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Home | Benefits Coverage | 1400 Hour Employees | Medical | Plan Comparison

Medical Plan Comparison

The chart below provides a high-level comparison of JBT-sponsored medical plan benefits. This is a summary only, and shows what you can expect to pay for health care services. For more detailed descriptions of plan benefits, review the following documents:

Medical Plan Comparison Chart

Frequently Asked Questions

JBT Medical PPO Plan

Kaiser Permanente HMO

PacifiCare HMO

Preferred Provider

Non-Preferred Provider

Provider Choice

Use an Anthem Blue Cross preferred provider and receive higher benefits

Use a non-preferred provider and receive lower benefits

Use of Kaiser Permanente HMO providers and facilities required

Use of PacifiCare HMO providers and facilities required

Calendar Year Deductible

$200 per person
$500 per family

$400 per person
$1,000 per family

$500 per individual
$1,000 per family

No deductible

You must satisfy a separate deductible for preferred and non-preferred care. The deductible does not apply to certain services.

Annual
Out-of-Pocket Maximum

$2,000 per individual

$4,000 per individual

$3,000 per individual
$6,000 per family

$5,000 per individual
Three individual maximums per family

Once you reach $2,000 in annual out-of-pocket expenses, claims can be submitted to JBT for reimbursement until reaching $5,000. Thereafter, Pacificare will pay covered expenses at 100%.

Preferred and non-preferred out-of-pocket maximums accumulate separately

Doctor Office Visits

No charge after $20 copayment (no deductible)

30% of covered charges after deductible plus any amount over the plan’s reasonable and customary limit

$10 copay per visit

(No copay per visit for prenatal care and first post-partum visit)

$20 copay per visit for primary care physician

$40 copay per visit for specialist

Well Baby

Not covered

No copay for child 23 months or younger

No copay for child under 2 years of age

Annual Physicals

Annual physicals not covered. However, if you are eligible for the myhealthIQ program, you can receive your myhealthIQ screening (provided at your worksite). You are also eligible for enhanced preventive care benefits if you complete the myhealthIQ screening process.

$10 copay

$20 copay (1 visit per year)

Inpatient Hospital

No charge for covered services after deductible

30% of covered charges after deductible plus any amount over the plan’s reasonable and customary limit

(Failure to use a PPO and pre-authorize a non-emergency admission will result in substantial penalties)

10% of covered charges after deductible per admission

50% copay per admission

Outpatient Surgery

20% of covered charges after deductible

30% of covered charges after deductible plus any amount over the plan’s reasonable and customary limit

(You must use a PPO facility or benefits will be reduced 50%)

10% of covered charges after deductible per procedure

50% copay per occurrence, including oral surgery

Surgeon/
Anesthesiologist

20% of covered charges after deductible

30% of covered charges after deductible plus any amount over the plan’s reasonable and customary limit

10% of covered charges after deductible per procedure

50% copay per occurrence

Laboratory/
X-rays

20% of covered charges after deductible

30% of covered charges after deductible plus any amount over the plan’s reasonable and customary limit

$10 copay per visit after deductible is met

$50 copay per procedure for MRI, PET, CT

No charge for routine diagnostic procedures

$200 for specialized scanning

Prescription Drugs

Prescriptions dispensed in accordance with CVS/Caremark drug list

Participants must use their CVS/Caremark ID card and a network pharmacy/mail order

Retail (30-day supply)
$10 generic
$20 preferred brand-name
$35 non-preferred

Mail Order (90-day supply)
$20 generic
$40 preferred brand-name
$70 non-preferred

Note: If you receive a preferred brand-name or non-preferred drug when a generic equivalent exists, you pay the higher copayment plus the difference in cost between the two drugs.

Prescriptions dispensed in accordance with Kaiser formulary drug list

Retail (30-day supply)
$10 generic
$30 preferred brand-name

Mail Order (100-day supply)
$20 generic
$60 preferred brand-name

Prescriptions dispensed in accordance with PacifiCare formulary drug list

Retail (30-day supply)
$15 generic
$35 preferred brand-name

Mail Order (3 units or
90-day supply)
$30 generic
$70 preferred brand-name

Emergency Care

See hospital inpatient and outpatient surgery benefits above. Emergency room and urgent care center charges are paid the same as inpatient care if you are admitted directly to a hospital. Otherwise they will be paid as any other outpatient service.

10% of covered charges after deductible

$100 copay per visit; notification of primary care physician within 24 hours is required

Chiropractic Care

$20 per visit for office visit, then 20% of covered charges after the deductible for any x-rays

30% of first $50 in charges after the deductible plus any charges in excess of $50 per visit

Not covered

Not covered

$680 maximum benefit per calendar year

Orthotic Devices

Not covered

20% of covered charge; shoes and arch supports not covered

Not covered


This summary chart is provided for comparison purposes only. Refer to the Summary Plan Description (1.1 MB PDF) for exclusions, limitations and exact terms and conditions. Each HMO contains exclusions and limitations not listed above. Each HMO’s Plan Contract and Combined Evidence of Coverage and Disclosures must be consulted to determine the exact terms and conditions. HMOs furnish these documents upon request.

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The information on this website is intended only to provide highlights of the benefits available under the Joint Benefit Trust. Complete information about the Plan is contained in the governing Plan documents and any applicable insurance contracts. In the event of any inconsistency between the information on this website and the official Plan documents, the terms of the official Plan documents will govern. The Joint Benefit Trust reserves the right to amend, modify, or terminate all or part of the Plan at any time.

Page modified on 4/24/12 5:26 PM