Medical
CENTURY 21 Affiliated provides group health insurance through Dean Health Plan by Medica with three (3) HMO options. Under the HMO plan, you must see a provider within network for coverage. For more information on the health insurance and to find in-network providers, visit www.deancare.com .
OPTION
HMO OPTION 1
HMO OPTION 2
HMO OPTION 3
Network Name
Dean $5000 HMO
Dean $1000 HMO
Dean $500 HMO
Group Number
17FGHEG
17FGHEG
17FGHEG
Benefits
In-Network
Non-Network
In-Network
Non-Network
In-Network
Non-Network
Deductible Ind/Family
$5,000 / $10,000
N/A
$1,000 / $3,000
N/A
$500 / $1,000
N/A
$10 / $50 / $80 / 30% coinsurance
$10 / $50 / $80 / 30% coinsurance
$10 / $15 / $60 / 30% coinsurance
RX Benefit
Not Covered
Not Covered
Not Covered
PCP Office Visits
$20 Copayment
Not Covered
$20 Copayment
Not Covered
$25 Copayment
Not Covered
Specialty Office Visits
$60 Copayment
Not Covered
$60 Copayment
Not Covered
$25 Copayment
Not Covered
Chiropractic Services
$20 Copayment
Not Covered
$20 Copayment
Not Covered
$20 Copayment
Not Covered
Preventive Exams
$0 Copayment
Not covered
$0 Copayment
Not Covered
$0 Copayment
Not Covered
$20 copay and/or 20% coinsurance after deductible
$20 copay and/or 20% coinsurance after deductible
$25 copay and/or 20% coinsurance after deductible
Urgent Care
Emergency Room
$350 copay and/or 20% coinsurance after deductible
$350 copay and/or 20% coinsurance after deductible
$150 copay and/or 20% coinsurance after deductible
Hospital Services
20% coinsurance after deductible
20% coinsurance after deductible
20% coinsurance after deductible
Out-of-Pocket Maximum
$7,150 / $14,300
N/A
$4,000 / $12,000
N/A
$1,000 / $2,000
N/A
Employee Only $114.82 Employee / Spouse $386.81 Employee / Child(ren) $368.82 Family $611.70
Employee Only $216.96 Employee / Spouse $606.41 Employee / Child(ren) $578.21 Family $958.97
Employee Only $292.60 Employee / Spouse $769.04 Employee / Child(ren) $733.27 Family $1,216.15
Employee Monthly Premiums
Out-of-Pocket Maximum includes Deductible, Rx, Office, Urgent Care & Emergency Room Copays
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