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HEALTH PLAN DETAILS
The chart below is a breakdown of
health care benefits provided under the new contract to the members of the
CTC.
|
Class 1 Employees (makes under $30,000) |
|
|
|
PPO |
In Network |
Out of Network |
|
Deductible: Per Individual, Per Plan
Year |
$350 |
|
Family Deductible: Aggregate |
$700 |
|
Out of Pocket Expenses Limitation:
Individual
Family |
$550
$1100 |
$850
$1700 |
Note: Coverage’s that
are not described above (Class 1 employee insurance matrix) shall be those
set forth in the Class 2 Teachers PPO health/dental plan document.
|
Class 2 Employees (makes over $30,000) |
|
|
|
PPO |
In Network |
Out of Network |
|
Lifetime Maximum |
2,000,000 |
|
Deductible: Per
Individual, Per Plan Year |
$500 |
|
Family Deductible:
Aggregate |
$1000 |
|
Out of Pocket
Expenses Limitation:
Individual
Family |
$700
$1400 |
$1100
$2000 |
|
Pre-Admission
Testing: |
100%** |
100%** |
|
Outpatient Surgery: |
100%** |
100%** |
|
Outpatient X-Ray &
Diagnostic Testing |
100%** |
100%** |
|
Supplemental
Accident |
100%** |
100%** |
|
Preventive
Care/Routine Exams ($300) (previously $175) |
100%** |
100%** |
|
Wellness ($350
under 7 yrs, $700 under 3 yrs) (previously
$150/$500) |
100%** |
100%** |
|
Inpatient Hospital
Services |
90% |
75% |
|
Outpatient
Emergency |
90% |
90% |
|
Inpatient
Psychiatric & Substance Abuse |
90%** |
75%** |
|
Outpatient
Psychiatric & Substance Abuse |
50% |
50% |
|
Medical/Surgical
Care |
90% |
75% |
|
Other Covered
Services - include wellness for dependent children |
80% |
|
Prescription Drug
card |
|
|
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Prescription drug
benefit 34 day supply paid 100% after co-pay
(previously 90 day) |
$15 generic brand* |
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Mail order
prescription drug 90 day supply (previously 180
day) |
$25 formulary
brand* |
|
(not
offered previously) |
$40 non-formulary
brand* |
|
*If the cost of the
prescription is less than the co-pay amount, the lesser amount will be
charged |
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** Indicates that
the deductible does not apply |
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Summary:
Per the new contract health care benefits are essentially unchanged except
for a few areas:
1. Single coverage is still paid 100% by the district and
family coverage is paid 50% by the district.
2. Preventive Care/Routine exams has increased $125 from
$175/year to $300/year.
3. Wellness (Well Baby Care) has increased $200 from $500 per
child through age 2 to $700 and from $150 per child through age
6 to $350.
4. Drug Plan changed from 180 day mail order prescriptions to
90 days and 90 day pharmacy drug supply changed to 34 days. This
increases the number of co-pays made by the participant.
5. Teachers that job share and work half days will now be
eligible for pro-rated benefits only.
The Bottom
Line
Benefits, premium
contributions, Rx and other co-pays are still out of sync with the D15
Community.
Health care costs have increased at a double digit rate for the past several
years and most of us have had these increases passed on from our employers
to us. Increases in premium deductions have shrunk our paychecks and we are
paying more and more out of our pockets because our benefits have been
reduced and our co-pays or coinsurance have increased. The CTC's benefits
and the associated costs have remained virtually unchanged. This type of
spending does not help to alleviate budget deficits of the district.
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Kids Must Count!
