There are three options the employee may
choose from, Plan A (Low Option), Plan B (Medium Option), Plan C (High
Option). The Plan you select
will apply to both you and your covered dependents.
The plans and monthly premiums are
listed below, the actual cost to the employees (+30 hours), and the rates
for 2002-2003:
MEDICAL BENEFIT OPTIONS
Low Option Medium Option
High Option
Plan A_
_ ____Plan
B____
_ _
Plan C
Individual
Deductible ($)
$1,000 Combined
$200 Combined $
-0- / $500 (In/Out)
Family
Deductible ($)
$3,000 Combined $600
Combined
$ -0- / $1,500
(In/Out)
Co-Insurance
(In/Out)
70% / 50%
90% / 70%
90% / 70%
Office
Visit Co-Pay*
$35
$25
$15
Preventive
Care
$500 per year
$500 per year $500 per year
Ind.
Co-Ins. Max. (In/Out)
$2,000/
$3,000
$1,000/
$2,000 $500 / $2,000
Family
Co-Ins. Max. (In/Out)
$6,000 / $9,000
$3,000 /
$6,000
$1,500 / $6,000
Prescription
Co-Pay
$20 / $40 / $60
$5 / $20 / $35
$5 / $20 / $35
*In-Network Only
PAYROLL DEDUCTIONS EFFECTIVE
9-1-02*
Low Option Medium Option
High Option
Plan A_
_ ____Plan
B____
_ _
Plan C
Employee Only
$ -0-
$ 75.00
$110.00
Employee
& Child(ren)
$150.00
$275.00
$360.00
Employee
& Spouse
$300.00
$450.00
$520.00
Employee
& Spouse &
Child(ren)
$450.00
$650.00
$770.00
PT Employees (<30 hrs)
Who pay ½ of insurance
$150.00
$225.00
$260.00
Employee
& Children
$300.00
$425.00
$510.00
Employee
& Spouse
$450.00
$600.00
$670.00
Employee
& Spouse &
Child(ren)
$600.00
$800.00
$920.00
DENTAL PLAN
Effective with the September 2002,
payroll deductions, the deductions for Andrews ISD Employee Dental
Benefits will increase. The
increase is necessary to keep premium equal to claim expenses.
Benefits are not being
changed. The new payroll
deductions are:
Employee Only $28.00
Employee & Child(ren)
$56.00
Employee & Spouse
$56.00
Employee & Spouse & Child(ren)
$62.00
Blue Cross Blue Shield’s telephone
number (800) 521-2227: Our group number 63484.
If you have any questions, please call Mandy Pace at ext. 783 or
Melisa Martin at ext. 781.
