HMO Co-pays and Deductibles:
The HMO Plan shall have the following co-pays and deductibles:
(a) Twenty Dollars ($20.00) per medical visit;
(b) One Hundred Dollars ($100.00) per emergency room visit;
(c) Two Hundred Fifty Dollars ($250.00) Per Person, Five Hundred Dollars
($500.00) Per 2 Person/Family Inpatient/Outpatient Facility Deductible; and
(d) Three Tier Pharmacy Benefit of $5/$15/$35 ($5/$30/$70 Mail Order).
Effective July 1, 2021, the HMO Plan shall have the following co-pays and deductibles:
(a) Twenty-Five Dollars ($25.00) per medical visit;
(b) One Hundred Dollars ($100.00) per emergency room visit;
(c) One Thousand Five Hundred Dollars ($1.500.00) Per Person, Three Thousand
Dollars ($3,000.00) Per 2 Person/Family Inpatient/Outpatient Facility Deductible;
and
(d) Three Tier Pharmacy Benefit of $10/$30/$50 ($20/$60/$100 Mail Order).
High Deductible Health Plan with Health Savings Account (HDHP w/ HSA):
The deductibles in the High Deductible Health Plan with Health Savings Account (HDHP w/
HSA) are $2,000 individual / $4,000 2-person or family. The City’s contribution to Health
Savings Accounts is $1,500 individual / $3,000 2-person or family.
The City HSA contribution will be distributed in 2 installments, one on or about July 1 and on
one or about October 1, provided however that if an employee is required to pay more towards
his / her deductible than the initial 50% contribution, upon presentation of suitable
documentation, the City will contribute the remaining 50% before October 1.
Employees who jon the HDHP w/HSA. at any time other than July 1 will receive a pro-rated
City contribution of $125 monthly for a single plan and $250 monthly for 2-person or family
plan for each full month remaining in that fiscal year.
Article 24
Dental Insurance
The City shall pay one hundred (100%) percent of the premium of a two person plan
dental insurance program such as Delta Dental, currently in effect on the date of execution
hereof. The
City reserves the right to change insurance carriers or plans, or to self insure the same. Such
new
plans shall offer benefits commercially available in the market and shall have overall
comparability of coverage to the above referenced plans to the extent said coverages are
commercially available.
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