5 Comprehensive Plans...
With Prescription Drug Coverage: Options 1, 2, or 3
| OPTION 1: | $100 Deductible Comprehensive Plan |
| Health: |
$100 Ded. Ind./$200 Ded. Fam. per calendar year, Plan pays 80%* of next $2000 Ind./$4000 Fam., and 100%* over $2000 Ind./$4000 Fam. of eligible claims to end of calendar year. |
| Drug: | $0 Ded., 20% Co-pay to pharmacist. Mail order for maintenance drugs = 90 day supply $10 for generics and $20 co-pay for name brand. |
Individual
Coverage...........$212.25/Mo.
Family Coverage...............$528.00/Mo.
| OPTION 2: | $250 Deductible Comprehensive Plan |
| Health: |
$250 Ded. Ind./$500 Ded. Fam. per calendar year, Plan pays 80%* of next $2000 Ind./$4000 Fam., and 100%* over $2000 Ind./$4000 Fam. of eligible claims to end of calendar year. |
| Drug: | $50 Ded., 20% Co-pay to pharmacist. Mail order for maintenance drugs = 90 day supply $10 for generics and $20 co-pay for name brand. Deductible does not apply to mail order. |
Individual
Coverage...........$196.75/Mo.
Family Coverage...............$488.00/Mo.
| OPTION 3: | $500 Deductible Comprehensive Plan |
| Health: | $500 Ded. Ind./$1000 Ded. Fam. per calendar year, Plan pays 80%* of next $5000 Ind./$10,000 Fam., and 100%* over $5000 Ind./$10,000 Fam. of eligible claims to end of calendar year |
| Drug: | $100 Ded., 20% Co-pay to pharmacist. Mail order for maintenance drugs = 90 day supply $10 for generics and $20 co-pay for name brand. Deductible does not apply to mail order. |
Individual Coverage...........$172.50/Mo.
Family Coverage...............$426.50/Mo.
| OR, For a Lower Cost Comprehensive Plan... |
|
|
| With NO Prescription Drug Coverage: Options 4 or 5 |
| OPTION 4: | $500 Deductible Comprehensive Plan |
| Health: | $500 Ded. Ind./$1000 Ded. Fam. per calendar year, Plan pays 80%* of next $5000 Ind./$10,000 Fam., and 100%* over $5000 Ind./$10,000 Fam. of eligible claims to end of calendar year. |
Individual
Coverage...........$149.50/Mo.
Family Coverage...............$368.00/Mo.
| OPTION 5: |
$1000 Deductible Comprehensive Plan |
| Health: | $1000 Ded. Ind./$2000 Ded. Fam. per calendar year, Plan pays 80%* of next $5000 Ind./$10,000 Fam., and 100%* over $5000 Ind./$10,000 Fam. of eligible claims to end of calendar year. |
Individual
Coverage...........$129.50/Mo.
Family Coverage...............$316.50/Mo.
| How do the 5 comprehensive Plans Work? |
|
|
- Subscriber pays the annual deductible
- BC/BS pays 80%*
of the Allowed Amount
- Subscriber pays 20%* of the Allowed Amount
- BC/BS pays 100%* of the remaining expenses incurred for the remainder of the calendar year
The maximum benefit is an Unlimited Lifetime Benefit!
NOTE: Your out-of-pocket expenses will increase when non-covered benefits are utilized and/or using a non-participating physician.
3 Managed Care Products..
Try 1 of our BC/BS HMO Products...
OPTION
6: HMOBlue Preferred Plan
The Subscriber chooses a Primary Care Physician (PCP) from a listing of
participating doctors (In-Network). The PCP directs the subscriber’s care,
provides referrals to specialists, and the subscriber pays a $15 co-pay
for most services. If a subscriber elects to receive services without
a referral from their PCP, this is referred to as Out-of-Network. If you
elect to go out-of-network, a $200 annual deductible applies and reimbursement
will be similar to Options 1 and 2 of the Comprehensive Plan.
In the
event the subscriber becomes unexpectedly ill or injured while traveling
out-of-town, HMOBlue Preferred provides “Urgent Care”. By just calling
a toll-free number, the subscriber will be put in touch with an affiliated
HMO near his/her location.
Students away at college, or anyone away at least 90 days, HMOBlue Preferred offers Guest Membership at an affiliated HMO near their travel destination.
| Drugs: | $5
co-pay for generic prescriptions and $20 for name brands at the pharmacy.
