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Schedule of Benefit Changes for Individual Plan Policyholders Effective July 1, 2007

We know how important it is to have the latest information about your health plan. To keep you up-to-date on the latest changes in your ODS schedule of benefits, this quick reference chart outlines the majority of benefit changes, language changes or benefit additions and deletions affecting contracts with the 2007 policy renewal. Please refer to your member handbook for detailed plan information. If a change is specific to a particular ODS Individual Plan, it will be noted in the chart below.

All Individual Medical Plans
Maximizer Plan specific changes compared to Plus, Preferred and Traditional plans
Beneficial Plan specific changes
Health Savings Account (H.S.A) specific changes
Individual Dental changes for those who have elected the Premier or Preferred PPO Dental Plan Rider

All Individual Medical Plans

Add preventive care for Dependent Children Outside the Service Area
Remove Student verification requirement and cover dependent children up to age 23.
Add periodic health exams and immunizations and remove as contract exclusions
Indicate that emergency care is paid at the in-network level
Change Injectable Medication to Medication Administered by Providers, Infusion Center or Home Infusion. Change benefit to cover all medications administered in this manner as a medical supply. Specialty self-injectables and most injectable drugs must be purchased from a Specialty Pharmacy Provider.
Eliminate Plus, Preferred PPO and Traditional plan designs
Introduce Maximizer plan PPO alternative to Plus, Preferred and Traditional policyholders

Maximizer Plan specific changes compared to Plus, Preferred and Traditional plans

Allow office visits by physician or specialist and urgent care centers with $20 co-pay.
Add per person deductible options of $2,500 and $5,000 and per family deductible options of $7,500 and $15,000. (Traditonal, Plus)
Change per person out-of-pocket maximum from a combined maximum to two separate maximums that do not co-mingle. Change amounts to $5,000 for in-network and $10,000 for out-of-network.
Change prescription drug co-payment levels to from $15 or 50% whichever is greater, to $15 generic or 50% brand to benefit maximum (Plus)
Replace major medical prescription drug coverage with $15 generic or 50% brand benefit. (Preferred PPO and Traditional).
Change coinsurance levels from 20% to 30% in-network; from 40% to 50% out-of-network (Preferred, Plus)
Change from paying 20% for most services using any provider to 30% in-network and 50% out-of-network (Traditional)
Remove PCP requirement (Plus)

Beneficial Plan specific changes

Allow urgent care and home visits to be counted toward the first three first-dollar visits. Visits for physical therapy do not count toward the first three first dollar visits.
Change per person out-of-pocket maximum from a combined maximum to two separate maximums that do not co-mingle. For Beneficial Value, change out-of-pocket amount from $3,000 for both in-network and out-of-network expenses to $5,000 in-network and $10,000 out-of-network out-of-pocket maximum amounts. For Beneficial Rx, add $6,000 out-of-network out-of-pocket maximum amount.
Change prescription drug co-payment levels to $15 generic or 50% brand to benefit maximum.
Change the name of Beneficial 5,000 and 7,500 to Beneficial Value.
Change coinsurance levels from 20% to 30% in-network; and from 40% to 50% out-of-network (Beneficial Value)
Change visit co-payment from $15 to $25. (Beneficial Value)
Remove major medical prescription drug coverage (Beneficial Value)
Allow a member to decline the prescription rider (Beneficial Value)
Add a maximum amount to the Additional Accident Benefit of $10,000 (Beneficial Value)

Health Savings Account (H.S.A) specific changes

Change H.S.A. PPO plan name to H.S.A. Value
Change administration so in-network and out-of-network expenses accrue toward the same deductible amount. The out-of-network per person and per family deductible amounts are removed.
Change “per person” and “per family” out-of-network maximum to no maximum.
Change deductible from $1,200 to $1,500/individual, $2,400 to $3,000/family (HSA Choice)
Change in-network out-of-pocket from $3,800 to $3,500/individual, $7,600 to $7,000/family (HSA Choice)

Individual Dental changes for those who have elected the Premier or Preferred PPO Dental Plan Rider

Add Oral Health, Total Health Program including coverage for Oral Cancer Screening tests: Vizilite and Brush Biopsy; 3rd cleaning for expectant mothers; and 4th cleaning for patients with diabetes.
Allow prior coverage credit towards the 12-month waiting period from a comparable plan

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