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TPM Trust Not For-Profit Health Insurance Serving TPM members in multiple states since 1960. Providing health care coverage with an emphasis on personal service. PLAN SUMMARIES |
For current information call TPM at (877) 535-4646
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| Preventive benefits | ||||||||
| Essential Preventive Health Services for Adults & Children | ||||||||
| Preferred Provider Organization Plans (PPO) | ||||||||
| Plan | Office Visit | Deductible | Out-of-Pocket | |||||
| 15B | PPO 90% | - | $250 | $2000 | ($2250 combined-out-of pocket) | |||
| 18D | PPO 80% | - | $250 | $2000 | ($2250 combined-out-of pocket) | |||
| 18G | PPO 80% | - | $500 | $1000 | ($1500 combined-out-of pocket) | |||
| 16C | PPO 90% | - | $500 | $3000 | ($3500 combined-out-of pocket) | |||
| 17A | PPO 90% | - | $1000 | $1000 | ($2000 combined-out-of pocket) | |||
| 17C | PPO 90% | - | $1000 | $3000 | ($4000 combined-out-of pocket) | |||
| 18L | PPO 80% | - | $1000 | $3000 | ($4000 combined-out-of pocket) | |||
| 18N | PPO 80% | - | $2000 | $3000 | ($5000 combined-out-of pocket) | |||
| 13P | PPO 60% | - | $2000 | $4000 | ($6000 combined-out-of pocket) | |||
| Point of Service Plans (POS) | ||||||||
| Plan | Office Visit | Deductible | Out-of-Pocket | |||||
| 25A | POS 90% | $15 | $500 | $2000 | ($2500 combined-out-of pocket) | |||
| 22A | POS 80% | $30 | $500 | $2000 | ($2500 combined-out-of pocket) | |||
| 26A | POS 80% | $30 | $1000 | $2000 | ($3000 combined-out-of pocket) | |||
| 26B | POS 80% | $30 | $1000 | $3000 | ($4000 combined-out-of pocket) | |||
| 28A | POS 80% | $30 | $2000 | $2000 | ($4000combined-out-of pocket) | |||
| 28B | POS 80% | $30 | $2000 | $3000 | ($5000 combined-out-of pocket) | |||
| 28D | POS 80% | $40 | $2500 | $3000 | ($5500 combined-out-of pocket) | |||
| 20U | POS 70% | $45 | $3000 | $3000 | ($6000 combined-out-of pocket) | |||
| 20W | POS 70% | $45 | $3000 | $5000 | ($8000 combined-out-of pocket) | |||
| 20M | POS 70% | $45 | $1000 | $3000 | ($4000 combined-out-of pocket) | |||
| 20P | POS 70% | $45 | $2000 | $2000 | ($4000 combined-out-of pocket) | |||
| 30D | POS 70% | $20 | $1000 | $3000 | ($4000 combined-out-of pocket) | |||
| 33C | POS 70% | $20 | $5000 | $5000 | ($10,000 combined-out-of pocket) | |||
| 34A | POS 70% | $50 | $8000 | $5000 | $13,000 combined-out-of pocket) | |||
| Health Saving Account | ||||||||
| Plan | Deductible | Out-of-Pocket | ||||||
| HSA | 100% after deductible | $3000 | $3000 | ($3000 combined-out-of pocket) | ||||
| Pharmacy
Benefit Plans (specific preventive drugs may be covered in full) |
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| Plan | Tier 1 | Tier 2 | Tier 3 | |||||
| RX 1 | Retail Pharmacy | $7 | $15 | $35 | (Retail - up to 30 day supply) | |||
| Mail Order | $14 | $30 | $70 | (Mail Order - up to 90 day supply) | ||||
| RX 2 | Retail Pharmacy | $10 | $20 | $40 | (Retail - up to 30 day supply) | |||
| Mail Order | $20 | $40 | $80 | (Mail Order - up to 90 day supply) | ||||
| RX 3 | Retail Pharmacy | 30% | 30% | 50% | (Retail - up to 30 day supply - maximum $200 per prescription fill) | |||
| Mail Order | 30% | 30% | 50% | (Mail Order - up to 90 day supply - maximum $400 per perscription fill) | ||||
| RX 4 | Retail Pharmacy | $10 | $30 | $50 | (Retail - up to 30 day supply) | |||
| Mail Order | $20 | $60 | $100 | (Mail Order - up to 90 day supply) | ||||
| RX 5 | Retail Pharmacy | 50% | 50% | 50% | (Retail - up to 30 day supply) | |||
| Mail Order | 50% | 50% | 50% | (Mail Order - up to 90 day supply) | ||||
| Dental Benefit Plans | ||||||||
| Plan | Deductible | Diagnostic | Basic | Major | ||||
| Plan 7 | - | 100% | 80% | 50% | (annual maximum benefit $2000) | |||
| Plan 8 | $50 | 100% | 80% | 50% | (annual maximum benefit $1000) | |||
| Plan 9 | $25 | 100% | 80% | 50% | (annual maximum benefit $1500) | |||
| vision Plans | ||||||||
| Plan | Yearly Eye Exam | Frames per 2 years | Single vision Lenses | Bifocal Lenses | Trifocal Lenses | Lenticular | Basic Contacts | Post Surgery Contacts |
| Plan 1 | $30 | $40 | $50 | $72 | $95 | $95 | $50 | $190 |
| Plan 2 | $60 after $10 copayment | $100 after $25 copayment | $72 | $108 | $132 | $156 | $120 | $240 |
| life insurance/short term disability | ||||||||
| Group Life Insurance - Certificate and Summary Plan Description | ||||||||
| Group Short Term Disability Insurance - Certificate and Summary Plan Description | ||||||||
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All information contained in this website is not intended nor designed to offer legal advice.
For additional information about the website and any article(s) contained here in please contact Timber Products Manufacturers Association at (509) 535-4646 or tpm@tpmrs.com. Copyright 1998-2011 Timber Products Manufacturers Association All rights reserved. |
