Medical - Active Employees
PPO Network & Out-of-Area
Non-Network
Deductible - Excludes Co-Pays
  • Individual (per person)
  • Family (aggregate)
  • $750
  • $1,500
  • $1,500
  • $3,000
If two or more covered members of a family are injured in the same accident and as a result of that accident, incur covered expenses, only one individual deductible amount will be deducted from the total covered expenses of all covered family members related to the accident for the remainder of the calendar year.
Annual Out-of-Pocket Maximum - Excludes Deductibles
  • Individual (per person)
  • Family (aggregate)
  • $3,750
  • $7,500
  • $7,500
  • $15,000
Refer to Medical Expense Benefit, Out-of-Pocket Expense Limit for a listing of charges not applicable to the out-of-pocket expense limit.
Maximum Lifetime Benefit Per Covered Person While Covered By This Plan
  • Hospice Care
  • Alcoholism/Chemical Dependency Treatment
  • Smoking Cessation
  • 6 Months
  • $20,000
  • $500
Coinsurance:  The Plan pays the percentage listed below for covered expenses incurred by a covered person during a calendar year after the individual or family deductible has been satisfied and until the individual or family out-of-pocket expense limit has been reached.  Thereafter, the Plan pays one hundred percent (100%) of covered expenses for the remainder of the calendar year or until the maximum benefit has been reached.
Benefit Description
PPO Network (% of negotiated rate, if applicable, otherwise % of customary & reasonable amount)
Non-Network (% of customary & reasonable amount)

In-Patient Hospital

Refer to the Medical Claim Filing Procedure section for Health Care Management Pre-certification requirements.

80%
60%

Out-Patient Hospital or Ambulatory Surgical Facility Charges

Including Surgery

80%
60%

Emergency Room Charges

Limitation: $150 copay per visit (waived if admitted)

80%
80%
Pre-Admission Testing
80%
60%

Second Surgical Opinion

Deductible waived

100%
100%

Out-Patient Diagnostic X-Rays & Lab

When not rendered with a PCP office visit

80%
60%

Primary Care Physician's Office Visit

Includes supplies, diagnostic testing, laboratory and x-ray services including interpretation when sent to an indpendent lab (deductible waived)

100% after $20 copay
60%
Specialist Physician's Office Visit
80%
60%

All Other In/Out-Patient Physician Charges

Including Surgery

80%
60%

Wellness Benefits

Limitation: $500 calendar year maximum benefit (*deductible waived)

100% after $20 copay
60%*

Routine Newborn Care

Nursery Care and Newborn Well Baby physician care while in the hospital is payable under the baby's coverage with no deductible provided dependent coverage is in place (or added within 30 days of delivery). The waived deductible is for PPO services only.

80%
60%
Pathology
80%
60%
Anesthesiology
80%
60%
Radiology
80%
60%

Home Health Care

Limitation: 120 visits maximum benefit per calendar year

80%
60%

Hospice Care

Limitation: 6 months maximum benefit per lifetime

80%
60%

Chiropractic Care

Limitation: $750 maximum benefit per calendar year (includes lab and x-ray procedures)

80%
80%

Extended Care Facility

Limitation: 60 days maximum benefit per calendar year

80%
60%

Acupuncture Expenses

Limitation: $750 maximum benefit per calendar year

80%
80%

Smoking Cessation program

Limitation: $500 maximum benefit per lifetime (program must be completed to receive benefit)

80%
80%
Physical Therapy Expenses
80%
60%
Maternity Expenses
80%
60%

Mental Health Disorders

Inpatient Services

Limitation: 30 days maximum benefit per calendar year

Outpatient Services

Limitation: 30 days maximum benefit per calendar year

50%

50%

50%

50%

Alcoholism/Chemical Dependency Care

Inpatient Services

Outpatient Services

Limitation: $10,000 In/Out-Patient combined maximum benefit per calendar year. $20,000 In/Out-Patient combined maximum benefit per lifetime.

