Employee Benefit Options
Medical Benefits
Overview
AGA offers three medical plan options administered by Blue Cross Blue Shield of Alabama. All plans are Preferred Provider Organization plans.
All 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 | Value PLUS | Silver | |
|---|---|---|---|
| Custom 5000 w/ MedPlus $500 ded $4,500 IP/OP Bucket |
Custom 5000 w/ MedPlus $2,000 ded $3,000 IP/OP Bucket |
Blue Custom 5000 | |
| Medical Benefits | In-Network Single/Family | In-Network Single/Family | In-Network Single/Family |
| Office Copay (PCP / SPC) | $35 / $50 | $35 / $50 | $35 / $50 |
| Calendar Year Deductible (Individual / Family) | $500 / $1,000 | $2,000 / $4,000 | $5,000 / $10,000 |
| Out-of-Pocket Maximum | $2,500 / $5,000 | $4,000 / $8,000 | $7,000 / $14,000 |
| Emergency Room | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Urgent Care | $35 Copay | $35 Copay | $35 Copay |
| Inpatient Facility | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Outpatient Facility | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Outpatient Diagnostics (X-ray/Lab) | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Outpatient Imaging (MRI, CAT, PET) | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Prescription Drugs | $15 / $60 / $100 / $425 | $15 / $60 / $100 / $425 | $15 / $60 / $100 / $425 |
Monthly Medical Premiums
| Rates and Enrollment | Premier | Value PLUS | Value |
|---|---|---|---|
| Employee Only | $733.67 | $701.99 | $658.93 |
| Employee + Spouse | $1,467.24 | $1,397.54 | $1,302.81 |
| Employee + Child(ren) | $1345.99 | $1,287.38 | $1,207.72 |
| Family | $2,079.60 | $1,982.97 | $1,851.64 |
Dental Benefits
Overview
AGA offers dental coverage to you through Canopy 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.
| Canopy (Enhanced) | Canopy (Basic) | |
|---|---|---|
| Out of Network Reimbursement | MAC | MAC |
| Deductible | In-Network | In-Network |
| Individual Deductible | $25 single | $50 single |
| Family Deductible | $75 family | $150 family |
| Maximums | ||
| Plan Maximum | $2,000 | $1,500 |
| Orthodontia Lifetime Maximum | $2,000 | $1,000 |
| Type I - Diagnostics & Preventatives | ||
| Exams, X-Rays, Fluoride, Routine Cleanings, Space Maintainers, Restoration | 100% | 100% |
| Waiting Period | None | None |
| Type II - Basic Services | ||
| Filings, Sealants, Simple Extractions, Emergency Treatment, Oral Surgery, Endo/Perio | 90% | 80% |
| Waiting Period | None | None |
| Type III - Major Services | ||
| Crowns, On-lays, Surgical Extractions, General Anesthesia | 60% | 50% |
| Waiting Period | None | None |
| Type IV - Orthodontic Services | ||
| Children Ages 8-19 | 50% | 50% |
Monthly Dental Premiums
| Rates and Enrollment |
Enhanced |
Basic |
|---|---|---|
| Employee Only | $38.00 | $31.00 |
| Employee + Spouse | $75.00 | $60.00 |
| Employee + Child(ren) | $94.00 | $58.00 |
| Family | $142.00 | $108.00 |
Vision Benefits
Overview
AGA offers vision coverage to you through Canopy (VSP Network). 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.
| Canopy | |
|---|---|
| Benefits | In-Network |
| Exams - Once every 12 Months | VSP |
| Eye Exam | $10 Copay |
| Contact Lens Fit & Follow-Up (Standard Fit) | Covered in Full |
| Lenses - Once Every 12 Months | |
| Single | $10 Copay |
| Bifocal | $10 Copay |
| Trifocal | $10 Copay |
| Lenticular | $10 Copay |
| Elective | $130 Allowance |
| Frames | |
| Standard Frames | $130 Retails Allowance |
| Contacts - Once Every 12 Months | |
| Medically Necessary | Covered in Full |
| Elective | $130 Retails Allowance |
Monthly Vision Premiums
| Rates and Enrollment | Rate |
|---|---|
| Employee Only | $11.23 |
| Employee + Spouse | $15.56 |
| Employee + Child(ren) | $15.80 |
| Employee + Family | $23.03 |
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 |
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 |
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.
