Comparing the SAIC Medical Plans
The chart below provides some basic plan information about the SAIC self-insured plans.
Download the SAIC Medical Plans Table (28k)
| MEDPLUS | MEDBASIC | CATASTROPHIC | OUT OF AREA | ||||
|---|---|---|---|---|---|---|---|
| NETWORK* | OUT-OF-NETWORK** | NETWORK* | OUT-OF-NETWORK** | NETWORK* | OUT-OF-NETWORK** | ||
|
Annual Deductible |
$250 per person |
$600 per person |
$2,000 per person |
$350 per person |
|||
Common Accident Deductible |
$250 |
$600 |
$2,000 |
$350 |
|||
Special Accident Benefit |
Deductible waived for first $500 in eligible expenses due to an accident. Expenses must be incurred within 90 days of an accident. |
N/A |
N/A |
N/A |
N/A |
N/A |
|
Annual Out-Of-Pocket Maximum | $1,250 per person plus deductible | $3,750 per person plus deductible | $2,500 per person plus deductible | $7,500 per person plus deductible | $5,000 per person, $10,000 per family, deductible included | $5,000 per person, $10,000 per family, deductible included | $2,000 per person plus deductible |
Office Visits - Primary Care Provider (PCP) | $15 copay then plan pays 100% | Plan pays 65% after deductible | $25 copay then plan pays 100% | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Office Visits - Specialist | $25 copay then plan pays 100% | Plan pays 65% after deductible | $35 copay then plan pays 100% | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Emergency Room | $50 copay per visit (waived if admitted) then plan pays 85% after deductible. For non-emergency use of the emergency room, plan pays 50% after deductible. | $50 copay per visit (waived if admitted) then plan pays 65% after deductible. For non-emergency use of the emergency room, plan pays 50% after deductible. | $50 copay per visit (waived if admitted) then plan pays 80% after deductible. For non-emergency use of the emergency room, plan pays 50% after deductible. | $50 copay per visit (waived if admitted) then plan pays 60% after deductible. For non-emergency use of the emergency room, plan pays 50% after deductible. | Plan pays 70% after deductible. For non-emergency use of the emergency room, plan pays 50% after deductible. | Plan pays 50% after deductible | $50 copay per visit (waived if admitted) then pays 80% after deductible |
Hospital Admission | $200 copay per admission then plan pays 85% after deductible | $200 copay per admission then plan pays 65% after deductible | $200 copay per admission then plan pays 80% after deductible | $200 copay per admission then plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | $200 copay per admission then plan pays 80% after deductible |
Periodic Health Assessments (PCP) | $15 copay then plan pays 100%; up to age 65: 1 exam every 24 months; age 65 or older: 1 exam every 12 months. Deductible waived for associated x-ray and lab services | Not covered | $25 copay then plan pays 100%; up to age 65: 1 exam every 24 months; age 65 or older: 1 exam every 12 months. Deductible waived for associated x-ray and lab services | Not covered | Not covered | Not covered | Plan pays 80% after deductible; up to age 65: 1 exam every 24 months; age 65 or older: 1 exam every 12 months |
Well-Child Care (PCP) | $15 copay then plan pays 100%; up to age 1: maximum 7 visits; age 1 – 2: maximum 2 visits; age 3 – 17: maximum 1 visit. Deductible waived for associated x-ray and lab services | Not covered | $25 copay then plan pays 100%; up to age 1: maximum 7 visits; age 1 – 2: maximum 2 visits; age 3 – 17: maximum 1 visit. Deductible waived for associated x-ray and lab services | Not covered | Not covered | Not covered | Plan pays 80% after deductible |
Lab and X-Ray | Plan pays 85% after deductible for non-routine lab & x-ray services provided outside the office visit | Plan pays 65% after deductible | Plan pays 80% after deductible for non-routine lab & x-ray services provided outside the office visit | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Outpatient Surgery | Plan pays 85% after deductible | Plan pays 65% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Routine Mammograms | Plan pays 85% – Deductible waived | Plan pays 65% after deductible | Plan pays 80% – Deductible waived | Plan pays 60% after deductible | Plan pays 70% – Deductible waived | Plan pays 50% after deductible | Plan pays 80% after deductible |
