THE NITTY GRITTY

PLANS & COVERAGE

Here's the plan options we have on the table for 2023.

No Waiting Period to join plan

PLAN INCLUSIONS

PLAN 1-5

Overall plan max

$200,000 over the lifetime of the policy

PLAN INCLUSIONS

PLAN 1-5

Deductible​​

$0

PLAN INCLUSIONS

PLAN 1-5

Coverage ends

65 years

PLAN INCLUSIONS

PLAN 1-5

Life Insurance / AD&D

$30,000

PLAN INCLUSIONS

PLAN 1-5

Prescription Drugs

Coinsurance

80%

70%

70%

70%

80%

PLAN INCLUSIONS

PLAN 1

PLAN 2-4

PLAN 5

Maximum

$3000 / Year

PLAN INCLUSIONS

PLAN 1-5

Other details

Pay-Direct drug card
Anti-Smoking $300/lifetime

Pay-Direct drug card
Anti-Smoking $300/lifetime
Includes diabetes prior authorization and pharmacogenetic testing

Pay-Direct drug card
Includes fertility drugs at $1,500 per family (lifetime)
Anti-Smoking $300/lifetime diabetes prior authorization and pharmacogenetic testing

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3-5

Vision

Coinsurance

100%

90%

100%

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3-5

Maximum

Reasonable/ 24 Months

$150/two years combined

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Coinsurance

90%

PLAN INCLUSIONS

PLAN 1-5

Maximum

$150/two years combined with eye exams

$150 / two years

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Paramedical

Coinsurance

90%

80%

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Maximum

$500 combined max/year

$750 combined max/year

PLAN INCLUSIONS

PLAN 1-3

PLAN 4-5

Hospital

Coinsurance

75%

Not Covered

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Maximum

$175/day and $6,000/year, max 180 days per stay

-

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Other details

Semi-Private

-

80%

-

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3

PLAN 4-5

Private duty nursing

Coinsurance

75%

PLAN INCLUSIONS

PLAN 1-5

Maximum

$5,000/year, $25,000 lifetime

PLAN INCLUSIONS

PLAN 1-5

Medical Supplies & Equipment

Coinsurance

75%

PLAN INCLUSIONS

PLAN 1-5

Maximum

$3,000/year

PLAN INCLUSIONS

PLAN 1-5

Other details

Includes prosthesis, orthotics/orthopaedic shoes, wheelchairs, wigs and hairpieces, glucometers, casts, crutches, hospital bed, hearing aids
Health coverage is not optional (to participate, both health and dental participation is necessary)

PLAN INCLUSIONS

PLAN 1-5

Dental Accident

Coverage

$5,000/lifetime

PLAN INCLUSIONS

PLAN 1-5

Ambulance

Coverage

100% coverage for ground services only subject to the overall plan maximum

PLAN INCLUSIONS

PLAN 1-5

Travel

Emergency medical coverage

A maximum of $1 million over the lifetime of the policy
Maximum 60-day trip duration

PLAN INCLUSIONS

PLAN 1-5

Non-emergency medical

None

PLAN INCLUSIONS

PLAN 1-5

Emergency travel assistance

Included

PLAN INCLUSIONS

PLAN 1-5

Dental

Basic Coinsurance

70%

80%

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Major Coinsutance

40%

None

Not Covered

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3-5

Maximum

$750/year combined Basic/Major

$1,000 / year

PLAN INCLUSIONS

PLAN 1

PLAN 2-5

Other details

Basic Cleaning and Scaling 1 unit /9 months

Routine Services
periodontal services for treatment of diseases of the gums and other supporting
tissue of the teeth, including:
i) scaling not covered under Basic Services, and root planing, up to a combined maximum
of 8 units per calendar year(s) ;
ii) provisional splinting; and
iii) occlusal equilibration, up to a maximum of 8 units per calendar year(s)

endodontic services (which include root canals and therapy, root amputation,
apexifications and periapical services). Root canals and therapy are limited to one
initial treatment plus one re-treatment per tooth per lifetime. Re-treatment is covered
only if the expense is incurred more than 12 months after the initial treatment.

