Page 3 - Agate Software 2021 Renewal

AGATE SOFTWARE

GROUP BENEFIT OFFERINGS

BCBSM – SB PPO $1000

$1000/$2000 per family deductible followed by 80% coinsurance to an embedded
coinsurance maximum of $2500/$5000, then to an overall maximum of
$6350/$12,700 per calendar year, $30 Office Visit Copay, including Online Visits, $50
Specialist Copay, $60 Urgent Care Copay, $150 Emergency Room Copay, $15
Generic/$50 Preferred Brand Name/50% Non Preferred Brand Name/20% Preferred
Specialty/25% Non Preferred Specialty Prescription Drug Copay

BLUE Vision – VSP: $5 Copay for Exam, $10 For Lenses/Frames to $130 Allowance;
Frequency: 12/12/12

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, $50/$150 per family deductible.

UNUM – Life Insurance

All full time eligible employees receive a flat $10,000 of Group Term Life and $10,000
Accidental Death and Dismemberment.

UNUM – Voluntary Short Term Disability

1 day accident, 8 day sickness for a duration of 13 weeks, 60% of weekly earnings
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to a maximum of $1000/week, 3/12 Pre-Ex Clause

UNUM – Voluntary Life Insurance

Employee: Increments of $10,000 - $500,000;$100,000 Guaranteed Issue
Spouse: Increments of $5,000 - $100,000; $25,000 Guaranteed Issue
Child: $10,000

UNUM policies are up for renewal Jan 2021

Accident policies can be purchased directly with UNUM’s call center. See HR for
details