Killeen ISD 2020 BENEFITS
Med i ca l Bene f i t s , con t ’ d…
*Plan 5 – BSW Preferred HMO Network $5,000 deductible(HSA qualified plan) $5,000 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
$432.73
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$32.73 $727.14 $397.68 $961.24
Employee & Spouse
$1,127.14
Employee & Child(ren)
$797.68
Employee & Family
$1,361.24
Plan 6 - PPO Choice Network (Tier 1 ICSW PPO/ Tier 2 Cigna PPO) $0 deductible in-network Tier 1 - $30 Primary Care Copay / $70 Specialist Copay/ Urgent Care $75 Copay/ ER $500/$6,500 Individual Out of Pocket Maximum/RX $10-$45-$90 Tier 2 - $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*
$723.80
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$323.80
Employee & Spouse**
$1,881.89 $1,331.80 $2,272.73
$1,481.89
Employee & Child(ren)**
$931.80
Employee & Family**
$1,872.73
For 2020, the maximum contribution as set by the IRS for an individual HSA account is $3,550 and the maximum contribution for family coverage is $7,100. People over the age of 55 can make an additional “catch-up” contribution of $1,000. These limits are the same regardless of the source of the contribution.
Employees that make / receive contributions to an HSA cannot also make contributions to the FSA
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