Page 2 - Habitat for Humanity 2020 Benefit Guide

Habitat for Humanity of Michigan

2020 Benefits

 Base Plan- BCN HMO Gold $1,000: $1,000/$2,000 Deductible,
20% Coinsurance to a maximum of $3,500/$7,000, Maximum Out
of Pocket $8,150/$16,300.

 BCBSM Simply Blue PPO Gold $500: $500/$1,000 Deductible,
20% Coinsurance to a maximum of $4,500/$9,000, Maximum Out
of Pocket $8,150/$16,300.
 BCBSM Pediatric Dental

 Principal Dental PPO 100/80/50: $50 Single/$150 Family Deductible
applies to Class II and Class III services. Annual Maximum $1000 per
member.

 EyeMed: 12/12/12, $10/$25:
 Examination- once every 12 months
 Lenses or Contact Lenses- once every 12 months
 Frame- once every 12 months
 $130 Allowance

 Principal:
 Life/AD&D: $25,000
 Dependent Life Benefit- Spouse- $10,000, Child-$5,000 (Age 6
months to 19 years)
 Short Term Disability: 7/7/12, 60% of weekly earnings to a
maximum of $1,500 per week
 Long Term Disability: 90 Day Elimination Period, 66.67% of Monthly
earnings to a maximum of $8,000 per month