GIC Explanation of Benefits

Full and part time employees are eligible for benefits on the first of the month following 60 days of employment.

Medical Benefits: Dependents can be covered at employee expense. Cafeteria125 Plan for FSA medical & dependent care, as well as four additional supplemental plans are offered.  There are three different medical plans to choose from:

 

***  BASE PLAN  –  PPO -  100% Employer Contribution for FT Employee Premium

In-Network:

$2,500 deductible ,80% Co-insurance, $20 Co-pay for Primary Care Physician office visit

$40 Co-pay for Specialty Physician office visit, $40 Co-pay for Urgent Care

Rx: Same on  all three plans: $10 Preferred Generic; $30 Preferred Brand Name; $45 or 40% (whichever is greater) Non-Preferred

Out-of-Network

$5,000 Deductible,60% Co-insurance

 

***  BUY UP  –  PPO

In-Network

$1,000 Deductible, 80% Co-insurance, $15 Co-pay for Primary Care Physician office visit

$30 Co-pay for Specialty Physician office visit, $35 Co-pay for Urgent Care

Out-of-Network

$2,000 Deductible , 60% Co-insurance

 

***  BUY UP  –  HMO

$25 Co-pay for Primary Care Physician or OB/GYN office visit

$50 Co-pay for Specialty Physician office visit,  $35 Co-pay for Urgent Care

 

***  Dental Guard PPO  -  100% Employer Contribution for FT Employee Premium

Dental Guard Preferred

$50 Deductible    Waived for Preventive Services

Preventive Services:  Covered 100% for in-network or out-of-network

Basic Services:  Covered 90% for in-network   /   Covered 80% for out-of-network

Major Services:  Covered 60% for in-network  /   Covered 50% for out-of-network

$1,000 Annual Maximum for all services, $1,000 Lifetime Maximum for Ortho

Child & Adult Ortho:  Covered 50% in network   /   Covered 50% out-of-network

 

***  BUY UP  –  Dental Guard

Same benefits as above plan with the following differences, $1,500 Annual Maximum for all services

$1,500 Lifetime Maximum for Ortho

 

***  Life Insurance              -      100% Employer Contribution for only  FT Employee Premium

$25,000 Term Life and AD&D

 

***  Employee Assistance Program -    100% Employer Contribution for Employee Premium

Unlimited Telephone Counseling

3 visits per family member per year with Psychologist or other Health Care Professional

Variable Resources of Assistance

 

***  Short Term Disability  ( FT Employees Only) 50% Employer Contribution for Employee Premium

15 Days Elimination Period for Accidents or Sickness, 52 Week maximum benefit, 66 2/3 % of Salary to $750

weekly maximum

  Medical Eye Services          

$10 Co-pay for Eye Exam, One Exam every 12 months (covered by insurance), Frames and Lenses every 24 months

($120 covered by insurance), $25.00 Co-Pay Materials (Frames, Lenses, Contacts)