Benefits Book 2014

Page 47

MEDICAL PLAN HIGHLIGHTS 2013-2014 BENEFIT

IN-NETWORK

OUT-OF-NETWORK POS PLAN ONLY

Preventive Care

Covered In Full

Covered in full up to $300; 80% covered

Covered In Full

$500 deduct, 80% Covered

Group Health

$15

$15 co-pay, deductible and coinsurance apply

Kaiser

$30

No out-of-network allowed

$200 co-pay

$200 co-pay

Group Health

$0

$500 and services may not be covered depending on your plan

Kaiser

$0

Not allowed

Mammograms

NOTES

Routine mammograms

Urgent Care

Emergency Room

Waived if admitted

Out-of-Network Deductible

No out-of-network allowed

HEALTH BENEFITS BASICS

2013-2014 BENEFITS BOOK

47


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