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					                            Classified Employee Insurance Plans 2009-2010
MEDICAL PLANS: CHOOSE ONE
Name of Plan                                               Plan 2 - POS           Plan 3 – PPO Plan        Plan 6 – PPO Plan         Plan 8 - PPO Plan
GENERAL INFORMATION                                        Providence                      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)                           None / $300                    $100                      $300                    $1,000
Family Deductible (plan year)                               None / $900                    $300                      $900                    $3,000
Individual Out of Pocket Maximum (plan year)              $600           $2,000     $500          $1,500    $1,500          $3,000    $2,000          $4,000
Family Out of Pocket Maximum (plan year)                 $1,200          $4,000     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                                        None            50%       10%             30%      20%             40%       20%             40%
COVERED SERVICES
Hospital Benefit
Inpatient Hospital Coinsurance Service authorization
required                                                  None            50%       10%             30%      20%             40%       20%             40%
Inpatient Days Covered                                    None            50%     unlimited    unlimited   unlimited    unlimited    unlimited    unlimited
Pre-admission Testing                                     None            50%       10%             30%      20%             40%       20%             40%
Inpatient Rehabilitative Hospital Care (30/60 days
per plan year)                                            None            50%       10%             30%      20%             40%       20%             40%
Emergency & Urgent Care
Emergency Room (copayment waived if admitted)                                      $100 copayment per       $100 copayment per        $100 copayment per
                                                            $100 per visit           visit then 10%           visit then 20%            visit then 20%
RN Advice for minor illnesses & injuries                          N/A                      eDoc                      eDoc                      eDoc
Urgent Care Visits                                                 $25               $10 copayment            $20 copayment                    20%
Ambulance Transportation                                          $100                      10%                      20%                       20%
Skilled Nursing Facility
Skilled Nursing Facility 60 days per plan year          Up to 30     50% up to    10% up to    30% up to   20% up to    40% up to    20% up to   40% up to
                                                         days         30 days      60 days      60 days     60 days      60 days      60 days     60 days


ODS DENTAL PLANS: CHOOSE ONE
Name of Plan                                              DENTAL PLAN 1             DENTAL PLAN 2            DENTAL PLAN 4
Deductible                                                        None                     None                      $25
Annual Maximum                                                   $2,200                    $1,500                  $1,500
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                    80%
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

				
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