Pharmacy, Dental, Vision

When you enroll in the PPO Plan, pharmacy, dental and vision coverage are automatically included.

Pharmacy

	In-network
Preferred Drugs	$10 co-pay
Non-Preferred Drugs	$10 co-pay
Specialty Drugs	30% coinsurance
Medical Component Drugs	10% coinsurance

Dental Plan

	In-network
Annual maximum benefit per member	$2,000
In-network benefits	Your coinsurance
Diagnostic and preventive services	0%
Restorative treatment, periodontal treatment, endodontic treatment and oral surgery	20%
Prosthesis and crowns	50%
Orthodontia services	50% ($2,000 lifetime maximum per member)

Vision

	In-network
Exam	One per policy year: $15 co-pay
Coverage	$250 reimbursement benefit, every 12 months

Questions?

Pre-65 Retirees

You are eligible for coverage through the plan, which includes medical, prescription, vision and dental benefits. You must be enrolled in a plan yourself to cover dependents. You may only cover dependents who are currently covered; new dependents may not be added to coverage.

If you are enrolled in coverage and drop Umbrella Partners retiree coverage, you will lose your eligibility and not be able to re-enroll at a later date.

Upon reaching age 65, you are no longer eligible for medical, prescription drug, vision and dental benefits through the PPO Plan. In the months prior to reaching age 65 you should begin to explore your Medicare options at www.medicareinfo.org. You will have the option of joining traditional Medicare or a Medicare Advantage Organization (MAO).