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Published byShona Butler Modified over 9 years ago
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GEORGIA IN-NETWORK Plan Vendor:1 st Medical Network DEDUCTIBLE $300 PER PERSON $900 PER FAMILY $20 COPAY FOR OFFICE VISITS (not subject to general deductible) $750 per person Wellness Care STOP LOSS: $1,000/person $2,000/family PPO PLAN
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NATIONAL IN-NETWORK Plan Vendor: Beech Street DEDUCTIBLE $400 PER PERSON $1,200 PER FAMILY $20 COPAY FOR OFFICE VISITS (not subject to general deductible) $750 per person Wellness Care STOP LOSS: $2,000/person $4,000/family PPO PLAN
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OUT-OF-NETWORK DEDUCTIBLE $400 PER PERSON $1,200 PER FAMILY %60 of network rate for most of the services SUBJECT TO DEDUCTIBLE AND BALANCE BILLING PPO PLAN
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PHARMACY PROGRAM u Network of Retail Pharmacies u Services Outside of Network u 90 Day Maximum Drug Supply ¶ $10 co-payment for generic ¶ $25 co-payment for preferred brand name ¶ 20% of non-preferred brand name cost ($40 min. and $100 max.)
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VISION CARE PROGRAM BLUE CHOICE VISION PROVIDERS LensCrafters Independent Optometrists Independent Ophthalmologists VISION DISCOUNTS LensCrafters Preset Vision Packages ~Silver, Gold, and Blue Choices~ 30% Off Eyeglasses/Frames/Lenses/Lab Fees 25% Off Non-Prescription Sunglasses Low Fixed Prices on Contact Lenses
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emergency room copayment: $75 reduced to $50 if referred by MedCall Copayment fully waived if admitted. PPO PLAN MEDCALL
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PPO PLAN COST PER MONTH -Employee$105.18 -Employee/Spouse$220.84 -Employee/Child$189.30 -Family$304.96
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