City Care Benefits Chiropractic & Acupuncture Plan Summary

2006 Plan Year

American Specialty Health Plans Chiropractic Only (CHI01)*

No Deductibles

$15 Copayment per Visit

20 Visits Annual Maximum

Must use Participating Provider

Monthly Premiums: Employee Only $ 2.50

Employee & Spouse 5.00

Employee & Child(ren) 3.75

Employee & Family 7.25

American Specialty Health Plans Chiropractic &

Acupuncture (CAP01)*

No Deductibles

$15 Copayment per Visit

20 Visits Annual Maximum in any combination of Chiropractic and

Acupuncture Visits

Must use Participating Provider

Monthly Premiums: Employee Only $ 4.40

Employee & Spouse 8.80

Employee & Child(ren) 6.60

Employee & Family 11.45

*Employers must provide their employees a Group Medical Plan in order to offer the above plans.

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