Page 2 - Sparky's Electric - 2020 Renewal Presentation

Sparky's Electric

Benefit Offerings

Blue Care Network – HMO Gold

$2500 per single, $5000 per family deductible, 80% coinsurance to an
embedded coinsurance maximum of $2000/$4000 per family, then to an
overall out of pocket maximum of $7350/$14,700 per family per calendar
year, $30 PCP Office Visit Copay, including Online Visits, $50 Specialist
Copay and Urgent Care Copay, $150 Emergency Room Copay after
deductible, $4 Generic (Tier 1)/$15 Generic (Tier 2)/$40 Preferred Brand
Name/$80 Non Preferred Brand Name/20% Specialty Prescription Drug
Copays , No Out of Network Benefits

Delta Dental – Dental

This plan covers 100% of Preventative Services, 80% Basic Services and
50% Major Services. Each person on the plan has $1000 of annual benefit
running on a calendar year basis, $75 deductible per person; deductible
applies to Basic and Major Services only. There is a 12-month waiting
period on certain services when you are new to the plan.