right to provide prescription benefits through a separate provider managed by a pharmacy
benefits manager.
Any Administrator requesting initial membership in a plan may enter during a specified
enrollment period. Any eligible Administrator desiring to select a different plan may make such
a change only during the annual enrollment period or a qualifying event.
The group health insurance of any Administrator terminating employment with the District for
whatever reason - resignation, retirement, lay-off, discharge or unpaid leave of absence other
than sick leave - shall expire on the last day of the month following the month the Administrator
terminates employment with the District.
The District shall contribute 70% of the premium for a point-of-service plan, and 80% of the
premium for an HMO and High Deductible plans. All plans offered by the district shall have the
following co-pays and deductibles:
1. POS and HMO:
Twenty Dollars ($20.00) per medical visit;
. One Hundred Dollars ($100.00) per emergency room visit;
c. Two Hundred Fifty Dollars ($250.00) per person, Five Hundred Dollars ($500.00) per
two-person/Family Inpatient/Outpatient Facility Deductible; and
d. Three (3) Tier Pharmacy Benefit of $5/15/35 ($5/$30/$70 mail order).
oS
The following co-pays and deductibles below will become effective on July 1, 2023.
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 ($1500.00) per person, Three Thousand Dollars
($3000.00) per two-person/family Inpatient/Outpatient Facility Deductible; and
d. Three (3) Tier Pharmacy Benefit of $10/30/50 ($20/$60/$100 mail order).
2. Anthem HDHP with Health Savings Account (HSA):
a. Deductibles for the HOHP are $2,000 (single) and $4,000 (two-person/family);
. Annual $1,500 single and $3,000 (two-person/family) contriubtion to the HSA;
c. Prorating of HSA contribution based upon enrollment date — Employees who join
the HDHP with HSA at any time other than July 1 will receive a pro-rated city
contribution of $125 montly for a single plan and $250 monthly for 2-person or
family plan for each full month remaining in that fiscal year.
d. Annual disbursement of HSA contribution in two (2) installments (July and October)
—- The Board’s contribution will be distributed in two (2) installments, one on or
about July 1 and one on 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.
Specific provisions of each plan, including pharmacy benefits, will be provided to each employee
at the time of hire, upon request, or in advance of any changes to the benefits provided by a
plan.
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