EFFECTIVE February 1, 2004

No Physical Exams Required for Coverage    Sole Proprietors or Large Groups    Identification Card Recognized World Wide    All Programs Include Rx and Vision Coverage

Four plans to choose from

 

Comprehensive 1000 Program         Lowest Cost Plan       Capital Blue Cross Network of Providers       $1000 Calendar Year Deductible       80/20 Coinsurance After Deductible       $5000 Out of Pocket Max Per Person (3-family)       Prescription Drugs Included       Maternity & Oral Contraceptives Included       Dependent Student Coverage to Age 23       Pays 100% for Covered Services for Emergency           Medical & Accident Care, Not Subject to the           Deductible       Chiropractic Services Included – 20 Visits Per           Benefit Period       Maximum Lifetime Benefit is $1,000,000

PPO Program         Most Comprehensive Plan       Capital Blue Cross Network of Providers       You choose in network or out-of-network       In-Network Deductible $500       No Coinsurance In-Network       $15 Office Visit Co-Pay In-Network       Prescription Drugs Included       Maternity & Oral Contraceptives Included       Dependent Student Coverage to Age 23       Emergency Care by out-of-network treated as in-network       Adult & Pediatric Preventive Services Included       Chiropractic Services Included – 20 Visits Per Benefit Period       Unlimited Maximum Lifetime Benefit

Traditional Program         Capital Blue Cross Network of Providers       Prescription Drugs Included       Scheduled Benefits plus Major Medical Benefits @ 80/20 Co-pay       Unlimited Maximum Lifetime Benefit

Benefit Enhancements to Association Programs, not available in Community Offered Programs

Senior Program         Medicare Supplement Program       Drug Rider Included       $$3000 Annual Maximum Rx Benefit       $ Co-pay Generic Prescriptions       $3,000 Calendar Year Benefit Maximum

Annual Deductible $50 Per Person (3 per Family)       Calendar Year Deductible $1000 Per Person          Diagnostic & Preventive Covered at 100%       Basic Services Covered at 100%       Two-Tier Rate Structure; Single & Family       Nationwide Coverage and Eligibility

Dental Plan Option

Competitively priced     Benefits your Association

ENROLL NOW!!         Call for rate quote

1-888-718-0092/Local 657-6202

The Association Programs have an Unlimited Lifetime Maximum Benefit (except the Comprehensive 1000 Program) vs. $1,000,000 Lifetime Maximum Benefit in Community Offered Programs.    The Association’s PPO pays 100% after a $500 deductible In-Network, whereby the Community Offered Program requires a Co-Insurance payment of 10% over and above the $500 deductible up to a maximum out-of-pocket of $3,000 per member and $6,000 per family.    The Association’s Co-Pay for Out-Of-Network is 20%, whereby the Community Offered Program’s Co-Pay for Out-Of-Network is 30%    The Association’s Rx Program includes: Oral Contraceptives, Contraceptive Implants and Injections, and Contraceptive Devices, whereby the Community Offered Program does not.    The Association Programs allows one-person groups, whereby the Community Offered Programs require two-person groups.