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Ameriflex HRA Debit Card

Employee Benefits


Benefits Comparison Current Plans (rotate counter clockwise to view in landscape mode.)

My Blue Service

Major Medical Claim Form (Oct. - Sept.)

Effective FY 2014-15

(Click the plan for more info.)

Blue Options Plan #1150 Rx 7/20/35Blue Cross2

Employee: No cost to employee.

Family: $286.32 per month.

Blue Options Plan #1351 Rx 15/30/50

Employee: No cost to employee.

Family: $281.95 per month.

H.S.A #1167 Rx CYD, 100%

Employee: No cost to employee.

Family: $252.92 per month.

H.S.A. # 1166 Rx CYD, 100%

Employee Only: No cost.

Note: 4th quarter deductible carryover no longer applies.

Lab Tests/Services

Quest Labs is the only Blue Cross/Blue Shield provider in our area. You must request that your physician/hospital use this lab to stay in network. Our cost for using this facility is $0. the use of any other lab facility will result in calender year deductible plus co-insurance fees.

BlueDental Choice

Combined Life Dental

Preventive ServicesBlue Cross Blue Shield Logo

Oral Evaluations Exams
Prophylaxes (Cleanings)- Adult/Child
Fluoride Treatment-Child
Bite wing X-rays
Series/Panoramic Sealants

Pays 100% In-Network, 100% Out-of-Network

Basic Services

Space Maintainers
Amalgam Restorations (Silver Fillings)
Resin-Based Restorations - Anterior and Posterior
Extractions - Routine and Surgical
Root Canal Therapy
Periodontal Treatment

Pays 100% In-Network, 80% Out-of-Network

Major Services

Crowns- Single Restorations
Osseous Surgery
Complete Dentures
Partial Dentures
Fixed partial dentures (Bridges)

Pays 60% In-Network, 50% Out-of-Network

Rates as of 10-01-2013 - 09-30-2014

Employees Only


Employee + Family


Employee + Children


Employee + Spouse


The Finance Office will provide your deduction for 24 pay periods.

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