Gold - PPO - MOE Funds

gold - PPO. Comprehensive Medical Expense Benefits Effective April 1, 2017. OPERATORS' HEALTH CENTER -Annual/School, Physical Exams, preventive Care/Wellness Visits, Immunizations, Blood Draws, 100% - Not subject to the deductible Condition Manager (Ages two and up). CVS MINUTE CLINICS Non Emergency, Unscheduled Acute Illness Most services 100% - Not subject to the deductible or Injuries Additional cash pay services are available at a cost to the patient Annual Maximum per Plan year Unlimited Individual Deductible (per person, per plan year. All benefits are $1,000-In Network subject to the deductible unless otherwise noted) Three month carryover $2,000-Out of Network applies Family Deductible - (per plan year) Three month carryover does not $2,500-In Network apply $5,000-Out of Network Out of pocket expense limitation The amount of money an $4,000 per individual-In Network individual pays toward covered hospital and medical expenses during $8,000 per individual-Out of Network any one plan year, including the deductible.

Gold - PPO Comprehensive Medical Expense Benefits Effective April 1, 2017 OPERATORS’ HEALTH CENTER -Annual/School, Physical Exams, Preventive Care/Wellness Visits, Immunizations, Blood Draws,

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  Preventive, Gold, Gold ppo

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