Business Services Department
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Columbia
Public Schools
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Columbia,
Missouri
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Employee Benefits - Medical Plan |
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Employee Eligibility - All staff members who work 35 hours or more per week, other than individuals employed on a temporary basis, will receive board paid medical, dental, and life insurance. Staff members working 25 to 34 hours per week may elect to purchase medical and/or dental insurance at the current group rates. Dependent coverage is also available at the expense of the employee.
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The Medical Plan has Enrollment Guidelines for Adding Dependents:
Qualifying Event
Rules - The employee has 31 days to add their dependents to
the medical plan under qualifying event rules. A qualifying
event is defined as marriage, birth (or adoption), or if
dependents (or part-time employees) lose coverage due to a
spouse's loss of employment. Open Enrollment - If the employee fails to enroll dependents as a new employee or under the qualifying event rule, dependents or part-time employees may be added to the medical plan during the open enrollment month (November) with an effective date of January 1st, the following year. To add a dependent, contact the Employee Benefits Office at 214-3710.
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Age Limit on Dependents - Dependents can be covered up to age 26. |
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Effective Date - Your first day of eligibility depends upon your classification. If you are an exempt employee within the meaning of the U.S. Fair Labor Standards Act (FLSA), you are eligible on your first day of active work on a regular basis with the District. If you are a non-exempt employee within the meaning of the FLSA, then you are first eligible on the first day of the month following the ninetieth (90th) day after commencing active work on a regular basis. There is a "no-waiting period" for pre-existing conditions. |
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Pre-Certification - Required for all in-patient admissions. The employee, a family member, or the doctor should contact HealthLink, Inc. prior to the admission or within 24 hours of an emergency admission. Failure to have a hospital admission pre-certified will result in a reduction of benefits or a maximum penalty of $500. The HealthLink, Inc. pre-certification toll free number is 877-284-0102, and is listed on the medical identification card.
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TWO MEDICAL
PLAN CHOICES - 2012 BASIC PLAN Summary of Benefits - FMH Benefit Services: The District's Basic Medical Plan has the following deductibles: In-Network Providers (HealthLink Open Access II): The Basic medical policy has a $500 deductible per person or $1,000 per family. Once the deductible has been met, eligible expenses are paid at 80% of "Ordinary and Customary Rates." The maximum out-of-pocket expense (including deductible) is $1,500 per person or $3,000 per family if using network providers. Discounts for medical services are available for utilization of HealthLink Open Access II providers resulting in savings for the employee and the District's benefits program. Out-of-Network Providers: The Basic medical policy has a $600 deductible per person of $1,200 per family. Once the deductible has been met, eligible expenses are paid at 70% of "Ordinary and Customary Rates." The maximum out-of-pocket is $2,100 per person or $4,200 per family if using out-of-network providers. In addition to the out-of-pocket expense, an out-of-network provider can bill the employee for the difference between the approved amount and amount charged for any service provided. PLUS PLAN Summary of Benefits - FMH Benefit Services: The District's Plus Medical Plan has the following deductibles: In-Network Providers (HealthLink Open Access II): The Plus medical policy has a $1,400 deductible for employee only coverage or $2,800 per family. Once the deductible has been met, eligible expenses are paid at 100% of "Ordinary and Customary Rates." The maximum out-of-pocket expense (including deductible) is $1,400 for employee only coverage or $2,800 per family if using network providers. Discounts for medical services are available for utilization of HealthLink Open Access II providers resulting in savings for the employee and the District's benefits program. Out-of-Network Providers: Once the deductible has been met, eligible expenses are paid at 70% of "Ordinary and Customary Rates." The maximum out-of-pocket is $4,200 per person or $8,400 per family if using out-of-network providers. In addition to the out-of-pocket expense, an out-of-network provider can bill the employee for the difference between the approved amount and amount charged for any service provided.
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PHARMACY BENEFIT - MEDTRAK SERVICES BASIC PLAN For a 30-day supply, at participating pharmacies, the pharmacy benefit has a $15 co-pay for Tier 1 (generic drugs), a $30 co-pay for Tier 2 (preferred brand name drugs), and a $45 co-pay for Tier 3 (non-preferred drugs). For a 90-day supply via mail order, the co-pay for Tier 1 (generic drugs) is $25, for Tier 2 (preferred brand name drugs) is $55, and for Tier 3 (non-preferred drugs) is $90. Use the MedTrak Services identification card at participating pharmacies. For greater savings on maintenance prescriptions, use the Mail Order Service and save money! Contact the Employee Benefits Office to request mail order envelopes. PLUS PLAN Under the Plus Plan, your prescription costs apply to the deductible. You pay 100% of prescription costs until your deductible is met. Once the deductible has been met, covered prescriptions, like other qualified medical expenses are reimbursed at 100% (subject to applicable plan limitations). There are no prescription copays under the Plus Plan. When you use your medical ID card and get your prescription filled, the cost information is submitted to the medical plan, and the amounts are applied to your deductible. You can use the mail order option to purchase three months of prescriptions, but you will be charged for the three month cost of the prescriptions. Mail order does provide additional discounts on prescription drugs you purchase. |
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HealthLink Open Access II: Effective January 1, 2005, Columbia Public Schools has chosen HealthLink Open Access II network to maintain savings on area physicians and hospital services. Utilization of the HealthLink Open Access II providers may result in savings for the employee and the District's benefit program. HealthLink's directory of providers is available on their website www.healthlink.com and is updated weekly. A directory is also available by contacting the Employee Benefits Office or you can contact HealthLink at 1-800-624-2356 for provider lookup.
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Claims: In-Network Providers (HealthLink, Inc. Network) - Employees should present their FMH Benefit Services identification card to network providers. Network providers file claims directly to HealthLink where each claim is "priced" and designated discounts are applied. Claims are then forwarded to FMH Benefit Services for payment processing. FMH pays the network provider direct. FMH also sends an explanation of benefits notification to the employee. Out-of-Network Providers - Employees must file all claims for out-of-network providers. Claim forms should be sent to HealthLink. Claims are then "priced" and forwarded to FMH Benefit Services for payment processing. FMH sends an explanation of benefits notification to the employee, and pays either the provider or the employee as designated on the claim form. Claim forms for out-of-network services are available by contacting the Employee Benefits Office. |
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Questions or problems regarding this web site
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