Provides payment of a percentage of the UCR for covered expenses. Diagnostic and preventive care are paid at 80%. Many other services are covered at 50% to 70% of UCR. The maximum individual benefit per year is $1,200. Lifetime orthodontic benefits of $1,800 per covered eligible individual are available after six months.
The percentage of coverage is higher in some categories under the Enhanced Dental Plan compared to the Basic Dental Plan. Diagnostic, Preventive and Basic Restorative services are covered at 100%. This upgrade to Enhanced Dental is included in some options of the ESP program and can be elected on an employee paid basis in others.
Covered employees and their dependents are entitled to one eye exam each benefit period. The standard benefit period is 24 months for adults 19 and older, and 12 months for children under 19. Adults 19 and older can choose a new pair of glasses or contacts every 24 months. Children under 19 can choose new lenses every 12 months. Frames are covered once every 24 months for any age. This benefit is included in some of the options under the ESP Plan, or may be purchased separately under other options.
Prescription Drug Plan:
Enrollment in a Health Plan includes prescription coverage through the Total Life Care (TLC) Pharmacies. There is a formulary that applies with three categories of covered prescriptions, each with an applicable copay. The three levels with co-payments are: Generic Drugs/$10.00 co-payment; Preferred Branded Drugs/$25.00 co-payment; and, Non-Preferred Branded Drugs/$35.00 co-payment. One co-payment normally provides a 30-day supply of the prescription.