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State of Michigan

Comparison of Health Care Options

Outpatient Physical, Speech, and Occupational Therapy

Combined maximum of 90 visits per calendar year.

State Health Plan PPO

HMO Benefits

In-network

Out-of-network

Outpatient physical, speech and occupational therapy – facility and clinic services

Covered 100% after deductible

Outpatient physical therapy – physician’s office

Covered 100% after deductible

Covered 90% after deductible

Office visit: $10 co-pay

Office visit: $10 co-pay

In-network

Out-of-network

Deductible

$300 per member $600 per family

$600 per member $1,200 per family

None

Fixed dollar co-pays

$15 for office visits, office consultations, urgent care visits, osteopathic manipulations, chiropractic manipulations and medical hearing exams. $50 for emergency room visits, if not admitted

Not applicable, but deductible and co- pay apply

$10 for office visits $50 for emergency room visits, if not admitted

Percent co-pays

10% for private duty nursing, chiropractic manipulation (for MCO members) and acupuncture

10% for most services

None

Annual out-of-pocket dollar maximums

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$1,000 per member $2,000 per family

$2,000 per member $4,000 per family

None

Deductible, Co-Pays, and Out-of-Pocket Dollar Maximums

State Health Plan PPO

HMO Benefits

11

The out-of-pocket limit does not apply to deductibles, fixed dollar co-payments, or private duty nursing co-payments.

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