Medical Coverage Premiums Monthly Rates
Collectively Bargained
| PLAN NAME | SINGLE | PARENT/ CHILD | PARENT/ CHILDREN | COUPLE | FAMILY | |
|---|---|---|---|---|---|---|
| Keystone | SDP Contribution |
$540.58 | $756.81 | $973.04 | $1,081.15 | $1,621.74 |
| Personal Choice 20/30/70 w/Modifications |
SDP Contribution |
$632.01 | $884.83 | $1,137.64 | $1,264.05 | $1,896.06 |
*Additional 2% charge added to COBRA rates
| Benefit | Personal Choice Plan | Keystone HMO | |
|---|---|---|---|
| Deductible Individual/Family | In-Network $0/$0 | Out of Network $2,000 Individual/$6,000 Family | $1,000 |
| After deductible, Plan pays: | N/A | 50% | $2,000 |
| Tier Level | Keystone 20 PFT 1.5% Salary | Personal Choice 25/35/50% 0% PFT + 1.5% Salary | Personal Choice 25/35/50% 3% PFT + 1.5% Salary* | Personal Choice 25/35/50% 5% PFT + 1.5% Salary* | Personal Choice 25/35/50% 8% PFT + 1.5% Salary* |
|---|---|---|---|---|---|
| PHMO | PPO | PPO3 | PPO5 | PPO8 | |
| Single | $0.00 | $0.00 | $23.16 | $38.60 | $61.76 |
| Employee & Child | $0.00 | $0.00 | $32.43 | $54.04 | $86.47 |
| Employee & Children | $0.00 | $0.00 | $41.69 | $69.48 | $111.18 |
| Employee & Spouse or Life Partner | $0.00 | $0.00 | $46.33 | $77.21 | $123.53 |
| Family | $0.00 | $0.00 | $69.48 | $115.81 | $185.30 |
| Employee & Spouse or Life Partner with Surcharge | $75.00 | $75.00 | $121.33 | $152.21 | $198.53 |
| Family with Spouse or Life Partner with Surcharge | $75.00 | $75.00 | $144.48 | $190.81 | $265.81 |
*Those hired before 9/1/10 and are switching to Personal Choice will pay 3% of premium + 1.50% of salary. Those hired on or after 9/1/10 will pay 5% + 1.50% of salary. Those switching to Personal Choice on or after 9/1/25 will pay 8% + 1.50% of salary” Effective 2019-2020 school year all members will pay 1.50% of salary for Personal Choice and Keystone
Employees covering a spouse or domestic partner will be subject to a $75.00 monthly surcharge (spread over 27 paychecks) if the spouse/domestic partner is eligible for employee group coverage from his/her own job and continues to be enrolled in District Medical Coverage. Those whose spouse or domestic partner is a District employee are not subject to the charge.