5
Framework Health Plan
Framework Health plan is a limited medical plan insured
by Pan American Life. It is available to part-time Team
Members, full-time Team Members during their 90 day
waiting period, and to full-time Team Members not
meeting the 30 hours per week requirement. You pay for
the full cost of this coverage directly with pre-tax payroll
contributions.
Plan Option
The following chart illustrates some of the benefits available
under the Framework Health Plan option.
Benefits
Coverage
Life / AD&D Insurance
• Team Member Only
$5,000
Life Insurance
• Spouse
• Child over 6 months
• Child 14 days to 6 months
$2,500
$1,250
$200
Doctor’s Office Visit
Pays $60 per visit / $300 calendar year maximum per person
Preventive Care
Pays $50 per visit / $150 calendar year maximum per person
Outpatient Diagnostic Lab
Pays $35 per lab test / $105 calendar year maximum per person
Outpatient X-ray
Pays $100 per x-ray / $200 calendar year maximum per person
Emergency Room Indemnity
Pays $75 per visit / $300 calendar year maximum per person
Daily In-Hospital Indemnity
Pays $100 per day / 60 days per calendar year maximum / 500 days lifetime maximum
Tiered-Pricing Pharmacy Program
The Tiered-Pricing Pharmacy card is accepted at over 48,000 pharmacies in the U.S. including Rite Aid, Medicine Shoppe,
Walgreens and thousands of independent pharmacies. Benefits are available for brand and generic drugs.
The program segments brand and generic drugs into three price classifications (Tiers I, II, and III). A listing of the most commonly
prescribed medications in the tier program is available online at
and is included with your ID cards after
you enroll in the program. Discounts are available for drugs not listed in one of the three tiers as well as maintenance medications
purchased through the mail order program.
Retail Prescriptions
• Tier I
• Tier II
• Tier III
• Non-Tiered Drugs
$10 or less for the scheduled quantity and dose
$20 or less for the scheduled quantity and dose
$40 or less for the scheduled quantity and dose
Contract price (average discount of approximately 16%) or the pharmacy’s price,
whichever is less.
Mail Order (90-day supply)
Discounts available for mail order medications. All completed orders processed and
shipped within 48 hours. Orders are shipped free of charge via First Class Mail. Mail
order form is included in your fulfillment kit.
