Insurance Basics - December 2020

Dates

Cost

Current plan

Through December 31

No out of pocket expenses except for current co-pays for prescriptions.

Current premiums

Through March 1

$700 single/$1,850 family annually

Board’s Imposed Plan Design

January 1- January 31 or

January 1 - February 28.
We will inform you when that change occurs as it is based on Medical Mutual’s ability to switch.

Deductible: $100/$200

Co-insurance (90%/10%): $500/$1,000

Co-pays: $20 per office visit/urgent care visit

Max out of pocket: $600/$1,200

Prescriptions:  Members who continue to fill a brand name prescription when a generic is available pay the generic copay plus the difference in cost between the generic and brand drug regardless of dispense as written orders from your doctor

Negotiated Premiums

New annual premiums begin on March 1, 2021.

If your Regular Salary is:

Less than $35,623 then the annual premium is $977 single/$2,645 family

Between $35,623 and and less than $62,340 then annual premium is $1,086 single/$2,939 family

$62,340 and higher then annual premium is $1,194 single/$$3,233 family

New Plan Design

February 1, 2021, or March 1, 2021

Understanding Insurance Terms (LINK)

Deductible: $100/$200

Coinsurance (90%/10%): $400/$800

Out of pocket total for Deductible and Coinsurance: $500/$1,000

ER visits

When to use ER vs Urgent vs Convenience Clinic: 

(LINK)

$25 for emergency(new language)

$100 for non-emergency use of the emergency room(existing language)

Urgent care 

Starting March 1

$15 Copay

Office visits for injury or illness

Starting March 1

$15 Copay

Dental 

No change to the plan

100% Preventative (to include pit and fissure sealants) 

80% basic/major/restorative (to include implants) (annual limit of $3,300) on dental

80% orthodontia (lifetime limit of $3,300)

Vision

No change to the plan 

Eye Exam - up to $70.00 

Lenses and Frames: 

Single Vision up to $180.00

Bifocals up to $205.00 

Trifocals up to $230.00

Contacts up to $130.00