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Health care edition of Currents (.pdf)
University health care plans: How they work and what it means for you
University High Deductible Plan
| The High Deductible Plan provides a higher deductible and out-of-pocket maximum, which requires the member to potentially pay higher overall costs for services incurred under the plan. However, there are lower payroll deductions associated with enrollment. | ||
see these employee examples |
||
| Deductible 1 | SINGLE | FAMILY |
| In-Network |
$500 | $1,250 |
| Out-of-Network | $1,000 | $2,500 |
| Out of Pocket Maximum2 | ||
| In-Network (Earning less than $44,100) | $1,500 | $3,750 |
| In-Network (Earning $44,100 or more) |
$2,000 | $5,000 |
| Out-of-Network | $4,000 | $10,000 |
| Coinsurance |
80% In-Network / 60% Out-of-Network | |
| Office Visit (PCP and Specialist) |
Subject to deductible and coinsurance |
|
| Well Care (Preventive Care)3 |
100%, no deductible | |
| Flexible Spending Account (FSA) |
FSA Eligible Limit $6,500 |
|
| Lifetime Maximum |
Unlimited | |
| Prescription Drugs4 |
||
| Retail (30 days supply) | $10/$25/$40 | |
| Mail Order (90 days supply) | 2.5 times retail | |
| 1Rx does not count toward deductible 2Rx not included/Includes deductible |
3Not covered out-of-network 4Not subject to out-of-pocket maximum |
|
Employee Contributions (Monthly Pre-Tax Payroll Deductions) |
||||
| Single |
Family | Employee and Child(ren) |
Employee and Spouse/ Domestic Partner |
|
| Full-time, Earns Less Than $44,100 |
$15.52 | $46.54 | $27.94 | $34.14 |
| Full-time, Earns $44,100–$110,100* |
$53.62 | $160.88 | $96.54 | $117.98 |
| Part-time, Earns Less Than $110,100† |
$88.14 | $264.44 | $158.68 | $193.92 |
| Full-time/Part-time, Earns More Than $110,100 | $122.66 | $368.00 | $220.80 | $269.86 |
| * Also, part-time earning less than $110,100 with more than 5 years of service | ||||
University Low Deductible Plan
| The Low Deductible Plan provides a lower deductible and out-of-pocket maximum, which means lower overall costs for services incurred under the plan. However, there are higher payroll deductions associated with enrollment. | ||
see these employee examples |
||
| Deductible 1 | SINGLE | FAMILY |
| In-Network |
$200 | $500 |
| Out-of-Network | $400 |
$1,000 |
| Out of Pocket Maximum2 | ||
| In-Network (Earning less than $44,100) | $1,000 | $2,500 |
| In-Network (Earning $44,100 or more) |
$1,500 | $3,750 |
| Out-of-Network | $3,000 | $7,500 |
| Coinsurance |
90% In-Network / 70% Out-of-Network | |
| Office Visit (PCP and Specialist) |
Subject to deductible and coinsurance |
|
| Well Care (Preventive Care)3 |
100%, no deductible | |
| Flexible Spending Account (FSA) |
FSA Eligible Limit $6,500 |
|
| Lifetime Maximum |
Unlimited | |
| Prescription Drugs4 |
||
| Retail (30 days supply) | $10/$20/$35 | |
| Mail Order (90 days supply) | 2.5 times retail | |
| 1Rx does not count toward deductible 2Rx not included/Includes deductible |
3Not covered out-of-network 4Not subject to out-of-pocket maximum |
|
Employee Contributions (Monthly Pre-Tax Payroll Deductions) |
||||
| Single |
Family | Employee and Child(ren) |
Employee and Spouse/ Domestic Partner |
|
| Full-time, Earns Less Than $44,100 |
$52.76 | $158.24 | $95.02 | $116.04 |
| Full-time, Earns $44,100–$110,100* |
$92.38 | $277.10 | $166.26 | $203.20 |
| Part-time, Earns Less Than $110,100† |
$127.00 | $380.94 | $228.58 | $279.38 |
| Full-time/Part-time, Earns More Than $110,100 | $161.60 | $484.80 | $290.90 | $355.52 |