Major Restorative Services; Crowns, Bridges, Dentures only available after dental benefits have been in place for 1 year

PLAN INCLUSIONS

PLAN 1-5

Other Benefits

EFAP

Included

PLAN INCLUSIONS

PLAN 1-5

Single

$145

$159

$160

$162

$172

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3

PLAN 4

PLAN 5

Family

$298

$309

$312

$318

$334

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3

PLAN 4

PLAN 5

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PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3

PLAN 4

PLAN 5

PLAN INCLUSIONS

PLAN 1

PLAN 2

PLAN 3

PLAN 4

PLAN 5

No Waiting Period to join plan

No Waiting Period to join plan

No Waiting Period to join plan

No Waiting Period to join plan

No Waiting Period to join plan

Overall plan max

$200,000 over the lifetime of the policy

$200,000 over the lifetime of the policy

$200,000 over the lifetime of the policy

$200,000 over the lifetime of the policy

$200,000 over the lifetime of the policy

Deductible​​

$0

$0

$0

$0

$0

Coverage ends

65 years

65 years

65 years

65 years

65 years

Life Insurance / AD&D

$30,000

$30,000

$30,000

$30,000

$30,000

Prescription Drugs

Coinsurance

80%

70%

70%

70%

80%

Maximum

$3000 / Year

$3000 / Year

$3000 / Year

$3000 / Year

$3000 / Year

Other details

Pay-Direct drug card
Anti-Smoking $300/lifetime

Pay-Direct drug card
Anti-Smoking $300/lifetime
Includes diabetes prior authorization and pharmacogenetic testing

Pay-Direct drug card
Includes fertility drugs at $1,500 per family (lifetime)
Anti-Smoking $300/lifetime diabetes prior authorization and pharmacogenetic testing

Pay-Direct drug card
Includes fertility drugs at $1,500 per family (lifetime)
Anti-Smoking $300/lifetime
diabetes prior authorization and pharmacogenetic testing

Pay-Direct drug card
Includes fertility drugs at $1,500 per family (lifetime)
Anti-Smoking $300/lifetime
diabetes prior authorization and pharmacogenetic testing

Vision

Eye Examinations

-

-

-

-

-

Coinsurance

100%

90%

100%

100%

100%

Lenses/Frames/Contacts

-

-

-

-

-

Maximum

Reasonable/ 24 Months

$150/two years combined

Reasonable & Customary amount / two years

Reasonable & Customary amount / two years

Reasonable & Customary amount / two years

Coinsurance

90%

90%

90%

90%

90%

Maximum

$150/two years combined with eye exams

$150 / two years

$150 / two years

$150 / two years

$150 / two years

Other

-

-

-

-

-

Paramedical

Coinsurance

90%

80%

80%

80%

80%

Maximum

$500 combined max/year

$500 combined max/year

$500 combined max/year

$750 combined max/year

$750 combined max/year

Hospital

Coinsurance

75%

Not Covered

Not Covered

Not Covered

Not Covered

Maximum

$175/day and $6,000/year, max 180 days per stay

-

-

-

-

Other details

Semi-Private

-

80%

-

-

Private duty nursing

Coinsurance

75%

75%

75%

75%

75%

Maximum

$5,000/year, $25,000 lifetime

$5,000/year, $25,000 lifetime

$5,000/year, $25,000 lifetime

$5,000/year, $25,000 lifetime

$5,000/year, $25,000 lifetime

Medical Supplies & Equipment

Coinsurance

75%

75%

75%

75%

75%

Maximum

$3,000/year

$3,000/year

$3,000/year

$3,000/year

$3,000/year

Other details

Includes prosthesis, orthotics/orthopaedic shoes, wheelchairs, wigs and hairpieces, glucometers, casts, crutches, hospital bed, hearing aids
Health coverage is not optional (to participate, both health and dental participation is necessary)

Includes prosthesis, orthotics/orthopaedic shoes, wheelchairs, wigs and hairpieces, glucometers, casts, crutches, hospital bed, hearing aids
Health coverage is not optional (to participate, both health and dental participation is necessary)

Includes prosthesis, orthotics/orthopaedic shoes, wheelchairs, wigs and hairpieces, glucometers, casts, crutches, hospital bed, hearing aids
Health coverage is not optional (to participate, both health and dental participation is necessary)

Includes prosthesis, orthotics/orthopaedic shoes, wheelchairs, wigs and hairpieces, glucometers, casts, crutches, hospital bed, hearing aids
Health coverage is not optional (to participate, both health and dental participation is necessary)

Includes prosthesis, orthotics/orthopaedic shoes, wheelchairs, wigs and hairpieces, glucometers, casts, crutches, hospital bed, hearing aids
Health coverage is not optional (to participate, both health and dental participation is necessary)

Dental Accident

Coverage

$5,000/lifetime

$5,000/lifetime

$5,000/lifetime

$5,000/lifetime

$5,000/lifetime

Ambulance

Coverage

100% coverage for ground services only subject to the overall plan maximum

100% coverage for ground services only subject to the overall plan maximum

100% coverage for ground services only subject to the overall plan maximum

100% coverage for ground services only subject to the overall plan maximum

100% coverage for ground services only subject to the overall plan maximum

Travel

Emergency medical coverage

A maximum of $1 million over the lifetime of the policy
Maximum 60-day trip duration

