Review Your Benefit Options

Medical

Medical Benefits

Overview

AGA offers two medical plan options administered by Blue Cross Blue Shield of Alabama. Both plans are Preferred Provider Organization plans.

Both plans use the same network of providers who have agreed to charge discounted rates to plan members. The amount you pay for health care will vary depending on whether or not you use in-network providers and facilities. You always have the choice to go to any provider, but you’ll pay less if you stay within the Blue Cross Blue Shield of Alabama network.

	Premier Plan	Silver Plan
	In-Network	In-Network
Deductible
Individual	$500	$4,000
Family	$1,000	$8,000
Coinsurance	20%	20%
Out-of-Pocket Max.
Individual	$2,800	$6,800
Family	$5,600	$13,600
Inpatient Services
Inpatient Facility	20% Coinsurance	20% Coinsurance
Emergency Room	20% Coinsurance	20% Coinsurance
Physician Office Visits
Preventive Care	100% Covered	100% Covered
Primary Care	$45 Copay	$45 Copay
Specialist Office	$65 Copay	$65 Copay
Outpatient Services
Outpatient Surgical	20% Coinsurance	20% Coinsurance
Diagnostic X-Ray Lab	20% Coinsurance	20% Coinsurance
Mental Health / Substance Abuse	20% Coinsurance	20% Coinsurance
Prescription Drug
Tier 1	$15 Copay	$15 Copay
Tier 2	$60 Copay	$60 Copay
Tier 3	$100 Copay	$100 Copay
Tier 4	$425 Copay	$425 Copay

Employee Monthly Contributions

	Premier Plan	Silver Plan
Single	$663.80	$599.67
Employee + Spouse	$1,325.38	$1,184.30
Employee + Child	$1,216.74	$1,098.10
Family	$1,878.35	$1,682.76

Dental

Dental Benefits

Overview

AGA offers dental coverage to you through Delta Dental. Your dental plan provides coverage to help with the cost of many dental services including routine cleanings, x-rays, restorative and prosthetic services. The plan includes an extensive network of dental providers. Maximize your benefits by selecting an in-network dentist to save more on all covered services and avoid balance billing.

	Dental Enhanced Plan	Dental Basic Plan
Benefits	In-Network	In-Network
Annual Maximum per Individual	$1,500	$750
Type I – Diagnostic & Preventive
Exams, Cleanings, Flouride Treatment, Space Maintainers, X-Rays, Sealants	100%	100%
Type II – Basic Services
Fillings, Simple Extractions, General Anesthesia, Oral Surgery, Endodontics	80%	80%
Type III – Major Services
Crowns, Inlays, Onlays, Bridges, Dentures, Periodontic, Implants, TMJ	50%	50%
Type IV – Orthodontic Services	50% (Child)	Not Covered
Calendar Year Deductible Applies to:
Individual	$50 single	$50 single
Family	$150 family	$150 family
Lifetime Orthodontia Maximum	$1,000	Not Covered

Employee Monthly Contributions

Coverage Tier	Enhanced Plan	Basic Plan
Single	$32.09	$29.74
Employee + Spouse	$61.79	$57.31
Employee + Child	$60.38	$57.23
Family	$111.51	$105.68

Vision

Vision Benefits

Overview

AGA offers vision coverage to you through VSP. Receive the maximum benefits and pay less out-of-pocket by visiting an in-network provider. The network includes provider access points nationwide. A comprehensive vision exam is available every 12 months and you may purchase eyewear in the form of an eyeglass frame and lenses, or contact lenses.

Class Description	In-Network	Out-of-Network
Eye Examination
Comprehensive exam of visual fuctions and prescription of corrective eye wear.	$10 Copay	$45 Allowance
Contact Lens Evaluation and Fitting	Up to $60 Copay	Not Covered
Elective	$130 Allowance	$105 Allowance
Medically Necessary	Covered in full	$210 Allowance
Materials/ Eye wear
Single Vision Eyeglass Lenses	$25 Copay	$30 Allowance
Lined Bifocal Eyeglass Lenses	$25 Copay	$50 Allowance
Lined Trifocal Eyeglass Lenses	$25 Copay	$60 Allowance
Lenticular Eyeglass Lenses	$25 Copay	$100 Allowance
Frame Allowance
Standard Frame	$130 Allowance + 20% off balance	$70 Allowance
Lens Upgrades
PolyCarbonate (single vision/multi-vision)	$31 / $35	Not Covered
Anti-Reflective (single vision/multi-vision)	$41 / $41	Not Covered
Scratch Resistant (single vision/multi-vision)	$17 / $17	Not Covered
Transitions / Photochromic (single vision/ multi-vision)	$75 / $75	$70 Allowance
Progressive Lenses
Tier 1	No-Copay	Not Covered
Tier 2	$95-$105	Not Covered
Tier 3	$150-$175	Not Covered
Laser Vision Correction	15% off Laser Correction	15% off Laser Correction

Employee Monthly Contributions

Coverage Tier	Rate
Employee Only	$11.41
Employee + Spouse	$15.86
Employee + Child(ren)	$16.11
Employee + Family	$23.52

Complete Participating Employer Agreement

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