| Benefit |
What You Receive |
| Medical Insurance Buy Down |
Type: PPO
Deductible: $500.00 per calendar year (last 3 mo roll over to
next year)
Family Deductible: $1500.00 per family/no one family member to
exceed $500
Wellness Coverage: Covered at 100% for $10 co-pay - "in-network"
only
All other covered services "in-network" - 70% after deductible |
| Medical Insurance Basic |
Type: PPO
Deductible: $250.00 per calendar year (last 3 mo roll over to
next year)
Family Deductible: $750.00 per family/no one family member to
exceed $250
Wellness Coverage: Covered at 100% for $10 co-pay - "in-network"
only
All other covered services "in-network" - 80% after deductible |
| Medical Insurance Buy-Up |
Deductible: $150.00 per calendar year (last 3 mo roll over to next
year)
Family Deductible: $500.00 per family/no one family member to exceed
$150
Wellness Coverage: Covered at 100% for $10 co-pay - "in-network"
only
All other covered services "in-network" - 90% after deductible |
| Vision Insurance |
In-Network Benefits
Deductible: None
Eye Exam: $10.00 "in
network"
Contact Lens Exam: $25.00 co-pay PLUS $10.00 eye exam
co-pay
Lenses: $20.00 co-pay
Frames: Allowance up to $100.00
Contacts:
(in lieu of eyeglasses) Allowance up to $120.00
Note: out of network coverage may be lower and is based on reimbursement
schedule |
| Prescription Drug Plans |
Buy Down Plan
Deductible: $0
Generics: $10.00 co-pay
Brand:
50% co-insurance subject to $20.00 co-pay minimum
Basic Plan
Deductible = $0
Generics = $10 copay
Brand = 35%
coinsurance subject to $20 copay minimum
Buy Up Plan
Deductible = $0
Generics = $10 copay
Brand = 20%
coinsurance subject to $20 copay minimum |
| Dental Insurance |
Preventive Care: 80% no deductible, once every 6 months
Basic Care: 80%
with $50.00 deductible per calendar year
Major Care: 50% with $50.00
deductible per calendar year
($1,000.00 max per year)
Orthodontic Services: $1,000.00 lifetime maximum - minor dependents only
|
