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Medical Plan Annual Cost

ACTIVE EMPLOYEES
Medical Insurance Rate Summary
May 2018 – April 2019

Monthly Single 

Monthly 
Family 

Medical Plan 2

  • 250/500 Deductible; 80% coinsurance*
  • $20 office co-pay** (in-network)
    $40 office co-pay** (out-of-network) 60% coinsurance for out-of-network Prescription drugs 30% cost share***
  • Prescription drug OPM 3,000/4,000

 

District
$713.39

Employee
$0.00

 

District
$713.39

Employee
$764.45

Total 
$1,477.84

Medical Plan 3

  •  500/1,000 Deductible with 80% coinsurance*
  • 1,250/2,500 OPM
    $20 office co-pay** (in-network)
    $40 office co-pay** (out-of-network) 60% coinsurance for out-of-network Prescription drugs 30% cost share***
  • Prescription drug OPM 3,000/4,000

District 
$671.26

Employee
$0.00

 

District 
$671.26

Employee 
$718.42

Total 
$1,389.68

Medical Plan 4

  • 1,000/2,000 Deductible with 80% coinsurance
  • 2,000/4,000 OPM
    $20 office co-pay** (in-network)
    $40 office co-pay** (out-of-network) 60% coinsurance for out-of-network Prescription drugs 30% cost share***
  • Prescription drug OPM 3,000/4,000

 

District 
$618.67

Employee
$0.00

 

District 
$618.67

Employee
$662.16

Total 
$1,280.83

*Coinsurance is the percentage paid by the plan after the deductible has been met.
For example, with 80% coinsurance on a medical claim and once the deductible has been met, the
plan pays 80% and the employee (or dependent) pays 20%, up to the appropriate out-of-pocket maximum.

**Office co-pays apply with each visit, with exceptions that include chemotherapy, physical therapy, preventative care, and cardiac rehabilitation. This is not an all-inclusive list of exceptions.

***Cost Share is the employee paid portion of a health care cost not covered by insurance

Vision Insurance Rate Summary

Single   $5.90
Two-Person   $11.22
 Family     $16.52

Dental Insurance Rate Summary

Single    +  Depedent  = Family 
$30.14         $70.34         $100.48

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