Coverage Options

Medical: The Pool offers a flexible benefit program that allows you the choice of two different medical plan options.

High Deductible Health Plan: This Plan has the lowest monthly premium, but your out-of-pocket medical expenses may be the highest. To help you pay for these increases medical expenses, this plan option includes a Health Savings Account (HSA).

Dental: The Pool’s dental coverage offers you and your family a large network of Delta Dental PPO dentists. By using a PPO provider you will pay less out-of-pocket costs. However, members also have the choice of using a dentist outside of the Delta Dental network. If you receive services by an out-of-network provider, you will have to pay the difference between your dentist’s charges and Delta Dental’s allowable fee in addition to your normal percentage of cost.

Vision: The Pool also provides voluntary vision benefits. Avesis and VSP are the provider networks. If you elect this coverage, you can see an Avesis or a VSP provider and receive coverage for eye exams, lenses, and frames, depending on which provider network you are enrolled in.

Prescription: All medical options include the same prescription drug coverage, as listed in the Medical Benefits Highlights chart. Prescription drug benefits are paid based on a formulary. A formulary is a list of drugs that are covered under the plan. These medicines that are covered fall under three categories: generic, preferred brand name, and non-preferred brand name. If a drug is not on the list, it is not covered by the plan.

HDHP Participants: You must meet your annual deductible before the plan will pay medical and prescription drug benefits, with the exception of certain preventative medication and medical services not subject to the deductible.