Health
Care Plan Open Enrollment For
July 1, 2005 (Excludes all non-faculty athletic
coaches)
Open Enrollment Period –
April 18 – April 29, 2005
For Eligible Managers;
Senior Policy Executives; Faculty; Security, Police, and Fire
Professionals of
|
Family
Coverage |
||||
|
Low Usage – 1st
person - 2 $50 office visits; 2nd person 2 $50 office visits; 3rd
person 2 $50 office visits |
||||
|
|
Indemnity |
PPO |
||
|
Annual
Employee Contribution |
$1,291.68 |
$1,068.08 |
||
|
1st
person Deductible |
$100.00 |
$0.00 |
||
|
1st
person Coinsurance/Co-Pay |
$0.00 |
$30.00 |
||
|
2nd
person Deductible |
$100.00 |
$0.00 |
||
|
2nd
person Coinsurance/Co-Pay |
$0.00 |
$30.00 |
||
|
3rd person Deductible |
$100.00 |
$0.00 |
||
|
3rd person Coinsurance/Co-Pay |
$0.00 |
$30.00 |
||
|
Total |
$1,591.68 |
$1,158.08 |
||
|
Medium Usage – 1st
person 10 $50 office visits; 2nd person 10 $50 office visits; 3rd
person 10 $50 office visits |
||||
|
Annual
Employee Contribution |
$1,291.68 |
$1,068.08 |
||
|
1st
person Deductible |
$500.00 |
$0.00 |
||
|
1st
person Coinsurance/Co-Pay |
$0.00 |
$150.00 |
||
|
2nd
person Deductible |
$500.00 |
$0.00 |
||
|
2nd
person Coinsurance/Co-Pay |
$0.00 |
$150.00 |
||
|
3rd person Deductible |
$500.00 |
$0.00 |
||
|
3rd person Coinsurance/Co-Pay |
$0.00 |
$150.00 |
||
|
Total |
$2,791.68 |
$1,518.08 |
||
|
Catastrophic
Scenario – 1st person major surgery ($300,000), 10 $50 office visits,
ambulance ($1,200), and durable medical equipment ($800); 2nd person 10 $50
office visits; 3rd person 10 $50 office visits |
||||
|
Annual
Employee Contribution |
$1,291.68 |
$1,068.08 |
||
|
1st
person Deductible |
$500.00 |
$0.00 |
||
|
1st
person Coinsurance/Co-Pay |
$350.00 |
$150.00 |
||
|
2nd
person Deductible |
$500.00 |
$0.00 |
||
|
2nd
person Coinsurance/Co-Pay |
$0.00 |
$150.00 |
||
|
3rd
person Deductible |
$500.00 |
$0.00 |
||
|
3rd
person Coinsurance/Co-Pay |
$0.00 |
$150.00 |
||
|
*Assumes
all services in PPO plan provided by in-network providers and services in
the indemnity plan provided by participating providers. |
$3,141.68 |
|
||
2005—2006 Medical/Hospital Plan
Comparison Benefits
News
Page 3 of 7
Glossary of Terms
Plan Service
Areas Highmark
ClassicBlue Indemnity Plan and Highmark PPOBlue Plan Offered
in all counties in Offered
in the following counties: ·
( ·
(Berks)
Berks, Carbon and Monroe ·
(Central)
Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon,
Perry, Schuylkill and York Geisinger
Health Plan HMO Offered
in the following counties: Bedford,
Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clearfield,
Clinton, Columbia, Cumberland, Dauphin, Elk, Huntingdon, Jefferson,
Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming,
Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Potter,
Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming and
York. Keystone
Health Plan Central HMO Offered
in the following counties: Adams,
Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata,
Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry,
Schuylkill, Snyder, Union and York Keystone
Health Plan East HMO Offered
in the following counties: Berks,
Bucks, UPMC
HMO Offered
in the following counties: Allegheny,
Armstrong, Beaver, Blair, Bedford, Butler, Cambria, Cameron, Clarion, Clearfield,
Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence,
McKean, Mercer, Potter, Somerset, Venango, Warren, Washington and
Westmoreland.
Employees continue to contribute 10
percent of the premium for their health and prescription drug
coverage. Costs are calculated on
the type/size of contracts. Rates
are based on the following categories:
single, two-party, or family.
All contributions will be made through bi-weekly pre-tax payroll
deductions. Employee contributions
will be taken over 20 or 26 pays depending on your work schedule and the
pay option you selected. Below are employee costs for
participation in the health and prescription drug plan in the Pennsylvania
State System of Higher Education Group Health Program. These contribution rates are effective
July 1, 2005, through June 30, 2006.
For most employees, the first payroll deduction will be reflected in
the pay you receive on July 8, 2005.
Twenty-six pay faculty converting from the 20 pay rate will have
their first deduction on the pay to be received on August 19, 2005.
2986
N. Phone: (717)
720-4160 Fax: (717)
720-4162 Please
visit us on the Web! Search
the Site “Benefits” The Women’s Health and Cancer Rights
Act requires that health care plan members receive annual notification of
the coverage provided for mastectomy patients who elect reconstructive
surgery. Your State System coverage provides
benefits for reconstruction of the breast on which the mastectomy is
performed, surgery and reconstruction of the other breast to produce a
symmetrical appearance, and prostheses and treatment of physical
complications for all states of mastectomy, including lymphedemas. These services are elective and should be
chosen by consulting your physician.
Benefits are subject to any deductible and coinsurance provisions.
Important Health Care Coverage Notification