A maximum of $1 million over the lifetime of the policy
Maximum 60-day trip duration

A maximum of $1 million over the lifetime of the policy
Maximum 60-day trip duration

A maximum of $1 million over the lifetime of the policy
Maximum 60-day trip duration

A maximum of $1 million over the lifetime of the policy
Maximum 60-day trip duration

Non-emergency medical

None

None

None

None

None

Emergency travel assistance

Included

Included

Included

Included

Included

Dental

Basic Coinsurance

70%

80%

80%

80%

80%

Major Coinsurance

40%

None

Not Covered

Not Covered

Not Covered

Maximum

$750/year combined Basic/Major

$1,000 / year

$1,000 / year

$1,000 / year

$1,000 / year

Other details

Basic Cleaning and Scaling 1 unit /9 months

Routine Services
periodontal services for treatment of diseases of the gums and other supporting
tissue of the teeth, including:
i) scaling not covered under Basic Services, and root planing, up to a combined maximum
of 8 units per calendar year(s) ;
ii) provisional splinting; and
iii) occlusal equilibration, up to a maximum of 8 units per calendar year(s)

endodontic services (which include root canals and therapy, root amputation,
apexifications and periapical services). Root canals and therapy are limited to one
initial treatment plus one re-treatment per tooth per lifetime. Re-treatment is covered
only if the expense is incurred more than 12 months after the initial treatment.

Major Restorative Services; Crowns, Bridges, Dentures only available after dental benefits have been in place for 1 year

Basic Cleaning and Scaling 1 unit /9 months

Routine Services
periodontal services for treatment of diseases of the gums and other supporting
tissue of the teeth, including:
i) scaling not covered under Basic Services, and root planing, up to a combined maximum
of 8 units per calendar year(s) ;
ii) provisional splinting; and
iii) occlusal equilibration, up to a maximum of 8 units per calendar year(s)

endodontic services (which include root canals and therapy, root amputation,
apexifications and periapical services). Root canals and therapy are limited to one
initial treatment plus one re-treatment per tooth per lifetime. Re-treatment is covered
only if the expense is incurred more than 12 months after the initial treatment.

Major Restorative Services; Crowns, Bridges, Dentures only available after dental benefits have been in place for 1 year

Basic Cleaning and Scaling 1 unit /9 months

Routine Services
periodontal services for treatment of diseases of the gums and other supporting
tissue of the teeth, including:
i) scaling not covered under Basic Services, and root planing, up to a combined maximum
of 8 units per calendar year(s) ;
ii) provisional splinting; and
iii) occlusal equilibration, up to a maximum of 8 units per calendar year(s)

endodontic services (which include root canals and therapy, root amputation,
apexifications and periapical services). Root canals and therapy are limited to one
initial treatment plus one re-treatment per tooth per lifetime. Re-treatment is covered
only if the expense is incurred more than 12 months after the initial treatment.

Major Restorative Services; Crowns, Bridges, Dentures only available after dental benefits have been in place for 1 year

Basic Cleaning and Scaling 1 unit /9 months

Routine Services
periodontal services for treatment of diseases of the gums and other supporting
tissue of the teeth, including:
i) scaling not covered under Basic Services, and root planing, up to a combined maximum
of 8 units per calendar year(s) ;
ii) provisional splinting; and
iii) occlusal equilibration, up to a maximum of 8 units per calendar year(s)

endodontic services (which include root canals and therapy, root amputation,
apexifications and periapical services). Root canals and therapy are limited to one
initial treatment plus one re-treatment per tooth per lifetime. Re-treatment is covered
only if the expense is incurred more than 12 months after the initial treatment.

Major Restorative Services; Crowns, Bridges, Dentures only available after dental benefits have been in place for 1 year

Basic Cleaning and Scaling 1 unit /9 months

Routine Services
periodontal services for treatment of diseases of the gums and other supporting
tissue of the teeth, including:
i) scaling not covered under Basic Services, and root planing, up to a combined maximum
of 8 units per calendar year(s) ;
ii) provisional splinting; and
iii) occlusal equilibration, up to a maximum of 8 units per calendar year(s)

endodontic services (which include root canals and therapy, root amputation,
apexifications and periapical services). Root canals and therapy are limited to one
initial treatment plus one re-treatment per tooth per lifetime. Re-treatment is covered
only if the expense is incurred more than 12 months after the initial treatment.

Major Restorative Services; Crowns, Bridges, Dentures only available after dental benefits have been in place for 1 year

Other Benefits

EFAP

Included

Included

Included

Included

Included

Single

$145

$159

$160

$162

$172

Family

$298

$309

$312

$318

$334

Your content has been submitted