50%

50%

50%

50%

All Other Covered Expenses
80%
60%
PRESCRIPTION DRUG PROGRAM

Pharmacy Option

Prescription Drug Card Copayment

Limitation: 34 day supply

  • 100% after copay
  • Generic: $10 copay
  • Preferred Brand: $35 copay
  • Non-Preferred Brand: the greater of $50 copay or 20%

Mail Order Option

Mail Order Prescription Copayment

Limitation: 90 day supply

  • 100% after copay
  • Generic: $20 copay
  • Preferred Brand: $70 copay
  • Non-Preferred Brand: the greater of $100 copay or 20%
CONTACT INFORMATION

Medical Claims

For claims questions call (800) 554-4491. To pre-certify in-patient and partial hospital stays and home health care stays call (800) 480-6658.

For Non-PPO Providers, mail claims to:

  • CoreSource
  • PO Box 83301
  • Lancaster, PA 17608-3301

For PPO Providers , mail claims to:

  • MedCost
  • PO Box 25307
  • Winston-Salem, NC 27114-5307

 

To check benefit coverage and claims status visit: coresource.com

MedCost Preferred Provider Network

PPO Provider questions call (800) 824-7406.

To check the provider directory visit: medcost.com

Prescription Claims

For Rx questions call Caremark: (866) 644-7527

Mail claims to:

  • Caremark
  • PO Box 961066
  • Fort Worth, TX 76161-0066

To check benefit coverage and refill a prescription visit: caremark.com

Short Term Disability
66.7% of weekly earnings (maximum of $300 per week) for up to 26 weeks.  Benefit period starts on the 1st day of disability due to a non-work related accident or on the 8th day of disability due to a non-work related illness.
Life Insurance
$15,000 Basic Life Insurance
Long Term Disability Insurance

60% of monthly earnings to a maximum benefit of $7,500 per month.

Elimination period of 180 days.  Maximum period of payment to age 67.

Dental Insurance

For questions call (800) 554-4491

Mail claims to:

  • Coresource
  • PO Box 2920
  • Clinton, IA 52733-2920

To check benefit coverage and claims status visit: coresource.com

100% coverage for preventive service, 80% for basic service, and 50% for major service.  There is a calendar year deductible of $50 and a maximum benefit of $1000.

401(K) Plan

For account information, retirement planning questions or enrollment assistance call Fidelity NetBenefits Retirement Benefits Line at (800) 835-5097 or log on to 401k.com

You may contribute between 1% and 60% of your gross earnings.  IBC will match 100% of the first 2% of your gross earnings, 50% of the next 2% of your gross earnings, and 25% of the next 2% of your gross earnings.
In addition to these benefits, the company offers the opportunity to purchase life insurance for yourself and your dependents. Please see Human Resources for plan information and rates.

Weekly Employee Payroll Deduction
Coverage
Non-Tobacco
Tobacco*
Employee Only
$14.50
$28.50
Employee & Child
$45.00
$59.00
Employee & Spouse
$54.00
$68.00
Family
$65.00
$79.00

USEFUL EMPLOYEE BENEFIT WEBSITES

www.indepedndentbeverage.com - We have created a website so that our most valuable asset, you, can be informed of the benefits made available to you and your family. We value your contribution to our organization and would like you to have a convenient way to access the information necessary to take advantage of the many benefits we offer. The IBC website provides a brief summary of these benefits as well as clickable links to access more specific details about our many benefit plans.

 

www.allstateatwork.com/benefitsselection/enroll - For important information about your benefits we encourage you to visit the Allstate website. This website is setup for viewing purposes only. But you may print employee forms and view summary plan description booklets. Your Employee Number is your Employee ID and your PIN is the last 4 digits of your social security number + the last 2 digits of your birth year. Both of these numbers are located on your Benefit Statement.

 

www.coresource.com - We also encourage you to visit the CoreSource website to check the status of your medical/dental claims, order new insurance cards or to utilize the complimentary HealthCenter feature. This new HealthCenter enhancement allows you to keep up with your health goals and progress free of charge.

 

NOTICE: In the event the descriptions on this website disagree with any of the plans presented,

the plan documents will govern the administration of that plan.

 

© 2007- 2013 Independent Beverage Company