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PPO PLAN
GEORGIA IN-NETWORK
Plan Vendor:1st Medical Network
DEDUCTIBLE
$300 PER PERSON
$900 PER FAMILY
$20 COPAY FOR OFFICE VISITS
(not subject to general deductible)
$750 per person Wellness Care
STOP LOSS:
$1,000/person
$2,000/family
PPO PLAN
NATIONAL IN-NETWORK
Plan Vendor: Beech Street
DEDUCTIBLE
$400 PER PERSON
$1,200 PER FAMILY
$20 COPAY FOR OFFICE VISITS
(not subject to general deductible)
$750 per person Wellness Care
STOP LOSS:
$2,000/person
$4,000/family
PPO PLAN
OUT-OF-NETWORK
DEDUCTIBLE
$400 PER PERSON
$1,200 PER FAMILY
%60 of network rate for most of the services
SUBJECT TO DEDUCTIBLE
AND BALANCE BILLING
PHARMACY PROGRAM
 Network of Retail Pharmacies
 Services Outside of Network
 90 Day Maximum Drug Supply
 $10 co-payment for generic
 $25 co-payment for preferred brand name
 20% of non-preferred brand name cost
($40 min. and $100 max.)
VISION CARE PROGRAM
BLUE CHOICE VISION PROVIDERS
LensCrafters
Independent Optometrists
Independent Ophthalmologists
VISION DISCOUNTS
LensCrafters Preset Vision Packages
~Silver, Gold, and Blue Choices~
30% Off Eyeglasses/Frames/Lenses/Lab Fees
25% Off Non-Prescription Sunglasses
Low Fixed Prices on Contact Lenses
PPO PLAN
MEDCALL
emergency room copayment: $75
reduced to $50 if referred by MedCall
Copayment fully waived if admitted.
PPO PLAN
COST PER MONTH
-Employee
$105.18
-Employee/Spouse
$220.84
-Employee/Child
$189.30
-Family
$304.96