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Plan Comparison

You can choose from two different plans: The Premier Plan (HMO) or the Freedom Plan (HMO POS). They both give you comprehensive coverage, but there are differences the doctors you can see, and how much you’ll pay for services. The Premier Plan is an HMO, which means you can only see doctors that are in the plan’s network; if you see out-of-network doctors, you may be responsible for the entire cost. The Freedom Plan is an HMO POS, which means you can also see doctors that aren’t in the plan’s network, but it’ll usually cost you more out-of-pocket.

2022 Benefit Comparison

Here’s an overview of how the plans compare. For more in-depth information on how each plan works, visit Premier Plan Details and Freedom Plan Details.

 

OHP Premier Plan (HMO)

OHP Freedom Plan (HMO POS)

In-network

Maximum Out-of-Pocket Cost $3,500 $3,700
Monthly Plan Premium $0 $0
Monthly Part B Giveback $30 $0
Over-the-Counter (OTC) items  $75 / quarter $75 / quarter
Primary Care Physician (PCP) visit $0 $0
Specialist visit $20 $20
Inpatient Surgery
  $65/day 1-10 $65/day 1-7
  $0/day 11-90 $0/day 8-90
Outpatient Hospital  $125 $130 

2022 Medical Benefits

Use this chart to do a side-by-side comparison of cost and coverage on more services. Keep in mind, with the Premier Plan (HMO), you’re required to use in-network providers. With the Freedom Plan (HMO POS), cost and coverage vary between in- and out-of-network providers.

Medical Benefits OHP Premier Plan (HMO)

OHP Freedom Plan (HMO POS) 

In-network

OHP Freedom Plan (HMO POS) 

Out-of-network 

Health Premium $0 $0 $0
Part B Giveback $30/Month Not Applicable Not Applicable
Health Deductible $0 $0 $0
PCP Visit $0 $0 20% coinsurance
Specialist Visit $20 copay $20 copay 20% coinsurance
Telehealth $0 PCP/$20 Specialist $0 PCP/$20 Specialist 20% coinsurance
Chiropractic Services  $10 copay  $20 copay 20% coinsurance
Inpatient Hospital  $50/day 1-10; $0/day 11-90 unlimited Days  $65/day 1-10; $0/day 11-90 unlimited Days  20% coinsurance after deductible 
Outpatient Hospital  $125 copay $130 copay 20% coinsurance
Preventive Services (flu shots, etc.) $0 copay $0 copay 20% coinsurance
Urgent Care $20 copay $20 copay 20% coinsurance
Emergency Care $90 copay  $90 copay  $90 copay
Ambulance  $235 copay ground; 20% coinsurance air $235 copay ground; 20% coinsurance air  $235 copay ground; 20% coinsurance air
Home Health $0 $0 20% coinsurance
Durable medical equipment (wheelchairs, oxygen, etc.) 20% coinsurance per item 20% coinsurance per item; 20% coinsurance out-of-network 20% coinsurance
Prosthetics (braces, artificial limbs, etc.) 20% coinsurance per item 20% coinsurance per item; 20% coinsurance out-of-network 20% coinsurance
Dialysis In-network: 20% coinsurance In-network: 20% coinsurance 20% coinsurance
Diabetes Supplies $0 copay $0 copay 20% coinsurance per item
In-network Out-of-Pocket Maximum $3,500 $3,700 $11,300

2022 Supplemental Health & Wellness Benefits

Taking care of your health and well-being is about more than just doctor visits. With both plans, you also have access to things like a wellness hotline, meal delivery, and an allowance for over-the-counter items.

Supplemental Health & Wellness Benefits OHP Premier Plan (HMO) OHP Freedom Plan (HMO POS) In-network OHP Freedom Plan (HMO POS) Out-of-network 
Over-the-Counter-Items-Allowance $75/quarter $75/quarter No OON Coverage 
Fitness Benefits (In-network) $0 $0 No OON Coverage 
Wellness Programs (Nurse Hotline) $0 $0 No OON Coverage 
Meal Delivery $0 copay; 14 meals after discharge $0 copay; 14 meals after discharge No OON Coverage 
Opioid Treatment Program Services $0 in-network $20 copay in-network No OON Coverage 

2022 Prescription Drug Benefits

Use this chart to do a side-by-side comparison of cost and coverage for the different parts of your Prescription Drug Benefits.

Prescription Drug Benefit OHP Premier Plan (HMO) OHP Freedom Plan (HMO POS)
Initial  Retail 30 Days Retail 30 Days
Preferred Generics $0 $0
Generics $10 $10
Preferred Brands $45 $45
Brands $100 $100
Specialty 33% 33%
Select Insulin (Senior Savings Model) $35 $35
GAP Retail 30 Days Retail 30 Days
Preferred Generics (GAP) $0 $0
Generics (GAP) $10 $10
Preferred Brands (GAP) 25% 25%
Brands (GAP) 25% 25%
Specialty (GAP) 25% 25%
Catastrophic $0  $0S
Preferred Generics $3.95 for Rx < $79 and 5% > $79 $3.95 for Rx < $79 and 5% > $79
Generics $9.85 for Rx < $79 and 5% > $197 $9.85 for Rx < $79 and 5% > $197
Preferred Brands $9.85 for Rx < $79 and 5% > $197 $9.85 for Rx < $79 and 5% > $197
Brands $9.85 for Rx < $79 and 5% > $197 $9.85 for Rx < $79 and 5% > $197
Specialty $9.85 for Rx < $79 and 5% > $197 $9.85 for Rx < $79 and 5% > $197

Download and review a Complete Summary of Benefits

Visit our Resource Library to download a complete summary of benefits.