You have four medical plan options: the Platinum Plan, Gold Plan, Silver Plan and the Bronze Plan. All plans are administered by BlueCross BlueShield (BCBS) and provide the maximum benefits when a BCBS provider is used for services. The ALVMA Platinum Plan and Silver Planincludes both primary and secondary insurance. The secondary plan does not cover office visits or prescription drug copays or home health services. NOTE: The out-of-pocket maximum excludes office visits and prescription drug co-pays.
Physician Office Visits Preventative Care Primary Care Specialist Office
100% Covered $45 Copay $65 Copay
100% Covered $40 Copay $60 Copay
100% Covered $45 Copay $65 Copay
100% Covered $45 Copay $65 Copay
Outpatient Services Outpatient Facility
$500 CYD, then GAP pays up to $3,500
$250 Copay
$2,000 CYD, then GAP pays up to $2,000
20% Coinsurance Subject to CYD
Diagnostics (X-ray / Lab)
$500 CYD, then GAP pays up to $3,500
$250 Copay
$2,000 CYD, then GAP pays up to $2,000
20% Coinsurance Subject to CYD
Mental Health / Substance Abuse
$500 CYD, then GAP pays up to $3,500
$250 Copay
$2,000 CYD, then GAP pays up to $2,000
20% Coinsurance Subject to CYD
Prescription Drugs Tier 1 Tier 2 Tier 3 Tier 4
$15 Copay $60 Copay $100 Copay $425 Copay
$15 Copay $50 Copay $100 Copay $395 Copay
$15 Copay $60 Copay $100 Copay $425 Copay
$15 Copay $60 Copay $100 Copay $425 Copay
Monthly Medical Premiums
Coverage Tier
Platinum (Includes Secondary)
Gold
Silver (Includes Secondary)
Bronze
Employee Only
$618.65
$696.49
$580.88
$536.32
Employee + Spouse
$1,284.03
$1,447.36
$1,203.19
$1,107.80
Employee + Child(ren)
$1,056.95
$1,176.15
$985.99
$902.26
Family
$1,788.15
$2,039.47
$1,683.02
$1,558.96
Dental Benefits
Overview
ALVMA 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.
Type I - Diagnostics & Preventatives Exams, Cleanings, Fluoride, 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, On-lays, Bridges, Dentures, Periodontics, TMJ
50%
50%
Type IV - Orthodontic Services
50%
N/A
Calendar Year Deductible Applies to: Individual Family
$25 Single $75 Family
$50 Single $150 Family
Lifetime Orthodontia Maximum
$1,000
Not Covered
Monthly Dental Premiums
Coverage Tier
Enhanced Plan
Basic Plan
Employee Only
$27.41
$23.29
Employee + Spouse
$54.85
$46.85
Employee + Child(ren)
$71.29
$60.01
Family
$103.51
$87.63
Vision Benefits
Overview
ALVMA offers vision coverage to you through Canopy (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.
Eye Examination Comprehensive exam of visual functions and prescriptions of corrective eye wear
$10 Copay
Contact Lens Evaluation and Fitting Elective Medically Necessary
Up to $60 Copay Covered in full
Material / Eye Wear Single Vision Eyeglass Lenses Lined Bifocal Eyeglass Lenses Lined Trifocal Eyeglass Lenses Lenticular Eyeglass Lenses
$15 Copay $15 Copay $15 Copay $15 Copay
Frame Allowance Standard Frame
$130 Allowance Covered + 20% Off Balance
Standard Progressive Lenses
Covered in full
Lens Enhancements
All lens enhancements are covered with a copay, saving an average of 30%
Monthly Vision Premiums
Coverage Tier
Rate
Employee Only
$11.35
Employee + Spouse
$16.37
Employee + Child(ren)
$16.65
Family
$25.00
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
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.
You have four medical plan options: the Platinum Plan, Gold Plan, Silver Plan and the Bronze Plan. All plans are administered by BlueCross BlueShield (BCBS) and provide the maximum benefits when a BCBS provider is used for services.
The ALVMA Platinum Plan and Silver Plan includes both primary and secondary insurance. The secondary plan does not cover office visits or prescription drug copays or home health services. NOTE: The out-of-pocket maximum excludes office visits and prescription drug co-pays.
ALVMA 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.
ALVMA offers vision coverage to you through Canopy (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.
