Page 3 - Affiliate Mortgage Services September 2020 Renewal

Affiliate Mortgage Services:

Renewal Benefits

September 1, 2020

 Health Plan Options: Affiliate Mortgage pays 75% of Base
Plan

 BASE PLAN - BCN HMO Gold $1,000: $1,000 Single/$2,000

Family Deductible, 20% Coinsurance to a maximum of
$3,500/$7,000, $8,150/$16,300 Annual Maximum Out of
Pocket

 BCN HMO Platinum 20%: $0 Deductible, 20% Coinsurance to
a maximum of $1,000/$2,000, $6,600/$13,200 Annual
Maximum Out of Pocket

 Delta Dental: 100/80/50, $50 Single/$150 Family Deductible

applies to Class 2 & 3 Services, Annual Maximum $2,000.

 EyeMed Vision: 12/12/12 Frequency, $10/$25

 Examination- once every 12 months

 Lenses or Contact Lenses- once every 12 months
 Frame- once every 12 months
 $200 Allowance

 Freedom Pass- $0 copay for any frame at Target Optical