AtlantiCare 2025 Benefits Booklet

MEDICAL (CONT.)

Welcome.................................... 2 What’s New?............................. 3 How to Enroll........................... 4 Medical....................................... 6 Prescription Drug.................14 FQHC.........................................16 Additional Medical Plan Resources................................17 AtlantiCare Longevity Lifestyle Program................18 Dental.......................................20 Vision.........................................22 Life Insurance........................25 Disability..................................26 Voluntary Offerings.............27 Educational Support & Career Development..........27 Financial Well-being...........28 Health &Wellness................29 Savings.....................................31 Voluntary Benefits...............32 Spending Accounts.............35 Retirement Benefits............36 Contacts...................................38 Legal Notices.........................40 Wellness Checklist...............42

Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$50- 109,999k

$110.01k - $149,999k

$150,000- 199,999k

$50- 109,999k

$110.01k - $149,999k

$110,000- 199,999k

$0-49,999k

$200k+ $0-49,999k

$200k+

OMNIA Employee

$42.51 $53.13 $79.70

$95.64

$106.27 $85.02 $100.96 $148.78 $185.97 $212.54

Employee + Spouse Employee + Child(ren)

$76.51 $95.64 $143.46 $172.16 $191.28 $153.03 $181.72 $267.80 $334.75 $382.57

$59.51 $74.39 $111.58 $133.90 $148.78 $119.02 $141.34 $208.29 $260.36 $297.55

Family

$119.02 $148.78 $223.17 $267.80 $297.55 $238.04 $282.68 $416.58 $520.72 $595.11

PPO Employee

$142.97 $167.30 $197.72 $215.97 $234.23 $188.60 $219.02 $267.69 $316.36 $365.03

Employee + Spouse Employee + Child(ren)

$257.34 $301.15 $355.90 $388.75 $421.61 $339.47 $394.23 $481.83 $569.44 $657.05

$200.16 $234.23 $276.81 $302.36 $327.92 $264.04 $306.62 $374.76 $442.90 $511.04

Family

$400.31 $468.45 $553.62 $604.73 $655.83 $528.07 $613.24 $749.52 $885.80 $1,022.07

*$25 surcharge will be added to your bi-weekly deductions if you utilize tobacco products. A Spouse & Partner Preferred Choice Premiummay also apply. See page 8 for details.. ** Note, salary changes may result in changes to your contribution rate

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