On this page: Deductibles/Maximums - Preventive Care - Dr. Visits and Related Benefits - Hospital and Facility Benefits - Mental Illness/Substance Abuse Benefits
Hospital/Medical Benefits for Working Participants & Families
Basic Explanation of Benefit	Once you become eligible under the Plan, your health care expenses will be reimbursed at the percentages shown below (60%-100%) under the Plan's comprehensive major medical set of benefits, subject to rates, deductibles, maximums, and limitations of the program.
PPO Plan	Click here to Find Network Providers The Plan uses a Preferred Provider Organization (PPO Network) of physicians and hospitals. There are different networks and reimbursement levels available based on the location you receive medical services and the type of service you receive. In general, it will be preferable for you to use a PPO provider whenever possible, because you receive a higher level of reimbursement when you use a PPO provider.
Cost Containment	Your Plan is designed to provide Participants with financial protection from significant health care expenses. To enable the Plan to provide coverage in a cost-effective way, the Plan has adopted Utilization Management Programs, including a pre-certification review of proposed health care services before the services are provided. These programs are designed to help control increasing health care costs by not paying benefits for services that are not Medically Necessary. By doing this, the Plan is better able to continue to maintain its level of benefits.
Deductibles and Maximums
	Employee	Family
Annual Deductible	$100	$200
Lifetime Maximum	$1,000,000	$1,000,000 (each)
Mental Illness/Substance Abuse Specific Max. Lifetime Benefit	$50,000	$50,000 (each)
Annual Out-of-Pocket Maximum	$2,000	$4,000
NON-PPO Hospital Deductible	$1,000	$1,000
Preventive
Routine Physicals and Well Child Care	100% up to $300 per year per person; not subject to annual deductible
Immunizations	100% up to $500 per year per person; not subject to annual deductible
Doctor Visits/Professional Services & Supplies
Dr. visits (anywhere), physical/speech therapy, Cardiac rehab, ambulance service	70%
Surgeon and Assistant Surgeon	70% Charges for surgeries performed at non-PPO facilities in the Anchorage area are limited to the PPO negotiated rate. Benefits for all charges related to surgery are subject to rules regarding precertification and to rules about reimbursement for services rendered on an inpatient versus outpatient basis. Check the SPD, section 5.9 when arranging for a surgery.
Chiropractic	70% for up to 10 visits per calendar year
Physical/Occupational Therapy	70% for up a combined benefit limitation of 20 visits per calendar year
Hearing Aid Benefit	70% Up to $800 per ear during any 3 consecutive years
Home Health Care	80% for PPO 70% of PPO rate for non-PPO in Anchorage 70% for non-PPO outside of Anchorage
Hospital and Facility Benefits
	PPO	Non-PPO
In Anchorage	80%	70% of PPO-rate after additional $1,000 deductible
In Alaska (outside of Anchorage)	80%	70%
Outside Alaska	N/A	70%
Emergency Room	Emergency room treatment is highly expensive! You should avoid using the emergency room except in cases of bona fide emergency. If the doctor's office or an urgent care clinic is available, use that facility first. Emergency room charges are only covered for real Emergencies and only when alternate facilities are not available.
Facility Charges related to Surgery	Benefits for all charges related to surgery are subject to rules regarding precertification and to rules about reimbursement for services rendered on an inpatient versus outpatient basis. Check the SPD, section 5.9 when arranging for a surgery.
Skilled Nursing Facility	80% up to 365 days
Hospice	80%
Mental Illness/Substance Abuse
Separate Maximum Lifetime Benefit	$50,000
Inpatient detoxification	3 days per confinement subject to lifetime limit of 2 confinements
Inpatient Treatment	30 days per calendar year
Outpatient Treatment	26 visits per calendar year