Medical Coverage Premiums Monthly Rates

Collectively Bargained

School District of Philadelphia (SDP) Contributions

PLAN NAME SINGLE PARENT/ CHILD PARENT/ CHILDREN COUPLE FAMILY
Personal Choice
20/30/70 w/Modifications
SDP
Contribution
$619.62 $867.48 $1,115.33 $1,239.26 $1,858.88
Keystone SDP
Contribution
$529.98 $741.96 $953.96 $1,059.95 $1,589.94

*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 N/A
After deductible, Plan pays: 100% 50% N/A

Those hired between 11/01/2004 and 8/31/2010 who switched to Personal Choice will pay 3% of the premium + 1.25% of salary.

Those hired ON or AFTER 9/1/10 and are switching to Personal Choice will pay 5% of the premium + 1.25% of salary.

Employees covering a spouse or domestic partner will be subject to a $50.00 monthly surcharge (spread over 26 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.