Health Insurance
Eligibility: First of month following one month of employment.
Cost per pay period: Discounted premiums for non-tobacco users (not shown).
Cost per pay period: Discounted premiums for non-tobacco users (not shown).
| Full Time Plans | |||
|
|
Healthy
Choice
Gold |
Healthy
Choice
Silver |
Healthy
Choice
Bronze |
| Employee | $54.83 | $45.21 | $29.82 |
| Employee +1 | $143.40 | $117.61 | $94.16 |
| Family | $199.07 | $154.45 | $127.36 |
| Part Time Plans | |||
|
|
Healthy
Choice
Gold |
Healthy
Choice
Silver |
Healthy
Choice
Bronze |
| Employee | $101.15 | $76.49
| $51.14 |
| Employee +1 | $278.27 | $226.68 | $179.81 |
| Family | $389.60 | $300.35
| $246.20 |
One Plan - choice of three different levels.
Visits to primary physicians: Plan pays 100 percent after a $20 or $30 co-pay
for in-network providers.
Visits to specialists: Plan pays 100 percent after a $30 or $40 co-pay for in-network
providers.
Lab/Diagnostic pays 90, 80, or 70 percent after deductible, depending on choice
of plan.
Hospital Services: Services performed at St. Francis are covered at 100 or 90
percent after plan deductible. In network services are covered at 90, 80, or 70
percent after deductible.
Out of network services are covered at 60 percent after plan deductible. Pre-authorization
of all hospital services is required.
Routine Well Child care: Plan pays 100 percent after plan co-pay.
Routine Well Adult care: Plan pays 100 percent after plan co-pay. For women,
includes an annual gynecological exam and pap smear, and a mammogram subject to
ACS guidelines. For men, includes an annual PSA test/prostate screening.
Urgent Care: Plan pays 90, 80, or 70 percent after plan co-pay in network and
60 percent
for unauthorized services after meeting deductible.
Opt-out credit available if other insurance is maintained upon proof of coverage.
Spousal surcharge added if spouse has access to other coverage.
Prescription Drug Card:
| CO-PAYMENTSCHEDULE | Retail
30 days | Mail Order
90 days |
| Tier 1
Generic Drugs | $10 | $20 |
| Tier 2
Name Brand (formulary) | $25 | $50 |
|
Tier 3
Name Brand (other) Employee pays 100% | $75 max. | $150 max. |