| * Also, part-time earning less than $110,100 with more than 5 years of service | ||||
University HSA-Eligible Plan
| The HSA-Eligible plan combines the highest deductible and out-of-pocket maximum with the lowest monthly payroll deductions. Individuals enrolled in this plan must be prepared, in the event of a catastrophic illness or injury, to pay up to the out-of-pocket maximum outlined below. An HSA plan, similar to an FSA plan, to which employees contribute pre-tax dollars, is available. | ||
see these employee examples |
||
| Deductible 1 | SINGLE | FAMILY |
| In-Network | $1,200 | $2,400 |
| Out-of-Network | $1,200 | $2,400 |
| Out of Pocket Maximum2 | ||
| In-Network |
$2,400 | $4,800 |
| Out-of-Network | $2,400 | $4,800 |
| Coinsurance |
80% In-Network / 80% Out-of-Network | |
| Office Visit (PCP and Specialist) |
Subject to deductible and coinsurance | |
| Well Care (Preventive Care)3 |
100%, no deductible | |
| Flexible Spending Account (FSA) |
HSA Eligible 2011 limits: Single $3,050/Family $6,150 |
|
| Lifetime Maximum |
Unlimited | |
| Prescription Drugs4 |
||
| Retail (30 days supply) | $10/$30/$50 | |
| Mail Order (90 days supply) | 2.5 times retail | |
| 1Rx does not count toward deductible 2Rx not included/Includes deductible |
3Not covered out-of-network 4Not subject to out-of-pocket maximum |
|
Employee Contributions (Monthly Pre-Tax Payroll Deductions) |
||||
| Single |
Family | Employee and Child(ren) |
Employee and Spouse/ Domestic Partner |
|
| Full-time, Earns Less Than $44,100 |
$7.88 | $23.62 | $14.18 | $17.32 |
| Full-time, Earns $44,100–$110,100* |
$8.18 | $24.50 | $14.70 | $17.98 |
| Part-time, Earns Less Than $110,100† |
$41.82 | $125.46 | $75.28 | $92.02 |
| Full-time/Part-time, Earns More Than $110,100 | $75.48 | $226.42 | $135.84 | $166.04 |
| * Also, part-time earning less than $110,100 with more than 5 years of service | ||||
University Copay Plan
| The Copay plan requires the highest monthly payroll deductions, but provides the lowest cost for services incurred under the plan, in most cases. | ||
see these employee examples |
||
| Deductible 1 | SINGLE | FAMILY |
| In-Network |
$2505 |
$2505 |
| Out-of-Network | $400 | $1,000 |
| Out of Pocket Maximum2 | ||
| In-Network | None | None |
| Out-of-Network | $3,000 | $7,500 |
| Coinsurance |
100% In-Network / 70% Out-of-Network |
|
| Office Visit (PCP and Specialist) |
In-Network Co-pay: $20/$30 Out-of-Network: Subject to deductible and coinsurance |
|
| Well Care (Preventive Care)3 |
100%, no copay | |
| Flexible Spending Account (FSA) |
FSA Eligible Limit $6,500 |
|
| Lifetime Maximum |
Unlimited | |
| Prescription Drugs4 |
||
| Retail (30 days supply) | $10/$20/$35 | |
| Mail Order (90 days supply) | 2.5 times retail | |
| 1Rx does not count toward deductible 2Rx not included/Includes deductible 3Not covered out-of-network |
4Not subject to out-of-pocket maximum 5 Applies to in-patient admission |
|
Employee Contributions (Monthly Pre-Tax Payroll Deductions) |
||||
| Single |
Family | Employee and Child(ren) |
Employee and Spouse/ Domestic Partner |
|
| Full-time, Earns Less Than $44,100 |
$68.66 |
$205.96 | $123.58 | $151.04 |
| Full-time, Earns $44,100–$110,100* |
$108.94 | $326.84 | $196.10 | $239.68 |
| Part-time, Earns Less Than $110,100† |
$143.64 | $430.90 | $258.54 | $316.00 |
| Full-time/Part-time, Earns More Than $110,100 |
$178.32 | $534.96 | $320.98 | $392.30 |
| * Also, part-time earning less than $110,100 with more than 5 years of service | ||||
