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Supplemental Medical Plan B

Supplemental Medical Plan B to City of Seattle's Traditional Plan (or other plan) for Active and Retired Members of SPRA and SPOG

The purpose of the Plan is to promote the health and welfare of all covered persons through supplemental medical, vision, and prescription drug benefits. The Plan reimburses:

  1. co-insurance expenses for which you are responsible under your primary insurance plan, to a maximum of $400.00 per person per calendar year;
  2. prescription co-pays to a maximum of $250.00 per person per calendar year;
  3. deductibles to a maximum of $100.00 per person or $300.00 per family per calendar year;
  4. vision co-pays, glasses and contact lense expenses up to the maximum amounts listed below.

Schedule of Benefits

Categories of Expenses  SPRA Reimburses You
Medical Deductibles Actual deductible paid, not to exceed $100.00 per person or $300.00 per family per calendar year

Eligible Medical Expenses including:

  • Physician Services
  • Hospital Services
  • Chiropractic Care (10 visits)
  • Ambulance
  • Physical Therapy
           		 Remaining 20% of Eligible Medical Expenses not paid under the City of Seattle Traditional Plan (or other plan) up to $400.00 per person per calendar 
Mental Health Expenses 2-day lifetime maximum; inpatient only
Chemical Dependency only  $2,000.00 lifetime maximum; inpatient only
Prescription Co-pays:  
Generic, Brand Name and/or Non-formulary Up to $15 per co-pay
Mail order,  90-day supply Up to $30 per 90-day supply
Vision Expenses:  
Vision Exam Up to $10.00 co-pay
Glasses (Lenses and/or frames) Up to $50 per calendar year
Contact Lenses Up to $40.00 per calendar year
Lifetime Maximum Benefit $50,000.00