2023 AtlantiCare Benefits Booklet

Medical

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-14 PRESCRIPTION DRUG. ................15-17 ADDITIONAL MEDICAL PLAN RESOURCES........18-22 DENTAL...............23-24 VISION.....................25 LIFECENTER..............26 LIFE INSURANCE. .....27 DISABILITY...............28 VOLUNTARY OFFERINGS. ........29-32 SPENDING ACCOUNTS. ............33 RETIREMENT BENEFITS..................34 WELLNESS. .........35-38 LEGAL NOTICES...39-41 GLOSSARY..........42-43 FAQs...................44-46 CONTACTS.........47-48 FORMS................49-58

2023 Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$0-49,999k $50-109,999k $110,000-199,999k

$200k+

$0-49,999k $50-109,999k $110,000-199,999k $200k+

Horizon Engaged Plan

Employee

$40.68 $49.22

$90.73

$100.36 $81.21 $93.61

$181.45

$200.70

Employee + Spouse

$69.65 $84.29

$155.37

$171.86 $139.08 $160.30

$310.73

$343.69

Employee + Child(ren)

$56.14 $67.94

$125.26

$138.53 $112.10 $129.21

$250.45

$277.03

Family

$111.23 $134.59

$248.09

$274.45 $222.08 $255.97

$496.18

$548.82

Horizon PPO

Employee

$161.94 $178.54

$222.53

$231.85 $191.77 $211.43

$345.10

$360.65

Employee + Spouse

$277.33 $305.76

$381.08

$397.03 $328.42 $362.07

$592.82

$617.63

Employee + Child(ren)

$223.53 $246.46

$307.18

$320.05 $264.72 $291.84

$477.81

$497.81

Family

$442.85 $488.24

$608.54

$634.01 $524.42 $578.16

$946.62

$986.26

*$25 surcharge will be added to your bi-weekly deductions if you utilize tobacco products. A Spouse & Partner Preferred Choice Premium may also apply. See page 9 for details. ** Note, salary changes may result in changes to your contribution rate

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