2012 Benefit Enrollment Guide - Education Management Corporation

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Medical Benefits Summary Benefit Benefit Period Individual Deductible Family Deductible 650 Deductible 450 Deductible 250 Deductible In Network Out of Network In Network Out of Network In Network Out of Network Calendar Year Calendar Year Calendar Year $650 $1,300 $450 $900 $250 $500 $1,300 $2,600 $900 $1,800 $500 $1,000 Payment Level/ Coinsurance 80% after deductible until out-of-pocket maximum is met, then 100% 60% after deductible until out-of-pocket maximum is met, then 100% 90% after deductible until out-of-pocket maximum is met, then 100% 70% after deductible until out-of-pocket maximum is met, then 100% 100% after deductible 80% after deductible until out-of-pocket maximum is met, then 100% Out-of-Pocket Maximums $2,000 Individual $4,000 Family $5,000 Individual $10,000 Family $1,000 Individual $2,000 Family $2,500 Individual $5,000 Family Not Applicable $2,500 Individual $5,000 Family Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Physician Office Visits Specialist Office Visits 100% after $20 copayment* 100% after $35 copayment* 60% after deductible 60% after deductible 100% after $20 copayment* 100% after $35 copayment* 70% after deductible 70% after deductible 100% after $20 copayment* 100% after $35 copayment* 80% after deductible 80% after deductible Preventive Care — Adult Routine Physical Exams Routine Gynecological Exams, Including a Pap Test 100% after $20 copayment* 100% after $20 copayment* Not Covered 100% after Not Covered 100% after Not Covered $20 copayment* $20 copayment* 60%* 100% after $20 copayment* 100% after 70%* $20 copayment* 80%* Mammograms 100%* 60%* 100%* 70%* 100%* 80%* Preventive Care — Pediatric Routine Physical Exams 100% after $20 copayment* Not Covered 100% after $20 copayment* Not Covered 100% after $20 copayment* Not Covered Pediatric Immunizations 100%* 60%* 100%* 70%* 100%* 80%* Medical and Hospital Expenses Emergency Room Services Ambulance Inpatient Outpatient Maternity Infertility Counseling, Testing and Treatment Assisted Fertilization Procedures 100% after $75 copayment* (waived if admitted) 100% after $75 copayment* (waived if admitted) 100% after $75 copayment* (waived if admitted) 80% after In-Network deductible 90% after In-Network deductible 100% after In-Network deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible 60% after deductible 60% after deductible 60% after deductible 60% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after deductible 70% after deductible 70% after deductible 70% after deductible 70% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible Not Covered Not Covered Not Covered 80% after deductible 80% after deductible 80% after deductible 80% after deductible Medical/Surgical Expenses (except office visits) 80% after deductible 60% after deductible 90% after deductible 70% after deductible 100% after deductible 80% after deductible Spinal Manipulations 100% after $20 copayment* 60% after deductible 100% after $20 copayment* 70% after deductible 100% after $20 copayment* 80% after deductible Combined limit: 25 visits/benefit period Combined limit: 25 visits/benefit period Combined limit: 25 visits/benefit period 10 Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).
Medical Benefits Summary Benefit Diagnostic Services (Lab, X-ray and other tests) Physical Therapy Speech Therapy Occupational Therapy Durable Medical Equipment, Orthotics and Prosthetics Skilled Nursing Facility Care Home Health Care Private Duty Nursing (excludes inpatient) Hospice 650 Deductible 450 Deductible 250 Deductible In Network Out of Network In Network Out of Network In Network Out of Network 80% after deductible 100% after $20 copayment* 60% after deductible 60% after deductible 90% after deductible 100% after $20 copayment* 70% after deductible 70% after deductible 100% after deductible 100% after $20 copayment* 100% after deductible 80% after deductible 80% after deductible Combined limit: 50 visits/benefit period Combined limit: 50 visits/benefit period Combined limit: 50 visits/benefit period 80% after deductible 80% after deductible Limit: 100 days/benefit period Limit: 100 days/benefit period Limit: 100 days/benefit period 80% after deductible 90% after deductible 80% after deductible Limit: 100 visits/benefit period Limit: 100 visits/benefit period Limit: 100 visits/benefit period 80% after deductible Limit: 200 visits/benefit period Limit: 200 visits/benefit period Limit: 200 visits/benefit period 80% after deductible 60% after deductible 60% after deductible 60% after deductible 60% after deductible 60% after deductible 90% after deductible 90% after deductible 90% after deductible 90% after deductible 70% after deductible 70% after deductible 70% after deductible 70% after deductible 70% after deductible 100% after deductible 100% after deductible 100% after deductible 100% after deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible Mental Health Inpatient & Outpatient Hospital Office Visits 80% after deductible 100% after $20 copayment* 60% after deductible 60% after deductible 90% after deductible 100% after $20 copayment* 70% after deductible 70% after deductible 100% after deductible 100% after $20 copayment* 80% after deductible 80% after deductible Substance Abuse Inpatient Detoxification and Rehabilitation 80% after deductible 60% after deductible 90% after deductible 70% after deductible 100% after deductible 80% after deductible Outpatient Hospital 80% after deductible 60% after deductible 90% after deductible 70% after deductible 100% after deductible 80% after deductible Office Visits 100% after $20 copayment* 60% after deductible 100% after $20 copayment* 70% after deductible 100% after $20 copayment* 80% after deductible * Deductible does not apply This is not intended as a contract of benefits. It is designed purely as a reference of the many benefits available under your program. For more detailed information, visit Employee Resource. Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC). 11
Page 1 and 2: Educated Choices 2012 Benefit Enrol
Page 3 and 4: Educated Choices Your Educated Choi
Page 5 and 6: Benefit Costs If you choose to enro
Page 7 and 8: About domestic partner coverage You
Page 9 and 10: When Participation Ends For medical
Page 11: How the plans work You have the fre
Page 15 and 16: Brought To You By: Prescription Dru
Page 17 and 18: Brought To You By: Dental A healthy
Page 19 and 20: Dental Benefits Summary Benefit Ind
Page 21 and 22: Vision Benefits Summary Benefit Ben
Page 23 and 24: Brought To You By: Life Insurance L
Page 25 and 26: Life Insurance: Take it with you if
Page 27 and 28: Brought To You By: Disability Insur
Page 29 and 30: Brought To You By: Flexible Spendin
Page 31 and 32: Brought To You By: The Retirement P
Page 33 and 34: Your Wellness EDMC’s benefit prog
Page 35 and 36: Manage your chronic condition Asthm
Page 37 and 38: How The Plan Might Use Or Disclose
Page 39 and 40: If you have limited income and reso

2012 Benefit Enrollment Guide - Education Management Corporation

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