BENEFITS
FY21 Health Plan Benefit/CoPay Breakdowns
$492 EMPLOYEE - EPO $3,500 DEDUCTIBLE
$524 EMPLOYEE - PPO - $3,000 DEDUCTIBLE
$570 EMPLOYEE - PPO $2,000 DEDUCTIBLE
$455 EMPLOYEE - HDHP $5,000 DEDUCTIBLE
FY22 HEALTH PLAN INFORMATION
Employee, Employee & Spouse, Employee & Children, Family Rates
Option 1 - HDHP 100%, $6500 Deductible (2xFam - Embedded), $7000 MOOP, $30 PCP/$60 SPC OV Inclusive (after deductible). RX: Medical Decutible $15 - $45 - $75 - $200 (All copays after deductible)
Employee Emp & Spouse Emp & Kids Family
EPO - $370 $758 $628 $1,072
PPO - $411 $842 $698 $1,191
Option 3 - Partners 70, $5000 Deductible (2xFam), $7000 MOOP, $30 PCP/$60 SPC OV inclusive, $300 ER, $75 UC. RX: $100 Ded (T3-T4) - $15 - $45 - $75 - $200
Employee Emp & Spouse Emp & Kids Family
EPO - $439 $901 $747 $1,274
PPO - $488 $1,001 $830 $1,416
Option 4 - Partners 70, $3500 Deductible (3xFam), $6000 MOOP, $30 PCP/$60 SPC OV inclusive, $300 ER, $75 UC. RX: $100 Ded (T3-T4) - $15 - $45 - $75 - $200
Employee Emp & Spouse Emp & Kids Family
EPO - $482 $988 $819 $1,397
PPO - $535 $1,097 $910 $1,552
DENTAL
Option 1 - High Plan Option 2
$25 Individual $50 Individual
$75 Family $150 Family
Care information
Preventative Care 100%
Basic 90%
Major 60%
Endodontics 90%
Peridontics 90%
Oral Surgery 90%
Orthodontia 50%