The Health Plan offers coverage for wellness and preventive care, subject to annual maximum benefits for individuals and families.
All Providers (Network/
Non-Network Combined) | Coverage
|
| | None
|
| | 80% of covered expenses up to the maximum benefit.
|
| | 20% of covered expenses up to the maximum benefit.
|
- Annual Benefit Maximum1
- Individual
| $400 per individual
An additional $400 in coverage ($800 total) is available for each infant during the first 12 months of life. This additional $400 does not count against the $1,200 family maximum
$1,200 per family |
Health Plan at-a-glance intro page
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1Excludes costs for infant immunizations during the first year of life.
See pages 50-51 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.
Excludes costs for infant immunizations during the first year of life.See pages 50-51 of the 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.