Welborn HMO - Evansville area

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General Information

Plan Name:	Welborn HMO
Service Area:	Evansville area
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	No
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	HMO
Enrollment Code-Self:	H31
Enrollment Code-Self & Family:	H32
Link to Plan Home Page:	http://www.welbornhealthplans.com
Telephone:	812/426-6600
Summary results of the 2001 consumers assessment of health plans survey

Benefits

Doctor Care/ Primary Office Visits:	$10
Hospital Inpatient Room and Board Charges:	None
RX/ Generic/ Retail:	$5
RX/ Brand/ Retail:	$15
RX/ Brand/ NonFormulary:	$25

Rates

Non-Postal
___Monthly	Self: $79.08	Self: & Family: $268.53
___Biweekly	Self: $36.50	Self: & Family: $123.94
___Twice Biweekly	Self: $73.00	Self: & Family: $247.88
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Annuitants
___Monthly	Self: $79.08	Self: & Family: $268.53
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U.S. Postal Service Employees (Type A)
___Biweekly	Self: $18.84	Self: & Family: $83.60
___Monthly	Self: $40.82	Self: & Family: $181.13
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U.S. Postal Service Employees (Type B)
___Biweekly	Self: $25.13	Self: & Family: $112.21
___Monthly	Self: $54.44	Self: & Family: $243.12
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Worker's Compensation Recipients
___Twice Biweekly	Self: $73.00	Self: & Family: $247.88
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Certain Temporary Employees
___Biweekly	Self: $134.36	Self: & Family: $347.35
___Monthly	Self: $291.11	Self: & Family: $752.59
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Former Spouse Enrollees
___Biweekly	Self: $134.36	Self: & Family: $347.35
___Monthly	Self: $291.11	Self: & Family: $752.59
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Temporary Continuation of Coverage
___Monthly	Self: $296.93	Self: & Family: $767.64
___Biweekly	Self: $137.05	Self: & Family: $354.30
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FDIC
___Biweekly	Self: $18.84	Self: & Family: $83.60
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