HomeMy WebLinkAbout1.1.2027 - City of Rexburg - Renewal V4 Final VersionComparison of Benefits
AJ Argyle
Employee Benefits Broker
aj.argyle@gbsbenefits.com (208) 529-3541
Magen Smith
Account Manager
magen.smith@gbsbenefits.com (208) 529-3541
Prep: gc
January 2027 Renewal
City of Rexburg
Carrier(s)Plan Year Monthly Premium Annual Premium Percent Increase
Current $222,919 $2,675,028
Proposed Renewal $296,486 $3,557,826
Current $14,451 $173,415
Proposed Renewal $16,908 $202,900
Current $3,336 $40,029
Proposed Renewal $3,336 $40,029
Current $1,682 $20,188
Proposed Renewal $1,413 $16,953
Current $2,153 $25,838
Proposed Renewal $1,723 $20,670
$244,541 $2,934,498
$319,866 $3,838,378
Change from Current $75,325 $903,880
City of Rexburg
Annual Renewal Summary
Life MetLife
Medical SelectHealth 33.00%
Dental MetLife 17.00%
Vision MetLife 0.00%
-16.02%
Totals
MetLife
30.80%
LTD -20.00%
Benefits illustrated in summary for comparison purposes only. Please refer to the carrier plan document for further plan details.
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Comparison of Benefits
Medical
Carrier Option Funding Type Monthly Premium Annual Premium Annual Increase Percent Increase
SelectHealth CURRENT Fully Insured $222,919 $2,675,028 ----
SelectHealth RENEWAL Fully Insured $296,486 $3,557,826 $882,798 33.00%
Regence QUOTE-1 Fully Insured $349,986 $4,199,831 $1,524,803 57.00%
BC of ID QUOTE-2 Fully Insured $297,017 $3,564,199 $889,171 33.24%
BC of ID QUOTE-3 Fully Insured $298,837 $3,586,040 $911,012 34.06%
BC of ID QUOTE-4 Fully Insured $325,854 $3,910,252 $1,235,224 46.18%
*Reminder: Fees will apply for HSA bank account vendors.
This information is based on census information at the time of quoting. Subsequent enrollment changes may not be reflected and are not expected to materially impact plan comparisons
City of Rexburg
Medical Summary
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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System Facility Ch
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Benewah Community Hospital X X X X
Bonner General Hospital X X X X
Shoshone Medical Center (West Shoshone Hosp District)X X X X X
Syringa General Hospital X X X X
Boundary Community Hospital X X X
Kootenai Health X X X
Clearwater Valley X X X
Northern Idaho Advanced Care Hospital X X X
Rehabilitation Hospital of the Northwest X X
St. Mary's Hospital X X X
Gritman Medical Center X X X
St. Joseph Regional X X X
Northwest Specialty Hospital X X X
West Valley Medical Center X X X X X
Cassia Regional Hospital X X X X X X
Treasure Valley Hospital X X X
Saint Alphonsus Regional Medical Center X X X X
Saint Alphonsus Medical Center Nampa X X X X
Saint Alphonsus Medical Center Baker City X X
Saint Alphonsus Medical Center Ontario X X
Saint Alphonsus Regional Rehab Hosp (Encompass Health)X X X X
St. Luke's McCall LTD X X X X
St. Luke's Regional Medical Center LTD X X X X
St. Luke's Nampa Medical Center X X X X
St. Luke's Elmore Medical Center X X X X
St. Luke's Jerome Medical Center X X X X
St. Luke's Magic Valley Regional Medical Ceneter X X X X
St. Luke's Wood River X X X X
North Canyon Medical Center X X X X X X
Cascade Medical Center Hospital Distict X X X X X X
Cottonwood Creek Behavioral Hospital X X X
BHC Intermountain Hospital X X X
Lifeways Hospital X X X
Steele Memorial Medical Center X X X X X
Minidoka Memorial Hospital X X X X X X
Memorial Hospital (Weiser Valley Hospital District)X X X X X X X
Vibra Hospital of Boise X X
Valor Health - Walter Knox Memorial Hospital X X X X X X X
Bear Lake Memorial Hospital X X X X X
Bingham Memorial Hospital X X X X X
Grove Creek Medical Center X X X X X
Caribou Memorial Hospital X X X X X
Eastern Idaho Regional Medical Center - EIRMC X X X X
Franklin County Medical Center X X X X X
Lost Rivers Medical Center X X X X X
Madison Memorial Hospital X X X X X
Nell J Redfield Memorial Hospital X X X
Oneida County Hospital X X
Portneuf Medical Center X X X X X
Power County Hospital District X X X X X
Teton Valley Health Care X X X X X
Mountain View Hospital X X X X
Idaho Falls Community Hospital X X X X
Total 49 13 52 39 15 16 23 9
Network information is for illustrative purposes only and is subject to change. Please refer to carrier documents for further details.
