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

$900 per calendar year

$900 per calendar year

$900 per calendar year

$900 per calendar year

$900 per calendar year

$800 per calendar year

$900 per calendar year

$800 per calendar year

N/A

N/A

N/A

PBC Schedule 2

Fee Guide +10%

July 31st following the school year in which the employee attains age 65, or if earlier, the end of the month following the month of retirement.

Yes, to a maximum of 6 months

100%

Unlimited

2 per Calendar year

2 per Calendar year

100%

Unlimited

60%

$1,250/Calendar year

75%

$5,000/Lifetime

Covers adults and children

Under age 35: 3 x annual earnings;
Age 35 to 44: 2.5 x annual earnings;
Age 45 to 54: 2 x annual earnings;
Age 55 and over: 1.5 x annual earnings

$150,000, $12,000 without dependents

July 31st coincident with or next following the date you attain age 65 or retire, whichever is earlier.

N/A

Matches LTD

N/A

$150,000

N/A