Medical – Atlantic Packaging

Medical Insurance

Atlantic Packaging offers medical coverage administered through our Third-Party Administrator, Health Plans, Inc. (HPI). The chart below provides a brief outline of what is offered.

Please refer to the summary plan description for complete plan details.

Cost of Coverage

Employee Contributions

	Weekly Employee Contributions
	Less Than 5 Years Service			More Than 5 Years Service
	Standard Rate	Wellness Rate*	Standard Rate	Wellness Rate*
Employee	$50.30	$41.75	$40.02	$18.41
Employee & Spouse	$138.90	$106.95	$113.97	$78.64
Employee & Child(ren)	$106.72	$78.97	$87.31	$57.62
Employee & Family	$226.23	$178.72	$205.65	$156.30

	Monthly Employee Contributions
	Less Than 5 Years Service			More Than 5 Years Service
	Standard Rate	Wellness Rate*	Standard Rate	Wellness Rate*
Employee	$217.98	$180.92	$173.43	$79.78
Employee & Spouse	$601.88	$463.44	$493.87	$340.77
Employee & Child(ren)	$462.45	$342.21	$378.33	$249.70
Employee & Family	$980.34	$774.47	$891.17	$677.29

*Wellness premiums are based on program participation

Coverage

Medical Plan Benefits	Health Plans, Inc. (HPI)
Annual Deductible
Individual	$500
Family	$1,000
Coinsurance	20%

Maximum Out-of-Pocket*
Individual	$2,500
Family	$5,000

Physician Office Visit
Primary Care	$25 copay
Specialty Care	$50 copay
Teladoc	$0 copay

Preventive Care
Adult Periodic Exams	100% Covered
Well-Child Care	100% Covered

Diagnostic Services
X-ray and Lab Tests	20% after deductible
Complex Radiology	20% after deductible
Urgent Care Facility	$50 copay
Emergency Room Facility Charges	$250 copay for first visit, then 20% after deductible for subsequent visits
Inpatient Facility Charges	20% after Deductible
Outpatient Facility and Surgical Charges	20% after deductible

Mental Health
Inpatient	20% after deductible
Outpatient	$25 copay

Substance Abuse
Inpatient	20% after deductible
Outpatient	$25 copay

Other Services
Chiropractic	$50 Copay (30 visits combined with other outpatient therapies per plan year)
Acupuncture	$50 Copay