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GEORGIA IN-NETWORK Plan Vendor:1 st Medical Network DEDUCTIBLE $300 PER PERSON $900 PER FAMILY

PPO PLAN. GEORGIA IN-NETWORK Plan Vendor:1 st 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

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GEORGIA IN-NETWORK Plan Vendor:1 st Medical Network DEDUCTIBLE $300 PER PERSON $900 PER FAMILY

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  1. 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

  2. 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

  3. 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

  4. PHARMACYPROGRAM • 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.)

  5. 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

  6. PPO PLAN MEDCALL • emergency room copayment: $75 • reduced to $50 if referred by MedCall • Copayment fully waived if admitted.

  7. PPO PLANCOST PER MONTH -Employee $105.18 -Employee/Spouse $220.84 -Employee/Child $189.30 -Family $304.96

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