Compare Plans
Compare Capital Health Plan's two plans: Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO). For Medicare coverage through your employer, please click here to learn about Capital Health Plan Retiree Advantage (HMO).
| Capital Health Plan Advantage Plus | Capital Health Plan Preferred Advantage | |
| Premium | $30 per month | $96 per month |
| Primary Care | $10 per visit | $10 per visit |
| Specialty Care | $30 per visit | $25 per visit |
| Chiropractic Care | $20 per visit | $20 per visit |
| Medicare Covered Preventive Services | $0 | $0 |
| Urgent Care | $20 per visit | $20 per visit |
| Emergency Room Visit (Worldwide) | $50 per visit | $50 per visit |
| Inpatient Hospital Coverage | $150 per day (days 1-5) $0 per day (days 6-90) (no limit on days) $750 maximum for each stay | $250 for each stay $0 per day (days 1-5) $100 per day (days 6-10) $0 per day (days 11-90) (no limit on days) $750 maximum for each stay |
| Skilled Nursing Facility | $0 per day (days 1-6) $100 per day (days 7-100) (Limited to 100 days per benefit period) | $0 per day (days 1-6) $75 per day (days 7-100) (Limited to 100 days per benefit period) |
| Outpatient Surgery | $100 per procedure | $100 per procedure |
| Home Health Care | $0 | $0 |
| Ambulance Services | $100 per transport | $100 per transport |
| Durable Medical Equipment | 20% of the cost | 20% of the cost |
| Diabetes Supplies | 20% of the cost | 20% of the cost |
| MRI / CT / PET / Thallium Scans | $100 per scan | $100 per scan |
| Lab & X-Ray | $0 | $0 |
| Radiation Therapy | 20% of the cost | 20% of the cost |
| Routine Eye Exams | $10 | $10 |
| Eyeglass or Contact Reimbursement | $150 (every 2 years) | $150 (every 2 years) |
| Health Club Membership Reimbursement | Up to $150 (yearly) | Up to $150 (yearly) |
| Annual Out of Pocket Maximum (Medical Only) | $3400 | $3400 |
| Prescription Drug Coverage (Part D) | Initial Coverage Limit (up to $2930 total drug cost) you pay: | Initial Coverage Limit (up to $2930 total drug cost) you pay: |
| 30-Day Retail | Tier 1 - $7 / 30-day supply Tier 2 - $35 / 30-day supply Tier 3 - $60 / 30-day supply Tier 4 - $250 or 25% (whichever costs less) | Tier 1 - $7 / 30-day supply Tier 2 - $35 / 30-day supply Tier 3 - $60 / 30-day supply Tier 4 - $250 or 25% (whichever costs less) |
| 90-Day Retail | Tier 1 - $21 / 90-day supply Tier 2 - $105 / 90-day supply Tier 3 - $180 / 90-day supply Tier 4 - Not Available | Tier 1 - $21 / 90-day supply Tier 2 - $105 / 90-day supply Tier 3 - $180 / 90-day supply Tier 4 - Not Available |
| 90-Day Mail Order | Tier 1 - $17.50 / 90-day supply Tier 2 - $87.50 / 90-day supply Tier 3 - $150 / 90-day supply Tier 4 - Not Available | Tier 1 - $17.50 / 90-day supply Tier 2 - $87.50 / 90-day supply Tier 3 - $150 / 90-day supply Tier 4 - Not Available |
| Gap coverage (after reaching Initial Coverage Limit of $2930) you pay: | 86% of Generics 50% of Brand Name Drugs (plus dispensing fee) | Tier 1 - $7 / 30-day supply Tier 1 - $21 / 90-day retail supply Tier 1 - $17.50 / 90-day mail order 86% of Generics in other tiers 50% of Brand Name Drugs (plus dispensing fee) |
| Catastrophic Coverage (after $4700 out of pocket) you pay: | Generic- $2.60 or 5% (whichever is greater) All others- $6.50 or 5% (whichever is greater) | Generic- $2.60 or 5% (whichever is greater) All others- $6.50 or 5% (whichever is greater) |
| For coverage details and additional copayments/coinsurance please see the Capital Health Plan Advantage Plus (HMO) and Capital Health Plan Preferred Advantage (HMO) Summary of Benefits, the Capital Health Plan Advantage Plus (HMO) Evidence of Coverage or the Capital Health Plan Preferred Advantage (HMO) Evidence of Coverage. Conditions and limitations may apply. | ||
Last updated: 10/1/2011
= open external link in new window