HomeMy WebLinkAboutDocumentation_Miscellaneous_Tab 6_3/14/1997 ✓
VILLAGE OF TEQUESTA
FLA. MUNICIPAL UNITED HEALTHCARE
COMPANY HEALTH TRUST
Current Plan
PLANS PPO POS Plan 210
Benefits In Network Out of Network• In Network Out of Network
Lifetime Maximum $1,000,000 $1,000,000 unlimited $2,000,000
CASH DEDUCTIBLE
(Individual/Fluidly) $100/$200 $100/$200 none $500/$1,000
OUT-OF-POCKET MAXIMUM $350/$700 $850/$1,700 $1,500/$3,000 $3,000/$6,000
(Indlvidual/Family)
HOSPITAL SERVICES 90%after 70%after 100% 70%after
annual deductible annual deductible annual deductible
EMERGENCY ROOM SERVICES 90%after 70%after 100%after 70%after
annual deductible annual deductible $50 co-pay annual deductible
PHYSICIAN SERVICES 100%after
Office Visits CO-PAY-PRIMARY 90%after 70%after $5 co-pay 70%after
Office Visits CO-PAY-SPECIALIST annual deductible annual deductible $5 co-pay annual deductible
ROUTINE ADULT PHYSICALS not included not included 100% not included
MATERNITY same as any same as any same as any same as any
illness illness illness illness
PRESCRIPTION DRUG BENEFITS 100%after 100%after
Generic $10 co-pay N/A $5 co-pay N/A
Brand $10 co-pay $5 co-pay
MONTHLY PREMIUM RATES I CURRENT I PROPOSED *
Employee (28) $244.99 $180.87
Employee and Family (38) $621.87 $459.11
MONTHLY TOTAL $30,490.78 $22,510.54
ANNUAL TOTAL $365,889.36 $270,126.48
*Proposed rates quoted assume a 5/1/97 effective date of coverage
1 .
This summary is not intended to be a complete explanation of benefits of the proposed insurance policies. Actual premiums and benefits will be determined by the final enrollment and are subject to underwriting
approval.
ordia