GEORGIA INNETWORK

1

PPO PLAN
GEORGIA IN-NETWORK Plan Vendor1st 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
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.)

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