Overview of Available Plans

Review the benefits available to you and your dependents, compare plan options, and make informed enrollment decisions.

Overview of Available Plans

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Your Benefits at a Glance

Medical

Plan: PPO $1,700
Carrier: BCBSTN

Medical

Plan: PPO $2,700
Carrier: BCBSTN

Medical

Plan: HDHP $2,200
Carrier: BCBSTN

Medical

Plan: HDHP $3,500
Carrier: BCBSTN

Medical

Plan: HDHP $4,700
Carrier: BCBSTN

Dental

Plan: High Plan
Carrier: Delta Dental of TN

Dental

Plan: Low Plan
Carrier: Delta Dental of TN

Vision

Plan: VSP Choice Plan
Carrier: VSP

Benefit	Plan	Carrier
Medical	PPO $1,700	BCBSTN
Medical	PPO $2,700	BCBSTN
Medical	HDHP $2,200	BCBSTN
Medical	HDHP $3,500	BCBSTN
Medical	HDHP $4,700	BCBSTN
Dental	High Plan	Delta Dental of TN
Dental	Low Plan	Delta Dental of TN
Vision	VSP Choice Plan	VSP

Medical Premiums

PPO $1,700

Employee: $52.58
Employee + spouse: $165.40
Employee + children: $100.64
Employee + family: $171.67

PPO $2,700

Employee: $39.80
Employee + spouse: $138.67
Employee + children: $76.60
Employee + family: $132.56

HDHP $2,200

Employee: $36.15
Employee + spouse: $129.41
Employee + children: $68.67
Employee + family: $119.58

HDHP $3,500

Employee: $19.47
Employee + spouse: $99.48
Employee + children: $36.99
Employee + family: $70.92

HDHP $4,700

Employee: $0
Employee + spouse: $90.21
Employee + children: $28.61
Employee + family: $56.79

Plan	Employee	Employee + spouse	Employee + children	Employee + family
PPO $1,700	$52.58	$165.40	$100.64	$171.67
PPO $2,700	$39.80	$138.67	$76.60	$132.56
HDHP $2,200	$36.15	$129.41	$68.67	$119.58
HDHP $3,500	$19.47	$99.48	$36.99	$70.92
HDHP $4,700	$0	$90.21	$28.61	$56.79

*Medical rates shown are discounted non-tobacco rates.

Dental Premiums

High Plan

Employee: $5.21
Employee + spouse: $9.35
Employee + children: $11.80
Employee + family: $18.61

Low Plan

Employee: $1.81
Employee + spouse: $2.44
Employee + children: $3.93
Employee + family: $5.70

Plan	Employee	Employee + spouse	Employee + children	Employee + family
High Plan	$5.21	$9.35	$11.80	$18.61
Low Plan	$1.81	$2.44	$3.93	$5.70

Vision Premiums

VSP Choice Plan

Employee: $1.06
Employee + spouse: —
Employee + children: —
Employee + family: $2.92

Plan	Employee	Employee + spouse	Employee + children	Employee + family
VSP Choice Plan	$1.06	—	—	$2.92

Frequently asked

Overview of Available Plans

Overview of Available Plans

Your Benefits at a Glance

Medical Premiums

Dental Premiums

Vision Premiums

Key Benefit Terms

Copayment

Coinsurance

Deductible

Formulary

In-network

Out-of-network

Out-of-pocket maximum

High Deductible Health Plan (HDHP)