Mail order for maintenance drugs = 90 day supply $10 for generics
and $40 for name brands. |
|
Individual Coverage...........$187.00/Mo. Family Coverage...............$460.50/Mo. |
OPTION
7: HMO Blue Plan
The Subscriber chooses a Primary Care Physician (PCP) from a listing of
participating doctors. The PCP directs the subscriber’s care, provides
referrals to specialists, and the subscriber pays a $15 co-pay for most
services. Many services require no co-payment and are free!
Health
benefits will not be covered if a subscriber obtains services from a physician
other than their PCP, or sees a specialist without first getting a referral
from their PCP, thus resulting in out-of-pocket expenses.
In the
event the subscriber becomes unexpectedly ill or injured while traveling
out-of-town, HMO Blue provides “Urgent Care”. By just calling a toll-free
number, the subscriber will be put in touch with an affiliated HMO near
his/her location.
Students
away at college, or anyone away from home at least 90 days, HMO Blue offers
Guest Membership at an affiliated HMO near their travel destination.
Drugs:There
is no drug benefit with this program.
Individual
Coverage...........$156.00/Mo.
Family Coverage...............$382.00/Mo.
OPTION 8: Partners Health Plans™
With this HMO contract, the subscriber chooses a Primary Care Physician (PCP) from a listing of participating doctors. The PCP directs the subscriber’s care, provides referrals to specialists, and the subscriber pays a $20 co-pay for most services. Many services require no co-payment and are free!
Health
benefits will not be covered if a subscriber obtains services from a physician
other than their PCP, or sees a specialist without first getting a referral
from their PCP, thus resulting in out-of-pocket expenses.
Partners
Health Plans provides for worldwide emergency coverage in the event the
subscriber is out-of-town and needs to receive urgent or emergency care
due to sickness or injury.
Students
away at college are covered for urgent or emergency care, anywhere, anytime.
| Drugs: |
$10 co-pay for generic prescriptions, $20 for name brands, and $30 for non-formulary drugs at the pharmacy. Vision: $40 co-pay for frames and lenses, $45 co-pay for disposable contacts, $25 co-pay for daily-wear contacts. Additional allowances for various lenses/coatings. |
|
Individual
Coverage...........$165.00/Mo.
2 Person Coverage...........$326.00/Mo. Family Coverage...............$433.00/Mo. |
Health Insurance Options 1-7 listed above contain a “Pre-Existing Condition” clause which states if you have been diagnosed, receive treatment for, or have been advised to seek treatment for a medical condition that a prudent person would seek treatment for, no benefit will be paid for the first 11 months from the effective date (9 months for maternity). Credit will carry over from prior current group health coverage and will be applied towards this waiting period, as long as coverage was continuous and in effect within 60 days of the effective date of this contract.
Partners
Health Plans™ contains a “Pre-Existing Condition” clause which states
if during the previous six (6) months you have been diagnosed, received
treatment for, or have been advised to seek treatment for a medical condition
that a prudent person would seek treatment for, no benefit will be paid
for the first 12 months from the effective date (9 months for maternity).
Credit will carry over from prior current group health coverage and will
be applied towards this waiting period, as long as coverage was continuous
and in effect within 60 days of the effective date of this contract.
Choose 1 of our 2 Group Dental Plans!
OPTION
1: Low Option Package B Dental Program
This option provides benefits for “preventive” and “basic” services. This
includes those services received at six month check-ups, such as x-rays,
cleanings, minor fillings, fluoride treatments, and space maintainers,
just to name a few.
These
services are paid with NO deductible at 100% of their allowed amounts
or maximum amount payable (MAP)*.
The calendar year maximum is $1,000 per person. There is no deductible.
Individual
Coverage...........$15.50/Mo.
Family Coverage...............$44.50/Mo.
OPTION
2: High Option Package N Dental Program
This option provides benefits for “preventive” and “basic” services (same
as those covered under Option 1 - Low Option Package B) that are paid
at 100% of MAP* with no annual deductible.
In addition,
this option also includes coverage for “major” services and “orthodontia”.
Major services include crowns, caps, restorations, inlays, onlays, bridge
work, and dentures, just to name a few.
These
services are paid at 50% of their allowed amounts (MAP) AFTER satisfying
an annual deductible of $50 ($150 per family).
Orthodontia
is also a covered benefit for dependents under age 19 or up to age 25
if they are a full-time student. This benefit is also paid at 50% of MAP*.
