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  1. Medical Plan- HDHP 4 w HSA-2021

    Human Resources | Page

    Calendar Year $1,700 Individual $3,400 Family Out-of-Pocket Maximum Per Calendar Year Category 1, 2, & ... copays*) $3,400 Individual $6,800 Family *Important Note: The family out-of-pocket maximum for a calendar ... that calendar year total and meet the family’s out-of-pocket maximum amount. Medical Services Member ...

  2. Map Text Amendment Application

    Community Development | Page

    amendments to the text and map(s) of this Ordinance in a form convenient for use by the public. 12.07 ...

  3. Medical Plan PCPA 2023

    Human Resources | Page

    BCBS, pays for your covered medical services and supplies. HDHP-4 w/HSA Deductible Per Calendar Year ... $1,700 Individual $3,400 Family Out-of-Pocket Maximum Per Calendar Year Category 1, 2, & ... copays*) $3,400 Individual $6,800 Family *Important Note: The family out-of-pocket maximum for a calendar ...

  4. Medical Plan 2023

    Human Resources | Page

    BCBS, pays for your covered medical services and supplies. HDHP-4 w/HSA Deductible Per Calendar Year ... $1,700 Individual $3,400 Family Out-of-Pocket Maximum Per Calendar Year Category 1, 2, & ... copays*) $3,400 Individual $6,800 Family *Important Note: The family out-of-pocket maximum for a calendar ...

  5. Regence Medical-Fire-2022

    Human Resources | Page

    covered medical services and supplies. Copay Plan E Deductible Per Calendar Year $250 Individual $750 ... Family Out-of-Pocket Maximum Per Calendar Year Category 1 & 2- Preferred and Participating Provider ... Scripts Pharmacy Program (90-day supply) Member Pays Individual deductible per calendar year No deductible ...

  6. Medical Plan- Co-Pay Plan E-2021

    Human Resources | Page

    your covered medical services and supplies. Copay Plan E Deductible Per Calendar Year $250 Individual ... $750 Family Out-of-Pocket Maximum Per Calendar Year Category 1 & 2- Preferred and Participating ... deductible per calendar year No deductible Out-of-pocket maximum each calendar year $2,500 per person/$7,500 ...

  7. Medical Plan Fire 2023

    Human Resources | Page

    covered medical services and supplies. Copay Plan E Deductible Per Calendar Year $250 Individual $750 ... Family Out-of-Pocket Maximum Per Calendar Year Category 1 & 2- Preferred and Participating Provider ... (90-day supply) Member Pays Individual deductible per calendar year No deductible Out-of-pocket maximum ...

  8. Co-Pay Plan A Summary 2019

    Human Resources | Page

    your covered medical services and supplies. Copay Plan A Deductible Per Calendar Year $250 Individual ... $750 Family Out-of-Pocket Maximum Per Calendar Year Category 1 & 2- Preferred and Participating ... Member Pays Mail Order Program (90-day supply) Member Pays Individual deductible per calendar year No ...

  9. Co-Pay Plan A Summary 2020

    Human Resources | Page

    your covered medical services and supplies. Copay Plan A Deductible Per Calendar Year $250 Individual ... $750 Family Out-of-Pocket Maximum Per Calendar Year Category 1 & 2- Preferred and Participating ... Order Program (90-day supply) Member Pays Individual deductible per calendar year No deductible ...

  10. Bloodborne Pathogens Exposure Checklist & Forms

    Human Resources | Page

          14. Birthdate:       15. Gender: |_|M |_|F 16. Mailing address, city, state and zip:       17. Home ...

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