atr 053e 2011 benefit plan comparison
TRANSCRIPT
8/6/2019 ATR 053E 2011 Benefit Plan Comparison
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Carrier Blue Care Network MI
Plan Name PPO 3 PPO 8 HMO
Calendar Year Deductible
Single (IN/OON) $750 / $1,500 $750 / $1,500 $0
Family (IN/ONN) $1,500 / $3,000 $1,500 / $3,000 $0Coinsurance 80% / 60% 60% / 50% 80%
Out-of-Pocket Maximum
Single (IN/OON) $2,500 / $5,000 $5000 / $10,000 $1,500
Family (IN/ONN) $5000 / $10,000 $10,000 / $20,000 $3,000
PCP Office Visit
(IN/OON) $30 / 60% $40 / 50% $25
Specialist Office Visit
(IN/OON) $30 / 60% $40 / 50% $30
Emergency Room$150 copay
waived if admitted
$150 copay
waived if admitted
$150 copay
waived if admitted
Retail
Generic $15 $15 $15
Brand $50 $50 $50
Non-preferred Brand N/A N/A N/A
Generic $30 $30 $30
Brand $100 $100 $100
Non-preferred Brand N/A N/A N/A
Employee $85.12 $51.81 $63.46
Employee + 1 $183.00 $111.38 $136.44
Family $204.28 $124.33 $149.13
Carrier
In-Network Out-of-Network
Calendar Year Deductible
Single $50 $50 $0
Family $150 $150 $0
Annual Maximum Benefit
Per Person $1,000 $500 Unlimited
Preventive Care Services 100% 100% 100%
Basic Restorative Services 80% 50% 85%
Major Restorative Services 50% 50% 50-65%
Orthodontia
Lifetime Maximum (per person) $1,000 $1,000 savings
Employee $4.32
Employee + 1 $6.91
Family $12.33
Employee $1.19
2 Party $2.39
Employee + Child $2.55
Family $4.08
Well Vision Exam $12 copay every 12 months
Prescription Glasses $25 copay every 12 months
$130 Frame allowance every 24 months
Contact Lens $130 allowance every 12 months
Weekly Payroll Deduction
Prescription Drug
Community BCBS Michigan
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Guardian Life Insurance Company
Plan NamePPO
DHMO
Weekly Payroll Deduction
$8.23
$17.49
$21.98
VSP Vision Plan
Weekly Payroll Deduction
ATR 053ERevised: 03.01.11
Location: DCL - Payroll-Benefits - Benefit Plans - ATR 053E 2011 Benefit Plan Comparison.pdf
1 "Printed Copies are Uncontrolled"
8/6/2019 ATR 053E 2011 Benefit Plan Comparison
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Paid Time Benefit Plan
Each time you have completed 500 straight time hours, you will receive the paid time benefitbased on the formula below. It is an automatic payment added to your payroll check. Pleaseallow 3 weeks for processing.
Years of
Employment
Maximum Yearly
Earning Potential
PTB per Installment
1 40 10.53 hours2 56 14.50 hours3 64 17.0 hours4 80 21.0 hours
Holiday Benefit Options
Holiday Plan 1Includes 10 Paid Holidays
New Years Day Fourth of July Christmas DayMartin Luther King Day Labor Day New Year's Eve
Good Friday Thanksgiving Day
Memorial Day Christmas Eve
Holiday Plan 2 Includes 6 Paid Holidays
New Years Day Fourth of July Thanksgiving Day
Memorial Day Labor Day Christmas Day
Additional Benefits*
x $15,000 Life Insurancex Short-term Disability (STD) – 50% of salary up to $500/week up to 13 weeks. STD weekly
cost $3.58 maximumx Long-term Disability (LTD) – 60% of salary up to $5,000/month after 90-day elimination
period. LTD weekly cost is wage dependent. Weekly Cost Calculation:
[(Hourly Rate x 40 hours)/100] = Total DollarsTotal Dollars x .36 = Weekly Cost
Example: ($20/hour x 40)/100 = 8 x .36 = $2.88
x Child Dependent Care Accountx 401K Option – administered through Charles Schwabx Direct Depositx $1000.00 Referral Bonus
ATR 053ERevised: 03.01.11
Location: DCL - Payroll-Benefits - Benefit Plans - ATR 053E 2011 Benefit Plan Comparison.pdf
2 "Printed Copies are Uncontrolled"