This benefit is paid with no deductible and the amount paid DOES NOT go
towards the calendar year maximum allowance. There is a separate lifetime
maximum of $1,250.
The annual maximum benefit for Option 2 is $1,250
Individual
Coverage...........$27.50/Mo.
Family Coverage...............$83.75/Mo.
*MAP = Maximum Amount Payable is the level of reimbursement for covered services or procedures assigned by the Board of Directors of the Carrier and is subject to change periodically.
What
if there are no participating Dentists in my area?
The MAP works out to be 85% - 95% of the actual billed charge in the North Country area. Therefore, the subscriber’s out-of-pocket exposure by using a non-participating dentist may only be 5% - 15% of the billed charge!
What About Pre-Existing Conditions?
There is no pre-existing condition clause with the Low or High Option Dental
Group
Term Life Insurance!
With a variety of
insurance plans to fit your needs and the needs of your employees, you
get the advantage of having low cost group insurance rates with as few
as two employees, and you can be one of those employees!
If your company is a corporation, premiums paid under the plan (even your benefits as a stockholder/employee) are tax deductible as a business expense. If your company is a sole proprietor or partnership, premiums for employees, other than yourself, are tax deductible.
How Does It Work?To qualify, a business must have a minimum of two eligible employees. Full time employees, proprietors, partners, and officers who work thirty hours per week are eligible for coverage.
Select 1 of the 4 Life Insurance programs. Each includes accidental death benefits and common carrier death benefits. A business must have a minimum of 2 employees.
| L-1. | $10,000 for all covered employees, regardless of earnings or position. |
| L-2. | $25,000 for all covered employees, regardless of earnings or position. |
| L-3. | An amount equal to each employee's annual earnings, up to $50,000. |
| L-4. | An amount equal to twice each employee's annual earnings, up to $100,000. |
What are Some of the Highlights?
Conversion Privilege: If an employee elects to leave their place of employment, they reserve the right to convert their Group Term Life Insurance policy to an individual policy, regardless of the condition of their health at the time of conversion.
Waiver of Premium: In the event an employee becomes totally and permanently disabled before age 60, premiums will be waived for as long as the disability lasts.
What Happens After Age 65?
Benefits reduce to 65% at age 65, 45% at age 70, and 25% of the original amount at age 75.
Long
Term Disability Insurance!
This program, titled
D-4, helps replace income lost when an employee is unable to work because
of a covered sickness or injury.
To qualify, a business must have a minimum of 2 eligible employees. Full-time employees, proprietors, partners and officers who work thirty or more hours per week are eligible for coverage.
How Does It Work?This program pays 2/3 of wages or salary up to a maximum of $3,000 per month.
Benefits begin on
the 31st day of disability resulting from an accident, or on the 31st
day of disability due to sickness.
The program provides 24-hour coverage - both on and off the job. Plan benefits are integrated with benefits which may be received from other employer or government sponsored disability programs (primary and family Social Security, Workman’s Compensation or Retirement Benefits).
Maximum
Benfit Period
Based on the Insured's Age
| Age when Disability Begins |
Maximum
Benefit Period
|
|
Through
Age 62
|
24
Months
|
|
63
|
21
Months
|
|
64
|
20
Months
|
|
65
|
18
Months
|
|
66
|
15
Months
|
|
Age
67 and Over
|
12
Months
|
Define Disability
The individual will be considered to be totally disabled if he/she cannot perform the material and substantial duties of his/her usual work when disability begins and is under the care of a licensed physician.
Pre-Existing Conditions
No benefit will be paid for a period of disability beginning with the first six months after coverage becomes effective if the disability is a result of a condition for which the insured recieved medical treatment or medication within three months prior to the insured's effective date of coverage
Exclusions
Disabilities due to alcoholism or drug addiction and disabilities due to mental disease or psychotic or psychoneurotic disorders, unless the insured is hospital confined, or has been hospitalized within 3 months
7 Group Health Plans Underwritten by:
|
Comprehensive
Plans
315-798-4238 800-765-1718 (NY) 800-765-5226 (USA) |
HMO
Plans
315-798-4384 800-722-7884 (USA) |
1 Group Health Plan Underwritten by:
Glens
Falls, NY
800-447-8610
2 Group Dental Plans Underwritten by:
1-800-233-0384
4 Group Term Life Insurance Plans Underwritten by:
Monitor Life Insurance Company of NY
Utica, NY
Group Long Term Disability Income Insurance Plan Underwritten by:
Commercial Travelers Mutual Insurance Co.
Utica, NY