|HR Benefits - Medical Coverage|
Medical Insurance Plan:
Pinal County Community College District Employee Benefit Trust
Claims Payer/Third Party Administrator: Gilsbar, Inc.
Medical Plan Document
First of the month following first day of full-time employment.
Employees will receive ID cards within a few weeks of initial date of employment.
Note: The Open Enrollment period is the month of May with an effective date of July 1st. A qualifying event must occur in order for changes to be made at any time other than the open enrollment period.
There is no monthly premium paid for Employee Only medical coverage. Contribution rates for dependent medical coverage are as follows:
|Employee Monthly Contribution
|Employee + Spouse||$92.09|
|Employee + Children||$71.54|
|Employee + Family||$114.19|
|Doctor Visit Co-Pays:||[In-Network, Blue Cross/Blue Shield PPO] - $25 per visit General Practitioner; $40 per visit Specialist
[Out-of-Network] - Subject to out-of-network deductible, coinsurance and annual out-of-pocket maximum
|Major Medical Benefits:||[In-Network, Blue Cross/Blue Shield PPO] - $100 Deductible Per Person, 80% Coinsurance, Annual out-of-pocket maximum of $1,500 per individual and $3,000 total per family
[Out-of-Network] - $250 Deductible Per Person (will not cross accumulate), 50% Coinsurance, Annual out-of-pocket maximum of $2,500 per individual (will not cross accumulate)
Annual Deductible: The annual deductible is $100 per person per calendar year for in-network major medical claims. There is an annual deductible of $250 per person per calendar year for out-of-network claims. Anything paid toward a deductible during the last three months of the year (October, November, December) will be carried over to the next calendar year and applied to the next calendar year deductible.
There is no Lifetime Maximum.
Blue Cross/Blue Shield PPO: The College contracts with Blue Cross/Blue Shield of Arizona in order to utilize their provider network. To determine whether a physician or facility is a Blue Cross provider, refer to the Blue Cross/Blue Shield of Arizona website at www.azblue.com.
Desert Wellness events are offered to employees and their covered dependents at no out-of-pocket cost.
Prescription Medication Co-Pays: Retail (up to 30 day supply):
Generic - $10 Co-Pay
Preferred Brand - $25 Co-Pay
Non-Preferred Brand - 50% of Total - Up to a Maximum of $100
Retail or Mail Order (up to 90 day supply):
Generic - $14 Co-Pay
Preferred Brand - $50 Co-Pay
Non-Preferred Brand - 50% of Total - Up to a Maximum of $200
Prescription Benefit Manager: Optum Rx