Here are the different Insurance Monthly Premium options.
Here are the Insurance Plan Details.
| Standard Plan | Value Plan |
| Annual Deductible per Individual | $1,500 | $2,000 |
| Family Deductible Limit | $4,500 | $6,000 |
| Out-of-Pocket Limit per Individual (includes deductible) | $4,000 | $5,000 |
| Family Out-of-Pocket Limit (includes deductible) | $8,000 | $10,000 |
| Plan Coinsurance / Member Coinsurance | 80% / 20% | 80% / 20% |
| Hospital Services Inpatient hospitalization Outpatient facility / surgery | 20% after deductible | 20% after deductible |
| Preventive and Wellness Care Annual routine physical exam, annual well woman exam, well baby care, immunizations lab/x-ray, testing and other screenings. | 100% – deductible waived | 100% – deductible waived |
| Physician Services Office Visits for illness & injury includes exam, lab & X-ray, surgery, supplies provided by and billed by Physician at the time of the office visit) | 20% after deductible | 20% after deductible |
| Emergency Services Emergency Room Urgent Care Facility | 20% after deductible | 20% after deductible |
| Chiropractic Care / Spinal Manipulation (Includes X-rays)Calendar Year Maximum $1,000 | 50% after deductible | 50% after deductible |
| Rx Deductible | $150 Deductible per covered person annually | Combined with Medical Deductible |
| Generic | $10 Copay | 20% after deductible |
| Brand Name | $25 or 20% Copay (whichever is greater) |
Mail Order (90 Day Supply) 2 X or 20% for Brand Name (whichever is greater)
In-Network Benefits shown. For full Plan Summary please contact your Human Resources Department
| Standard Plan | Value Plan |
| Deductible (individual / family limit) | $3,750 / $11,250 | $6,000 / $12,000 |
| Coinsurance (plan / individual) | 60% / 40% | 60% / 40% |
| Out of pocket Limit (individual / family) | $14,000 / 28,000 | $15,000 / 30,000 |
