Health Care Plans

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A summary of the benefits provided by the Ohio AFSCME Care Plan and Ohio AFSCME Legal Care Plan are as follows:


Life Insurance Benefit Level I

Coverage in amounts between $14,000 and $30,000
Accidental Death and Dismemberment Benefit
Dependent Coverage- $2,000
Spouse coverage - $2,000
Child coverage - $2,000 to age 19 (up to 23 years if full-time student)
Disability Life Insurance Extension
Accelerated Death Benefit
Seat Belt Benefit
For full details click here
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Life Insurance Benefit Level II

Amount of Life Insurance – Member $50,000
Amount of Accidental Death & Dismemberment $26,000
Dependent Coverage - $2,000
Spouse coverage - $2,000
Child coverage - $2,000 to age 19 (23 years if a full-time student)
Disability Life Insurance Extension
Accelerated Death Benefit
Seat Belt Benefit

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Prescription Drug Refund Benefit

Covers Employee, Spouse and Dependent Children.
90% reimbursement on each prescription.
$500.00 maximum each year per family member.

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Prescription Card Plan


Covers Employee, Spouse and Dependent Children.

Plan covers 90 percent of the cost of the perscription.

Co-pay of 10% of cost at the pharmacy.
$2,000.00 maximum each year per family member.
An Employer can agree to make contributions to the Care Plan to provide coverage for the cost of prescription drugs in excess of the $2,000.00 maximum each year on an individual basis.

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Vision Care Benefit Level I

Covers Employee, Spouse and Dependent Children. Adults once every 24 consecutive months and children under the age of 19 once every 12 consecutive months.
Covers Exam (including Glaucoma testing), standard frames, basic single vision, bifocal or trifocal lenses at no cost when provider network used.
Provides an allowance for contact lenses.

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Vision Care Benefit Level II

Covers Employee, Spouse and Dependent Children once every 12 consecutive months.
Covers Exam (including Glaucoma testing), standard frames, basic single vision, bifocal or trifocal lenses at no cost when provider network used.
Provides an allowance for contact lenses.

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Vision Care Benefit Level III

Covers Employee, Spouse and Dependent Children once every 12 consecutive months.
Covers Exam (including Glaucoma testing), standard frames, basic single vision, bifocal or trifocal lenses at no cost when provider network used.
Provides an allowance for contact lenses.
Additional covered services include:
Polycarbonate lenses
No-line Bifocals (Basic)
Ultra light lenses
Scratch coating
Tints (Basic)

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Hearing Aid Benefit

Covers Employee, Spouse and Dependent Children (Benefits are payable once every 4 years)
$80.00 toward an examination by a doctor (otologist)
$800.00 toward the purchase of a Hearing Aid, Ear Mold and the services of an Audiologist for each ear.

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Dental Care Benefit Level I

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment according to fee schedule
No deductible

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Dental Care Benefit Level II

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment according to fee schedule
$1,500.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member. No deductible

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Dental Care Benefit Level III

Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment will be made based on applying the following schedule of benefit percentages to the lesser of the UCR or the actual amount charged.
Diagnostic/Preventive 100% UCR
Minor Restorative 80% UCR
Major Restorative 50% UCR
$2,000.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member. No deductible

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Dental Care Benefit Level IV


Covers Employee, Spouse and Dependent Children
Open Panel (choose your own dentist)
Payment will be made based on applying the following schedule of benefit percentages to the lesser of the UCR or the actual amount charged.
Diagnostic/Preventive 100% UCR
Minor Restorative 80% UCR
Major Restorative 60% UCR
$2,000.00 Orthodontic Benefit for Dependent Children under the age of 19
Annual Maximum Benefit – $4,000.00 per each family member No deductible
Certificate booklets which contain a complete description of the covered benefits and any exclusions, are available from any Ohio AFSCME Care Plan office.


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Employee Assistance Program Level I                                                                   
 

Covers Employee, Spouse and Dependent Children

Provides confidential counseling and referral assistance 24/7

Phone counseling by masters and doctoral-level clinicians - up to 3 calls per problem per year

Password protected online access to Employee Assistance related services  

 

Click here for more information on ComPsych GuidanceResources  

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