Currently included in the District's health benefits -
1. HMO/POS - In Network (Methodist, Proctor, Pekin) and Out of Network (OSF) providers
2. In Network - no deductible
3. In Network - maximum calendar year out of pocket $1,500 individual / $3,000 family (all copays
and coinsurance applied to out of pocket - except for prescription card copays) (SEE EXAMPLE
a. Coinsurance - employee share (%) owed for provider service (see schedule of benefits on
b. Copay - employee share (flat $ amount) owed for provider service (see schedule of
benefits on line)
4. Pharmacy - $10 generic / $30 formulary / $45 non-formulary
5. In Network - Urgent Care Centers - $40 copayment
6. Emergency Services - Ambulance 40% coinsurance (medical emergency only)
7. Emergency Room Facility - $50 copayment (medical emergency only)
8. Emergency Room Physician - 40% coinsurance (medical emergency only)
9. In Network - Hospital inpatient - 40% coinsurance (SEE EXAMPLE BELOW)
10. In Network - Office visits - Co pay of $25 for General Practitioners and $40 for Specialists
11. In Network - Outpatient Surgery - 40% coinsurance
12. No pre-certification (pre-approval for specialists) (HMO benefit only) (PPO requires
13. Two tiers - Employee and Employee & Family
Example #3 & #9 - (In Network hospital overnight stay = $10,000. Coinsurance @ 40% = $4,000.
Maximum out of pocket is $1,500. Insurance will pay 100% after employee's deductible of $1,500 is
Currently the District's dental plan is a passive PPO which means you can use your dentist of choice whether in network or not with no penalty attached.
See full Schedule of Benefits for both health and dental on District website under Business Office.