Idaho Carrier Network Comparison
Blue Cross of Idaho Regence BlueShield
of ID Select Health
*Moda Health not available in Twin Falls, Jerome, or Gooding Counties
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*UHC Navigator network not available in ID
SelectHealthMed 70% $2,500 Trad-1SelectHealthMed 70% $2,500 Trad-2SelectHealthMed 70% $2,500 Trad-3RENEWALSelectHealthMed 70% $2,500 Trad-1RENEWALSelectHealthMed 70% $2,500 Trad-2RENEWALSelectHealthMed 70% $2,500 Trad-3
In/Out In-Network Out-of-Network In-Network Out-of-Network
Deductible $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000
Out of Pocket Maximum $4,500/$9,000 $6,500/$13,000 $4,500/$9,000 $6,500/$13,000
Deductible Embedded
OOP Max Embedded
Primary Care Physicians $20 50% AD $20 50% AD
Specialists $40 50% AD $40 50% AD
Mental Health & Chemical Dependency $20 50% AD $20 50% AD
Urgent Care $20 50% AD $20 50% AD
Emergency Room
Minor Lab / X-Ray 0%50% AD 0%50% AD
Major Lab / X-Ray 30% AD 50% AD 30% AD 50% AD
Hospital Outpatient Surgery 30% AD 50% AD 30% AD 50% AD
Preventive Care 0%50% AD 0%50% AD
Inp Hospital / Physicians 30% AD 50% AD 30% AD 50% AD
Inp Maternity 30% AD 50% AD 30% AD 50% AD
Chiropractic/Manipulations $20 (20 vis/yr)50% AD
(20 vis/yr)$20 (20 vis/yr)50% AD
(20 vis/yr)
Adult Routine Eye Exam $40 50% AD $40 50% AD
Rx Deductible
Tier 1
Tier 2
Tier 3
Tier 4
Mail Order
Monthly Rates
Subs Enrollment Tier Subscribers Subscribers
20 Employee 20 20
29 Employee + Spouse 29 29
2 Employee + Child 2 2
3 Employee + Children 3 3
65 Family 65 65
119 TOTAL BY PLAN 119 119
Percent of Increase
$300 then 30% AD $300 then 30% AD
33.00%
$222,919 $296,486
$2,480.20 $3,298.70
CURRENT RENEWAL
Yes Yes
$50 AD $50 AD
30% AD 30% AD
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Prescription Drugs (In-Network)
$500 $500
$10 $10
$10/$60 AD/$150 AD $10/$60 AD/$150 AD
$100 AD
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Inpatient Services
Additional Benefits
Employee Navigator Compatibility
City of Rexburg
Medical Comparison
Yes Yes
Yes Yes
Professional Services
SelectHealth SelectHealth
Med 70% $2,500 Trad Med 70% $2,500 Trad
$100 AD
Premium Rate Premium Rate
Fully Insured Fully Insured
$2,145.80 $2,853.90
$1,191.30 $1,584.40
$1,356.00 $1,803.50
$678.10 $901.90
Medical Benefits
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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QUOTE-1RegenceClassic Preferred 70% $2,500 Trad-1QUOTE-1RegenceClassic Preferred 70% $2,500 Trad-2QUOTE-1RegenceClassic Preferred 70% $2,500 Trad-3QUOTE-2BC of IDCCO-MVN 70% $2,500 Trad-1QUOTE-2BC of IDCCO-MVN 70% $2,500 Trad-2QUOTE-2BC of IDCCO-MVN 70% $2,500 Trad-3QUOTE-3BC of IDCCO-PQA 70% $2,500 Trad-1QUOTE-3BC of IDCCO-PQA 70% $2,500 Trad-2QUOTE-3BC of IDCCO-PQA 70% $2,500 Trad-3QUOTE-4BC of IDPreferred Blue PPO 70% $2,500 Trad-1QUOTE-4BC of IDPreferred Blue PPO 70% $2,500 Trad-2QUOTE-4BC of IDPreferred Blue PPO 70% $2,500 Trad-3
In/Out In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000 $2,500/$5,000
Out of Pocket Maximum $4,500/$9,000 $6,500/$13,000 $4,500/$9,000 $6,500/$13,000 $4,500/$9,000 $6,500/$13,000 $4,500/$9,000 $6,500/$13,000
Deductible Embedded
OOP Max Embedded
