Page 5 - Habitat for Humanity 2020 Benefit Guide
P. 5
Habitat for Humanity of Michigan
Dental/Vision Analysis: July 2020
Employer Paid
Current Renewal
Principal Principal
PPO PPO
Rates
Single $30.86 $30.86
Employee + 1 $55.61 $55.61
Family $96.13 $96.13
Deductible In-Network In-Network
Individual $50 $50
Family $150 $150
Annual Maximum
Individual $1,000 $1,000
Family $1,000 per member $1,000 per member
Class 1 100% 100%
Class 2 80% 80%
Class 3 50% 50%
This is a summary analysis only. Refer to certificate of coverage for all specific details.
This summary is not a contract and makes no representations or warranties as to final outcomes of claim adjudication.
Employer Paid
Current Renewal
EyeMed EyeMed
12/12/12 12/12/12
Rates
Employee $6.28 $6.40
Employee + 1 $11.94 $12.17
Employee + 2 $17.53 $17.86
In-Network In-Network
Frequency 12/12/12 12/12/12
Eye Exam $10 $10
Materials/Eyewear $0**/$25 $0**/$25
Allowance $130 $130
