Medical
Dental
Vision
Life Insurance
Short Term Disability
Long Term Disability
401(k)
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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque faucibus justo et est semper, et fermentum urna iaculis. Nullam finibus mauris et commodo porttitor. Praesent at est viverra, porttitor erat quis, 12345678arcu. Sed nec nunc tristique, lobortis metus viverra, lacinia metus. Aenean hendrerit nisl ut nisl interdum, eu ultrices lorem efficitur. Nam commodo sed sem vitae scelerisque. Praesent sed lacinia velit. In purus diam, aliquet sit amet purus nec, pretium varius libero. Etiam quam elit, efficitur sed diam a, tincidunt elementum nisl. Suspendisse blandit condimentum lorem eu vulputate.
|
Medical Company Name |
Anthem Policy Effective Date |
|
|
3/1/2017 - 3/1/2018 |
||
| Plan Attributes | In Network | Out of Network |
| Deductible |
$2,400 Individual $600 Family |
$1,200 Individual $3,600 Family |
| Plan Pays / You Pay (Coinsurance) |
80% / 20% | 80% / 20% |
| Out-of-Pocket Max |
$2,500 Individual $5,000 Family |
$2,800 Individual $5,000 Family |
| Physician Office Visit | $30 Copay | $30 Copay |
| Specialist Office Visit | $50 Copay | $50 Copay |
| Inpatient Hospital | 80% after deductible | 80% after deductible |
| Outpatient Hospital | 80% after deductible | 80% after deductible |
| Emergency Room | 80% after deductible | 80% after deductible |
| Prescriptions | ||
| Rx Deductible | $30 Copay | $30 Copay |
| Generic Brand | $50 Copay | $50 Copay |
| Formulary Brand | 80% after deductible | 80% after deductible |
| Non-Formulary Brand | $30 Copay | $30 Copay |
| Specialty | $50 Copay | $50 Copay |
| Mail Order | 80% after deductible | 80% after deductible |
| What you pay per paycheck | ||
| Employee Only | $100 | |
| Employee + Spouse | $200 | |
| Employee + Child(ren) | $300 | |
| Family | $700 | |
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque faucibus justo et est semper, et fermentum urna iaculis. Nullam finibus mauris et commodo porttitor. Praesent at est viverra, porttitor erat quis, convallis arcu. Sed nec nunc tristique, lobortis metus viverra, lacinia metus. Aenean hendrerit nisl ut nisl interdum, eu ultrices lorem efficitur. Nam commodo sed sem vitae scelerisque. Praesent sed lacinia velit. In purus diam, aliquet sit amet purus nec, pretium varius libero. Etiam quam elit, efficitur sed diam a, tincidunt elementum nisl. Suspendisse blandit condimentum lorem eu vulputate.
|
Medical Company Name |
Medical Option 2 |
|
|
Policy Effective Date |
3/1/2017 - 3/1/2018 |
|
| Plan Attributes | In Network | Out of Network |
| Deductible |
$1,200 Individual $3,600 Family |
$1,200 Individual $3,600 Family |
| Plan Pays / You Pay (Coinsurance) |
80% / 20% | 80% / 20% |
| Out-of-Pocket Max |
$2,500 Individual $5,000 Family |
$2,500 Individual $5,000 Family |
| Physician Office Visit | $30 Copay | $30 Copay |
| Specialist Office Visit | $50 Copay | $50 Copay |
| Inpatient Hospital | 80% after deductible | 80% after deductible |
| Outpatient Hospital | 80% after deductible | 80% after deductible |
| Emergency Room | 80% after deductible | 80% after deductible |
| Urgent Care | 80% after deductible | 80% after deductible |
| Prescriptions | ||
| Rx Deductible | $30 Copay | $30 Copay |
| Generic Brand | $50 Copay | $50 Copay |
| Formulary Brand | 80% after deductible | 80% after deductible |
| Non-Formulary Brand | $30 Copay | $30 Copay |
| Specialty | $50 Copay | $50 Copay |
| Mail Order | 80% after deductible | 80% after deductible |
| What you pay per paycheck | ||
| Employee Only | $100 | |
| Employee + Spouse | $200 | |
| Employee + Child(ren) | $300 | |
| Family | $400 | |
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque faucibus justo et est semper, et fermentum urna iaculis. Nullam finibus mauris et commodo porttitor. Praesent at est viverra, porttitor erat quis, convallis arcu. Sed nec nunc tristique, lobortis metus viverra, lacinia metus. Aenean hendrerit nisl ut nisl interdum, eu ultrices lorem efficitur. Nam commodo sed sem vitae scelerisque. Praesent sed lacinia velit. In purus diam, aliquet sit amet purus nec, pretium varius libero. Etiam quam elit, efficitur sed diam a, tincidunt elementum nisl. Suspendisse blandit condimentum lorem eu vulputate.
|
Dental Company Name |
Dental Option |
|
|
Policy Effective Date |
3/1/2017 - 3/1/2018 |
|
| Plan Attributes | In Network | Out of Network |
| Deductible |
$1,200 Individual $3,600 Family |
$1,200 Individual $3,600 Family |
| Annual Maximum Benefit | $1,000 | $1,000 |
| Preventive Care |
0% |
0% |
|
Basic Services (Endo, Perio) |
$30 Copay | $30 Copay |
| Major Services | $50 Copay | $50 Copay |
| Orthodontic Treatment | 80% after deductible | 80% after deductible |
| Orthodontic Lifetime Maximum | $2,000 | $2,000 |
| Waiting Period | 0 | 0 |
| What you pay per paycheck | ||
| Employee Only | $10 | |
| Employee + Spouse | $20 | |
| Employee + Child(ren) | $30 | |
| Family | $40 | |
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque faucibus justo et est semper, et fermentum urna iaculis. Nullam finibus mauris et commodo porttitor. Praesent at est viverra, porttitor erat quis, convallis arcu. Sed nec nunc tristique, lobortis metus viverra, lacinia metus. Aenean hendrerit nisl ut nisl interdum, eu ultrices lorem efficitur. Nam commodo sed sem vitae scelerisque. Praesent sed lacinia velit. In purus diam, aliquet sit amet purus nec, pretium varius libero. Etiam quam elit, efficitur sed diam a, tincidunt elementum nisl. Suspendisse blandit condimentum lorem eu vulputate.
|
Vision Company Name |
Vision Option |
|
|
Policy Effective Date |
3/1/2017 - 3/1/2018 |
|
| Plan Attributes | In Network | Out of Network |
| Eye Exam |
0 |
0 |
| Prescription Glasses | 0 | 0 |
| Frames |
0 |
0 |
| Contact Lenses | 0 | 0 |
| What you pay per paycheck | ||
| Employee Only | $10 | |
| Employee + Spouse | $20 | |
| Employee + Child(ren) | $30 | |
| Family | $40 | |
