MEDICAL INSURANCE

MADE SIMPLE - What happens when you need health care?

Be an educated health consumer. All three plans offered to employees cover in-network preventive care 100%. Beyond that, your responsibility depends on the plan you choose, the services you need, and where you receive your care.

Know your terms!

PSF - Partially Self Funded account Your employer contracts with a third-party administrator (TPA) to administer all aspects of the health plan, including claim adjudication, but the employer funds the claims payments Advantage Administrators will again be the TPA for the District’s PSF services

Calendar Year - Deductible and Out of Pocket Maximums are based on a calendar year which begins January 1st - December 31st annually

Deductible - a fixed dollar amount that you pay for covered services in a benefit year before medical benefits become available

Out of pocket maximum - the most you will pay during the calendar year for covered expenses This includes copays, deductibles, coinsurance, and prescription drugs

Copay - a flat fee you pay whenever you use certain medical services, like a doctor visit

High Deductible Health Plan (HDHP) - a plan with a higher deductible than a traditional insurance plan that must be paid before insurance coverage kicks in

Health Savings Account (HSA) - a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses

PLAN OPTIONS - There are three (3) choices

1. PSF 500 = Partial Self Funded Plan with a $500 Per Person Deductible. The district purchases a $5000 deductible plan with Wellmark and self-funds it down to the $500 deductible with Advantage Administrators services to track and make payments

2. PSF 2500 HDHP w/ HSA = Partial Self Funded Plan with a $2500 High Deductible Health Plan that is eligible for Health Savings Account contributions. The district purchases a $5000 HDHP plan with Wellmark and self-funds it down to the $2500 deductible with Advantage Administrators services to track and make payments THIS IS A CHANGE As of July 1st the $2500 HDHP Plan will also be a PSF health plan with Advantage Administrators paying the claims between the district covered $2500 HDHP and the Wellmark Plan $5000 HDHP.

3. 5000 HDHP w/ HSA = A $5000 High Deductible Health Plan that is eligible for Health Savings Account contributions.

Your Cost For Medical Coverage

We do our very best to get the most competitive prices while getting you the best possible coverage. These premiums are the amount you pay for your insurance each paycheck Remember that they come out before taxes, lowering your taxable income.

Note: Married Employees (two eligible full time employees sharing employee benefits) and Bus Route Driverssee your designated Plan Options on the pages following as they are different from below