Health Plan at-a-glance:
          Major Medical benefits
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The Health Plan provides coverage for medical services from Network health care providers and Non-Network health care providers, subject to deductibles, copayment and coinsurance. To maximize your benefits and reduce out-of-pocket costs, choose doctors and other health care providers within the AFTRA Health Plan’s Preferred Provider Organization (PPO) networks.

Network Providers
  • Copayment
$10 per visit.
  • Provider benefit
90% of first $10,000 in covered expenses per year after the deductible; 100% thereafter. Excludes copayment.
  • Coinsurance
10% of first $10,000 in covered expenses per year after the deductible.
  • Annual out-of-pocket limit
$1,000 (plus deductible and copayment).
Non-Network Providers
  • Copayment
$10 per visit.
  • Provider benefit
60% of the scheduled allowance for the first $8,000 in covered expenses per year after the deductible; 100% of the scheduled allowance for covered expenses thereafter. Excludes copayment.
  • Coinsurance
40% of the scheduled allowance for first $8,000 in covered expenses per year after the deductible.
  • Annual out-of-pocket limit
$3,200 (plus deductible, copayment, and expenses that exceed the scheduled allowances).

See pages 37-43 of the 2005 Health Plan Summary Plan Description and relevant Benefits Updates for additional information and details.The information provided above is summarized and is not a complete description of the actual terms and provisions of the Health Plan documents. If any conflict arises between this information and the Plan documents, or if any point is not discussed above or is only partially discussed, the Plan documents will govern in all cases.