MyLoomis Login |
Loomis is the new TPA Group # LBIVFU
Customer Service: 800-367-3721 benefits@loomisco.com The Loomis Company P.O. Box 7011 850 North Park Road Wyomissing, PA 19610-6011 |
Medical Plan Coverage:
Prescription Drugs (In Network)*
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Out-of-Pocket Limit (Per Year)*
Co-Pays (in and out of network)Primary care visit to treat an injury or illness: $25 copay/ visit (in network) ; $25 copay/ visit (out of network)
Major Diagnostic & Imaging: Imaging (MRI, MRA, CT, PET): 10% coinsurance (in network) ; 10% coinsurance (out of network) ER: $200 copay per visit, then you pay 10% after deductible ; Co-pay is waived if admitted. Surgery (outpatient): $25 copay/visit (in network) ; $25 copay/ visit (out of network) Mental Health (Inpatient): 10% coinsurance (in network) ; 10% coinsurance (out of network - preauthorization required) Hospital Inpatient Stays: 10% coinsurance (in network) ; 10% coinsurance (out of network) - Preauthorization required **Please review the latest summary of benefits (SBC) for full benefits coverage. |
Covered Vision Expenses (Loomis)
1 Eye Exam - Plan pays for one vision exam.
Glasses - Maximum benefit of $200 every calendar year for all vision hardware expenses combined for ages 0-17; Maximum benefit of $200 every two calendar years for all vision hardware expenses combined for ages 18 and older.
Exclusions and Limitations The following exclusions and limitations are in addition to those set forth in the Articles entitled “General Limitations and Exclusions” and “Summary of Benefits”
1 Eye Exam - Plan pays for one vision exam.
Glasses - Maximum benefit of $200 every calendar year for all vision hardware expenses combined for ages 0-17; Maximum benefit of $200 every two calendar years for all vision hardware expenses combined for ages 18 and older.
Exclusions and Limitations The following exclusions and limitations are in addition to those set forth in the Articles entitled “General Limitations and Exclusions” and “Summary of Benefits”
This web site is not a legal document. This web site is not a guarantee of coverage, eligibility, or provider status and is designed for informational illustration only. Benefits outlined on this web site are subject to change at any time. Please consult your benefit plan provider(s) or administrator(s) for legal documents regarding your plan and to check coverage and/or eligibility.