Health Plan Benefits and Rates Effective January 1, 2007

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Health Insurance benefits for 2007 will continue with CareFirst BlueChoice. There will be no changes to the medical plan benefits. Rates for the 2007 plan year and a summary of plan benefits are below.

Rates for 2007
(5% increase over 2006)

HEALTH PLAN RATES (Combined Medical and Dental Coverage)	2006 Rates	2007 Monthly Rates	2007 Yearly Rates
Individual	568	597	7164
2-per family	1135	1191	14292
Family	1507	1582	18984
Medicare	302	*349 (Adj.)**	4188
*2007 Medicare rate includes Dental. Dental was not inadvertently omitted in the 2006 rates.)
DENTAL ONLY RATES	2006 Rates	2007 Monthly Rates	2007 Yearly Rates
Individual (Same for Medicare)	28	29	348
2-per family	55	59	708
Family	73	79	948

The following is a summary of plan benefits. There have been no changes this year.

Medical Benefits

In-network office visit co-pays are $15 primary care/$25 specialist with 100% coverage
Out of network coverage is available after satisfying a $500 per member ($1000 per family) deductible. After meeting the deductible benefits will be paid at 80% (20% member responsibility)
Prescription drugs

Retail - $50 deductible, then $15 generics/$25 preferred brand/$40 non-preferred brand
Mail order - $50 deductible, then $30 generics/$50 preferred brand/$80 non-preferred brand (Please remember, most mail order offers a 90 day supply while retail is typically a 30 day supply. Therefore, mail order co-pays are 2x retail co-pay. You get one month free.)

Dental Benefits

Dental is covered under four levels. Coverage is based on the UCR (Usual, Customary, and Reasonable) fees. A dental provider does not have to participant with CareFirst. There are some dentists that participate and will accept their UCR fees. Receiving dental care from a preferred dentist will save on out-of-pocket cost.

Below is a general overview of the Dental Plan. For more detailed information, download the Dental Plan Summary [pdf].

Level I: Preventive and Diagnostic Services -- covered at 100% of UCR
Oral Exams (Two Per Benefit Period)
X-Rays
Fluoride Treatments

Level II: Complex Surgical and Endodontic Services – covered at 80% UCR
Direct placement fillings
Simple extractions

Level III: Periodontal and Major Restorative Services – covered at 50% UCR
Oral Surgery
Endodontics (i.e. root canal therapy)
General Anesthesia

Level IV: Major Services – Restorative – Covered at 50% UCR
Full and/or partial dentures; Denture adjustments and relining
Fixed and/or Re-cementation, of Bridges crowns, inlays and onlays

Level V: Orthodontic Services – covered at 50% UCR with maximum of $800
Diagnosis
Active treatment (necessary appliances and progress X-rays)
Retention treatment following active treatment