Health & Security Plan > SPD > Medical Benefits

Summary Plan Description

Medical Benefits

Summary

The Employee Health Plan is a "90-10" plan which means most covered expenses are paid at 90 percent by the plan and at 10 percent by the patient, once the patient's $200 annual deductible is satisfied. When a patient's coinsurance reaches $2,300 during a calendar year, the plan pays 100 percent of the covered expenses for the remainder of that calendar year. Benefits for chemical dependency, chiropractic care, mental health care, and neuropsychological assessments or tests are always paid at 80 percent (20 percent coinsurance) and the patient's coinsurance expenses for these services do not apply toward the $2,300 annual coinsurance maximum. Benefits for orthognathic surgery and TMJ are always paid at 50 percent (50 percent coinsurance) and the patient's coinsurance expenses for these services do not apply toward the $2,300 annual coinsurance maximum (except orthognathic surgery). The payment percentage for each benefit is indicated next to the benefit title. If a covered service or supply qualifies under more than one of the benefits described in this section, the plan reserves the right to determine under which benefit payment is made.

This section is comprised of an alphabetical listing of the most commonly used benefits. Benefits are described in detail, including exclusions specific to that benefit. Specific benefit features are designated by "•" Exclusions are designated numerically.

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