Primary Care Physicians $20 50% AD $0 50% AD $0 50% AD $0 50% AD
Specialists $40 50% AD $40 50% AD $40 50% AD $40 50% AD
Mental Health & Chemical Dependency $20 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Urgent Care $40 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Emergency Room 30% AD 30% AD 30% AD 30% AD 30% AD 30% AD
Minor Lab / X-Ray 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Major Lab / X-Ray 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Hospital Outpatient Surgery 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Preventive Care 0%50% AD 0%50% AD 0%50% AD 0%50% AD
Inp Hospital / Physicians 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Inp Maternity 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD 30% AD 50% AD
Chiropractic/Manipulations 30% AD
(20 vis/yr)
50% AD
(20 vis/yr)See Plan Doc See Plan Doc See Plan Doc See Plan Doc See Plan Doc See Plan Doc
Adult Routine Eye Exam Not Covered Not Covered See Plan Doc See Plan Doc See Plan Doc See Plan Doc See Plan Doc See Plan Doc
Rx Deductible
Tier 1
Tier 2
Tier 3
Tier 4
Mail Order
Monthly Rates
Subs Enrollment Tier Subscribers Subscribers Subscribers Subscribers
20 Employee 20 20 20 20
29 Employee + Spouse 29 29 29 29
2 Employee + Child 2 2 2 2
3 Employee + Children 3 3 3 3
65 Family 65 65 65 65
119 TOTAL BY PLAN 119 119 119 119
Percent of Increase 57.00%33.24%34.06%46.18%
$349,986 $297,017 $298,837 $325,854
$3,562.50 $3,304.61 $3,324.86 $3,625.46
$2,652.10 $2,859.06 $2,876.58 $3,136.64
$1,916.20 $1,587.29 $1,597.01 $1,741.39
$2,706.30 $1,806.73 $1,817.80 $1,982.15
$1,407.60 $903.50 $909.04 $991.22
Premium Rate Premium Rate Premium Rate Premium Rate
Fully Insured Fully Insured Fully Insured Fully Insured
QUOTE-1 QUOTE-2 QUOTE-3 QUOTE-4
$30/$105 AD/$150 AD N/A N/A N/A
$100 AD N/A N/A N/A
$50 AD $50 $50 $50
$35 AD $30 $30 $30
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$500 $500 $500 $500
Prescription Drugs (In-Network)
$10 $10 $10 $10
Additional Benefits
Professional Services
City of Rexburg
Medical Comparison
Regence BC of ID BC of ID BC of ID
Classic Preferred 70% $2,500 Trad CCO-MVN 70% $2,500 Trad CCO-PQA 70% $2,500 Trad Preferred Blue PPO 70% $2,500 Trad
Yes Yes Yes Yes
Yes Yes Yes Yes
Employee Navigator Compatibility --------
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Inpatient Services
$300 then 30% AD
Medical Benefits
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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10/13/2026
Comparison of BenefitsDental
Carrier Option Funding Type Monthly Premium Annual Premium Annual Increase Percent Increase
MetLife CURRENT Fully Insured $14,451 $173,415 ----
MetLife RENEWAL Fully Insured $17,197 $206,366 $32,951 19.00%
MetLife REVISED RENEWAL Fully Insured $16,908 $202,900 $29,485 17.00%
This information is based on census information at the time of quoting. Subsequent enrollment changes may not be reflected and are not expected to materially impact plan comparisons
City of Rexburg
Dental Summary
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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10/13/2026
