| HR Benefits - Medical Coverage |  |
Medical Insurance Plan:
Pinal County Community College District Employee Benefit Trust. The College is self-insured.
Claims Payer:
Administrative Enterprises, Inc.
Coverage begins:
First of the month following 30 days of employment
You will receive your ID cards within a few weeks of your initial date of employment.
Note: If you ever want to drop or waive your coverage, or add a dependent, a qualifying event must occur such as marriage, divorce, birth or adoption of a child, or your dependents losing their benefits. You can also add dependents or drop coverage during our open enrollment period which is the month of May for an effective date of July 1, or if a qualifying event occurs.
The College pays the total monthly medical premium for the employee. Total premium rates and employee contribution rates for medical coverage are as follows:
| Employee Monthly Contribution Rate Medical Coverage | Total Monthly Premium Paid by College | |
| Employee Only | $0.00 | $508.58 |
| Employee + Spouse | $92.09 | $978.80 |
| Employee + Children | $71.54 | $876.05 |
| Employee + Family | $114.19 | $1232.02 |
| Doctor Visit Co-Pays: | [In-Network, Blue Cross/Blue Shield PPO] - $15 per visit [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 $1,000 [Out-of-Network] - $250 Deductible Per Person (will not cross accumulate), 60% Coinsurance, Annual out-of-pocket maximum of $2,500 (will not cross accumulate) |
Annual Deductible: You have an annual deductible of $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 you pay toward your 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.
Lifetime Maximum: $1,000,000.00 per participant.
Blue Cross/Blue Shield PPO: The College contracts with Blue Cross/Blue Shield in order to utilize their provider network. To determine whether your physician or facility is a Blue Cross provider, you can access the Blue Cross/Blue Shield website at www.bcbsaz.com.
Pre-Existing Conditions: The College’s plan has a pre-existing condition waiting period of 12 months for new employees. If you have had other insurance coverage, please submit a Certificate of Creditable Coverage to the Benefits Office so that we can credit your coverage. Just contact your previous insurance carrier and they will provide this document to you.
If you have had 12 or more months of continuous coverage, the pre-existing condition period will be waived. If you have had less than 12 months of continuous coverage, you will be credited for the amount of coverage you had.
If you have had a break in coverage of 63 days or more, you will be subject to pre-existing conditions.
Wellness Benefit: You and your eligible dependents each have $500 per calendar year for well checkup visits. This amount is not subject to a co-pay or a deductible. Please be sure that your physician knows it is a wellness visit and to bill it as such.
Prescription Medication Co-Pays: Retail (up to 30 day supply):
Generic - $7 Co-Pay
Preferred Brand - $25 Co-Pay
Non-Preferred Brand - $40 Co-Pay
Mail Order (90 day supply):
Generic - $7 Co-Pay
Preferred Brand - $50 Co-Pay
Non-Preferred Brand - $80 Co-Pay
Retail (up to 90 day supply):
Generic - $21 Co-Pay
Preferred Brand - $75 Co-Pay
Non-Preferred Brand - $120 Co-Pay
You can access Innoviant’s website at: www.innoviant.com