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Benefits & Plans
TACT offers a full range of group
life, health and vision plans. The current menu includes life, accidental death
and dismemberment, medical, vision and prescription cards. By offering a
variety of options you can customize the plans that best fit your needs
and the needs of your employees.
| LIFE and
AD&D PLANS |
|
|
Standard Life/AD&D
Benefit |
$25,000 per employee
|
|
Minimum Life/AD&D
Benefit |
$10,000 per employee
|
|
Maximum Life/AD&D
Benefit |
$250,000 per employee
|
|
Age
Cutback Schedule |
At
age 65, 65% of original
amount;
At age 70, 65% of the
amount at age 65;
At age 75, 65% of the
amount at age 70;
At age 80, 65% of the
amount at age 75;
Benefits cease at
retirement
|
|
AD&D Coverage Type |
Occupational coverage
standard
|
|
Dependent Life |
Plan A ("Low"): $5,000
spouse benefit;
$2,500
child benefit; and $1,000 infant
benefit
Plan B ("High"): $10,000
spouse benefit;
$5,000
child benefit; and $2,500 infant
benefit
|
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|
MEDICAL
PLANS |
Plan A
"Platinum" |
Plan B
"Gold" |
Plan C
"Silver" |
*
Plan D
"Bronze" |
*
Plan E
"Copper" |
|
In Network |
|
Deductible |
|
Per Member
|
$500 |
$750 |
$1,000 |
$2,000 |
$5,000 |
|
Per Family |
$1,500 |
$2,250 |
$3,000 |
$4,000 |
$10,000 |
|
Coinsurance |
80%/20% |
80%/20% |
80%/20% |
80%/20% |
100%/0% |
|
Out
of Pocket Maximum
(excluding deductible) |
|
Per Member |
$2,000 |
$2,500 |
$3,000 |
$3,000 |
Not
applicable |
|
Per Family
|
$6,000 |
$7,500 |
$9,000 |
$6,000 |
Not
applicable |
|
Office Visit Co Pay
Outpatient Diagnostic Testing Co Pay |
$20
100% up to $300 max
$10
100% up to $200 max
|
$25
100% up to $300 max
$12.50 100% up to $200 max
|
$30
100% up to $300 max
$15
100% up to
$200 max
|
$35
100% up to $300 max
$17.50 100% up to $200 max |
$35
100% up to $300 max
$17.50 100% up to $200 max |
|
|
Out of Network
Eligible
charges limited to %100
of Medicare allowable
amount. |
|
Deductible |
|
Per Member
|
$1,000 |
$1,500 |
$2,000 |
$4,000 |
$7,500 |
|
Per Family |
$3,000 |
$4,500 |
$6,000 |
$12,000 |
$22,500 |
|
Coinsurance |
50%/50% |
50%/50% |
50%/50% |
50%/50% |
50%/50% |
|
Out
of Pocket Maximum
(excluding deductible) |
|
Per Member |
$5,000 |
$6,000 |
$7,000 |
$10,000 |
Unlimited |
|
Per Family
|
$15,000 |
$18,000 |
$21,000 |
$30,000 |
Unlimited |
|
|
|
Maximums |
|
Lifetime |
$1,000,000 |
$1,000,000 |
$1,000,000 |
$1,000,000 |
$1,000,000 |
|
Preventive Care
|
$1,000
(First $500 at 100%
after copay; next $500,
ded/coin applies) |
$1,000
(First $500 at 100%
after copay; next $500,
ded/coin applies) |
$1,000
(First $500 at 100%
after copay; next $500,
ded/coin applies) |
$1,000
(First $500 at 100%
after copay; next $500,
ded/coin applies) |
$1,000
(First $500 at 100%
after copay; next $500,
ded/coin applies) |
|
Hospice |
$7,500 |
$7,500 |
$7,500 |
$7,500 |
$7,500 |
|
Home Health Care |
60
days |
60
days |
60
days |
60
days |
60
days |
|
Skilled Nursing
|
$5,000 |
$5,000 |
$5,000 |
$5,000 |
$5,000 |
|
DME/Prosthetics |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
|
Rehab |
|
In patient
|
$10,000 |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
|
Out patient
|
$3,000 |
$3,000 |
$3,000 |
$3,000 |
$3,000 |
| Pre certification of certain services are required.
Benefits reduced by 50% if services are not pre certified |
|
Other Coverages |
|
Alcohol/Drug
Dependency |
|
|
|
|
|
|
In patient
(maximum) |
45
days |
45
days |
45
days |
45
days |
45
days |
|
Out patient
(maximum) |
60
visits |
60
visits |
60
visits |
60
visits |
60
visits |
|
Mental/Nervous |
|
In patient
(maximum) |
45
days |
45
days |
45
days |
45
days |
45
days |
|
Out patient
(maximum) |
60
visits |
60
visits |
60
visits |
|
60
visits |
|
Invitro-Fertilization |
Not
Covered |
Not
Covered |
Not
Covered |
Not
Covered |
Not
Covered |
|
Prescription Drugs |
Not
Covered (must elected
separate rx plan) |
Not
Covered (must elected
separate rx plan) |
Not
Covered (must elected
separate rx plan) |
*
Not Covered (must
elected separate rx
plan) |
*
Not Covered (must
elected separate rx
plan) |
|
Maternity Coverage is excluded for dependent daughters on all plans. |
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RX PLANS
Script Care |
Plan B
"Gold" |
Plan C
"Silver" |
Plan D
"Bronze" |
Plan E
"Copper" |
Diabetes
Supply |
An Rx plan must be elected in order for rx to be a covered benefit. |
|
|
|
$5,000 annual max benefit.
