2018 US Benefits

Medical Options

Description

Option 1 HSA

Option 2 PPO

Option 3 PPO

Single $2,600 Family $5,200

Single $1,250 Family $2500

Single $500 Family $1500

Deductible

80% after deductible 80% after deductible 80% after deductible

Co-Insurance

Coverage requires the deductible to be met before coinsurance applies

Single $5,000 Family $10,000

Single $3,000 Family $6,000

Single $2,000 Family $4,000

Max out of Pocket

Unlimited

Unlimited

Unlimited

Life Max

20% after deductible $30 each visit

$25 each visit

Office Visit

100% no cost to associate

100% no cost to associate

100% no cost to associate

Preventative Care

20% after deductible $250

$250

Emergency Room

20% after deductible $75

$75

Urgent Care

20% after deductible 20% after deductible 20% after deductible

Lab/Diagnostic

20% after deductible $10/$30/$50/$100

$10/$30/$50/$100

RX Retail 30 day supply

20% after deductible $25/$75/$125/$250 $25/$75/$125/$250

RX Mail Order 90 day Supply

12 | The Power of Team. © 2017 Dwellworks, LLC