Group Medical Summaries

These are summaries only. Select benefit detail for more specific coverage.

Medical Plans - Effective 10/01/07
  In Plan Benefits Out Of Plan Benefits

*HSA deductible and out of pocket maximums apply to employee only enrollment. Please refer to the benefit summary for amount when coverage is for employee with one or more dependents.

**Five office visits plus One Preventive visit: One preventive office visit and first five office visits for illness or injury, deductible waived, not including TMJ, Mental Health, Chemical Dependency, Occupational Therapy, Speech Therapy, Family Planning or Biofeedback. Subsequent office visits are subject to the deductible and coinsurance.

Out of Pocket Maximums (OOP) include deductible amounts for all medical plans except HSA plans.

Plan Abbreviations Key:
BEN Beneficial
HSA Health Savings Account
PPO Preferred Provider Option
Type Plan Ded Office
Visit		 Co-ins. OOP Ded Co-ins. OOP
BEN AKBEN5000 $5,000 $25** 30% $7,500 $5,000 50% No Maximum
BEN AKBEN2500 $2,500 $20** 20% $5,000 $2,500 50% No Maximum
HSA AKHSA2800 $2,800* 50% 50% $2,200* $2,800* 50% No Maximum
HSA AKHSA2000 $2,000* 20% 20% $3,000* $2,000* 40% No Maximum
PPO AKHSA1200 $1,200* 20% 20% $3,800* $1,200* 40% No Maximum
PPO AKPPO500025 $5,000 $25 30% $7,500 $5,000 50% No Maximum
PPO AKPPO250025 $2,500 $25 30% $5,000 $2,500 50% No Maximum
PPO AKPPO100025 $1,000 $25 20% $3,500 $1,000 40% No Maximum
PPO AKPPO50020 $500 $20 20% $2,500 $500 40% No Maximum
PPO AKPPO25020 $250 $20 20% $1,750 $250 40% No Maximum

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Prescription Drug Riders
(with oral contraceptives & 90 day mail order) - Effective 10/01/07
Riders are only available to PPO and Beneficial plans.
Plan Copay
Option A 3-Tier $10/$30/$50, 2x Mail Order Copay
Option B 3-Tier $250 Ded., $10/$20/$50, 2x Mail Order Copay
Option C 3-Tier $10/$40/$60, 2x Mail Order Copay
Option D 1-Tier 40% Copay, 40% Mail Order Copay
Option E 1-Tier $15/50% (Whichever is greater) Copay, 2x Mail Order Copay; $5,000 Annual Limit.

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Vision Riders - Effective 10/01/07
Plan Description
View 100% w/ $200 Max
View 100% w/ $300 Max
View 100% Eye Exam Only
View High Option
View Super Option
View 80% w/ No Max

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Hearing Rider - Effective 10/01/07
Plan Description
View 80%; $800 every 3 years

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