| BENEFIT |
WHO
PAYS |
WHO IS
ELIGIBLE |
EFFECTIVE DATE |
COVERAGE |
MEDICAL PLAN
(PPO) |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
TMMC - 100%
PPO Facility - 80%
Other Facilities - 50%
PPO Physician - 80%
Non-PPO Physician - 50%
$250 deductible. |
| PHARMACY PLAN (Included with PPO Medical Plan) |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
Mail Service $15 generic; $45 brand.
TMMC 85% generic; 75% brand
No deductible.
Network 75% generic; 60% brand.
$50 deductible. |
| VISION PLAN (Included with PPO or HMO Plan) |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
$20 annual deductible every 12 months: vision exam, lenses and frames, or up to $105 for contacts. |
| BLUE SHIELD(HMO) |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
Annual maximums -
$2000(individual)
$4000 (family)
No deductible. $1000 per admission for hospital services. |
| DENTAL PLAN-DELTA |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
Annual maximum-$1,500
Preventive Care-100%
Basic-80%, Major-50%
Orthodontia not available.
DPO Benefits for specialty dentists (See DPO below) |
| DENTAL PLAN-DELTA PREFERRED OPTION (DPO) |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
Annual maximum $1,500
No deductibles
Preventive Care-100%
Basic-90%, Major-50%
Orthodontia not available. |
| DENTAL PLAN-DELTA PMI |
Hospital and Employee |
Regular FT and PT employees and their qualified dependents |
First of month following 60 days of employment |
No annual maximum.
No pre-existing conditions. No deductibles.
Preventive Care-100%, Basic-100%, Orthodontic-$1600 total child, $1800 total adult. |
| FLEXIBLE BENEFITS PLAN |
Employee |
Regular FT and PT employees |
First of month following 60 days employment |
Pay for your medical and dental premiums, certain health expenses, adult and child care with "untaxed" dollars. |