Health Insurance:
 Insurance Plan Through:
Wellmark Blue Cross & Blue Shield Eligible Class:
All regular full-time employees of the Company who work at least thirty (30) hours per week on a regular basis.
Probationary Period:
Health insurance available from first day of employment.
Employee Contribution:
Employer contributes two-thirds of premiums. Employee pays one-third of premiums.
Annual Deductible:
Individual:
$750.00 In Network,
$1,000.00 Out Network
Family:
$1,500.00 In Network,
$2,7750.00 Out Network
(All Family Members Combined)
Maximum Annual
Out of Pocket:
Individual:
$2,000.00 In Network,
$2,750.00 Out Network
Family:
$4,000.00 In Network,
$7,750.00 Out Network
Prescription Deductible:
Generic: $10.00
Preferred: $25.00
Non-Preferred: $40.00
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Dental Benefits:
Annual Individual Deductible:
$50.00
Annual Family Deductible:
$150.00
Benefit Percentage:
Class I: Preventative —
Exam, Cleaning, X-rays,
100% No Deductible
Class II: Basic Restorative —
Fillings, Root Canal, Tooth Extraction, 50% After Deductible
Class III: Major Restorative —
Crowns, Bridges, Dentures, Periodontics, 50% After Deductible
Class IV: Orthodontia —
Limited to Dependent Children up to Age 19, 50% After Deductible
Maximum Annual Benefit:
Per Individual Classes I, II and III Combined, $500.00
Maximum Lifetime Benefit:
Class IV, $1,000.00 per Individual
Class III and IV will not be considered eligible under the Plan until the individual has been covered for dental benefits under this plan for twelve (12) consecutive months.
Vision Benefits:
Deductible:
None
Copayment:
$10.00 copayment for exam
$20.00 copayment for frames, lenses, etc.
Scheduled Allowances:
Exam: $30.00
Frames/Contacts/Lenses: $105.00
Benefit is available once every two years. |
