Embed Size (px)
Citation preview
2019-20
1st
(9/1 to 8/31)
100%
1 –
2 –
In-Network Tier 1 Tier 2
Deductible
- Single/Family $1, 000/$2,000 $1,500/$3,000
Coinsurance 25% 45%
Out-of-Pocket Maximum
- Single/Family $3,500/$7,000 $4,500/$9,000
Preventive Care You pay $0 You pay $0
Office Visits 25% after deductible 45% after deductible
Convenience Care
Urgent Care, Emergency
25% after deductible 45% after deductible
Outpatient/Inpatient
Hospital Care
25% after deductible 45% after deductible
Prescription Drugs- Generic/Brand/Non-Formulary
- Preferred Specialty Drugs
- Non-preferred Specialty Drugs
$10/$50/$100
20% to a maximum of $200/script
40%
Out-of-network services: $2,000 single/$4,000 family deductible, then 50% coinsurance, to a maximum $6,000 single/$12,000
family out-of-pocket
In-Network Tier 1 Tier 2
Deductible
- Single/Family $2,700/$5,400 $3,000/$6,000
Coinsurance 20% 40%
Out-of-Pocket Maximum
- Single/Family $3,500/$7,000 $4,500/$9,000
Preventive Care You pay $0 You pay $0
Office Visits 20% after deductible 40% after deductible
Convenience Care
Urgent Care, Emergency
20% after deductible 40% after deductible
Outpatient/Inpatient Hospital Care 20% after deductible 40% after deductible
Prescription Drugs
- Preventive Rx
- Generic/Brand/Non-Formulary
- Specialty Drugs
You pay $0
20% after deductible
20% after deductible
Out-of-network services: $4,000 single/$8,000 family deductible, then 50% coinsurance, to a maximum $6,000 single/$12,000
family out-of-pocket.
1:
2:
3:
100%,
100%
2019-20 Monthly Medical Premiums
0.75 to 1.0 FTE
0.50 to .749 FTE
$ 714.00 $ 520.00 $ 194.00
$ 1,503.00 $ 1,003.00 $ 500.00
$ 2,293.00 $ 1,547.00 $ 746.00
$ 714.00 $ 414.00 $ 300.00
$ 1,503.00 $ 813.00 $ 690.00
$ 2,293.00 $ 1,261.00 $ 1,032.00
2019-20 Monthly Medical Premiums
0.75 to 1.0 FTE
0.50 to .749 FTE
$ 690.00 $ 546.00 $ 144.00
$ 1,403.00 $ 1,023.00 $ 380.00
$ 2,117.00 $ 1,547.00 $ 570.00
Total Premium
Equivalent
Employer
Contribution
Employee
Contribution
$ 690.00 $ 546.00 $ 144.00
$ 1,403.00 $ 813.00 $ 590.00
$ 2,117.00 $ 1,248.00 $ 869.00
$2,700
2019-20
1 – 31
1 – 31.
1 – 31.
$1,000
$1,500
$2,000
Contributions made by employees are pre-tax
You may change your contribution amounts throughout the year
IRS Calendar Year Contribution Limits (less employer contribution)
Age 55+ employees allowed additional annual $1,000 “catch up” contribution.
Some IRS participation restrictions apply!
2019 2020
$2,500 $2,550
$5,500 $5,600
$5,000 $5,100
