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
$1,8 00 INDIVIDUAL $3,6 00 FAMILY
$3,600 PER PERSON $7,400 FAMILY
$6 00 INDIVIDUAL $1, 2 00 FAMILY
$1,2 00 INDIVIDUAL $2,400 FAMILY
ANNUAL HEALTH SAVINGS ACCOUNT FUNDING (UC)
$325 – $825 EE $650 - $1,650 FAMILY *
$32 – $825 EE $650 - $1,650 FAMILY*
NOT APPLICABLE
NOT APPLICABLE
65% AFTER DEDUCTIBLE
65% AFTER DEDUCTIBLE
COVERED 100%
COVERED 100%
PREVENTIVE CARE**
65 % AFTER DEDUCTIBLE
80 % AFTER DEDUCTIBLE
COVERED SERVICES
80% AFTER DEDUCTIBLE
65% AFTER DEDUCTIBLE
TIER 1 (GREATEST VALUE): $20 TIER 2 (BRAND): $40 TIER 3 (HIGHER COST BRAND): $55 TIER 4 (SPECIALTY): 25% CO-INS, $250 MAX
80 % AFTER DEDUCTIBLE
RETAIL PHARMACY
MAIL ORDER 90 DAY SUPPLY (MANDATORY FOR
TIER 1: $40 TIER 2: $80 TIER 3 : $110
80 % AFTER DEDUCTIBLE
MAINTENANCE MEDICATIONS)
RATES VARY BASED ON PLAN SELECTION AND ANNUAL BASE PAY*
EMPLOYEE CONTRIBUTION PLAN ADMINISTRATOR
CHOOSE 2021 NON-AAUP
ANTHEM
* BASED ON TOTAL ANNUAL BASE PAY (UC + UCP) ** AS RECOMMENDED BY THE AMERICAN MEDICAL ASSOCIATION
FOR MORE INFORMATION ON MEDICAL PLANS:
Medical Insurance 2
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