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  1. Dental- Delta II- 2021

    Human Resources | Page

    Preventive services does not apply towards the calendar year maximum. ² See back for additional information ... Calendar year maximum, per member* $1,500 Calendar year deductible, per member $0 CLASS II- BASIC ² MEMBER ... SERVICES Under this plan, benefits start at 70% your first calendar year of coverage. Thereafter, payments ...

  2. Medical Plan- HDHP 1 HSA w Alternative Care-2021

    Human Resources | Page

    supplies. HDHP-1 w/HSA Deductible Per Calendar Year $1,500 Individual $3,000 Family Out-of-Pocket Maximum ... Per Calendar Year Category 1, 2, & 3 – Preferred, Participating, Non- Preferred Providers ... Note: The family out-of-pocket maximum for a calendar year is satisfied when two or more family members’ ...

  3. Vision Plan – VSP 12/12/24 2020

    Human Resources | Page

    calendar year w/safety glasses VSP-1 Regence Vision Plan 1 (12/12/24) Benefits Summary Effective January 1, ...  Focuses on your eye health and overall wellness  Every calendar year $0 Prescription Glasses Frame  $120 ... on the amount over your allowance  Every other calendar year $0 Lenses  Single vision, lined ...

  4. VSP-1- 2021

    Human Resources | Page

    Licensee of the Blue Cross and Blue Shield Association Vision every calendar year w/safety glasses VSP-1 ... overall wellness  Every calendar year $0 Prescription Glasses Frame  $120 allowance for a wide selection ... allowance  Every other calendar year $0 Lenses  Single vision, lined bifocal, and lined trifocal lenses ...

  5. Medical Plan- High Deductible Health Plan with Health Savings Account (HDHP w/HSA), with Alternative Care Rider 2019

    Human Resources | Page

    Deductible Per Calendar Year $1,500 Individual $3,000 Family Out-of-Pocket Maximum Per Calendar Year Category ... out-of-pocket maximum for a calendar year is satisfied when one or more family members’ deductible and ... coinsurance for covered services for that calendar year total and meet the family’s out-of-pocket maximum ...

  6. Medical Plan-Police-2022

    Human Resources | Page

    Regence BCBS, pays for your covered medical services and supplies. HDHP-1 w/HSA Deductible Per Calendar ... Year $1,500 Individual $3,000 Family Out-of-Pocket Maximum Per Calendar Year Category 1, 2, & ... copays*) $2,300 Individual $5,050 Family *Important Note: The family out-of-pocket maximum for a calendar ...

  7. Medical Plan-2022

    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 ...

  8. Medical Plan- High Deductible Health Plan with Health Savings Account (HDHP w/HSA) 2019

    Human Resources | Page

    Deductible Per Calendar Year $1,500 Individual $3,000 Family Out-of-Pocket Maximum Per Calendar Year Category ... a calendar year is satisfied when one or more family members’ deductible and coinsurance for covered services ... for that calendar year total and meet the family’s out-of-pocket maximum amount. Medical Services ...

  9. 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 ...

  10. 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 ...

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