At Sargent, employees have the option to adjust their coverage in order to customize their benefits to fit their personal needs. For example, employees may choose medical coverage for just themselves, while at the same time, choosing family vision coverage.
Blue Cross / Blue Shield
Medical – Employees can choose from three PPO Medical Plans administered by Blue Cross/Blue Shield. Current coverage includes but is not limited to (and may change as the benefit plans change):
|
Plan Provision (in network)
|
90/10
|
80/20
|
CDHP w/HRA
|
|
Annual Deductible
Individual
Family
HSA Provided by Dover
Individual
Family
|
$250
$750
|
$400
$1,200
|
$2,500
$7,500
$1,000
$3,000
|
|
Doctor’s visit
PCP Co-pay
Specialist Co-pay
|
$20
$40
|
$20
$40
|
80% after deductible
|
|
Wellness Benefit Co-pay
|
$15
|
$15
|
100%
|
|
Inpatient Hospitalization
(after deductible)
|
90%
|
80%
|
80%
|
|
Emergency Room
|
$150
|
$150
|
80%
|
|
Urgent Care
|
$40
|
$40
|
80%
|
|
X-Ray/Lab tests routine
|
100%
|
100%
|
100%
|
|
X-Ray/Lab tests non-routine
|
90%
|
80%
|
80%
|
|
Lifetime Maximum
|
Unlimited
|
Unlimited
|
Unlimited
|
|
Out of Pocket Maximum
Individual
Family
|
$2,000
$6,000
|
$2,500
$7,500
|
$5,000
$15,000
|
Caremark
Prescription Coverage through Caremark is included with the enrollment in one of the medical plans with the premiums paid by the company.
|
Plan Provision
|
Network Pharmacy
(up to a 30-day supply)
|
Mail-Order
(up to a 90-day supply)
|
|
|
|
$0
|
|
Generic
|
10% of the cost ($5min/$25max)
|
None
|
|
Preferred Brand-Name
|
25% of the cost ($20min/$75max)
|
25% of the cost ($40min/$150max)
|
|
Non-Preferred Brand-Name
|
50% of the cost ($40min/$125max)
|
50% of the cost ($80min/$250max)
|
Delta Dental
Dental: Employees can choose from a PPO plan or HMO plan.
|
Plan Provision
|
Delta Preferred Dentist
|
Delta Premier Dentist
|
Non-Participating Dentist
|
|
Annual Deductible
Individual
Family
|
$50
$120
|
$100
$240
|
$100
$240
|
|
Preventive and Diagnostic
|
100%
|
100%
|
100%
|
|
Basic Restorative (after deductible)
|
80%
|
70%
|
70%
|
|
Major Restorative (after deductible)
|
60%
|
50%
|
50%
|
|
Orthodontia (for child up to age 19)
|
50%
|
40%
|
40%
|
|
Annual Maximum (per individual)
|
$1,750
|
$1,750
|
$1,750
|
|
Lifetime Orthodontia (per individual)
|
$1,500
|
$1,000
|
$1,000
|
|
TMD (Temporomandibular Joint)
|
Not Covered
|
Employers Dental Services (EDS)
EDS Specialists offer up to 25% off their normal fees for services specifically described in the schedule of benefits we provide to employees during New Hire Orientation. A referral is not required. This benefit is only available in the state of Arizona.
|
Procedure Description
|
Average Cost
|
Member Cost
|
|
Office Visit
|
|
5.00
|
|
Periodic Oral Evaluation
|
40.00
|
No Charge
|
|
Comprehensive Oral Evaluation
|
70.00
|
No Charge
|
|
X-Rays – Complete Series (Including Bitewings)
|
105.00
|
No Charge
|
|
Adult Cleaning
|
74.00
|
7.00
|
|
Child Cleaning
|
56.00
|
5.00
|
|
Topical Fluoride Child and Adult
|
26.00
|
No Charge
|
|
Sealant – Per Tooth
|
43.00
|
12.00
|
|
Amalgam Filling – One surface – Primary or Permanent
|
125.00
|
13.00
|
|
Resin-Based Composite Filling – One surface – Anterior
|
130.00
|
30.00
|
|
Crown – Porcelain/Ceramic Substrate
|
930.00
|
280.00 + Lab
|
|
Temporary Crown – Fractured Tooth
|
160.00
|
40.00
|
|
Root Canal – Anterior
|
620.00
|
185.00
|
|
Extraction – Erupted Tooth or Exposed Root
|
140.00
|
55.00
|
|
General Anesthesia – 1st 30 minutes
|
300.00
|
150.00
|
|
Complete Denture – Upper or Lower
|
1320.00
|
325.00 + Lab
|
Vision (VSP)
|
Plan Provision
|
In-Network
|
Frequency
|
|
Eye Exams
|
$15
|
1 exam every 24 months
|
|
Frames
|
$25 co-pay lens and/or frame up to $120 allowance
|
1 set of frames and/or lenses every 24 months
|
|
Laser Surgery
|
An average of 15% off the regular price at contracted laser centers, or an additional 5% off the center’s promotional price
|
|
Patient Options
|
Discounts on lens coatings, tints, progressive lenses, high index lenses, etc.
|
|
Contacts
(in lieu of glasses)
|
Covered up to $150 allowance (allowance applied towards exam and lenses)
|
Anthem EAP
|
Employee Assistance Program - Sargent Controls & Aerospace recognize that a wide range of personal problems not directly associated with the job can interfere with an employee's health or performance. Almost any personal problem can be successfully treated if it is identified early and a referral is made to appropriate care.
· Available to employees and their household members at NO COST
· Services are confidential
· Anthem EAP representatives are available 24 hours a day, 365 days a year to assist you
· Up to four face to face counseling sessions per problem per year on issues such as
· Relationship or family problems
· Alcohol or drug abuse
· Legal/Financial consultation
· Feelings of loss or grief
· Depression or anxiety
· Stress management
· Times of crisis
· Work issues
This is a general overview of our benefits for information purposes only and may change as benefit plans change during the plan year or at plan renewal. More specific details regarding benefit coverage are provided during the interview process and new hire orientations.
|