Big Benefitsjust call usBig Ben
This Employee Benefit Statement Prepared for: [[f_name]]
Medical Benefits:Co-Pay Plan - - A PPO/Indemnity Plan administered by Pacific Life and Annuity Company (formerly PM Group). PPO office visits (except surgery, lab charges, psychiatric and substance abuse) are paid at 100%, once a $15 co-payment is made. There is a $400 deductible for charges not covered by the $15 PPO office visit co-payment. These charges are paid at 80% if a PPO provider is utilized and 50% if a non-PPO provider is utilized. The Annual Out-Of-Pocket Maximum is $2,000 per person for PPO and $4,400 for non-PPO charges. Once the maximum is met, the Plan pays 100% of all charges for the remainder of the year. The lifetime maximum benefit is $2,000,000 for each covered individual. The Plan includes a prescription drug program administered by PCS Recap. Your cost varies based on the drug utilized, generic vs. brand name. Generic drugs cost $5 while brand name drugs cost $10 plus 20% of the total drug charge.
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Dental Benefits:
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