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 $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

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

 

$250 per 2 benefit years

 

$250 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