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Beth Israel Lahey Health 2021 Plan Compare

Review and find the plan that's best for you!

Email a PDF of the plan comparison results and an optional personal message to yourself and a client.

Product Name Domestic and Community HMO HMO Plus HMO Plus (Out of Area*) Tiered POS
Monthly Premium $ $$ $$ $$$
Office Visit (PCP/Specialist Visit)† Tier 1: $30/$40
Tier 2:
For Child: $30/$40
For Adult: $55/$65		 Tier 1: $25/$35
Tier 2:
For Child: $25/$35
For Adult: $55/$65
Tier 3: $85/$95		 Tier 1/2: $25/$35
Tier 3: $85/$95		 Tier 1: $20/$30
Tier 2:
For Child: $20/$30
For Adult: $30/$45
Tier 3: $40/$60
Deductible (Individual/Family) Tier 1: $500/$1,000
Tier 2: $1,000/$2,000		 Tier 1: None/None
Tier 2: $1,000/$2,000
Tier 3: $1,500/$3,000		 Tier 1: None/None
Tier 2: None/None
Tier 3: $1,500/$3,000		 Tier 1: None/None
Tier 2: $500/$1,000
Tier 3: $1,000/$2,000
Annual Out-of-Pocket Max (Individual/Family) $3,500/$7,000 $3,500/$7,000 $3,500/$7,000 $3,000/$6,000
Coinsurance Tier 1: 10%
Tier 2: 30%		 Tier 1: None
Tier 2: 20%
Tier 3: 40%		 Tier 1: None
Tier 2: None
Tier 3: 40%		 Tier 1: None
Tier 2: 10%
Tier 3: 20%
Emergency Room Tier 1/2/3: $200/Visit Tier 1/2/3: $200/Visit Tier 1/2/3: $200/Visit Tier 1/2/3: $200/Visit
Hospital-Based Urgent Care Tier 1: $40/Visit
Tier 2:
For Adult: $90/Visit
For Child: $40/Visit		 Tier 1: $35/Visit
Tier 2:
For Adult: $85/Visit
For Child: $35/Visit
Tier 3: $125/Visit		 Tier 1/2: $35/Visit
Tier 3: $125/Visit		 Tier 1: $30/Visit
Tier 2:
For Adult: $70/Visit
For Child: $30/Visit
Tier 3: $110/Visit
Freestanding Urgent Care Tier 1: $40/Visit
Tier 2:
For Adult: $90/Visit
For Child: $40/Visit		 Tier 1: $35/Visit
Tier 2:
For Adult: $85/Visit
For Child: $35/Visit
Tier 3: $125/Visit		 Tier 1/2: $35/Visit
Tier 3: $125/Visit		 Tier 1: $30/Visit
Tier 2:
For Adult: $70/Visit
For Child: $30/Visit
Tier 3: $110/Visit
Convenience Care Clinic Tier 1/2/3: $30 Tier 1/2/3: $25 Tier 1/2/3: $25 Tier 1/2/3: $20
Inpatient Hospital Tier 1: Ded then 10%
Tier 2: Ded then 30%		 Tier 1: No Charge
Tier 2:
For Adult: Ded then 20%
For Child: No Charge
Tier 3: Ded then 40%		 Tier 1/2: No Charge
Tier 3: Ded then 40%		 Tier 1: No Charge
Tier 2:
For Adult: Ded then 10%
For Child: No Charge
Tier 3: Ded then 20%
Outpatient Surgery Tier 1: Ded then 10%
Tier 2: Ded then 30%		 Tier 1: No Charge
Tier 2:
For Adult: Ded then 20%
For Child: No Charge
Tier 3: Ded then 40%		 Tier 1/2: No Charge
Tier 3: Ded then 40%		 Tier 1: No Charge
Tier 2:
For Adult: Ded then 10%
For Child: No Charge
Tier 3: Ded then 20%
Labs Tier 1:
Non-hospital based: No Charge
Hospital based: Ded then 10%
Tier 2:
Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 30%
For Child: Hospital based: Ded then 10%		 Tier 1: No Charge
Tier 2:
For Adult: Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 20%
For Child: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 40%		 Tier 1/2: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 40%		 Tier 1: No Charge
Tier 2:
For Adult: Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 10%
For Child: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 20%
X-Rays Tier 1:
Non-hospital based: No Charge
Hospital based: Ded then 10%
Tier 2:
Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 30%
For Child: Hospital based: Ded then 10%		 Tier 1: No Charge
Tier 2:
For Adult: Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 20%
For Child: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 40%		 Tier 1/2: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 40%		 Tier 1: No Charge
Tier 2:
For Adult: Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 10%
For Child: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 20%
Scans: CT, MRI, PET Tier 1:
Non-hospital based: No Charge
Hospital based: Ded then 10%
Tier 2:
Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 30%
For Child: Hospital based: Ded then 10%		 Tier 1: No Charge
Tier 2:
For Adult: Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 20%
For Child: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 40%
 Tier 1/2: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 40%		 Tier 1: No Charge
Tier 2:
For Adult: Non-hospital based: $75/Visit
For Adult: Hospital based: Ded then 10%
For Child: No Charge
Tier 3:
Non-hospital based: $75/Visit
Hospital based: Ded then 20%
PT/OT/ST Tier 1: $40
Tier 2:
For Child: $40
For Adult: $65		 Tier 1: $35
Tier 2/3:
For Child: $35
For Adult: $65		 Tier 1/2: $35
Tier 3:
For Adult: $65/Visit
For Child: $35/Visit		 Tier 1: $30
Tier 2/3:
For Child: $30
For Adult: $45
Acupuncture Tier 1/2: $40 Tier 1/2/3: $35 Tier 1/2/3: $35 Tier 1/2/3: $30
Out-Of-Network
Deductible (Individual/Family) Not Applicable Not Applicable Not Applicable $2,000/$4,000
Annual Out-of-Pocket Max (Individual/Family) Not Applicable Not Applicable Not Applicable $3,000/$6,000
Coinsurance Not Applicable Not Applicable Not Applicable 30%
Pharmacy
Please see your CVS Caremark benefits for more details.