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					                            Licensed Employee Insurance Plans 2009-2010
ODS MEDICAL PLANS: CHOOSE ONE
Name of Plan                                           Plan 3 – PPO Plan Plan 5 – PPO Plan Plan 6 – PPO Plan Plan 7 – PPO Plan
GENERAL INFORMATION                                             ODS                     ODS                       ODS                       ODS
                                                             Member                  Member                    Member                    Member
                                                           Responsibility          Responsibility            Responsibility            Responsibility

                                                          In         Out of        In         Out of         In         Out of         In         Out of
                                                       Network      Network     Network      Network      Network      Network      Network      Network
Individual Deductible (plan year)                               $100                      $200                      $300                      $500
Family Deductible (plan year)                                   $300                      $600                      $900                    $1,500
Individual Out of Pocket Maximum (plan year)             $500          $1,500    $1,000          $2,000    $1,500          $3,000    $2,000          $4,000
Family Out of Pocket Maximum (plan year)                  N/A            N/A      N/A             N/A       N/A             N/A       N/A             N/A
Lifetime Benefit Maximum                                    $2,000,000              $2,000,000                $2,000,000                $2,000,000
Member Coinsurance                                        10%            30%      20%             40%       20%             40%       20%             40%
COVERED SERVICES
Hospital Benefit
Inpatient Hospital Coinsurance Service authorization
required                                                  10%            30%      20%             40%       20%             40%       20%             40%
Inpatient Days Covered                                 unlimited    unlimited   unlimited   unlimited     unlimited   unlimited     unlimited   unlimited
Pre-admission Testing                                     10%            30%      20%             40%       20%             40%       20%             40%
Inpatient Rehabilitative Hospital Care (30/60 days
per plan year)                                            10%            30%      20%             40%       20%             40%       20%             40%
Emergency & Urgent Care
Emergency Room (copayment waived if admitted)           $100 copayment per      $100 copayment per        $100 copayment per        $100 copayment per
                                                          visit then 10%          visit then 20%            visit then 20%            visit then 20%
RN Advice for minor illnesses & injuries                        eDoc                    eDoc                      eDoc                      eDoc
Urgent Care Visits                                        $10 copayment            $20 copayment             $20 copayment                    20%
Ambulance Transportation                                         10%                      20%                       20%                       20%
Skilled Nursing Facility
Skilled Nursing Facility 60 days per plan year            10%            30%      20%             40%       20%             40%               40%


ODS DENTAL PLANS: CHOOSE ONE
Name of Plan                                             DENTAL PLAN 1           DENTAL PLAN 3             DENTAL PLAN 6
Deductible                                                      None                    None                        $50
Annual Maximum                                                  $2,200                  $1,500                    $1,000
Preventive Care                                           70%+10% year            70%+10% year                    100%
Restorative Services                                      70%+10% year            70%+10% year                      80%
Major Services                                            70%+10% year            70%+10% year                      50%
Prosthodontics                                            70%+10% year                    50%                       50%


ODS VISION PlANS: ONE PLAN AVAILABLE
Name of Plan: ODS Vision Plan 3
Plan Maximum             $450.00                       Lenses: Single Vision, Bifocal, Lenticular, Trifocal, Contact Lenses: 100%
Routine Eye Exam           100%                        Lense Frequency: 12 months
Exam Frequency           12 months                     Frames: 100%                Frame Frequency: child @ 12 months / adult @ 24 months
Licensed Employee Insurance Plans 2009-2010

				
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