Current Eligibility Period:
Today's Date:
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Medical Benefit Information
Medical Deductible - $500 annual max
Family Deductible - $1000 annual max
Individual out-of-pocket
($5000 in network/$7500 out of network)
| When PIBF is secondary to Medicare |
Part B Services - No Deductible
Part A Services - $500 Deductible
|
Summary of Benefits and Coverage:
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Verification is not a guarantee of benefits or payment. Benefits are determined once the claim is received for processing.
Dental Benefit Information
PLAN DEDUCTIBLE START OVER EVERY JANUARY 1ST.
NO YEARLY MAX FOR CHILDREN 18 AND UNDER
ROUTINE CLEANING AND EXAMS ARE PAID AT 100% EVERY 6 MONTHS
Last dental cleaning visit
Verification is not a guarantee of benefits or payment. Benefits are determined once the claim is received for processing.
Vision Benefit Information
BENEFIT PERIOD STARTS OVER EVERY JANUARY 1ST.
NO YEARLY MAX FOR CHILDREN 18 AND UNDER
ACTIVE AND COBRA POLICIES ONLY (RETIREE'S NOT ELIGIBLE)
Annual Maximum ($200)
Covered Services and Materials Include:
Routine Vision Screening/Vison Analysis
Prescription Lenses/Frames
Prescription Contact Lenses
Lasik Eye Surgery ($1000)
Member Only Benefit
Once per lifetime
Annual Welding Hood Lenses ($75)
Member Only Benefit
PIBF is not contracted with any vision vendor.
Vision Claims Mailing Address: PIBF, P.O. Box 470950, Tulsa, OK 74147
Verification is not a guarantee of benefits or payment. Benefits are determined once the claim is received for processing.
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