Page 7 - Dent Wizard 2018 New Hire Guide 0123.18
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MEDICAL BENEFIT SUMMARY
HRA HealthFund Plan
In-Network
Out-Of-Network
Deductible
You Pay
You Pay
Employee
$1,500
$3,000
Family
$4,500
$9,000
HRA Fund: EE, E+1, FAM $400 / $800 / $1,200
Coinsurance
30%
60%
Total Out-Of-Pocket Maximum
(Includes Deductibles - Medical, & RX)
In-Network
Out-Of-Network
Employee
$6,000
$12,000
Family
$13,700
$36,000
Physician Office Visit
Covered At
In-Network
Out-Of-Network
Preventive Care
100%
60%*
Primary Care
30%*
60%*
Specialist
30%*
60%*
Hospital
Covered At
Emergency Room
30%*
60%*
Urgent Care
30%*
60%*
* After deductible is met
Dent Wizard | 2018 Benefits Guide 7
