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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.
REGULAR PLAN PPO

LOW OPTION PLAN
(For COBRA Participants and Extended Coverage Participants Only)
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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