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Benefit Summaries

PW_A122314

EmployeeElect Plans

To view specific details of each Plan, click on the English or Spanish version, as appropriate. 
Open Access HMO Plans (effective 07/01/10)  

OA HMO Plan $40/$2,000/70% (6801AX)*  
OA HMO Plan $25/$1,000/100% (6009AX)*  
OAHMO Plan $25/$500/100% (6005AX)*  
OA HMO Plan $25/$0/100% (6004AX)*  
 
* The Gatekeeper versions of these plans are also available (6800SX, 6009SX, 6001SX, 6000SX).  
 
Open Access POS Plans (effective 07/01/10)  

OA POS Plan $25/$1,000/100% (5010AX)* 
OA POS Plan $25/$500/80% (5506AX)* 
OA POS Plan $25/$500/100% (5007AX)* 
OA POS Plan $25/$0/100% (5006AX)* 
 
* The Gatekeeper versions of these plans are also available (5010SX, 5501SX, 5002SX, 5001SX).  
 
PPO Plans (effective 07/01/10)  

PPO Plan $25/$2,000/100% (4003SX)  
PPO Plan $40/$1,500/80% (4502SX)  
PPO Plan $25/$1,000/80% (4510SX)  
PPO Plan $25/$1,000/90% (4204SX)  
PPO Plan $25/$500/80% (4503SX)  
PPO Plan $25/$500/90% (4201SX)  
PPO Plan $25/$0/100% (4001SX)  
 
Lumenos Consumer-Driven Open Access POS Plans (effective07/01/10)  

CDHP (GHSA8)*  
 
CDHP HSA Plan (GEHSA8 w/embedded ded)*  
 
CDHP HSA Plan (GHSA12)*  
 
CDHP HSA Plan (GEHSA12 w/embedded ded)*  
 
CDHP HRA Plan (GHRA31)*  
 
CDHP HRA Plan (GHRA113)*  
 
 
*The Lumenos Consumer-Driven PPO versions of these plans are also available (GHSA46, GHSA58, GHSA50, GHSA62, GHRA127, GHRA141).  
 
Lumenos Consumer-Driven Open Access POS Plans w/Rx Copays (effective07/01/10)  

CDHP HSA Plan (GHSA177)* 
 
CDHP HSA Plan (GHSA181 w/embedded ded)*  
 
CDHP HSA Plan (GHSA178)*  
 
CDHP HSA Plan (GEHSA182 w/embedded ded)*  
 
CDHP HRA Plan (GHRA272)* 
 
CDHP HRA Plan (GHRA276)* 
 
 
*The Lumenos Consumer-Driven PPO versions of these plans w/Rx Copays are also available (GHSA105, GHSA109, GHSA106, GHSA110, GHRA224, GHRA228).  
 
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