| WhiteBasic · Non-ACA | GreenStandard | Blue 80/90/100Comprehensive | Blue 80/90/100 CAACA Comparable | |
| Core Benefits | ||||
| DeductibleIn-Network | $100 ◆ | $500 |
$500 $100 $0 |
$500 $100 $0 |
| DeductibleOut-of-Network | $100 ◆ | $750 |
$750 $500 $200 |
$750 $500 $200 |
| Maximum per policy year | $100,000per illness/injury · $250,000/yr | $500,000Lifetime unlimited | Unlimited ◆Unlimited | Unlimited ◆Unlimited |
| Out-of-pocket maximumIn-Network | UnlimitedNo cap ⚠ | $7,000 |
$7,000 $6,000 $5,000 ◆ |
$8,000 $7,000 $6,000 |
| CoinsuranceIn-Network | 100%* ◆most items · OON 80% | 80%OON 60% |
80% 90% 100% OON 70% |
80% 90% 100% OON 70% |
| Pre-existing condition | 6-month waitStudent / Dependents 24mo | 6-month waitStudent / Dependents 24mo | No waitStudent / Dependents 24mo | No wait ◆Student & Dependents |
| Vaccine & Physical Exam | ✗No separate benefit | ✓$250/yr cap | ✓In-Net 100% | ✓In-Net 100% |
| Copay — Office visitPhysician / Specialist | $0 ◆ | $30 | $25 | $25 |
| Copay — ERwaived if admitted | $250 | $250 | $150 ◆ | $150 ◆ |
| Copay — SHC / Urgent CareSHC / Urgent Care | $0 / $0 ◆ | $15 / $30 | $0 / $50 | $0 / $50 |
| Prescription Drugs | Reimbursement only · $100max per illness, no tiers | $20 / $40 / $70Tier 1 / 2 / 3 | $10 / $30 / $50 ◆Tier 1 / 2 / 3 | $10 / $30 / $50 ◆Tier 1 / 2 / 3 |
| Other Key Benefits | ||||
| Hospitalization | ✓$1,250/day · 30 days | ✓80% · no daily cap | ✓80%/90%/100% | ✓80%/90%/100% |
| ICU / Cardiac | ✓$1,750/day · 30 days | ✓ | ✓ | ✓ |
| Surgical Benefits | ✓included within limits | ✓within limits | ✓specified · 80%/90%/90% | ✓specified · 80%/90%/90% |
| Reconstructive Surgery | ✗ | ✗ | ✓ | ✓ |
| Inpatient Rehabilitation | ✗ | ✗ | ✓45 days | ✓ |
| Maternity | ✓Vaginal $5,000 / C-section $7,500 | ✓80% | ✓80%/90%/100% | ✓80%/90%/100% |
| Elective Abortion | ✗life-threatening only | ✗life-threatening only | ✓$1,500 | ✓80%/90%/100% |
| Mental Health | ✓$3,000 · 30 visits · 80% | ✓80% | ✓80%/90%/100% | ✓80%/90%/100% |
| Physical / Therapeutic | ✓12 visits · $35/visit | ✓80% | ✓12 visits | ✓80% |
| Cancer & Oncology | ✓Inpatient $1,000 + Outpatient $1,000 | ✓80% | ✓80%/90%/100% | ✓80%/90%/100% |
| AIDS · HIV · STD | ✗Excluded | ✓80% (schedule) | ✓80%/90%/100% | ✓80%/90%/100% |
| Alcohol / Substance | ✓$50/visit · 30 days | ✓80% UCR | ✓80%/90%/100% UCR | ✓80%/90%/100% UCR |
| Chiro / Acupuncture | ✗ | ✗ | ✓$500 | ✓$500 |
| Home Health / Hospice | ✗ | ✗ | ✓Hospice 45 days / $5,000 | ✓ |
| Organ / Transplant | ✗ | ✗ | ✗ | ✓1 per lifetime |
| Congenital / Habilitative | ✗ | ✗ | ✗ | ✓80% |
| Allergy / HIV Screening | ✗ | ✗ | ✗ | ✓HIV screening 100% |
| Pediatric Dental / Vision | ✗ | ✗ | ✗ | ✓Children only |
| Emergency Dental | ✓$500/tooth | ✓80% | ✓$250/tooth · $1,000 | ✓$250/tooth · $1,000 |
| Palliative Dental | ✗ | ✗ | ✓$600 | ✓$600 |
| Recreational Sports | ✗ | ✗ | ✓80%/90%/100% | ✓80%/90%/100% |
| Evacuation / Repatriation | ✓100% | ✓100% | ✓100% | ✓100% |
| Exclusions carved back in higher plans | ||||
| AIDS · HIV · STD | ✗ | ✓ | ✓ | ✓ |
| Elective Abortion | ✗ | ✗ | ✓ | ✓ |
| Chiro / Acupuncture | ✗ | ✗ | ✓ | ✓ |
| Recreational sports (non-competitive) | ✗ | ✗ | ✓ | ✓ |
| Organ / Transplant | ✗ | ✗ | ✗ | ✓ |
| Excluded in all four | ||||
| Gender identity/dysphoria · cosmetic/elective surgery · infertility (IVF)/sterilization · vision correction·glasses·LASIK (except pediatric vision) · dental (except accidental/pediatric) · hearing aids · obesity/weight-loss treatment · smoking cessation · sleep studies (sleep apnea) · sexual dysfunction · genetic screening · breast reduction · travel immunizations · competitive/hazardous sports (varsity·club competition, skydiving, scuba beyond 30m, etc.)·motorcycles · war·terrorism · home-country care (beyond schedule) · care by a family member · costs reimbursable by other insurance/government | ||||