Core Deductible Health Plan

benefits-chapter
Basic Definition Lower payroll deduction, higher deductible and generally out-of-pocket expenses are higher.
Calendar Year Deductible

In Network / Out of Network

Associate-only coverage: $2,000; Individual on Associate Plus Spouse, Child(ren) or Family Coverage: $2,700 Family maximum: $6,000

For Associate Plus coverages, no benefits, except preventive care, are paid by the plan to any family member until that individual family member meets the $2,700 individual deductible amount or the total medical expenses paid by the family equal the $6,000 family deductible maximum amount.

Calendar Year Out-of-Pocket Maximum

(This is the amount you would pay before benefits would paid at 100%.)

In Network / Out of Network

Separate Medical: $3,375 individual; $10,125 family (Includes $2,000 individual; $6,000 family medical deductible). Separate Prescription Drugs: $3,375/individual or family.

In-Network: Deductibles, Co-pays and Coinsurance apply to the out-of- pocket maximum.

Out of Network: Coinsurance applies to the out-of-pocket maximum.

Preventive Care

(See the Preventive Services Listing for details.)

In Network
100 percent coverage for all listed services

Out of Network
Not covered

Office Visit

In Network
75 percent coverage after calendar year deductible

Out of Network
55 percent MAC coverage (MAC*) after calendar year deductible

Hospital Visit

In Network
75 percent coverage after $500 per-admission co-pay

Out of Network
55 percent MAC coverage after $500 per-admission co-pay

Emergency Services

In Network
75 percent coverage after calendar year deductible

Out of Network
75 percent MAC coverage after calendar year deductible

Chiropractic Care

In Network
75 percent coverage after calendar year deductible limit of 30 total visits per person per calendar year

Out of Network
75 percent coverage after calendar year deductible limit of 30 total visits per person per calendar year

Speech, Physical and Occupational (hand) Therapy

In Network
75 percent coverage subject to calendar year deductible; limit of 40 habilitative and 40 rehabilitative visits per person per calendar year. Medical necessity review required for visits 20-40

Out of Network
75 percent coverage subject to calendar year deductible; limit of 40 habilitative and 40 rehabilitative visits per person per calendar year. Medical necessity review required for visits 20-40

PET Scans, CT Scans, MRI and MRA's

In Network
Covered at 75% of the allowance subject to the calendar year deductible

Out of Network
Covered at 55% of the allowance subject to the calendar year deductible

Need Help?

Contact the HR Connect Team at 1-877-562-8383

Related Information

Benefits Enrollment

Benefits Eligibility

Benefits Library

Benefits Sitemap

Documents and Forms

Summary Plan Descriptions

Where to Find Information

Health

Life & Disability

Retirement

Wellness

Additional Benefits