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Employee Benefits Plan Highlights: October 1st 2007 - September 30th 2008 | ||||||||||||
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Employee Contributions | ||||||||||||
| Employee | Employee +1 | Family | |||||||||
PPO Medical (11 month payment/12 month payment) | $183.86/$168.54 | $395.48/$362.52 | $542.48/$497.27 | |||||||||
PPO Dental (11 month payment/12 month payment) | $33.68/$30.88 | $60.78/$55.72 | $115.10/$105.52 | |||||||||
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Medical | ||||||||||||
Kaiser | Health Net | |||||||||||
HMO | HMO | PPO | ||||||||||
| In-Network | Out of Network | ||||||||||
Office Visit | $10 | $10 | $10 | 70% | ||||||||
Deductible |
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Individual | None | None | $250 | |||||||||
Family | None | None | $750 | |||||||||
Hospital | 100% | 100% | 90% | 70% + $500 | ||||||||
Emergency Room | $50 | $50 | 90% + $100 | |||||||||
Lifetime Maximum | Unlimited | Unlimited | $5,000,000 | $5,000,000 | ||||||||
Out of Pocket Maximum |
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Individual | $1,500 | $1,500 | $2,000 | $6,000 | ||||||||
Family | $3,000 | $4,500 | Per Member | Per Member | ||||||||
Prescription Drug Benefit Generic/Name Brand/Non-Formulary | $10/$20/NA | $10/$20/$35 | $10/$20/$35 | $10/$20/$35 | ||||||||
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VSP Vision |
| Delta Dental | ||||||||||
| DeltaCarePMI | PPO | ||||||||||
Co-payments | $10 Exam $25 Materials |
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| In Network | Out of Network | |||||||
Frequency |
| Calendar Year Maximum | None | $1,500 | ||||||||
Eye Exam | 12 months | Calendar Year Deductible |
| Waived for Diagnostic & Preventive | ||||||||
Lenses | 12 months | Individual | None | $25 | $50 | |||||||
Frames | 12 months | Family | None | $75 | $150 | |||||||
Eye Exam | 100%/$45 | Preventive | 100% | 100% | 100% | |||||||
Single Vision Lenses | 100%/$45 | Fillings | 100% | 80% | 80% | |||||||
Frames
| $120/$47 | Crowns | Various Co-pays | 50% | 50% | |||||||
$120/$105 | Orthodontic Benefit |
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Child | $1,700 | 60% | 60% | |||||||||
Adult | $1,900 | 60% | 60% | |||||||||
Life and Disability - Prudential | |||
Life/AD&D (Employer Paid) | Voluntary Life/AD&D (Employee Paid) | STD (Employer Paid) | LTD (Employer Paid) |
- 1x Base Annual Salary up to $200,000 | - $10,000 increments to lesser of 5x annual salary or $500,000 with guarantee issue of $150,000 - Spouse: $10,000 increments to $250,000, with guarantee issue of $20,000 - Children: $10,000 benefit
| - 60% of weekly earnings up to $1,500 per week - 7 day waiting period - Benefit coverage for 90 days
| - 60% of monthly earnings up to $10,000 per month - 90 day waiting period
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Contact Information | Phone Number | Website |
Kaiser Permanente (HMO) | 800-464-4000 | |
Health Net of California (HMO & PPO) | 800-522-0088 | |
Delta Dental (DHMO & DPO) | 800-765-6003 | |
Vision Service Plan (VSP) | 800-877-7195 | |
Prudential (Life/AD&D & Disability) | 800-778-2255 |