US - Jagged Peak Benefit Guide 2018

TELEMEDICINE PROGRAM

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Employee Cost Per Pay Period

Employees who are enrolled in a company medical plan

$0.00

Employees who are NOT enrolled in a company medical plan

$3.23

MEDLINK SUPPLEMENTAL

MedLink is a supplemental plan which can be used with certain Jagged Peak medical plans. It helps cover a portion or all of the deductible. MedLink is only available for employees who are enrolled in medical plan Options 2, 3 or 4.

Base Plan MedLink Plan

Enhanced Plan MedLink Plan

MedLink covers up to the lesser amount of 100% of your deductible or $2,500 for inpatient hospitalization on day 1 of your policy ($2,500 per covered person up to $7,500 max per policy period) and up to the lesser amount of 50% of your deductible or $1,250 per covered person (up to $3,750 max per policy period) for outpatient surgical or diagnostic services performed at a hospital or hospital affiliated outpatient center.

MedLink covers up to the lesser amount of 100% of your deductible or $4,000 for inpatient hospitalization on day 1 of your policy ($4,000 per covered person up to $12,000 max per policy period) and up to the lesser amount of 50% of your deductible or $2,000 per covered person (up to $6,000 max per policy period) for outpatient surgical or diagnostic services performed at a hospital or hospital affiliated outpatient center.

Employee Cost Per Pay Period

Base Plan

Enhanced Plan

Employee Only

$ 22.71 $ 52.25 $ 43.16 $ 72.68

$ 29.76 $ 68.44 $ 56.54 $ 95.22

Employee + Spouse

Employee + Child(ren)

Family

5

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