EPISCOPAL CHURCH MEDICAL TRUST2019 HEALTH PLANS

Diocese of the Rio Grande (0596)Effective Date: 2019-01-01

Rate Tiers: 3Rx Option: Standard

Last Modified: 2018-09-26

Single Plus Spouse Plus Child Family

Anthem BCBS BlueCard PPO 100 MPP1 1 958$ 1,724$ 1,724$ 2,682$

Anthem BCBS BlueCard PPO 70 MPP4 731$ 1,316$ 1,316$ 2,047$

Anthem BCBS BlueCard PPO 80 MPP3 802$ 1,444$ 1,444$ 2,246$ Anthem BCBS BlueCard PPO 90 MPP2 884$ 1,591$ 1,591$ 2,475$

Anthem BCBS CDHP-15/HAS MHDG 2 722$ 1,300$ 1,300$ 2,022$ EAP MEAP 5$ 5$ 5$ 5$

Anthem BCBS BlueCard MSP PPO 100 MSG9 767$ 1,381$ 1,381$ 2,148$

Anthem BCBS BlueCard MSP PPO 70 MS12 586$ 1,055$ 1,055$ 1,641$

Anthem BCBS BlueCard MSP PPO 80 MS11 642$ 1,156$ 1,156$ 1,798$ Anthem BCBS BlueCard MSP PPO 90 MS10 707$ 1,273$ 1,273$ 1,980$

Cigna Open Access Plus CDHP-15/H SA MCDH 722$ 1,300$ 1,300$ 2,022$

Cigna Open Access Plus MSP PPO 100 MGM1 767$ 1,381$ 1,381$ 2,148$

Cigna Open Access Plus MSP PPO 70 MGM4 586$ 1,055$ 1,055$ 1,641$

Cigna Open Access Plus MSP PPO 80 MGM3 642$ 1,156$ 1,156$ 1,798$ Cigna Open Access Plus MSP PPO 90 MGM2 707$ 1,273$ 1,273$ 1,980$

Cigna Open Access Plus PPO 100 MG01 958$ 1,724$ 1,724$ 2,682$

Cigna Open Access Plus PPO 70 MG04 731$ 1,316$ 1,316$ 2,047$

Cigna Open Access Plus PPO 80 MG03 802$ 1,444$ 1,444$ 2,246$ Cigna Open Access Plus PPO 90 MG02 884$ 1,591$ 1,591$ 2,475$

Preventive Dental DDPV 3 34$ 61$ 61$ 95$

Basic Dent-50/150 DD50 32 57$ 103$ 103$ 160$

Dent&Ortho-25/75 DD25 8 77$ 139$ 139$ 216$

PLANPLAN CODE

ENROLL TOTAL

2019