My Plan

80% until $1,000 paid per person per calendar year, 100% thereafter

$50

N/A

Coverage will terminate on June 30th following the date the Member attains age 75, or earlier retirement.

N/A

Yes, to a maximum of 24 months

Blue Rx

Yes

$0

Covered

Covered

$20,000 per lifetime

Not covered

Included

100%

N/A

Private or Semi-Private

$20,000 per calendar year

$3,500 every 48 months

Covered

$500 per calendar year

$500 per calendar year

$550 every 24 months

1 every 24 months – separate from vision care maximum

Covered

$1,000 per calendar year

$1,000 per calendar year

$1,000 per calendar year

$1,200 per calendar year

$900 per calendar year

$800 per calendar year

$1,000 per calendar year

$800 per calendar year

N/A

N/A

N/A

PBC Schedule 3

Fee Guide +10%

The last day of the month following the month in which you terminate, retire, or are no longer eligible for coverage. Coverage will continue until October 1 in the event you retire between June 30 and August 31.

For Dental work already in progress, within 90 days following the employees death an eligible dependent of the deceased employee may have dental work completed that commenced as part of a series of planned dental treatment(s) while the employee was living.

100%

N/A

2 per Calendar year

2 per Calendar year

100%

N/A

60%

$5,000 per calendar year

75%

$5,000/Lifetime

Covers adults and children

Flat $100,000

$100,000

The date you cease to be an insurable employee. However, if your employment ends between September 1st and May 31st, insurance terminates on the last day of the full semester following the semester in which the employment ends, provided the employee is not employed with another employer. If your employment ends between June 30th and August 31st, insurance terminates on the following October 1st.

N/A

Matches LTD

Available

N/A

N/A