MEDICAL COVERAGE
Baft Development Services LLC DBA Jan Pro offers the following plans through UnitedHealthcare.
Insurance Carrier:
UnitedHealthcare Medical Insurance
Medical Plan:
$1,000 Copay Plan
$3,500 Copay Plan
In-Network: Primary Care Visits
$25 Copay $75 Copay $50 Copay
$25 Copay $75 Copay $50 Copay
Specialist Care Visits
Urgent Care
Emergency Room Care
Deductible met; then 20% Coinsurance
Deductible met; then 20% Coinsurance
Preventative Visit Copay Diagnostic Testing (X-Ray / Blood Work)
$0
$0
Deductible met; then 20% Coinsurance
Deductible met; then 20% Coinsurance
Deductible met; then 20% Coinsurance
Deductible met; then 20% Coinsurance
Advanced Imaging
80%
80%
Plan Coinsurance
$1,000 $2,000 $4,500 $9,000
$3,500 $7,000 $8,150 $16,300
Employee Deductible
Family Deductible
Employee Out-of-Pocket Max
Family Out-of-Pocket Max
Deductible met; then 20% Coinsurance Deductible met; then 20% Coinsurance
Deductible met; then 20% Coinsurance Deductible met; then 20% Coinsurance
Inpatient Hospital
Outpatient Hospital or Facility
Out-of-Network Plan Coinsurance
50%
50%
Employee Deductible
$2,000 $4,000 $9,000 $18,000
$7,000
Family Deductible
$14,000 $16,300 $32,600
Employee Out-of-Pocket Max
Family Out-of-Pocket Max
Prescription Drugs 30-day supply Tier 1 - Generic
$10 Copay $35 Copay $75 Copay $250 Copay
$10 Copay $35 Copay $75 Copay $250 Copay
Tier 2 - Preferred
Tier 3 - Non-Preferred
Tier 4 - Specialty
Employee Bi-Weekly Deduction Employee Only
$294.72 $598.62 $543.37 $847.26
$240.17 $484.04 $439.70 $683.58
Employee + Spouse Employee + Child(ren)
Family
6 | Baft Development Services LLC DBA Jan Pro 2025 Benefits Guide
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