out-of-Network
60%
Health2 In-Network
100% after $35 copay
Health2 Out-of-Network
60%
Health1 In-Network
100% after $35 copay
Health1 Out-of-Network
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
Benefits
CDHP In-Network
80%
CDHP Out-of-Network
60%
Health2 In-Network
100% after $40 copay  
Health2 Out-of-Network
60%
Health1 In-Network
100% after $40 copay  
Health1 Out-of-Network
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
Benefits
CDHP In-Network
You pay a $45 fee or $10 copay after deductible is met.
CDHP Out-of-Network
You pay a $45 fee or $10 copay after deductible is met.
Health2 In-Network
100% after $10 copay
Health2 Out-of-Network
100% after $10 copay
Health1 In-Network
100% after $10 copay
Health1 Out-of-Network
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
Benefits
CDHP In-Network
You pay $75 fee or $35 copay after deductible is met.
CDHP Out-of-Network
You pay $75 fee or $35 copay after deductible is met.
Health2 In-Network
100% after $35 copay
Health2 Out-of-Network
100% after $35 copay
Health1 In-Network
100% after $35 copay
Health1 Out-of-Network
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
Benefits
CDHP In-Network
80%, network deductible applies
CDHP Out-of-Network
80%, network deductible applies
Health2 In-Network
100% after $100 copay (waived if admitted)
Health2 Out-of-Network
100% after $100 copay (waived if admitted)
Health1 In-Network
100% after $100 copay (waived if admitted)
Health1 Out-of-Network
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
Benefits
CDHP In-Network
80%, network deductible applies
CDHP Out-of-Network
80%, network deductible applies
Health2 In-Network
80%, network deductible applies
Health2 Out-of-Network
80%, network deductible applies
Health1 In-Network
90%, network deductible applies
Health1 Out-of-Network
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
Benefits
CDHP In-Network
Limit: $3,000 max. per ear (including fitting and testing) every 3 years
CDHP Out-of-Network
Limit: $3,000 max. per ear (including fitting and testing) every 3 years
Health2 In-Network
Limit: $3,000 max. per ear (including fitting and testing) every 3 years
Health2 Out-of-Network
Limit: $3,000 max. per ear (including fitting and testing) every 3 years
Health1 In-Network
Limit: $3,000 max. per ear (including fitting and testing) every 3 years
Health1 Out-of-Network
Limit: $3,000 max. per ear (including fitting and testing) every 3 years
Benefits
CDHP In-Network
100% deductible applies
CDHP Out-of-Network
100% deductible applies
Health2 In-Network
100% deductible does not apply
Health2 Out-of-Network
100% deductible does not apply
Health1 In-Network
100% deductible does not apply
Health1 Out-of-Network
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.

  1. 1. 

    The two PPO plan options have an embedded deductible: any member covered under Family coverage may meet the individual deductible before ERIE begins to share costs via coinsurance (the whole family does not have to first meet the higher Family deductible). The CDHP has a non-embedded deductible: all coverage levels other than individual must meet the Family deductible before ERIE begins to share the cost via coinsurance.

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  2. 2. 

    Both PPO plan options have embedded out-of-pocket (OOP) maximums: any member covered under Family coverage may meet the individual OOP maximum before ERIE begins paying 100% for all covered expenses for that individual (the whole family does not have to first meet the higher Family OOP maximum).

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  3. 3. 

    The CDHP option has a non-embedded out-of-pocket (OOP) maximum: all coverage levels other than individual must meet the Family OOP maximum before ERIE begins paying 100% for all covered expenses. The Family OOP maximum complies with the Affordable Care Act.

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