| |
Full- and part-time associates who work 20 or more hours per week are eligible to participate the first day of the month following 30 days of employment.
- Annual Deductible: This plan contains a $3,000 deductible for an associate only or $6,000 for a family.
- HealthFund:To help you pay the deductible, John Knox Village is providing a $500 HealthFund for associates enrolling only themselves; for those enrolling dependents (and therefore are subject to a family deductible of $6,000), the HealthFund amount will be $1,000.*
- The HealthFund will be funded by John Knox Village.
- The HealthFund will reimburse you for 100% of covered services and will be applied toward the first $500/$1,000 (associate only/family) of your deductible.
- At the end of the year, any unused Health Fund dollars will be rolled over into the next benefit plan year to be applied to your deductible.
In other words, if you are enrolled for associate-only coverage and incur significant claims, the first $500 of expenses will be paid from your HealthFund, leaving you a balance of $2,500 in deductible expenses to meet.
* The fund amount is prorated based on effective date of coverage during the calendar year.
Maximum Annual Out-of-Pocket: $4,500 (associate only)/$9,000 (family)
- Annual Deductible: This plan contains a $2,000 deductible for an associate only or $4,000 for a family.
- HealthFund:To help you pay the deductible, John Knox Village is providing a $500 HealthFund for associates enrolling only themselves; for those enrolling dependents (and therefore are subject to a family deductible of $4,000), the HealthFund amount will be $1,000.*
- The HealthFund will be funded by John Knox Village.
- The HealthFund will reimburse you for 100% of covered services and will be applied toward the first $500/$1,000 (associate only/family) of your deductible.
- At the end of the year, any unused Health Fund dollars will be rolled over into the next benefit plan year to be applied to your deductible.
In other words, if you are enrolled for associate-only coverage and incur significant claims, the first $500 of expenses will be paid from your HealthFund, leaving you a balance of $1,500 in deductible expenses to meet.
* The fund amount is prorated based on effective date of coverage during the calendar year.
Maximum Annual Out-of-Pocket: $3,500 (associate only)/$7,000 (family)
Preventive Care – 100% coverage for in-network covered expenses; coinsurance for non-participating providers is 40%. Base Plan 30% Buy-Up Plan. Includes Well Woman exams, Well Child exams, mammograms, adult routine physicals, routine eye exams and PSA tests.) You do NOT need to meet your deductible for this benefit.
Office Visits (non-specialist, non-surgical) – Coverage after deductible for in network providers is 80% Base Plan /90% Buy-Up and for non-participating providers, it is 60% Base Plan/70% Buy-Up Plan.
Specialists (non-specialist, non-surgical) – Coverage after deductible for in-network providers is 80% Base Plan/90%, and for non-participating providers, it is 60% Base plan/70% Buy-Up Plan.
Most prescriptions under this plan option will first be subject to the annual deductible*. Costs for Aetna’s discounted price for prescriptions will be deducted from the HealthFund until it is exhausted, then they will go toward the remainder of the annual deductible. Once the deductible is met, you will pay the appropriate co-pay amount for the remainder of the plan year. This applies to both retail and mail-order prescriptions.
Retail Pharmacy (30 day supply or less)
- Generic - $15 co-payment
- Formulary Brand-Name - $25 co-payment
- Non-Formulary Brand-Name - $40 co-payment
Mail Order Pharmacy (up to a 90 day supply)
- Receive up to a 3 month supply for the price of 2 retail co-payments
Generic - $30 co-payment total
Formulary Brand-Name - $50 total co-payment
Non-Formulary Brand-Name - $80 total co-payment
* Prescriptions that are on Aetna's chronic and preventive prescriptions list are not subject to the annual deductible but are provided directly under the co-pay amounts.
Outpatient lab and X-ray at in-network providers covered at the same levels of coverage as for non-preventive care office visits (as listed above).
Emergency Services: Covered at 100% after deductible.
Hospital Services (inpatient or outpatient): This same levels of coverage as for non-preventive care office visits (as shown above).
Other Covered Services: Mental health and substance abuse, skilled nursing, hospice, home health, chiropractic, durable medical equipment.
Contact Human Resources at:
Main line: (816) 347-2127
Fax: (816) 347-2760
E-mail: jobs@jkv.org
The information provided only as a summary. For more detailed information, refer to official plan summary descriptions or contracts. If there is a discrepancy between the information on this site and the Plan Document, the provisions of the Plan Document will apply.
John Knox Village provides equal employment opportunities to all individuals on the basis of merit, competence and essential qualifications. The Village does not discriminate on the basis of race, color, religion, sex, age, national origin or disability or on any other protected characteristic prohibited by law.
|
|