KISD Open Enrollment Guide 2020

Killeen ISD 2020 BENEFITS

Med i ca l Bene f i t s , con t ’ d…

Plan 1 – BSW Preferred HMO Network $500 Deductible $500 Individual Deductible / 20% Coinsurance / $35 Primary Care Copay / $50 Specialist Copay Urgent Care $75 Copay/ ER $300/$7,350 Individual Out of Pocket Maximum/RX $10-$45-$90

Monthly Cost (Total)

KISD Monthly Contribution

State Monthly Contribution

Monthly Cost

TIER Election

Employee Only

$641.88

$325.00 $325.00 $325.00 $325.00

$75.00 $75.00 $75.00 $75.00

$241.88

Employee & Spouse

$1,668.89 $1,181.06 $2,015.51

$1,268.89

Employee & Child(ren)

$781.06

Employee & Family

$1,615.51

*Plan 2 – BSW Preferred HMO Network $2,700 deductible (HSA Qualified Plan) $2,700 Individual Deductible* / 20% Coinsurance after Deductible $6,650 Individual Out Of Pocket Maximum**

** All claims, including prescriptions ( Not Including claims coded as Preventive Care ) are subject to the deductible. ***Once the Out of Pocket Maximum is met, covered benefits are received at 100% for the remainder of the calendar year.

Monthly Cost (Total)

KISD Monthly Contribution

State Monthly Contribution

Monthly Cost

TIER Election

Employee Only

$520.78

$325.00 $325.00 $325.00 $325.00

$75.00 $75.00 $75.00 $75.00

$120.78 $954.04 $558.24

Employee & Spouse

$1,354.04

Employee & Child(ren)

$958.24

Employee & Family

$1,635.26

$1,235.26

Plan 4 – SWHP HMO Network $1,000 Deductible $1,000 Individual Deductible / 0% Coinsurance / $35 Primary Care Copay / $80 Specialist Copay Urgent Care $75 Copay/ ER $500/$7,350 Individual Out of Pocket Maximum/RX $10-$45-$90

Monthly Cost (Total)

KISD Monthly Contribution

State Monthly Contribution

Monthly Cost

TIER Election

Employee Only

$665.86

$325.00 $325.00 $325.00 $325.00

$75.00 $75.00 $75.00 $75.00

$265.86

Employee & Spouse

$1,731.22 $1,225.17 $2,090.78

$1,331.22

Employee & Child(ren)

$825.17

Employee & Family

$1,690.78

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