Routine Pap Smears | Plan pays 85% – Deductible waived | Plan pays 65% after deductible | Plan pays 80% – Deductible waived | Plan pays 60% after deductible | Plan pays 70% – Deductible waived | Plan pays 50% after deductible | Plan pays 80% after deductible |
PSA/DRE Over age 40 | Plan pays 85% – Deductible waived | Plan pays 65% after deductible | Plan pays 80% – Deductible waived | Plan pays 60% after deductible | Plan pays 70% – Deductible waived | Plan pays 50% after deductible | Plan pays 80% after deductible |
Skilled Nursing Facility | Plan pays 85% after deductible for up to 60 days per condition | Plan pays 65% after deductible for up to 60 days per condition | Plan pays 80% after deductible for up to 60 days per condition | Plan pays 60% after deductible for up to 60 days per condition | Plan pays 70% after deductible for up to 60 days per condition | Plan pays 50% after deductible for up to 60 days per condition | Plan pays 80% after deductible for up to 60 days per condition |
Home Health Care (maximum visits combined with skilled nursing care and private duty nursing) | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit | Plan pays 100% for up to 100 visits per year, up to 4 hours = 1 visit |
Private Duty Nursing (maximum visits combined with Home Health Care benefit) | Plan pays 100% for up to 100 visits per year, up to 8 hours = 1 visit | Plan pays 65% after deductible | Plan pays 100% for up to 100 visits per year, up to 8 hours = 1 visit | Not covered | Plan pays 100% for up to 100 visits per year, up to 8 hours = 1 visit | Not covered | Plan pays 100% for up to 100 visits per year, up to 8 hours = 1 visit |
Hospice Care (up to 30 days per lifetime for inpatient and $10,000 per lifetime for outpatient) | Plan pays 85% – Deductible waived | Plan pays 65% – Deductible waived | Plan pays 80% – Deductible waived | Plan pays 60% – Deductible waived | Plan pays 70% – Deductible waived | Plan pays 50% – Deductible waived | Plan pays 80% – Deductible waived |
Outpatient Rehabilitation —Physical and Speech (as medically necessary) | Plan pays 85% after deductible | Plan pays 65% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Durable Medical Equipment | Plan pays 85% after deductible | Plan pays 65% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Mental Health and Substance Abuse – Outpatient (provided by CIGNA Behavioral Health)*** | $30 copay then plan pays 100% | Plan pays 50%; up to max $30 per visit and 50 visits per year | $30 copay then plan pays 100% | Plan pays 50%; up to max $30 per visit and 50 visits per year | Plan pays 70% after deductible | Plan pays 50% after deductible | $30 copay then plan pays 100% |
Mental Health and Substance Abuse – Inpatient (provided by CIGNA Behavioral Health)*** | Plan pays 85% | Plan pays 50% | Plan pays 80% | Plan pays 50% | Pre-certification is required. Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% |
Most Other Services | Plan pays 85% after deductible | Plan pays 65% after deductible | Plan pays 80% after deductible | Plan pays 60% after deductible | Plan pays 70% after deductible | Plan pays 50% after deductible | Plan pays 80% after deductible |
Prescription Drugs: | |||||||
Retail Pharmacy (up to a 30-day supply) | Copays: $10 generic | Not covered | Copays: $15 generic $25 brand formulary $35 brand non-formulary | Not covered | Plan pays 70% after deductible | Not covered | Copays: $10 generic |
Mail Order (up to a 90-day supply) | 2x retail pharmacy copay | 2x retail pharmacy copay | Plan pays 70% after deductible | 2x retail pharmacy copay | |||
Lifetime Benefit Maximum (Combined In-Network & Out-Of-Network) | $2 million per person (Lifetime maximum benefit is combined for all SAIC self-insured plans.) | ||||||
* Covered services received from a network provider will be paid based on the negotiated rate.
** Covered services received from an out-of-network provider will be paid based on the reasonable and customary (R&C) limit.
*** Deductible is waived for these services. Copays and coinsurances do not apply to the out-of-pocket maximum.