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Cana Inc.
Plan Design - Lifetime Maximum
In-Network - 1,000,000
Out-of-Network - 1,000,000
Comments - none
Plan Design - Calendar Year Deductible
In-Network - $0
Out-of-Network - $250
Comments - none
Plan Design - Out-of-Pocket Maximum Cost including Deductible
In-Network - $0
Out-of-Network - $1,050
Comments - none
Plan Design - Physician Office Visits
In-Network - 100% after $10 co-pay
Out-of-Network - 80% after deductible
Comments - none
Plan Design - In-House Physician (radiologist, pathologist, anesthesiologist)
In-Network - 100%
Out-of-Network - 80% after deductible
Comments - none
Plan Design - Preadmission Testing
In-Network - 100%
Out-of-Network - 80% after deductible
Comments - none
Plan Design - Hospital Services
In-Network - 100%
Out-of-Network - 80% after deductible
Comments - none
Plan Design - Emergency Room Visit
In-Network - 80% after $50 co-pay
Out-of-Network - 80% after $50 co-pay
Comments - none
Plan Design - Psychiatry / Drug / Alcohol (Inpatient)
In-Network - 50%
Out-of-Network - 50%
Comments - none
Plan Design - Psychiatry / Drug / Alcohol (outpatient)
In-Network - 80% ($50 maximum per visit)
Out-of-Network - 80% ($50 maximum per visits)
Comments - none
Plan Design - Wellness Benefit
In-Network - $10 co-pay ($300 maximum per calendar year)
Out-of-Network - $10 co-pay ($300 maximum per calendar year)
Comments - none
Plan Design - Other Covered Expenses
In-Network - 100%
Out-of-Network - 80% after deductible
Comments - none
Plan Design - Spinal Manipulation
In-Network - $10 co-pay
Out-of-Network - $10 co-pay
Comments - none
Plan Design - Home Health Care
In-Network - 100%
Out-of-Network - 100%
Comments - 400 hours maximum per calendar
Plan Design - Hospice Care
In-Network - 100%
Out-of-Network - 80%
Comments - none
Plan Design - Physical/Speech Therapy
In-Network - information unavailable
Out-of-Network - n/a
Comments - refer to human resources
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