Active: $20,000
AD&D: $10,000
Dependent: $ 1,500
Retiree: $3,000
|
Deductible:
$25.00 Individual
$50.00 Family
Max: $1,500/person/year reimbursed at 80% after the deductible
$1,500 (basic) services/member/year reimbursed at 100% after the deductible
Benefits paid in accordance with the 2003 fee schedule
|
Deductible:
$25.00 Individual
$50.00 Family
Max:
$1,000,000
Hospital call:
All expenses for semi-private room
Private nursing
Prescription Drugs:
Payable after deductible is paid
|
$400 per person every 24 months for materials; eye exam subject to deductible and coinsurance
|
$150 per week
Max: 26 Weeks |
