GBA - Individual Dental Coverage

Individual Medical Coverage
Simplified Quick Comparison Chart

Benefit Period - January 1 - December 31
Maximum Lifetime Coverage - $2,500,000
For out of network benefits, click on individual plan header columns below (A, B, C, etc.) for details.

Individual Medical Plans
Click For Details>>	S (Short Term)	A	B	C	D	E
Deductible Single/Family	$500/$1000	$500/$1000	$1000/$2000	$1500/$3000	$2500/$5000	$5000/$7500
Out-of-Pocket Maximum Single/Family In-Network	$2500/$5000	$2500/$5000	$3000/$6000	$3500/$7000	$2500/$5000	$5000/$7500
Co-Insurance In-Network	80%* After Copays or Deductible				100%* After Deductible
Medical Services
Office Visits Urgent Care Vistis In-Network	$15 Copay applies to office visit charge only. All other services subject to deductible and coinsurance.				100%* After Deductible
Prescription Coverage
Single/Family In-Network	$250/$500 deductible then 80% $2000 benefit max

**Emergency Room and Ambulance may have different copay per incident/percentage after deductible; Skilled/Private Duty Nursing have maximums per benefit period; Mental Health/substance has different copays/maximums; Hospice has different percentage after deductible. Short Term Medical - Well Child Care paid at 50% coinsurance.