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Plan Profile

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You are here: FEHB Home > 2002 Plan Comparison > North Dakota > Plan Profile: Heart of America HMO

General Information
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Plan Name: Heart of America HMO
Service Area: Northcentral North Dakota
Brochure: PDF Version
Brochure: Text Version
NCQA Accreditation: No
JCAHO Accreditation: No
URAC Accreditation: No
Plan Type: HMO
Enrollment Code-Self: RU1
Enrollment Code-Self & Family: RU2
Link to Plan Home Page: none listed http://
Telephone: 701/776-5848
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Benefits
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Doctor Care/ Primary Office Visits: $10
Hospital Inpatient Room and Board Charges: None
RX/ Generic/ Retail: 50%
RX/ Brand/ Retail: 50%
RX/ Brand/ NonFormulary: 50%
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Rates
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Non-Postal
___Twice Biweekly Self: $53.08 Self: & Family: $136.42
___Biweekly Self: $26.54 Self: & Family: $68.21
___Monthly Self: $57.51 Self: & Family: $147.79
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Annuitants
___Monthly Self: $57.51 Self: & Family: $147.79
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U.S. Postal Service Employees (Type A)
___Biweekly Self: $11.94 Self: & Family: $30.70
___Monthly Self: $25.88 Self: & Family: $66.51
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U.S. Postal Service Employees (Type B)
___Monthly Self: $25.88 Self: & Family: $81.71
___Biweekly Self: $11.94 Self: & Family: $37.71
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Worker's Compensation Recipients
___Twice Biweekly Self: $53.08 Self: & Family: $136.42
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Certain Temporary Employees
___Biweekly Self: $106.17 Self: & Family: $272.85
___Monthly Self: $230.04 Self: & Family: $591.18
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Former Spouse Enrollees
___Biweekly Self: $106.17 Self: & Family: $272.85
___Monthly Self: $230.04 Self: & Family: $591.18
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Temporary Continuation of Coverage
___Monthly Self: $234.64 Self: & Family: $603.00
___Biweekly Self: $108.29 Self: & Family: $278.31
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FDIC
___Biweekly Self: $11.94 Self: & Family: $30.70
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