|
|
Copays
(30 Day Supply) |
|
|
|
$150 Annual Deductible Per Member |
|
|
Generic Tier 1 |
$10 |
$15 |
$20 |
90% / 10% |
$0 |
|
Preferred Brand Name (formulary) Tier 2 |
$20 |
$25 |
$35 |
75% / 25% |
$0 |
|
Non-Preferred Brand Name (non-formulary) Tier 3
|
$50 |
$60 |
$75 |
50% / 50% |
$0 |
| |
|
Mail Order Copays (90 Day Supply) |
| Generic Tier 1 |
$15 |
$20 |
$25 |
90% / 10% |
$0 |
| Preferred Brand Name (formulary) Tier 2 |
$30 |
$35 |
$45 |
75% / 25% |
$0 |
|
Non-Preferred Brand Name (non-formulary) Tier 3 |
$75 |
$90 |
$110 |
50% / 50% |
$0 |
| The Drug "Accutane" is Excluded from Coverage on All TACT Rx Plans |
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VISION BENEFIT COMMUNICATION
Underwritten by United HealthCare
Insurance Company
TACT (Texas Ag Coop Trust)
Program Year Effective
August 1, 2005
* Necessary contact lenses are
determined at the provider’s discretion
for one or more of the following
conditions: Following post cataract
surgery without intraocular lens
implant; To correct extreme vision
problems that cannot be corrected with
spectacle lenses; With certain
conditions of anisometropia; With
certain conditions of keratoconus. If
your provider considers your contacts
necessary, you should ask your provider
to contact Spectera concerning the
reimbursement that Spectera will make
before you purchase such contacts.
Spectera’s vision benefit is very
affordable. The monthly premiums are:
|
|
Employee Only: |
FREE to TACT members |
|
Exam copay $10 |
Employee + Spouse: |
FREE to TACT members |
|
Materials copay $25 |
Employee + Child(ren): |
FREE to TACT members |
|
|
Employee + Family: |
FREE to TACT members |
Sample Illustration of Savings
- * For purposes of this sample calculation, Employee +
Child(ren) is calculated with 3 members.
- ** For purposes of this sample calculation, Employee +
Family is calculated with 4 members.
- *** Approximate retail value illustrated: Exam & Refraction
($65), Single Vision Lenses ($80), and Frames ($130). Average
retail costs may vary by provider
- Actual tax savings will depend upon your individual tax
bracket..
Important to Remember:
- Always identify yourself as a Spectera participant when
making your appointment. This will assist your provider in
obtaining a claim authorization number prior to your visit.
- Benefits available every 12 or 24 months (depending on
the benefit frequency), based on last date of service.
- Your $150 contact lens allowance is applied to the fitting/evaluation fees as well as the purchase of contact lenses. For example, if
the fitting/evaluation fee is $30, you will have $120 towards the purchase of contact lenses. The allowance may be separated at
some retail chain locations between the examining physician and the optical store. Toric, gas permeable, and bifocal contacts are all
examples of contacts that are outside of our covered-in-full selection.
The following Services and Materials are excluded from
coverage under the Policy:
- Post cataract lenses
- Non-prescription items
- Medical or surgical treatment for eye disease that
requires the services of a physician
- Worker’s Compensation services or materials
- Services or materials that the patient, without
cost, obtains from any governmental organization or
program
- Services or materials that are not specifically
covered by the Policy
- Replacement or repair of lenses and/or frames that
have been lost or broken
- Cosmetic extras, except as stated in the Policy’s
Table of Benefits
Please note: If there are differences in this
document and the Group Policy,
the Group Policy is the
governing document.
Please retain this Benefit Summary and Vision Care Program description that includes detailed benefit information and instructions on how to use the program. To contact Spectera’s Customer Service department, call toll-free 1.800.638.3120 or TDD 1.800.524.3157 for the hearing impaired
Customer service representatives are available:
Monday through Friday from 7:00 a.m. to 10:00 p.m. CT
Saturdays from 8:00 a.m. to 5:30 p.m. CT
Tact is contracted with several PPO Networks to provide the highest degree of quality providers and provide our members covered services at discounted charges.These networks provide TACT with managed care and a comprehensive provider network for the medical program. They work with providers throughout Texas and have access to preferred providers throughout the United States as well. TACT is very serious about prevention and education. To assist with the management of the prescription drug benefit, TACT contracts with Script Care and their extensive network of pharmacies.
There are a few requirements related to
the selection of benefits...
-
Dependent life coverage is only available if
employee life coverage is elected
-
Drug benefits can only be elected if medical
coverage is also elected..
-
$10,000 minimum of life and AD&D coverage is
required. Our standard procedure is to quote $25,000 of coverage per
employee if the employer does not provide any other life benefits.
-
Only one plan for each line of coverage can be
offered to a class of employees. Multiple plan options cannot be
offered to employees within a group unless they are differentiated
by employee class (e.g. management and staff).
The above plans as shown are only summaries. For complete details, please review the Plan Document, available upon request, or to view online click below.
TACT Plan Document (.pdf file)
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