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Overview

Benefit Overview 08/2016

DISTRICT HEALTH INSURANCE

District Health Plans are provided to all eligible district employees and their dependents. 
Features of the three health plans available are as follows:

BLUE CROSS PPO

  • Calendar Year Deductible - The employee pays the first $200.00 per calendar year beyond the Basic Plan benefits before qualifying for the Major Medical extended benefit coverage. 
  • Calendar Year Co-pay Maximum $400 per individual / $800 per family (In Network)
  • Office Visit –  $10 Co-pay (Deductible is waived.)
  • Professional & Diagnostic Services 90/10 (In-Network) - 70/30 (Outside Network)
  • Durable Medical Equipment  - 90/10 (In-Network) - 70/30 (Outside Network)
  • Prescription Coverage -  $10 co-pay Generic / $20 co-pay Brand Formulary / $40 co-pay Brand Non-Formulary.
  • Cost - Premium paid by District for employee and dependents.     

 

KAISER FOUNDATION HEALTH PLAN

  • Calendar Year Deductible No Deductible. 
  • Calendar Year Co-pay Maximum $1,500 per individual / $3,000 per family
  • Office Visit –  $10 Co-pay
  • Professional & Diagnostic Services No Charge.
  • Durable Medical Equipment  -The employee pays 20% of Base Coverage Offered.
  • Prescription Coverage – $5 co-pay Generic / $5 co-pay Brand Formulary / $5 co-pay Brand Non-Formulary.
  • Cost - Premium paid by District for employee and dependents.     

 

BLUE CROSS HMO

  • Calendar Year Deductible No Deductible. 
  • Calendar Year Co-pay Maximum $1,500 per individual / $3,000 per family
  • Office Visit –  $10 Co-pay
  • Professional & Diagnostic Services No Charge.
  • Durable Medical Equipment  - The employee pays 20% up to $5,000 per calendar year.
  • Prescription Coverage – $5 co-pay Generic / $5 co-pay Brand Formulary / $5 co-pay Brand Non-Formulary.
  • Cost - Premium paid by District for employee and dependents.     

Additional information with plan details is made available to employees during the scheduled open enrollment meetings

Additional copies are available in the District Office.

 

DISTRICT DENTAL PLANS

The District provides two dental health plans for the employees.

DELTA DENTAL

  • Coverage - The plan pays the usual, customary and reasonable fee for dental service.  Delta Dental will pay 70% of the covered fees for the covered basic benefits during the first calendar year. The portion that Delta Dental will pay increases to 80%, 90% respectively, during the subsequent calendar years.
  • Cost - Premium paid by District for   EMPLOYEE ONLY.  Cost share for dependents paid by employee. Cost for 1 dependent; or 2 or more is subject to change at the end of the contract year.
  • UNITED CONCORDIA DENTAL PLAN 
  • Coverage - Principle dental benefits and coverage without charges, with a co-payment required for some stated principle dental work and for any excluded procedures.
  • Cost - Premium paid by District for employee and dependents.
  • Additional Information: Subject to applicable principal benefits, with co-payment principal limitations and principal excluded services and procedures, all usual customary and necessary dental care is provided under this plan.   Member enrolled in UCCI Plan must use the dentist who is a registered professional provider for UCCI.

DISTRICT VISION PLAN 

  • Coverage - Schedule charges for doctor visits; frames and lenses.
  • Cost - Premium paid by District for   EMPLOYEE ONLY.  Cost share for dependents paid by employee. Cost for 1 dependent; or 2 or more is subject to change at the end of the contract year.

Schedule of Benefits for the Basic and Major Medical Health Plan, the Dental Insurance Plan and Vision.

  1. The master policy for each carrier is on file in the District Office. 
  2. Each employee is given an Information Booklet at the time of employment. 
  3. Additional copies are available in the District Office.

Coverage Changes:  You may only change coverage during the open enrollment period, in August/September, or at the time of employment.   Please note you may update dependent coverage when a “Life Event” occurs such as marriage, divorce, child’s birth or adoption, etc. 

For more details please contact the Human Resources Department.