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Defined Benefit Plans
Information to Review
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Other Items to Consider
Deductibles: The Consumer Choice 1 plan has a $1,500 annual deductible for employee coverage or $3,000 annual deductible for all other tiers. One family member or a combination of family members can satisfy the family deductible and the full family deductible must be met before post-deductible benefits are paid.
Coinsurance: Once the deductible is met the Consumer Choice 1 plan will pay 80% of covered expenses from in-network providers or 60% of covered expenses from out-of-network providers.
Annual Out-of-Pocket Maximums: Your maximum annual out-of-pocket expenses from in-network providers for the plan year is $3,000 for employee-only coverage and $6,000 for all other tier levels (employee + spouse, employee + child(ren) or family). Out-of-network annual out-of-pocket maximum is $6,000 for employee only and $12,000 for all other tier levels. Once you meet the out-of-pocket maximum, the plan will pay 100% of eligible expenses.
Office Visit Charges: Under the Consumer Choice 1 plan, office visits are subject to your deductible. Copays do not apply for the Consumer Choice 1 plan – you are responsible for the entire office visit charge until you have satisfied the deductible.
Prescription Drug Coverage (administered by CVS Caremark): Under the Consumer Choice 1 plan, prescription drugs are subject to your deductible. Copays do not apply for the Consumer Choice 1 plan. You are responsible for payment of 100% of the cost of prescription drugs until you have satisfied the deductible. Learn More ...
Consumer Choice 1
Pre-Existing Condition Exclusion
Employee only: $1,500Family: $3,000
Annual Out-of-Pocket Maximum (Includes deductible)
Employee only $3,000Family $6,000
Employee only $6,000Family $12,000
Coinsurance Paid After Deductible (Applies to all professional services except those noted below.)
You Pay 20%
You Pay 40%
Office Visit Copays (Copays do not apply to deductible or out-of-pocket maximum)
Subject to Deductibleand Coinsurance
Lab Work/ Professional Services
Subject to Deductible
Emergency Room Visit Copayment
100% of In-Network Eligible Charges
Maximum Lifetime Benefit (Unless noted)
Substance Abuse Treatment
Up to $1,500 After the Deductible is Met Every 3 Years Per Person Covered
Temporomandibular Joint Dysfunction and Related Disorders
and Speech Therapy
The deductible is the amount you must pay for covered medical services each year before the medical plan begins to pay benefits. The deductible starts over each January 1.
If you elect coverage for yourself, the individual deductible applies to you. You must pay for covered medical services for yourself.
The plan will not begin to pay for benefits until you meet the individual deductible.
If you elect coverage for yourself and one or more eligible dependents, a family deductible applies to all as a single-family unit.
Full family deductible must be met by at least one person before the plan begins to pay.
After the deductible has been met, the plan will pay for benefits for the rest of the family members.