Group Health Insurance

Health Coverage — Your Benefits at a Glance



 Option I   PPO  Non-PPO 
Deductible Single
Family
$0
$0
$0
$0
Coinsurance   70% 50%
OOP Max Single
Family
$1,300
$2,600
$2,800
$5,600
Office Visit Copay   Subject to coinsurance Subject to coinsurance
Wellness   100% up to $1,000, then subject to D&C 100% up to $1,000, then subject to D&C
Prescription Drug Copays Generics <$300
Generics >$300
Brand Name
$10
10%
$25 + 20%
 

Option I — Group Health Coverage Premiums



 Type of Coverage  Total Cost/Month  Employer Share  Employee Share  Deduction/Pay Period*
Single Health $674.30 $599.40 $74.90 $37.45
Family Health $1,568.34 $1,273.86 $294.48 $147.24
Single Dental $34.82 $22.74 $12.08 $6.04
Family Dental $74.66 $36.80 $37.86 $18.93

*24 pay periods each year

Vision


  • Exam — one per person per plan year, covered at 100%
  • Glasses (and/or contacts) — covered at 50% to a maximum benefit of $200 per person per 24-month period. (Co-insurance does not count toward out-of-pocket limit.)

Dental



Diagnostic and Preventative 100%
Restorative and Endodontic 50%
Periodontic 50%
*Prosthodontic, Major Restorative, Bridges and Dentures 50%

Dental benefits are capped at a plan year limit of $1,500. Any dental co-insurance, shared payment or maximum benefit limits are not applied toward the maximum out-of-pocket expense for medical.
Note: Orthodontics is excluded from coverage.

All medical and dental claims are paid based on the "allowable charge," the prevailing charge in the area for care of a comparable nature by a person of similar training and experience.

Health Insurance Option II (similar to Option I)



 Option II   PPO   Non-PPO
Deductible Single
Family
$125
$375
$250
$750
Coinsurance   70% 50%
OOP Max Single
Family
$1,300
$2,600
$2,800
$5,600
Office Visit Copay   $30 $30
Wellness   100% up to $1,000, then subject to D&C 100% up to $1,000, then subject to D&C
Prescription Drug Copays Generics <$300
Generics >$300
Brand Name
$15
10%
$30 + 20%
 

Other benefits reduced or eliminated in Option II:
  • Elimination of sleep apnea and related costs
  • Addition of $100 emergency room deductible
  • Addition of $100 ambulance deductible (per transport)
  • Elimination of routine vision expenses, i.e., exams, hardware, contacts
  • Durable medical equipment limited to $1,000 per year
  • Additional combined deductible of x-ray and lab services ($250 in network/$500 out of network, then subject to deductible and coinsurance)

Option II — Group Health Coverage Premiums



 Type of Coverage  Total Cost/Month  Employer Share Employee Share  Deduction/Pay Period* 
Single Health $527.20 $502.46 $24.74 $12.37
Family Health $1,236.04 $1,110.22 $125.82 $62.91
Single Dental $34.82 $22.74 $12.08 $6.04
Family Dental $74.66 $36.80 $37.86 $18.93

*24 pay periods each year

Option III


Option III is a high-deductible health plan (HDHP) with a health savings account (HSA)
  • A much higher deductible health plan for individuals who can afford out-of-pocket first dollar coverage
  • Offers a very low premium, contributing most of the funds to a health savings account
  • Money can be deposited straight from payroll pre-taxed
  • HSA is never taxed
  • No "use it or lose it" provision
  • No first dollar prescription drug coverage allowed. Upon reaching maximum deductible, prescription drugs will be subject to co-pay
  • Individual must not be covered by another health care plan such as Medicare
  • All expenses accrue toward the deductible and out of pocket
Option III    PPO   Non-PPO
Deductible Single
Family
$1,500
$3,000
$3,000
$6,000
Coinsurance   80% 50%
OOP Max Single
Family
$1,500
$3,000
$4,500
$9,000
Office Visit Copay   Subject to deductible and coinsurance Subject to deductible and coinsurance
Wellness   100% up to $1,000, then subject to D&C 100% up to $1,000, then subject to D&C
Prescription Drug Copays Generics <$300
Generics >$300
Brand Name
Subject to D&C
Subject to D&C
Subject to D&C
Subject to D&C
Subject to D&C
Subject to D&C

Option III — Group Health Plan Coverage Premiums



 Type of Coverage  Total Cost/Month  City Share Employee Share  Deduction/Pay Period* 
Single Health $476.66 $404.00 $72.66 $36.33
Family Health $1,113.48 $847.24 $266.24 $133.12
Single Dental $34.82 $22.74 $12.08 $6.04
Family Dental $74.66 $36.80 $37.86 $18.83