AultCare HMO - Stark/Carroll/Holmes/Tuscarawas/Wayne Co

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General Information

Plan Name:	AultCare HMO
Service Area:	Stark/Carroll/Holmes/Tuscarawas/Wayne Co
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	No
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	HMO
Enrollment Code-Self:	3A1
Enrollment Code-Self & Family:	3A2
Link to Plan Home Page:	http://www.aultman.com/
Telephone:	330/438-6360
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:	$10
RX/ Brand/ NonFormulary:	$10

Rates

Non-Postal
___Biweekly	Self: $23.81	Self: & Family: $59.63
___Monthly	Self: $51.58	Self: & Family: $129.21
___Twice Biweekly	Self: $47.62	Self: & Family: $119.26
_
Annuitants
___Monthly	Self: $51.58	Self: & Family: $129.21
_
U.S. Postal Service Employees (Type A)
___Monthly	Self: $23.21	Self: & Family: $58.14
___Biweekly	Self: $10.71	Self: & Family: $26.84
_
U.S. Postal Service Employees (Type B)
___Monthly	Self: $23.21	Self: & Family: $58.14
___Biweekly	Self: $10.71	Self: & Family: $26.84
_
Worker's Compensation Recipients
___Twice Biweekly	Self: $47.62	Self: & Family: $119.26
_
Certain Temporary Employees
___Monthly	Self: $206.33	Self: & Family: $516.84
___Biweekly	Self: $95.23	Self: & Family: $238.54
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Former Spouse Enrollees
___Biweekly	Self: $95.23	Self: & Family: $238.54
___Monthly	Self: $206.33	Self: & Family: $516.84
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Temporary Continuation of Coverage
___Monthly	Self: $210.46	Self: & Family: $527.18
___Biweekly	Self: $97.13	Self: & Family: $243.31
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FDIC
___Biweekly	Self: $10.71	Self: & Family: $26.84
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