GFPS 2011-2012 Health Insurance Summary Information

PLAN SUMMARIES—eligible employees may choose one from the following:

Blue Dimensions: $750 deductible with 75/25 (plan/member) split of costs after the deductible is met

(replaces Big Sky $5000 individual maximum member liability or $10,000/couple maximum

Select) $40 office co-pay

$200 emergency room co-pay

$0 preventative check-up co-pay

$200 prescription drug deductible (waived for generic) with a $5000 family maximum

liability, then:

$10 for Generic; $40 for Brand Name Formulary; 60% up to $200 for Brand Name Non Formulary; $100 for Specialty Brand Name; $200 for Specialty Brand Name Non Formulary

Catastrophic: $3000 deductible with 60/40(plan/member) split of costs after deductible is met

$7500 individual maximum member liability or $15,000 couple maximum

$0 out-of-pocket costs for preventative check-ups

$200 emergency room co-pay

$150 prescription drug deductible (waived for generic) with a $2500 family maximum

liability, then:

$10 for Generic; $40 for Brand Name Formulary; 60% up to $200 for Brand Name Non Formulary; $100 for Specialty Brand Name; $200 for Specialty Brand Name Non Formulary

Plan/Premium Year: October 1, 2011 to September 30, 2012

Deductible Year: January 1, 2012 to December 31, 2012

Flex Plan Year: October 1, 2011 to December 15, 2012

2011-2012 HEALTH INSURANCE PREMIUMS:

Both plans are composite rates meaning one price for singles, couples and families.

( ) indicate increase from 10/11 * RSR=Rate Stabilization Reserve Fund

Blue Dimensions=$881.29 (+$70.50) Catastrophic=$620.12 (+53.54)

*RSR Fund $55 $55

GFPS $470.36 (+$35.07) $470.36 (+$35.07)

Eligible Employees-12-pay $355.93 (+$35.43) $ 94.76 (+$18.47)

Eligible Employees-10-pay $427.12 (+$42.52) $113.71 (+$22.16)

OTHER INFO:

• Health insurance premiums can be flexed so they are paid with pre-tax dollars which reduces the actual cost of the premiums.
• The premium increase will be offset by the 3-month premium adjustments approved by the Board on 8/8/11. The premium adjustment will be at the 12-pay amount and will be in Sept., Nov. & Feb.
• Pooling: Insurance eligible GFPS employees who are married to insurance eligible GFPS employees may choose to have only one policy between the two of them with the per employee District contribution pooled to apply to the premium.
• A Flexible Spending Program is available for out-of-pocket medical expenses & for dependent care expenses. NEW FLEX FORMS MUST BE FILLED OUT FOR DEPENDENT CARE & OUT-OF-POCKET MEDICAL EXPENSES ON AN ANNUAL BASIS.
• Voluntary insurance products are also available for dental, vision, accident and cancer. Premiums are paid by the employee but they can also be flexed and paid with pre-tax dollars. The two carrier options are Aflac and ICME (Insurance Coordinators of Montana).
• One EYE EXAM per benefit year per person up to $60 for both Blue Dimension and Catastrophic:
• The following information needs to be submitted either by the office or by the employee:
• Patient name; Date of service; Diagnosis codes; Dollar amount of visit
• If doctor won’t submit do this:
• Mail, fax or scan information to Blue Cross Blue Shield

600 Smelter Ave. NE, 59404; Fax #: 761-3803

ann_janikula@bcbsmt.com