South San Antonio ISD 2020-2021 Benefits Enrollment

South San Antonio ISD is offering Aetna/HEB Rx Plan Options for the 2020-2021 benefits enrollment. Option 1 includes Aetna Whole Health ACO Baptist Providers, while Option 2 is a POS plan. Both options outline coverage details including deductibles, out-of-pocket maximums, physician services, hospital visits, emergency care, prescription drug coverage, and more.

• Benefits Enrollment
• 2020-2021
• Aetna
• South San Antonio ISD
• Healthcare

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Uploaded on Jul 22, 2024 | 1 Views

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1. South San Antonio ISD 2020 - 2021 Benefits Enrollment 1

2. Aetna / HEB Rx Plan Benefits Option 1 Aetna Whole Health ACO Baptist Providers (Tier 1) 100% General All other Aetna network (Tier 2) Out-of-Network Preventive Care Services Calendar Year Deductible Individual Family (Embedded) Hospital Admission- Inpatient Coinsurance % Out-of-Pocket Maximum: Individual Family Policy Maximum Physician Services: Primary Care Physician: Office Co-pays Specialist / Urgent Care: Office Co-pays 100% N/A N/A N/A N/A N/A N/A N/A N/A N/A $5,000 $10,000 $5,000 $10,000 85% after deductible 85% 65% after deductible 65% $6,350 $12,700 Unlimited $6,350 $12,700 Unlimited $35 copay $70/$100 copay $35 copay $70/$100 copay $250 copay; deductible waived Covered 100%, deductible waived $35 PCP $70 Specialist 65% after deductible $70 copay N/A N/A $250 copay; deductible waived Hospital Visits Emergency Room Service $250 copay; ded. waived Maternity Prenatal Care 100%; ded. waived N/A Allergy Injections $35 PCP/$70 Specialist N/A In-Patient Psych. Out-Patient Psych. Hospital Services: Room & Board Inpatient Services Surgery Hospital Services- Out Patient: Surgery Emergency - Facility Emergency - Physician Other Services: Home Health Care Hospice Care Ambulance- Emergency Medical Transportation Diagnostic X-ray & Lab, PET,MRI, Pharmacy (ESI) Prescription Drug Coverage Mail Order Pharmacy 85% after deductible $70 copay N/A N/A 85% after deductible 85% after deductible 65% after deductible 65% after deductible N/A N/A 85% after deductible $250 copay; ded. waived 80% after deductible 65% after deductible $250 copay; ded. waived 80% after deductible N/A $250 copay; ded. waived N/A 85% after deductible 100% ; ded. waived 85% after deductible 85% after deductible In-Network $15/$35/$70 $37.50/$87.50/$175 65% after deductible 100%; ded. waived 85% after deductible 65% after deductible N/A N/A N/A N/A N/A N/A N/A 2

3. Aetna / HEB Rx Aetna Option 2 POS Plan Benefits In-Network 100% Out-of-Network General Preventive Care Services Calendar Year Deductible Individual Family (Embedded) Hospital Admission- Inpatient Coinsurance % Out-of-Pocket Maximum: Individual Family Policy Maximum Physician Services: Primary Care Physician: Office Co-pays Specialist / Urgent Care: Office Co-pays Hospital Visits Emergency Room Service $6,000 $12,000 $10,000 $30,000 80% after deductible 80% 50% after deductible 50% $7,150 $14,300 NA $13,000 $39,000 NA $40 copay $60/$100 copay 80% after deductible Covered 100%, deductible waived $40 PCP $60 Specialist 80% after deductible $40 copay 50% after deductible 50% after deductible 50% after deductible 50% after deductible Maternity Prenatal Care Allergy Injections 50% after deductible In-Patient Psych. Out-Patient Psych. Hospital Services: Room & Board Inpatient Services Surgery Hospital Services- Out Patient: Surgery Emergency - Facility Emergency - Physician Other Services: Home Health Care Hospice Care Ambulance- Emergency Medical Transportation Diagnostic X-ray & Lab, PET,MRI, Pharmacy (ESI) Prescription Drug Coverage Mail Order Pharmacy 50% after deductible 50% after deductible 80% after deductible 80% after deductible 50% after deductible 50% after deductible 80% after deductible 80% after $250 copay; ded. waived 80% after deductible 50% after deductible 80% after $250 copay; ded. waived 50% after deductible 80% after deductible 100%, ded. waived 80% after deductible 80% after deductible In-Network $20/$50/$80 $50/$125/$200 50% after deductible 70% after deductible 80% after deductible 70% after deductible Out of network No coverage NA 3

