MEDICAL INSURANCE
MEDICAL PLAN INFORMATION
65%+ FTE FACULTY 75%+ FTE STAFF
ELIGIBILITY
PLAN INFORMATION (TWO AVAILABLE)
PPO
HDHP
IN NETWORK
OUT OF NETWORK
IN NETWORK
OUT OF NETWORK
ANNUAL DEDUCTIBLE
$ 400 INDIVIDUAL $ 800 FAMILY
$ 1,500 INDIVIDUAL $3, 0 00 FAMILY
$3, 0 00 PER PERSON $6, 0 00 FAMILY
$ 100 INDIVIDUAL $ 2 00 FAMILY
ANNUAL HEALTH SAVINGS ACCOUNT FUNDING (UC)
$325 – $825 EE $650 - $1,650 FAMILY *
$320 – $825 EE $650 - $1,650 FAMILY*
NOT APPLICABLE
NOT APPLICABLE
65% AFTER DEDUCTIBLE
COVERED 100%
COVERED 100%
70% AFTER DEDUCTIBLE
PREVENTIVE CARE**
COVERED SERVICES
9 0% AFTER DEDUCTIBLE
70 % AFTER DEDUCTIBLE
85% AFTER DEDUCTIBLE
70% AFTER DEDUCTIBLE
TIER 1 (GREATEST VALUE): $ 15 TIER 2 (BRAND): $ 25 TIER 3 (HIGHER COST BRAND): $ 35 TIER 4 (SPECIALTY): 25% CO-INS, $250 MAX
90 % AFTER DEDUCTIBLE IN NETWORK, 70% OUT OF NETWORK
RETAIL PHARMACY
MAIL ORDER 90 DAY SUPPLY (MANDATORY FOR
TIER 1: $ 3 0 TIER 2: $ 5 0 TIER 3 : $ 7 0
90 % AFTER DEDUCTIBLE IN NETWORK, 70% OUT OF NETWORK
MAINTENANCE MEDICATIONS)
RATES VARY BASED ON PLAN SELECTION AND ANNUAL BASE PAY* Rates Chart
EMPLOYEE CONTRIBUTION PLAN ADMINISTRATOR
ANTHEM
Medical Insurance 2
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