MetLifeMetLifeDental PPO $2,000-1MetLifeMetLifeDental PPO $2,000-2MetLifeMetLifeDental PPO $2,000-3RENEWALMetLifeMetLifeDental PPO $2,000-1RENEWALMetLifeMetLifeDental PPO $2,000-2RENEWALMetLifeMetLifeDental PPO $2,000-3REVISED RENEWALMetLifeMetLifeDental PPO $2,000-1REVISED RENEWALMetLifeMetLifeDental PPO $2,000-2REVISED RENEWALMetLifeMetLifeDental PPO $2,000-3
In/Out In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible $50/$150 $50/$150 $50/$150 $50/$150 $50/$150 $50/$150
Annual Maximum
Preventive / Diagnostic 100%80%100%80%100%80%
Basic 80%70%80%70%80%70%
Major 50%40%50%40%50%40%
Oral Surgery 80%70%80%70%80%70%
Periodontics 80%70%80%70%80%70%
Endodontics 80%70%80%70%80%70%
Implants 50%40%50%40%50%40%
Deductible
Lifetime Maximum
Child (under 19)50%50%50%50%50%50%
Adult 50%50%50%50%50%50%
Preventive
Basic
Major
Orthodontics
UCR Percentile
Voluntary / Employer Paid
Participation Requirements
Rate Guarantee
Monthly Rates
Plan Type
Subs Enrollment Tier Subscribers Subscribers Subscribers
17 Employee 17 17 17
34 Employee + Spouse 34 34 34
5 Employee + Child(ren)5 5 5
66 Family 66 66 66
122 TOTAL BY PLAN 122 122 122
Percent of Increase 19.00%17.00%
$14,451 $17,197 $16,908
$36.11 $42.97
$164.10 $195.28 $192.00
Premium Rate Premium Rate
$130.03
$84.35
$111.14 $132.26
$72.09 $85.79
$42.25
Premium Rate
CURRENT
Dental PPO $2,000
Fully Insured
Dental PPO $2,000 Dental PPO $2,000
Fully Insured Fully Insured
RENEWAL REVISED RENEWAL
Employer Paid Employer Paid
12/31/2027
Greater of 10 or 79%
12/31/2026 12/31/2027
Greater of 10 or 79%Greater of 10 or 79%
Employer Paid
Orthodontics
None
$2,000
Waiting Periods
MetLife
City of Rexburg
Dental Comparison
MetLife
None
$2,000
Employee Navigator Compatibility YesYesYes
None None
None
MetLife MetLife
MetLife MetLife
None
None
$2,000
$2,000 $2,000 $2,000
None None
None None
Fee Schedule Fee Schedule
None
None
None
None
Fee Schedule
Dental Benefits
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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Comparison of BenefitsVision
Carrier Option Funding Type Monthly Premium Annual Premium Annual Increase Percent Increase
MetLife CURRENT Fully Insured $3,336 $40,029 ----
MetLife RENEWAL Fully Insured $3,469 $41,627 $1,598 3.99%
MetLife REVISED RENEWAL Fully Insured $3,336 $40,029 $0 0.00%
This information is based on census information at the time of quoting. Subsequent enrollment changes may not be reflected and are not expected to materially impact plan comparisons
City of Rexburg
Vision Summary
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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MetLifeMetLife - Superior NetworkSuperior Vision-1CURRENTMetLifeMetLife - Superior NetworkSuperior Vision-2CURRENTMetLifeMetLife - Superior NetworkSuperior Vision-3RENEWALMetLifeMetLife - Superior NetworkSuperior Vision-1RENEWALMetLifeMetLife - Superior NetworkSuperior Vision-2RENEWALMetLifeMetLife - Superior NetworkSuperior Vision-3REVISED RENEWALMetLifeMetLife - Superior NetworkSuperior Vision-1REVISED RENEWALMetLifeMetLife - Superior NetworkSuperior Vision-2REVISED RENEWALMetLifeMetLife - Superior NetworkSuperior Vision-3
