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- Plan
Features
Physician Services
Hospital Services
Other Medical Services
Prescription Drugs
Mental Health & Substance Abuse
The Industry Health Network
Dental Plan Features
Important Telephone Numbers And Websites
Eligibility
Earnings Minimum (effective 1/1/06)*:
Premium for Dependent Coverage:
Life insurance Benefit for Active Participants: |
$30,145
(One hour network prime-time story and teleplay)*
$50 per month, payable quarterly
$5,000 |
| *
The eligibility earnings minimum from 1/1/05 through 12/31/05
was $29,482. In 2007, the eligibility earnings minimum will increase to $30,823. |
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REGULAR
PLAN PPO
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LOW
OPTION PLAN
(For COBRA Participants and Extended Coverage Participants Only)
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NETWORK
PROVIDER 1 |
NON-NETWORK
PROVIDER 2 |
OUT
OF AREA
(For participants residing outside the PPO service area only) 2 |
NETWORK
PROVIDER 1 |
NON-NET
PROVIDER 2 |
| PLAN
FEATURES |
| Calendar-Year
Deductible 3 |
$300/person;
$900/family |
$300/person;
$900/family |
$300/person;
$900/family |
$750/
person;
$2,250/
family |
$750/
person;
$2,250/
family |
| Out-of-Pocket
Maximum 4, 5 |
$1,000/person
6 |
$2,500/person
6 |
$1,000/person |
$4,500/
person 6 |
$6,000/
person 6 |
| Lifetime
Maximum 7 |
$5
million |
$5
million |
$5
million |
$5
million |
$5
million |
1.
Benefits for services received from a network provider will be paid
based on the contracted rate.
2.
Benefits for services received from a non-network provider will
be paid based on reasonable and customary (R&C) charges.
3.
All plan benefits are paid after the deductible unless otherwise
noted.
4.
Calendar-year deductible, office visit and inpatient hospital copays
do not apply toward the out-of-pocket maximum. When the out-of-pocket
maximum is reached, benefits are payable at 100% of R&C charges
or the contracted rate (whichever applies) for the rest of the calendar
year. Mental health and substance abuse expenses (and any such benefits)
don't count toward the out-of-pocket maximum.
5.
The out-of-pocket maximum (after deductible) for Medicare-eligible
Certified Retirees and their Medicare-eligible dependents/same-sex
domestic partners having benefits paid on a carve-out-basis is $400
for network providers (with coverage at 85%) and $600 for non-network
providers (with coverage at 70%).
6.
Both network and non-network charges apply toward your out-of-pocket
maximum.
7.
Lifetime maximum coordinates with the benefits provided by other
industry health plans (if applicable). See "Lifetime Maximum
Benefit" in Section 2: Medical Benefits of the handbook
for more information.
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