Digestive Disease Consultants: Coverage Summaries

Group Dental Insurance Proposal                     
Digestive Disease Consultants
Renewal Effective March 1, 2019
HUMANA INSURANCE PPO Plan
Deductible (In):$25 / $75
(Out):$50 / $150
Preventive (In):100%, Deductible Waived
(Out):80%, Deductible Waived
Basic (In):Ded., 80%
(Out):Ded., 50%
Major (In):Ded., 50%
(Out):Ded., 50%
Waiting Period: (10 Enrolled) None
Orthodontics:Not Covered
Calendar Year Maximum (In):Unlimited
(Out):Unlimited
Network Restrictions:Yes
Non-Par balance-billed
Pre-Existing Limitations:Yes
Oral Surgery (Simple):Basic Service
Oral Surgery (Complex)Major Service
Endodontics / Periodontics:Basic Service
Endodontics / Periodontics Surgery:Major Service
PER. PAYCHECK DEDUCTIONS
Employee:$0.00
Employee w/ Spouse:$10.50
Employee w/ Child(ren):$16.27
Employee w/ Family:$26.77
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER BENEFIT SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE HUMANA INSURANCE DENTAL CERTIFCATE OF COVERAGE

File name : HUMANA-Dental-PPO-14-Benefit-Summary-Digestive.pdf

Vision Group Insurance Benefits                                                                                                                                                                                                                                                         
Digestive Disease Consultants
Renewal Effective March 1, 2019
HUMANA Vision Plan 200
Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames12 months
In-Network Co-Pays:
Exam$0
Materials - Covered FramesUp to $200
Materials - Retail FramesUp to $200
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam with 2 Fittings$0
Materials - Retail Lenses10% Off then up to $55
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $100
Per Paycheck Deductions
Employee: $7.13
Employee with Spouse:$14.26
Employee with Child(ren):$13.55
Employee with Family:$21.30
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO HUMANA INSURANCE VISION CERTIFICATE OF COVERAGE

File name : HUMANA-Vision-200-Plan-Benefit-Summary.pdf

GROUP LIFE AND DISABILITY BENEFITS 
DIGESTIVE DISEASE CONSULTANTS
Renewal Effective March 1, 2019
HUMANA INSURANCE COMPANY
100% EMPLOYER PAID
Basic Life with AD&D:
ALL EMPLOYEES
Guaranteed Issue Benefit Amount $25,000
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE HUMANA INSURANCE CERTIFICATE OFCOVERAGE
VOLUNTARY GROUP TERM LIFE BENEFITS 
DIGESTIVE DISEASE CONSULTANTS
Renewal Effective April 1, 2019
HUMANA INSURANCE COMPANY
Voluntary Life with AD&D
EMPLOYEESGuaranteed Issue Benefit Amount $75,000
SPOUSEGuaranteed Issue Benefit Amount $35,000
* Can elect up to 50% of Employee Elected Amount for SP *
CHILD(REN)Guaranteed Issue Benefit Amount $10,000
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE HUMANA LIFE INSURANCE CERTIFICATE OF COVERAGE