In/Out In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Eye Examination $0 Copay up to $45 $0 Copay up to $45 $0 Copay up to $45
Standard Plastic Lenses
Single Vision $0 Copay up to $30 $0 Copay up to $30 $0 Copay up to $30
Bifocal $0 Copay up to $50 $0 Copay up to $50 $0 Copay up to $50
Trifocal $0 Copay up to $65 $0 Copay up to $65 $0 Copay up to $65
Frames*up to $200 then
20% off up to $70 up to $200 then
20% off up to $70 up to $200 then
20% off up to $70
Contact Lenses*
Conventional up to $200 up to $105 up to $200 up to $105 up to $200 up to $105
Disposable up to $200 up to $105 up to $200 up to $105 up to $200 up to $105
*Frames or Contact Lenses
Retail Chains (Frame allowance may vary)
Costco
Sam's/Walmart
Target
Visionworks
Frequency
Exams
Lenses
Frames
Contacts
Voluntary / Employer Paid
Participation Requirements
Rate Guarantee
Monthly Rates
Plan Type
Subs Enrollment Tier Subscribers Subscribers Subscribers
20 Employee 20 20 20
31 Employee + Spouse 31 31 31
6 Employee + Child(ren)6 6 6
75 Family 75 75 75
132 TOTAL BY PLAN 132 132 132
Percent of Increase 3.99%0.00%
$3,336 $3,469 $3,336
$31.82 $33.09 $31.82
$20.02 $20.82 $20.02
$20.23 $21.04 $20.23
$10.10 $10.50 $10.10
Premium Rate Premium Rate Premium Rate
Superior Vision Superior Vision Superior Vision
Fully Insured Fully Insured Fully Insured
12/31/2026 12/31/2027 12/31/2027
CURRENT RENEWAL REVISED RENEWAL
---
Voluntary Voluntary Voluntary
12 Months 12 Months 12 Months
12 Months 12 Months 12 Months
12 Months 12 Months 12 Months
12 Months 12 Months 12 Months
Included Included Included
Included Included Included
Included Included Included
City of Rexburg
Vision Comparison
MetLife MetLife MetLife
MetLife - Superior Network MetLife - Superior Network MetLife - Superior Network
Employee Navigator Compatibility Yes Yes Yes
Included Included Included
Vision Benefits
Benefits illustrated are for comparison purposes only. Please refer to carrier plan documents for further details. In case of discrepancy, carrier plan documents and rates will prevail.
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Comparison of BenefitsLife, AD&D, and Dependent Life
All Full-Time X X X
All Full-Time Who Elect
Management
Number of Eligible Employees 177 177 177
Eligible Employees with Family Status 161 161 161
$7,487,500 $7,487,500 $7,487,500
12/31/2026 12/31/2027 12/31/2027
Benefit
Life Insurance $50,000 $50,000 $50,000
AD&D Insurance $50,000 $50,000 $50,000
Conversion Included Included Included
Portability Included Included Included
Dependent Life
Spouse $5,000 $5,000 $5,000
Child (birth - 14 days)---
Child (14 days - 6 months)$100 $100 $100
Child (6 months - 19 years)$5,000 $5,000 $5,000
Monthly Rates CURRENT RENEWAL REVISED RENEWAL
Basic Life (per $1,000)$0.178 $0.178 $0.142
AD&D (per $1,000)$0.020 $0.020 $0.020
Dependent Life $1.241 $1.241 $1.241
MONTHLY TOTAL $1,682 $1,682 $1,413
ANNUAL TOTAL $20,188 $20,188 $16,953
Percent of Increase 0.00%-16.02%
Benefit Volume
City of Rexburg
Basic Life, AD&D and Dependent Life Comparison
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Rate Guarantee
MetLife
Benefits illustrated in summary for comparison purposes only. Please refer to the carrier plan document for further plan details.
