Health Insurance designed exclusively for the Employees of The Red Caboose Restaurant
- HOSPITAL CONFINEMENT
Pays the daily benefit of $100.00 for hospital confinement due to injury or sickness from the first day up to 180 days. - FIRST HOSPITAL CONFINEMENT BENEFIT
Pays the benefit amount up to $5,000.00 for the insured’s first hospital confinement for a covered sickness or injury during the calendar year based on the total number of days of hospital confinement. The benefit is not cumulative.- 1 day - $500.00
- 2 days - $1,000.00
- 3 days - $2,000.00
- 4 days - $3,000.00
- 5 days - $4,000.00
- 6 days - $5,000.00
- SURGICAL PLUS BENEFIT
Pays the percentage listed in the surgical schedule times the total benefit of $3,000.00 for surgery preformed due to a covered injury or illness by a physician in an approved facility.- MAMMOGRAPHY SCREENING – Pays $70.00
- PAP SMEAR – Pays $30.00 (1 test per year for ages over 18 years)
- EMERGENCY ACCIDENT
Pays up to $100.00 for emergency care rendered within 72 hours of the injury by a physician in a hospital emergency room, urgent care or the physician’s office. The benefit amount will be paid up to 4 times per calendar year. - OUTPATIENT SICKNESS
Pays up to $75.00 for treatment in an out-of-hospital facility (including a physician’s office) due to sickness. The benefit will pay up to $112.50 for sickness for treatment in a hospital emergency room. The benefit will pay up to 4 different sicknesses per calendar year. - SPECIFIED INJURY BENEFIT
Pays a specific amount for covered injuries for scheduled injuries up to $1,800.00. (Includes: Appliances, ambulance, blood/plasma, burns, dislocation, eye injuries, fractures, ruptured disk, tendons/ligaments, torn knee cartilage, gunshot wound) See Schedule
Dental Plan designed exclusively for the Employees of The Red Caboose Restaurant
- BENEFIT AMOUNT
Pays up to $1,000.00 per individual per calendar year. - PREVENTIVE DENTAL SERVICES
Pays for the following benefits at 100%-paid based on the average charges for our area.- Two evaluations per calendar year
- Two cleanings per calendar year
- Fluoride for children (under age 19)
- Space maintainers
- X-rays
- Bitewings (allowed twice per calendar year)
- BASIC DENTAL SERVICES ($50. annual deductible)
- Sealant-per tooth-once during a 3-year period (Age 16 and under) $21.00
- Amalgam restoration (silver filling) one surface, primary/permanent $48.00
- Extraction-erupted tooth or exposed root (elevation forceps removal) $54.00
- Surgical removal of tooth (completely bony) $200.00
- Denture Repair-Repair broken base $61.00
- Deep sedation/general anesthesia $154.00
- MAJOR DENTAL SERVICES
($50. annual deductible, 12 mo.- waiting period)
- Maxillary partial denture-resin base $166.00
- Endodontics – root canal, anterior $129.00
- Periodontal scaling & root planning-limited (per quadrant)-every 2 yrs. $43.00
- Crown-full cast noble metal $187.00
- Crown-repair $36.00
- Pontics-porcelain fused to noble metal $192.00
Vision Plan designed exclusively for the Employees of The Red Caboose Restaurant
- BENEFIT SERVICES
All covered services are offered once in a 12-month period. The services include:- Examination $45.00
- Frames $65.00
- Lenses (per pair of lens-patient pays the remainder)
- Single $40.00
- Bifocal $60.00
- Trifocal $75.00
- No line bifocal or progressive power or lenticular $80.00
- Contact Lenses $110.00
- PLAN DEDUCTIBLE
The plan has a lifetime per person deductible of $65.00 on frames and contact lenses only.
Premium Options designed exclusively for the Employees of The Red Caboose Restaurant
Employee participation in Medical and Dental $43.52/month $2.94 additional monthly for Vision.
Optional Premiums to be paid by employee
| Employee and Spouse | Employee and Child | Family | |
Medical: |
$57.54 | $44.89 | $103.23 |
Dental: |
$26.36 | $36.40* | $62.76 |
Vision: |
$5.08 | $5.08 | $10.08 |