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Home My Public Portal AboutAB 03-125 AttachmentHEALTH Plan Description Co-Pay Deductible Co-Insurance Out of Pocket Prescription Maternity Supp. Accident Preventative EAP Lifetime Max Family Status EE EE & SP EE, SP & 1 EE, SP & 2 EE, SP & 3 EE & 1 EE & 2 EE & 3 Blue Shield - Current Plan N/A $500 80/20 $2,000 $5/$15/$40 Yes $300 $250/24 8 Visits $1,000,000 Monthly Rates Blue Shield - Current Plan 205 425 500 570 638 280 350 418 Blue Shield - Renewal Plan N/A $500 80/20 $2,000 $5/20%/50% Yes $300 $250/24 8 Visits $1,000,000 Blue Shield - Renewal Plan 306 633 740 847 954 413 520 627 49% Increase Blue Cross - Recommended Plan N/A $500 80/20 $2,000 $10/$20, 30 Day Yes $500 Subject to Ded 8 Visits $1,000,000 Blue Cross - Recommended Plan 291 571 797 797 797 352 545 545 35% Increase VISION Plan Description Exam: Co-Pay Materials: Lenses Frames Contact Lens Laser Vision Corr. Additional Srvcs: Progressive Lens Oversize Lens Tinted or Coated Rate Guarantee Family Status EE Pacific Vision - Current Plan $10 (1 x per Yr) 25 Every Year Paid in Full (Every 2 Yrs) $120 Credit $320 Credit Paid by Patient 1 Year Monthly Rates Pacific Vision - Current Plan 8.9 Pacific Vision - Renewal Plan $10 (1 x per Yr) 25 Every Year Paid in Full (Every 2 Yrs) $120 Credit $320 Credit Paid by Patient 1 Year Pacific Vision - Renewal Plan 9.82 10.35% Increase Vision Services - Recommended Plan $10 (1 x per Yr) 25 Every Year Up to $120 (Every 2 Yrs) $25 then Paid in Full $105 Elect. Allow. 15% Discount Paid by Patient (Disc. Available) 2 Years Vision Services - Recommended Plan 9.38 5.4% Increase