Plan B - HEALTH AND WELFARE forHealth and Welfare Agreement • October 11th, 2007
Contract Type FiledOctober 11th, 2007Issue Old Agreement New Proposal Preventive Health Care Services(see attached for specifics) Paid at 75% after deductible Paid at 100% (no deductible) HRA Benefit* None $525 for single coverage$925 for family coverage Incentive for Annual HealthRisk Assessment Questionnaire None $200 for self and $50 for spouse($250 maximum) added to HRA benefit Deductible** $275 per person$825 for family $1,000 per person$2,000 for family Plan Payment (after deductible) for servicesother than preventive care 75% 75% Office visit co-pay $25.00 per visit Replaced with HRA / PPO plan design* Out-of-Pocket Maximum $2500 per person$5000 for family $2000 per person$4000 for family Drug Deductible $50 per person$150 for family Eliminated effective 10/1/07Eliminated effective 10/1/07 Drug co-pays $10 for Generic$25 for Brand$40 for Non-formulary PPO may pay drug co-pays out of HRA account (not applicable to HMO participants)*Drug co-pay reduced for certain drugs (see below)Maintenance drugs may be purchased a