| Benefits | ComboPlus Starter | ComboPlus Basic | ComboPlus Enhanced | Association Gold | ||||||||
| Prescription Drug | Generic | Generic | Brand Name, Includes birth control | Brand Name | ||||||||
| Dispensing fee cap of $6.50 | Birth Control Covered | |||||||||||
| 70% on $720 ($504) | 70% on 1st $765, 90% on next $3,850 ($4,000) | 90% on first $2,220, 100% on next $6,000 ($8,000) | 80% on first $500, 100% on next $4,000 | |||||||||
| Dental - Basic Coverage | -70% on $575 ($400) | -80% on first $300, 50% on next $850 ($665) | -Exams, Scaling, Diag. at 100% on first $500, | -80% co-payment | ||||||||
| all other basic services at 90% on first $500, | -Year 1: $500, Year 2: $750, Year 3 & 4: $1000 | |||||||||||
| -No waiting period | then both at 60% on next $700 ($920 or $870) | Year 5: $1250 | ||||||||||
| -No waiting period | ||||||||||||
| -Periodontics and | -No coverage | -No coverage | -1st and 2nd year at 60% to max of $1,250 | -Covered under above Basic Services | ||||||||
| Endodontics | every 3 years ($400 first year max) | |||||||||||
| -Crowns, Bridges, | -No coverage | -No coverage | -1st and 2nd year at 0%, then 60% included | -Starting in year 3, 60% co-pay under the above | ||||||||
| Orthodontics, Dentures | with perio and endo in 3 year maximum | same maximums | ||||||||||
| -Recall visits | -9 month recall | -9 month recall | -6 month recall | -6 month recall | ||||||||
| Vision Care | No coverage | $100 per 2 benefit years | $100 per 2 benefit years | $250 per 2 benefit years | ||||||||
| Eye Examinations | No coverage | $30 per 2 benefit years | $30 per 2 benefit years | $30 per 2 benefit years | ||||||||
| Travel Coverage | Unlimited trips up to 9 days - $5,000,000 | Unlimited trips up to 9 days - $5,000,000 | Unlimited trips up to 9 days - $5,000,000 | 30 day trips, $1,000,000 coverage | ||||||||
| Hospital Coverage | No coverage | Optional coverage | Optional Coverage | Semi-Private/Private, $200 per day unlimited | ||||||||
| Chiropractors, Osteopaths, | $15 maximum per visit, 20 visits per year per | $20 maximum per visit, 20 visits per year per | $20 maximum per visit, 20 visits per year per | $600 combined, $35 per Chiropractic x-ray | ||||||||
| Podiatrists, Naturopaths, | specialist and therapist | specialist and therapist | specialist and therapist | |||||||||
| Massage Therapists, | ||||||||||||
| Chiropodists, Acupuncturist | ||||||||||||
| Speech Pathologists/Therapist | $60 first visit, $40 subsequent, 10 visit max | $65 first visit, $45 subsequent, 10 visit max | $65 first visit, $45 subsequent, 10 visit max | $60 first visit, $40 subsequent, 12 visit max | ||||||||
| Psychologist | $75 first visit, $60 subsequent, 10 visit max | $80 first visit, $65 subsequent, 10 visit max | $80 first visit, $65 subsequent, 10 visit max | $75 first visit, $60 subsequent, 12 visit max | ||||||||
| Physiotherapist | $250 maximum per anniversary year | $250 maximum per anniversary year | $250 maximum per anniversary year | Covered in above with other Specialists | ||||||||
| Homecare and Nursing, | Year 1-$500, year 2-$800, year 3-$1000, | $3,000 per anniversary year, for each of these | $3,000 per anniversary year, for each of these | Combined max for all of these, $7,500 per year | ||||||||
| Medical Equip & Appliances | year 4-$1200, year 5-$2500, per category | three categories of benefits separately | three categories of benefits separately | |||||||||
| Ambulance Services | Unlimited + $4000 air ambulance | Unlimited + $4000 air ambulance | Unlimited + $4000 air ambulance | Unlimited + $4,000 air ambulance | ||||||||
| AD & D | $25000 per adult, $10000 for senior and child | $25,000 per adult, $10,000 for senior and child | $25,000 per adult, $10,000 for senior and child | $50,000 per adult, $20,000 per child/senior | ||||||||
| Accidental Dental | $2000 per anniversary year | $2,000 per anniversary year | $2,000 per anniversary year | $3,000 per anniversary year | ||||||||
| Hearing Aids | $400 every 4 consecutive benefit years | $400 every 4 consecutive benefit years | $400 every 4 consecutive benefit years | $500 every 4 consecutive benefit years | ||||||||
| Lifeline | 3 months | 3 months | 3 months | 6 months per 3 year period | ||||||||
| Best Doctors | Covered | Covered | Covered | |||||||||
| Survivor Benefit | In 2nd year, 1 yr coverage following death of sub | 1 yr coverage following death of sub | 1 yr coverage following death of sub | 12 months | ||||||||