Below is a brief summary of benefits covered by TEEBA *All co‐pay benefits combined cannot exceed a total of $800.00/year and after member has used $450.00 from his TECO medical dollar supplement.
- 1. *Non-elective surgery and anesthesia: up to $175.00 (after insurance carrier(s) pays) each.
- 2. *Laboratory/X-ray: up to $125.00 per quarter combined charges (after insurance carrier(s) pays)
- 3. *Doctor Visits: Medical doctor, Chiropractor – up to $30.00 per visit (after insurance carrier(s) pays or after co-payment) Maximum benefit of $90.00 per year.
- 4. *Hospital Services:
- A. $175.00 total for hospital services.
- B. $ 15.00 per day for room charges – maximum of 31 days.
- C. $ 15.00 per day in‐hospital doctor visits not to exceed 31 days.
- 5. *Ambulance: $50.00 per illness or ambulance ride.
- 6. *Maternity Benefits: up to $350 per pregnancy for out‐of‐pocket expense.
Benefits Not Covered by TEEBA
Operating Room Expense
Intravenous Cost
Physical Therapy
Mammogram (unless diagnostic)
Vasectomy or vasectomy reversal
Dental
Psychology/Psychiatric treatment
Implants (Pacemakers)
Drugs/Prescriptions
Injections or Inoculations
Annual/Routine Check-ups
Tubal Ligation
Optical
Artificial Limbs (prosthesis)
This is not intended to address all aspects of TEEBA, but to act as a quick reference in answering the most frequently asked questions. Please refer to “By-laws -ARTICLE IX – Benefits” for a more detailed description.
When updating your address/phone number with TECO please remember to do the same withTEEBA.
5/10/2014