(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).
HMO Co-pays and Deductibles:
Effective July 1, 2021, the HMO 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).
igh Deductible Health Plan with Health S avings Account (HDHP w/ HS A):
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 employ ee 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.
Emp loy ees who join the HDHP w/ HSA. at any time other than July_1 will receive a pro-rated
City contribution of $125 monthly for a single planand $250 monthly for 2-person or family
plan for each full month remaining in that fiscal y ear.
Annual Audit: Thecity hereby agrees to conduct ay carly loss ratio analy sis of all health insurance
plans offered to employ ces and return all employ ce overpay ments in the form of a health Insurance
Premium Holiday at the completion of the analy sis.
Article 22
Dental Insurance
The Board shall pay one hundred (100%) percent of the premium of a two person dental insurance
program such as Delta Dental, currently in effect on the date of execution hereof. The Board
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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