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Increments
Minimum Benefit
Maximum Benefit
Increments
Minimum Benefit
Maximum Benefit
Increments
Maximum Benefit
-Birth to 14 days
-14 days to 6 mths
-6 mths to 19 yrs
Employee
Spouse
Waiver of Premium
Conversion
Portability
Participation Required
Rate Guarantee
Rates Per $1,000
Employee Spouse Employee Spouse
<25 $0.081 $0.081 $0.081 $0.081
25-29 $0.081 $0.081 $0.081 $0.081
30-34 $0.086 $0.086 $0.086 $0.086
35-39 $0.111 $0.111 $0.111 $0.111
40-44 $0.159 $0.159 $0.159 $0.159
45-49 $0.220 $0.220 $0.220 $0.220
50-54 $0.358 $0.358 $0.358 $0.358
55-59 $0.547 $0.547 $0.547 $0.547
60-64 $0.811 $0.811 $0.811 $0.811
65-69 $1.333 $1.333 $1.333 $1.333
70-74 $2.142 $2.142 $2.142 $2.142
75+$2.142 $2.142 $2.142 $2.142
$0.021
MetLife
$1,000, $2,000, $4,000, $5,000, $10,000
$100,000
-
$1,000
$10,000
$500,000
$0.240 per $1,000
50% of EE
$5,000
$5,000
$250,000
Employee Benefit
Spouse Benefit
5x Salary
$10,000
$10,000
RENEWAL
$0.240 per $1,000
$0.021
$0.021
$0.021
$0.021
$25,000
Spouse
Included
Greater of 10 or 25%
Included
Included
12/31/2027
City of Rexburg
Supplemental Life
Guarantee Issue
Additional Benefits
Child
Voluntary AD&D
Dependent Rates
Employee
5x Salary
$10,000
$10,000
$500,000
50% of EE
$5,000
$25,000
$100,000
$5,000
$250,000
$1,000, $2,000, $4,000, $5,000, $10,000
-
$1,000
$10,000
Child Benefit
Included
Greater of 10 or 25%
Included
Included
$0.021
CURRENT
12/31/2026
Benefits illustrated in summary for comparison purposes only. Please refer to the carrier plan document for further plan details.
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Comparison of Benefits
Disability
All Full-Time X X X
All Full-Time Who Elect
Management
Number of Eligible Employees 177 177 177
Monthly Covered Payroll $861,252 $861,252 $861,252
Benefit
Elimination Period 90 Days 90 Days 90 Days
Benefit Percentage 50%50%50%
Maximum Monthly Benefit $4,500 $4,500 $4,500
Duration of Benefit SSNRA SSNRA SSNRA
Definition of Disability 24 Mo Own Occ 24 Mo Own Occ 24 Mo Own Occ
100%100%100%
100%100%100%
12/31/2026 12/31/2027 12/31/2027
Rates CURRENT RENEWAL REVISED RENEWAL
Per $100 of Covered Payroll $0.250 $0.250 $0.200
MONTHLY TOTAL $2,153 $2,153 $1,723
ANNUAL TOTAL $25,838 $25,838 $20,670
Percent of Increase 0.00%-20.00%
Rate Guarantee
City of Rexburg
Long Term Disability
El
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Employer Contribution
Participation Required
MetLife
Benefits illustrated in summary for comparison purposes only. Please refer to the carrier plan document for further plan details.
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