These instructions are for current enrollees in Freelancers Insurance Company (FIC) plans. For enrollees of the
Perfect Health Platinum plan, visit the instructions page for that plan.


The changes listed below for PPO plans are only the top benefit changes from 2009 to 2010. For a full list, please download the corresponding PDF.
| In-Network Benefits | 2009 | 2010 |
|---|---|---|
| PPO 1 Monthly premium | $460/mo (member) | $497/mo (member) |
| $850/mo (plus child(ren)) | $894/mo (plus child(ren)) | |
| $932/mo (plus spouse) | $1,043/mo (plus spouse) | |
| $1,337/mo (plus family) | $1,391/mo (plus family) | |
| Individual deductible / coinsurance / out-of-pocket max | $1,000 / 15% / $4,000 | $1,500 / 20% / $6,000 |
| Annual physical | $30 | $0 |
| Screening colonoscopy (age 50-74) | Subject to deductible and coinsurance | $0 |
| Primary care / specialist copay | $30 / $40 | $25 / $50 |
| Office Surgery | Subject to deductible and coinsurance | Included in office copay |
| Lab test copay in a doctor's office or freestanding lab | $0 | $10 |
| Lab tests in an outpatient facility | $0 | Subject to deductible and coinsurance |
| Specialty drugs provided and administered by a clinician* | $0 | Subject to deductible and coinsurance |
| Chemotherapy / radiation | ||
| Hemodialysis | ||
| Prescription deductible | $100 | $200 |
| Prescription copay: generic / brand formulary / brand non-formulary | $10 / $35 / $60 | $15 / $50 / $100 |
| Prescription copay: specialty brand formulary / brand non-formulary | $35 / $60 | $100 / $100 |
| Diabetic supplies | 20% | $15 copay / 1-month supply |
*Please note: Effective January 1, 2010 certain specialty drugs are covered only through Accredo, Medco's specialty mail order pharmacy.
| In-Network Benefits | 2009 | 2010 |
|---|---|---|
| PPO 2 Monthly premium | $320/mo (member) | $381/mo (member) |
| $568/mo (plus child(ren)) | $685/mo (plus child(ren)) | |
| $638/mo (plus spouse) | $800/mo (plus spouse) | |
| $932/mo (plus family) | $1,066/mo (plus family) | |
| Individual deductible / coinsurance / out-of-pocket max | $2,000 / 20% / $12,000 | $2,500 / 25% / $14,000 |
| Annual physical | $30 | $0 |
| Screening colonoscopy (age 50-74) | Subject to deductible and coinsurance | $0 |
| Office surgery | Subject to deductible and coinsurance | Included in office copay |
| Lab test copay in a doctor's office or freestanding lab | $0 | $0 |
| Outpatient diagnostic imaging tests | 20% | 25% |
| Specialty drugs provided and administered by a clinician* | $0 | Subject to deductible and coinsurance |
| Chemotherapy / radiation | ||
| Hemodialysis | ||
| Prescription deductible | $100 | $300 |
| Prescription copay: generic / brand formulary / brand non-formulary | $10 / $35 / $60 | $15 / $60 / Not covered |
| Prescription copay: specialty brand formulary / specialty brand non-formulary | $35 / $60 | $150 / Not covered |
| Diabetic supplies | 20% | $15 copay / 1-month supply |
*Please note: Effective January 1, 2010 certain specialty drugs are covered only through Accredo, Medco's specialty mail order pharmacy.
| In-Network Benefits | 2009 | 2010 |
|---|---|---|
| PPO 3 Monthly premium | $235/mo (member) | $285/mo (member) |
| $433/mo (plus child(ren)) | $513/mo (plus child(ren)) | |
| $478/mo (plus spouse) | $599/mo (plus spouse) | |
| $688/mo (plus family) | $798/mo (plus family) | |
| Individual deductible / coinsurance / out-of-pocket max | $3,000 / 20% / $13,000 | $3,500 / 30% / $18,000 |
| Annual physical | $30 | $0 |
| Screening colonoscopy (age 50-74) | Subject to deductible and coinsurance | $0 |
| Primary care / specialist copay | $30 / $50 | $35 / $55 |
| Office surgery | Subject to deductible and coinsurance | Included in office copay |
| Lab test copay in an outpatient facility | $0 | Subject to deductible and coinsurance |
| Outpatient diagnostic imaging tests | 20% | 30% |
| Specialty drugs provided and administered by a clinician* | $0 | Subject to deductible and coinsurance |
| Chemotherapy / radiation | ||
| Hemodialysis | ||
| Prescription copay: generic only | $10 | $15 | Diabetic supplies | 20% | $15 copay / 1-month supply |
*Please note: Effective January 1, 2010 certain specialty drugs are covered only through Accredo, Medco's specialty mail order pharmacy.

| In-Network Benefits | 2009 | 2010 |
|---|---|---|
| HD 5,000 Monthly premium | $215/mo (member) | $324/mo (member) |
| $425/mo (plus child(ren)) | $583/mo (plus child(ren)) | |
| $504/mo (plus spouse) | $680/mo (plus spouse) | |
| $711/mo (plus family) | $907/mo (plus family) | |
| HSA compatibility | Not HSA-compatible | HSA-compatible |
| Annual physical exam | Subject to deductible and coinsurance | $0 |
| Well child visits and immunizations | ||
| Routine gynecological services | ||
| Mammography screening | ||
| Prostate cancer screening | ||
| Adult immunizations | ||
| Out-of-pocket max on medical and pharmacy | Unlimited | $5,950 |
Please note: Effective January 1, 2010 certain specialty drugs are covered only through Accredo, Medco's specialty mail order pharmacy.

| In-Network Benefits | 2009 | 2010 |
|---|---|---|
| HD 10,000 Monthly premium | $149/mo (member) | $196/mo (member) |
| $294/mo (plus child(ren)) | $354/mo (plus child(ren)) | |
| $349/mo (plus spouse) | $413/mo (plus spouse) | |
| $492/mo (plus family) | $550/mo (plus family) | |
| Annual physical exam | Subject to deductible and coinsurance | $0 |
| Well child visits and immunizations | ||
| Routine gynecological services | ||
| Mammography screening | ||
| Prostate cancer screening | ||
| Adult immunizations |
Please note: Effective January 1, 2010 certain specialty drugs are covered only through Accredo, Medco's specialty mail order pharmacy.