- Administered by Health Alliance
- Requires Primary Care Physician (Clinic Physician)
- Must use in network services for best benefit
- No steerage towards any specific hospital
- In network services - $50 individual, $100 family deductible per year, 90% coverage (applies to most services)
- Out of network services - $200 individual, $600 family deductible, 70% of UCR after deductible
- $25 office visit co-pay (does not apply to preventive services)
- Prescription Drugs
- Generic $15 co-pay
- Preferred Brand$25 co-pay
- Non-Preferred Brand $35 co-pay
- Eligibility - must be scheduled to work 24 or more hours per week
- Coverage effective 1st day of month following 60 day initial employment period.
- Out-of-Pocket Maximum - $3000 In Network/$6000 Out of Network
Premiums (Monthly - split between first and second paycheck of the month)
Non Tobacco Users
| Hours |
Single Wellness* |
Single |
Family Wellness* |
Family |
| 36-40 |
60.00 |
75.00 |
170.00 |
185.00 |
| 28-35 |
90.00 |
105.00 |
200.00 |
215.00 |
| 24-27 |
120.00 |
135.00 |
230.00 |
245.00 |
Tobacco Users
| Hours |
Single Wellness* |
Single |
Family Wellness* |
Family |
| 36-40 |
105.00 |
120.00 |
215.00 |
230.00 |
| 28-35 |
135.00 |
150.00 |
245.00 |
260.00 |
| 24-27 |
165.00 |
180.00 |
275.00 |
290.00 |
* - For Employees who have completed the Partners in Prevention Checklist & submitted to HR by 06/30.