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Benefits |
ComboPlus Starter |
ComboPlus Basic |
ComboPlus Enhanced |
Association Gold |
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Prescription
Drug |
Generic |
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Generic |
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Brand Name, Includes birth control |
Brand Name |
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Dispensing fee cap of $6.50 |
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Birth Control Covered |
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70% on $720 ($504) |
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70% on 1st $750, 90% on next $4,972 ($5,000) |
90% on first $2,222, 100% on next $8,000
($10,000) |
80% on first $500, 100% on next $4,000 |
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Dental -
Basic Coverage |
-70% on $575 ($400) |
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-80% on first $300, 50% on next $850
($665) |
-Exams, Scaling, Diag.
at 100% on first $500, |
-80% co-payment |
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all other basic services at 90% on first
$500, |
-Year 1:
$500, Year 2: $750, Year 3 & 4: $1000 |
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-No waiting period |
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then both at 60% on next $700 ($920 or
$870) |
Year 5: $1250 |
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-No waiting period |
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-Periodontics and |
-No coverage |
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-No coverage |
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-1st and 2nd year at 60% to max of $1,250 |
-Covered under above Basic Services |
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Endodontics |
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every 3 years ($400 first year max) |
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-Crowns,
Bridges, |
-No coverage |
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-No coverage |
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-1st and 2nd year at 0%, then 60%
included |
-Starting in year 3, 60% co-pay under the
above |
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Orthodontics, Dentures |
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with perio and endo in 3 year maximum |
same maximums |
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-Recall
visits |
-9 month recall |
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-9 month recall |
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-6 month recall |
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-6 month recall |
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Vision Care |
No coverage |
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$250 per 2 benefit years |
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$250 per 2 benefit years |
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$250 per 2 benefit years |
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Eye
Examinations |
No coverage |
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$30 per 2 benefit years |
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$30 per 2 benefit years |
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$30 per 2 benefit years |
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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 |
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Hospital
Coverage |
No coverage |
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Optional coverage |
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Optional Coverage |
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Semi-Private/Private, $200 per day
unlimited |
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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 |
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Podiatrists,
Naturopaths, |
specialist and therapist |
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specialist and therapist |
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specialist and therapist |
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Massage
Therapists, |
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Chiropodists,
Acupuncturist |
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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 |
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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 |
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Physiotherapist |
$250 maximum per anniversary year |
$250 maximum per anniversary year |
$250 maximum per anniversary year |
Covered in above with other Specialists |
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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 |
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Medical
Equip & Appliances |
year 4-$1200, year 5-$2500, per category |
three categories of benefits separately |
three categories of benefits separately |
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Ambulance
Services |
Unlimited + $4000 air ambulance |
Unlimited + $4000 air ambulance |
Unlimited + $4000 air ambulance |
Unlimited + $4,000 air ambulance |
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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 |
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Accidental
Dental |
$2000 per anniversary year |
$2,000 per anniversary year |
$2,000 per anniversary year |
$3,000 per anniversary year |
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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 |
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Lifeline |
3 months |
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3 months |
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3 months |
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6 months per 3 year period |
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Best
Doctors |
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Covered |
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Covered |
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Covered |
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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 |
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