Page 2 - Wire Works 2020 Benefit Guide

WIRE WORKS, LLC

BENEFIT OFFERINGS

Medical - BCBSM – Simply Blue PPO H.S.A. Gold

Deductible: $1500 for a one-person contract
$3000 for a family contract (2 or more members)

Coinsurance: 80% coinsurance is payable

Out of Pocket Maximum: $3000 for a one-person contract

$6000 for a family contract

$10 Generic/$40 Preferred Brand Name/$80 Non-Preferred Brand
Name/15% for Preferred Specialty Drugs ($150 max)/25% Non-
Preferred Specialty Drugs ($300 max) after deductible

Pediatric Dental and Vision benefits are only available to members
up to Age 19

Life Insurance – Dearborn Group

All full-time employees receive a flat $50,000 of Life Insurance and

Accidental Death and Dismemberment