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Appendix and Legal Notices Summary of BenefitsGA/L/A/AFLAC CORPORATION:-PPO/NA/NA/01-17
*For more information about limitations and exceptions, see
plan
or policy document at https://eoc.bcbsga.com/eocdps/aso.
AFLAC INCORPORATED: PPO
Summary of Benefits and Coverage:
What this Plan Covers & What You Pay For Covered Services
Coverage Period:
01/01/2018 – 12/31/2018
Coverage for:
Individual + Family |
Plan Type:
PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share
the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only
a summary.
For more information about your coverage, or to get a copy of the complete terms of coverage,
https://eoc.bcbsga.com/eocdps/aso .
For general
definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You
can view the Glossary at
www.healthcare.gov/sbc-glossary/
or call (888) 893-6366 to request a copy.
Important Questions
Answers
Why this Matters:
What is the overall deductible?
$500/individual or $1,000/family for
In-Network Providers. $1,000/individual
or $2,000/family for Out-of-Network
Providers.
Generally, you must pay all of the costs from providers up to the deductible amount before
this plan begins to pay. If you have other family members on the plan, each family member
must meet their own individual deductible until the total amount of deductible expenses paid
by all family members meets the overall family deductible.
Are there services covered before
you meet your deductible?
Yes. Preventive care, Primary Care
visit, and Specialist visit for In-Network
Providers. Vision exam for In-Network
and Out-of-Network providers.
This plan covers some items and services even if you haven’t yet met the deductible amount.
But a copayment or coinsurance may apply. For example, this plan covers certain preventive
services without cost-sharing and before you meet your deductible. See a list of covered
preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for
specific services?
No.
You don't have to meet deductibles for specific services.
What is the out-of-pocket limit for
this plan?
$2,000/individual or $4,000/family for
In-Network Providers. $4,000/individual
or $8,000/family for Out-of-Network
Providers.
The out-of-pocket limit is the most you could pay in a year for covered services. If you have
other family members in this plan, they have to meet their own out-of-pocket limits until the
overall family out-of-pocket limit has been met.
What is not included in the out-of-
pocket limit?
Copayments, Deductibles, Services
deemed not medically necessary
by Medical Management and/or
Anthem, Penalties for non-compliance,
Premiums, balance-billing charges, and
health care this plan doesn’t cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a
network provider?
Yes, Blue Card PPO. See www.bcbsga.
com or call (888) 893-6366 for a list of
network providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s
network. You will pay the most if you use an out-of-network provider, and you might receive
a bill from a provider for the difference between the provider’s charge and what your plan
pays (balance billing). Be aware your network provider might use an out-of-network provider
for some services (such as lab work). Check with your provider before you get services.
REFERENCE Salary Redirection Managing Your Retirement 401(k) Plan Short- and Long-Term Disability Accidental Death and Dismemberment Group Term Life Flexible Spending Employee Assistance Program ADDITIONAL BENEF ITS Vision Plan Dental Plan Options Health Plan and Prescription Drug Benefits HEALTH AND WELLNESS PLANSHow to Apply for
Aflac Coverage
How to Make Your 2018 Benefits Elections 2018 Benefits Highlights 2018 BENEF ITS GUIDE About This Guide When to Enroll Glossary Quick Reference