4. Aetna / HEB Rx Aetna Option 3 POS Plan Benefits In-Network Out-of-Network General 100% Preventive Care Services Calendar Year Deductible Individual Family (Embedded) Hospital Admission- Inpatient Coinsurance % Out-of-Pocket Maximum: Individual Family Policy Maximum Physician Services: Primary Care Physician: Office Co-pays Specialist / Urgent Care: Office Co-pays Hospital Visits Emergency Room Service $3,000 $6,000 $5,000 $10,000 80% after deductible 80% 50% after deductible 50% $6,000 $12,000 NA $10,000 $20,000 NA $35 copay $45/$75 copay 80% after deductible Covered 100%, deductible waived $35 PCP $45 Specialist 80% after deductible $35 copay 50% after deductible 50% after deductible 50% after deductible 50% after deductible Maternity Prenatal Care 50% after deductible Allergy Injections In-Patient Psych. Out-Patient Psych. Hospital Services: Room & Board Inpatient Services Surgery Hospital Services- Out Patient: Surgery Emergency - Facility Emergency - Physician Other Services: Home Health Care Hospice Care Ambulance- Emergency Medical Transportation Diagnostic X-ray & Lab, PET,MRI, Pharmacy (ESI) Prescription Drug Coverage Mail Order Pharmacy 50% after deductible 50% after deductible 80% after deductible 80% after deductible 50% after $250/admission ded. 50% after deductible 80% after deductible 80% after $200 copay; ded. waived 80% after deductible 50% after deductible 80% after $200 copay; ded waived 80% after deductible 80% after deductible 100%, ded. waived 80% after deductible 80% after deductible In-Network $25/$45/$80 $62.50/$112.50/$200 50% after deductible 70% after deductible 80% after deductible 70% after deductible Out of network No Coverage NA 4

5. MEDICAL EMPLOYEE PLAN PREMIUMS Base Plan: Option 1 Mid Plan: Option 2 High Plan: Option 3 2020-2021 Premium 2020-2021 Premium 2020-2021 Premium Monthly Bi-Weekly Monthly Bi-Weekly Monthly Bi-Weekly $0 $0 $65 $32.50 $240 $120 EE $284 $142 $430 $215 $1124 $562 EE/SP $212 $106 $335 $167.50 $985 $492.50 EE/CH $495 $247.50 $735 $367.50 $1562 $781 EE/FM SSAISD will contribute $402 towards all 3 group medical plans beginning November 2020.

6. VISION EMPLOYEE PREMIUM PLAN COMPARISON 2020- 2021 Low Plan Mid Plan High Plan Monthly Bi-Weekly Monthly Bi-Weekly Monthly Bi-Weekly $5.90 $2.95 $9.80 $4.90 $11.00 $5.50 EE $11.00 $5.50 $19.00 $9.50 $21.08 $10.54 Employee + 1 Dep. Employee + 2 or more $17.00 $8.50 $29.00 $14.50 $32.34 $16.17

7. DENTAL EMPLOYEE PREMIUMS 2020 - 2021 Dental Plan HIGH Plan Monthly Bi-Weekly $27.11 $13.56 EE Employee+ 1 Dependent $59.39 $29.70 $85.62 $42.81 Employee + 1 Family Dental Plan L Plan Monthly Bi-Weekly $19.36 $9.68 EE Employee+ 1 Dependent $38.33 $1917 $60.48 $30.24 Employee + 1 Family

8. Other Voluntary Benefits Accident Cancer Voluntary Term Life Disability Hospital Indemnity Heart & Stroke Plan Life Insurance (Term/Whole) Disability Income Protection Flexible Spending Account For more information visit the District Webpage: https://www.southsanisd.net/VOLUNTARYBENEFITS