Complete Personnel Logistics: Health Insurance

December 1, 2020

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	HEALTH INSURANCE: COPPER

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Major Medical Benefits	Network	Non-Network
Individual Family	$2,000 $4,000	$4,000 $8,000
Co-Insurance	80% / 20%	50% / 50%
Out-of-Pocket (including deductable) Individual Family	$4,000 $8,000	Unlimited Unlimited
Inpatient Hospital Care	80% / 20% after deductable	50% / 50% after deductable
Emergency Room Treatment (Limited to severe medical condition)	$150 co-pay	50% / 50% after deductable
Outpatient Hospital Care	80% / 20% after deductable	50% / 50% after deductable
Office Visits	80% / 20% after deductable	50% / 50% after deductable
Inpatient Maternity Care	80% / 20% after deductable	50% / 50% after deductable
Lab and X-Ray	80% / 20% after deductable	50% / 50% after deductable
Therapy Services (limited to 10 visits per year)	80% / 20% after deductable	50% / 50% after deductable
Life Insurance	$10,000 Term
Urgent Care	$55 co-pay
Lifetime Maximum	$1,000,000
Retail Prescription Drugs	Discount Prescription Card
Mail Order Prescription Drugs	Discount Prescription Card

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This summary is intended to highlight your healthcare benefits and is not a contract of insurance. Please refer to your Summary Plan Description for a complete explanation of covered services, limitations, exclusions and a description of all terms and conditions of coverage.