2012 HIRSP Plans

	HIRSP 1,000	HIRSP 2,500	HIRSP 5,000
Premiums	HIRSP Premium Rate Tables effective *Jan 2012*
Medical deductible (you pay)	$1,000 per year	$2,500 per year	$5,000 per year
Medical Coinsurance	20% of allowed amount $1,000 per year	20% of allowed amount $1,000 per year	20% of allowed amount $1,000 per year
Individual medical out-of- pocket maximum (your total expenditures for medical deductible and medical coinsurance, after which HIRSP will pay at 100%)	$2,000 per year	$3,500 per year	$6,000 per year
Family medical out-of-pocket maximum (all family members must be on the same plan)	$4,000 per year	$7,000 per year	$12,000 per year
Drug Copay (you pay)	$5 Tier 1 / $55 Tier 2 / $75 Tier 3 Up to a maximum of $2,500 per year	$5 Tier 1 / $55 Tier 2 $75 Tier 3 Up to a maximum of $2,500 per year	$5 Tier 1 / $55 Tier 2 $75 Tier 3 Up to a maximum of $2,500 per year
Drug out-of-pocket maximum reductions available if you qualify	Yes	Yes	Yes
Maximum lifetime benefit	$2,000,000	$2,000,000	$2,000,000
Premium, Medical and Drug out-of-pocket reductions available if you qualify	Yes	Yes	Yes

HIRSP Health Savings Account (HSA)
	HIRSP HSA 2500	HIRSP HSA 3500
Premiums	HIRSP Premium Rate Tables effective *Jan 2012*
Medical/Drug deductible (you pay)	$2,500 per year	$3,500 per year
Medical Coinsurance	20% of allowed amount (after deductible is met)	20% of allowed amount (after deductible is met)
Drug Coinsurance (you pay)	20% of allowed amount (after deductible is met) HIRSP HSA does not offer first-dollar drug coverage	20% of allowed amount (after deductible is met) HIRSP HSA does not offer first-dollar drug coverage
Individual medical/drug coinsurance maximum	$2,100 per year	$2,100 per year
Individual medical/drug out-of-pocket maximum (your total expenditures for deductible and coinsurance, after which HIRSP will pay at 100%)	$4,600 per year	$5,600 per year
Family out-of-pocket maximum (all family members must be on the same plan)	$9,200 per year	$11,200 per year
Maximum lifetime benefit	$2,000,000	$2,000,000
Premium, Medical and Drug out-of-pocket deductible reductions available if you qualify	Yes	Yes