Multi-Life, Inc. |
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Marketers of: Group - Life - Health - Disability |
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American Health Centers
Open Enrollment Ends at Midnight on December 31, 2005
Benefits Offered
Group Medical Outline of Benifits |
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Calendar Year Deductible |
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PPO Provider |
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Per Covered Person | $ 300.00 | |
Per Family (aggregate) | $ 600.00 | |
Non-PPO Provider |
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Per Covered Person | $ 600.00 | |
Per Family (aggregate) | $ 900.00 | |
Percentage Payable for Covered Expenses |
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PPO Provider | 80% | |
Non PPO Provider | 60% | |
Physician Office Visit |
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PPO Provider | $ 20 per visit | |
Non PPO Provider | 60% | |
Emergency Room |
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$ 50 then | 80% | |
Non Emergency | 60% | |
Prescription Drug Program |
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Walk In | 80% after Ded. | |
Deductible |
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Per Covered Person | $ 50 | |
Per Family | $ 100 | |
Maximum Out of Pocket |
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PPO Provider |
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Per Covered Person | $ 2,500 | |
Per Covered Family | $ 7,500 | |
Non PPO Provider |
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Per Covered Person | $ 7,500 | |
Per Covered Family | $ 22,500 |
Pre-existing Conditions apply. A Pre-existing condition is a condition for which medical advice, diagnosis, care or treatment was recommended or received within the 6 month period ending on the person's enrollment date. Pregnancy will not be considered a Pre-existing condition. The Pre-existing Condition limitation period will be reduced by the number of days of a person's Creditable Coverage. This is an outline of benefits only. Please refer to the Summary Plan Description for a detailed benefit description of coverage. Voluntary Universal Life Insurance is available to Employees and their families. |
Group Voluntary Dental |
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Per Covered Person |
$ 50.00 |
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Type I Dental Services |
100% |
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Type II |
80% |
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Type III |
50% |
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Type IV |
50% |
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Type I, II, III |
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Maximum Benefit Per Calendar Year | $ 1,000 |
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Type IV |
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Orthodontic Services Maximum Overall Benefit |
$ 1,000 |
This is an outline of benefits only. Please refer to the Summary Plan Description for a detailed benefit description of coverage. |