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July 22, 2014
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Visit iaff.org/!
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Visit www.ci.el-paso.tx.us/government.asp!
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Retirees

Breakfast Meetings
May 22, 2008

Come Join the EPFD Retirees for Breakfast

Every 3rd Wednesday of the Month

Hometown Buffet at 9120 Viscount

Contact Pilo at 755-5725


Retiree Insurance Enrollment Summary
Jun 13, 2008

RETIREE INSURANCE ENROLLMENT SUMMARY

CITY OF EL PASO INSURANCE & BENEFITS DIVISION       PHONE #541-4208         3RD FLOOR CITY HALL

Rates effective from September 1, 2008December 31, 2009

 C  I  T  Y    H  E  A  L  T  H    P  L  A  N      ADMINISTRATOR – AETNA Inc.  (877) 800-8682  or www.AETNA.com

            AETNA REPRESENTATIVE LOCATED AT CITY HALL, 3RD FLOOR: GABRIELA ZUÑIGA  541-4117

 

 

MEDICAL PLAN

 

  BASIC PLAN

 

 

WITH

MEDICARE

 

 

WITHOUT

MEDICARE

 

 

 

     BUY-UP PLAN

 

WITH

MEDICARE

 

 

WITHOUT

MEDICARE

 

 

RETIREE

ONLY

 

 

 

 

 

$166.56

 

 

 

$333.14

MONTHLY

 

 

 

 

$202.24

 

 

 

$404.46

 

MONTHLY

 

 

RETIREE

+1

 

 

 

 

 

$333.14

 

 

 

$666.29

MONTHLY

 

 

 

 

$404.46

 

 

 

$808.93

 

MONTHLY

 

 

RETIREE+2 OR MORE

 

 

 

 

 

$499.71

 

 

 

 

 

$999.42

MONTHLY

 

 

 

 

 

 

 

 

 

$606.69

 

 

 

$1,213.39

 

 

 

 

 

 

MONTHLY

 
PREFERRED

ANY DOCTOR OR HOSPITAL ON AETNA  LIST

 

 

$ 1000.00 DEDUCTIBLE 

80% COVERAGE

 

$ 20.00 CO-PAY:

GP, FAMILY,INTERNAL, & PEDIATRICS

 

$ 30.00 CO-PAY:  SPECIALIST

 

 

 

$ 300.00 DEDUCTIBLE

 90% COVERAGE

 

$ 20.00 CO-PAY:

GP, FAMILY,INTERNAL, & PEDIATRICS

 

$ 30.00 CO-PAY : SPECIALIST

 

 
   NON-PREFERRED

DOCTOR / HOSPITAL NOT ON AETNA LIST

 

 

 

$ 3000.00 DEDUCTIBLE

 

50%COVERAGE

 

 

 

 

 

 

 

 

$ 1000.00 DEDUCTIBLE

 

50%COVERAGE

 

 

 

PRESCRIPTIONS THROUGH MEDCO: 30-DAY

$15.00 GENERIC, $30.00 BRAND PREFERRED & $45.00 BRAND NON-PREFERRED

MAIL ORDER THROUGH MEDCO: 90 – DAY

$30.00 GENERIC, $60.00 BRAND PREFERRED & $90.00 BRAND NON-PREFERRED

QUEST LABORATORIES WILL BE THE ONLY IN- NETWORK (POS) PREFERRED LAB PAID AT 100%

D E N T A L  & V I S I O N   P L A N S   SAFEGUARD: 1-800-880-1800   UNITED CONCORDIA:1-800-332-0366

BLOCK VISION:  1-866-265-0517 CITY ACCOUNT REPRESENTATIVE:  JESSICA CONCHA  541-4692 OR MARC HERNANDEZ 542-3531

 

SAFEGUARD

D-HMO PLAN

DENTAL CARE

 

 

RETIREE

ONLY

 

 $8.35

RETIREE

+ 1

 

$15.45

RETIREE + 2 OR MORE

 

$19.62

DENTIST MUST BE SELECTED FROM DENTAL PLAN LIST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNITED

CONCORDIA DENTAL WITHOUT

ORTHODONTICS

RETIREE

ONLY

 

 

$19.43

RETIREE

+ 1

 

 

$40.00

RETIREE + 2 OR MORE

 

 

$64.81

 

 

 

 

 

 

 

 

 

 

UNITED

CONCORDIA

DENTAL 

WITH ORTHODONTICS

 

RETIREE

ONLY

 

 

$20.39

RETIREE

+ 1

 

 

$43.29

 

RETIREE + 2 OR MORE

 

 

$77.54

 

 

 

BLOCK

VISION

RETIREE

ONLY

 

 

$4.98

RETIREE

+ 1

 

 

$8.72

 

RETIREE + 2 OR MORE

 

 

$12.95

HAS A VISION PROVIDERS LIST.  CAN GO OUT-OF-NETWORK WITH DIFFERENT COVERAGE.

CONTACT BLOCK FOR AN OUT OF NETWORK CLAIM FORM

RETIREES MAY ONLY ENROLL INTO THE MEDICAL, DENTAL OR VISION PLANS THEY ARE COVERED UNDER AT THE TIME OF THEIR RETIREMENT. RETIREES MAY COVER ONLY THOSE DEPENDENTS COVERED UNDER THEIR PLAN AT THE TIME OF RETIREMENT. ONCE A RETIREE CANCELS THEIR COVERAGE OR THE COVERAGE OF A DEPENDENT THAT COVERAGE CANNOT BE REINSTATED. NO NEW DEPENDENTS MAY BE ADDED AT ANY TIME.

           

 




Page Last Updated: May 22, 2008 (17:01:23)
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