| Benefits Class Description | In-Network | Out-of-Network |
|---|---|---|
| Eye Examination | ||
| Comprehensive exam of visual functions 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 |
For Employee Contribution Inquiries please reach out to your Southview Benefits consultant
Patrick Pittman:
patrick@southviewbenefits.com
(205) 215-8152
Medical Benefits
Overview
AGA offers three medical plan options administered by Blue Cross Blue Shield of Alabama. All plans are Preferred Provider Organization plans.
All 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 | Value PLUS | Silver | |
|---|---|---|---|
| Medical Benefits | In-Network Single/Family | In-Network Single/Family | In-Network Single/Family |
| Office Copay (PCP / SPC) | $35 / $50 | $35 / $50 | $35 / $50 |
| Calendar Year Deductible (Individual / Family) | $500 / $1,000 | $2,000 / $4,000 | $5,000 / $10,000 |
| Out-of-Pocket Maximum | $2,500 / $5,000 | $4,000 / $8,000 | $7,000 / $14,000 |
| Urgent Care | $35 Copay | $35 Copay | $35 Copay |
| Inpatient Facility | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Outpatient Facility | $500 CYD, then GAP Pays Up to $4,500 | $2,000 CYD, then GAP Pays Up to $3,000 | 80% coinsurance subject to CYD |
| Prescription Drugs | $15 / $60 / $100 / $425 | $15 / $60 / $100 / $425 | $15 / $60 / $100 / $425 |
Monthly Medical Premiums
| Rates and Enrollment | Premier | Value PLUS | Value |
|---|---|---|---|
| Employee Only | $733.67 | $701.99 | $658.93 |
| Employee + Spouse | $1,467.24 | $1,397.54 | $1,302.81 |
| Employee + Child(ren) | $1345.99 | $1,287.38 | $1,207.72 |
| Family | $2,079.60 | $1,982.97 | $1,851.64 |
Dental Benefits
Overview
AGA offers dental coverage to you through Canopy 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.
| Canopy (Enhanced) | Canopy (Basic) | |
|---|---|---|
| Out of Network Reimbursement | MAC | MAC |
| Deductible | In-Network | In-Network |
| Individual Deductible | $25 single | $50 single |
| Family Deductible | $75 family | $150 family |
| Maximums | $2,000 | $1,500 |
| Type I - Diagnostics & Preventatives | 100% | 100% |
| Type II - Basic Services | 90% | 80% |
| Type III - Major Services | 60% | 50% |
| Type IV - Orthodontic Services | 50% | 50% |
Monthly Dental Premiums
| Rates and Enrollment |
Enhanced |
Basic |
|---|---|---|
| Employee Only | $38.00 | $31.00 |
| Employee + Spouse | $75.00 | $60.00 |
| Employee + Child(ren) | $94.00 | $58.00 |
| Family | $142.00 | $108.00 |
Vision Benefits
Overview
AGA offers vision coverage to you through Canopy (VSP Network). 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.
| Canopy | |
|---|---|
| Benefits | In-Network |
| Exams - Once every 12 Months | VSP |
| Eye Exam | $10 Copay |
| Contact Lens Fit & Follow-Up (Standard Fit) | Covered in Full |
| Lenses - Once Every 12 Months | |
| Single | $10 Copay |
| Bifocal | $10 Copay |
| Trifocal | $10 Copay |
| Lenticular | $10 Copay |
| Elective | $130 Allowance |
| Frames | |
| Standard Frames | $130 Retails Allowance |
| Contacts - Once Every 12 Months | |
| Medically Necessary | Covered in Full |
| Elective | $130 Retails Allowance |
Monthly Vision Premiums
| Rates and Enrollment | Rate |
|---|---|
| Employee Only | $11.23 |
| Employee + Spouse | $15.56 |
| Employee + Child(ren) | $15.80 |
| Employee + Family | $23.03 |