Association Benefit Plan

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General Information

Plan Name:	Association Benefit Plan
Service Area:	Specific Groups
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	n/a
JCAHO Accreditation:	n/a
URAC Accreditation:	n/a
Plan Type:	FFS
Enrollment Code-Self:	421
Enrollment Code-Self & Family:	422
Link to Plan Home Page:	http://www.mutualofomaha.com
Telephone:	800/634-0069
Summary results of the 2001 consumers assessment of health plans survey

Benefits

	PPO	Non PPO
Deductible Per Person Calendar Year	$300	$300
Deductible Per Person-Prescription Drug	None	None
Deductible Per Hospital Stay-Inpatient	$100	$200
Copay Coinsurance Doctors & Outpatient Tests	10%	25%
Copay Coinsurance Hospital Inpatient R & B	Nothing	25%
Copay Coinsurance Hospital Inpatient Other	Nothing	25%
Copay Coinsurance Hospital Outpatient	10%	25%
Copay Coinsurance Prescription Drugs Home Delivery Generic	$15	$15
Copay Coinsurance Prescription Drugs Home Delivery Brand Name	$30	$45
Copay Coinsurance Prescription Drugs Generic	$10	$10
Copay Coinsurance Prescription Drugs Brand Name	$20	$20
Copay Coinsurance Prescription Drugs Nonformulary	$30	$30

Rates

Non-Postal
Twice Biweekly	Self: $94.54	Self: & Family: $221.84
Monthly	Self: $102.42	Self: & Family: $240.32
Biweekly	Self: $47.27	Self: & Family: $110.92
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Annuitants
Monthly	Self: $102.42	Self: & Family: $240.32
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U.S. Postal Service Employees (Type A)
Biweekly	Self: $29.61	Self: & Family: $70.58
Monthly	Self: $64.16	Self: & Family: $152.92
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U.S. Postal Service Employees (Type B)
Monthly	Self: $77.78	Self: & Family: $214.91
Biweekly	Self: $35.90	Self: & Family: $99.19
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Worker's Compensation Recipients
Twice Biweekly	Self: $94.54	Self: & Family: $221.84
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Certain Temporary Employees
Biweekly	Self: $145.13	Self: & Family: $334.33
Monthly	Self: $314.45	Self: & Family: $724.38
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Former Spouse Enrollees
Biweekly	Self: $145.13	Self: & Family: $334.33
Monthly	Self: $314.45	Self: & Family: $724.38
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Temporary Continuation of Coverage
Monthly	Self: $320.74	Self: & Family: $738.87
Biweekly	Self: $148.03	Self: & Family: $341.02
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FDIC
Biweekly	Self: $29.61	Self: & Family: $70.58
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