Page 3 - GLCVB Presentation

GLCVB’s

Group Benefit Offerings

Physicians Health Plan – GFH015 Gold PPO (Mapped Renewal)

$1400 Single/$2800 per family deductible followed by an 80/20 to an embedded
coinsurance maximum of $1600/$3200, then to an overall maximum of $8000/$16,000
per calendar year, $5 Online AmWell Visit, 25 PCP Office Visit Copay, $50 Specialist
Office Visit Copay, $60 Urgent Care Copay, 80% after deductible for Emergency Room
Copay, $10 Generic – Tier 1/$25 Generic – Tier 2/$60 Preferred Brand Name/$100 Non
Preferred Brand Name/20% Preferred and Non Preferred Specialty Drugs for Prescription
Drugs (former plan - $20/$50/$80/20% RX Copays)

MMA/Met Life Dental

The Dental plan covers 100% of Preventative Services, 80% of Basic Services, 50% of
Major Services, and 50% of Orthodontia Services. Each person on the plan has $2,000 of
annual benefit running on a calendar year basis, and a $2000 lifetime maximum for
Ortho. Pediatric dental is included.

No Increase Jan 2021; Next renewal Jan 1, 2022

Eye Med

The vision plan with Eye Med has a $175 allowance for Frames AND Lenses. You have a
$10 Copay for Exam and Materials. You are eligible for these benefits once every 12
months.

Rate lock: Aug 2019 – Aug 2023

UNUM - Life Insurance

GLCVB provides all full-time employees with 2 x annual salary to a maximum of
$235,000 of Term Life Insurance and Accidental Death and Dismemberment. $155,000
is Guaranteed Issue (No medical questions asked)

UNUM – Short Term Disability – 8th day accident, 8 day sickness to a duration up to 12
th
weeks, 60% of weekly earnings to a maximum of $1350/week.

UNUM - Long-Term Disability

Should you not be able to return to work after 90 days, LTD will cover 60% of monthly
earnings to a maximum of $6000/month. Includes EAP and Travel Assistance.
No Increase for UNUM policies. Next Renewal Jan 1, 2022