Police Trust | Medical Supplement PLUS for Retired Members

- Medical
- Disability
- Medical Supplements
- Retired Medical
- Retired Dental
- Life
- Dental
- Vision

Medical Supplement PLUS for Retired Members

HMO Benefits

Your medical supplement will reimburse up to the following:

$500	Hospital admission
$150	Emergency room co-pay
$200	Outpatient co-pay
$40	Urgent Care
$50	Well Woman Benefit. One time per calendar year out of network only.
$100	Per day while in the hospital (up to 7 days per confinement).
$10/$30/$45	Prescription co-pays (up to $160 per person per year).

Doctor's visits up to $20 per visit with a $100 per person annual maximum benefit. Inpatient Mental Health and Allergy testing are treated as a Doctor's visit.

Vision Benefitup to $100 per covered person for contacts or eyeglasses. This benefit will be paid one time in a 12-month period. Will not pay for exam, exams are provided by Davis Vision with a $3 co-pay. Davis Vision 1-800-501-1459.

Supplement limited to $1500 per person annual maximum benefit.

Point of Service

POS supplement will pay up to 15% coinsurance after deductibles and co-payments. In addition the supplement will reimburse up to the following.

$50	Well Woman Benefit. One time per calendar year out of network only.
$100	Per day while in the hospital (up to 7 days per confinement).
$10/$30/$45	Prescription co-pays (up to $300 per person per year).

Doctor's visits up to $20 per visit with a $100 per person annual maximum benefit. Inpatient Mental Health and Allergy testing are treated as a Doctor's visit.

Vision Benefit*

Supplement limited to $1000 per person annual maximum benefit.