Page 3 - Playmakers 2020 Renewal Benefits Booklet

Playmakers:

November 2020 Renewal Benefits

 Base Plan: BCN HMO $250 Deductible- $250 Single/$500 Family
Deductible, 20% Coinsurance to an Annual Coinsurance Maximum of
$2,500 Single/$5,000 Family; Annual Out of Pocket Maximum $6,350
Single/$12,700 Family

 Buy-Up Plan: BCN Platinum 10%- $0 Deductible, 10% Coinsurance to
an Annual Coinsurance Maximum of $1,000 Single/$2,000 Family;
Annual Out of Pocket Maximum $5,000 Single/$10,000 Family

 Delta Dental PPO: 100/80/50 with Ortho, $25 Single/$75 Family
Deductible on Class II and Class III services, $1,000 Annual Maximum,
$1,000 Lifetime Ortho Maximum

 EyeMed: 12/12/12 Frequency, $10/$25
 Examination- once every 12 months
 Lenses or Contact Lenses- once every 12 months
 Frame- once every 12 months
 $150 Allowance

 UNUM LTD: 90 Day Elimination Period; 60% of monthly earnings to a
maximum benefit of $6,000 per month. The monthly benefit for Owners
is 60% of earnings to a maximum of $10,000 per month.

 UNUM Life/AD&D: $10,000 Benefit to all Full-time eligible employees

 UNUM Voluntary Life/AD&D: $100,000 Guarantee Issue, up to 5 X
Annual Earning, max $500,000. Can apply in $10,000 increments

 UNUM Voluntary STD: Elimination Period: 0 Injury/7 Sickness/13 week
Benefit Duration, 60% to a maximum weekly benefit of $1,500