are eligible to enroll after months of employment.This -month period also serves
as the waiting period and coverage is effective immediately upon enrollment.
expenses include charges for up to 365 days of care per illness in a
room for accidental injuries or emergencies.
room, laboratory and x-rays are subject to a co-pay unless admitted.
provisions require all non-emergency inpatient stays be approved prior to
admission.Employees must receive
approval in order to avoid payment of a deductible and co-pays for any
inpatient days not considered medically necessary.
for office visits at participating providers for children, chemotherapy,
hemodialysis, radiation therapy are 100% covered at no cost to employees and
eligible dependents.OTHER VISITS CAN BE INCLUDED.Other office visits are subject to a
co-pay.Charges at nonparticipating
providers are reimbursed at percent once the deductible is paid.If an employee reaches the annual
out-of-pocket maximum of eligible medical expenses, the plan will pay 100
percent of any additional eligible expenses incurred in the same calendar year
(The deductible is not included in the out-of-pocket maximum).
in full benefits are available for mental health, substance abuse, and home
care services and equipment required at home. Pre-certification and use of
participating providers is required.
Generic Substitution Requirement.
pay a co-pay for each prescription filled through participating pharmacies.
approval is required for certain drugs.
are paid based on the dental fee schedule of allowable charges and are subject
to a annual deductible (maximum per family).Coverage is effective months from date of hire.Employer ABC provides this Plan at no cost to
dependents are automatically entitled to the same coverage as the employee
under the health and dental plans.Eligible dependents include:
spouse; partner (same or opposite sex).
under age 19.
up to age 25 inclusive who are enrolled as full-time students at an accredited
over the age of 25 who are dependent on the employee due to physical or mental
include natural children, legally adopted children, and step-children. Children
who reside permanently in the household, and who are dependent on the employee
are also eligible.
should contact HR for the required enrollment/change forms for any of these
change of health insurance can be made .Changes may be subject to waiting periods, or
qualifying periods, according to the plan provisions.
every attempt has been made to ensure the accuracy of the above summary, the
actual Plan text will prevail in the event of any discrepancy as this policy
does not constitute a legal document.