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ST. TAMMANY PARISH SCHOOL BOARD Benefit Summary |
BMS / BLUE CROSS |
| COVERED BENEFITS: IN NETWORK | |
| Lifetime Maximum | Unlimited |
| Plan Year Deductible Employee and Dependents |
$500 / $300 Retiree Family Unit Max: $1000 / $600 Retiree or 2 Deductibles |
| Co-Insurance Out-Pocket Expense in Network | $1000 per person / $2000 per family |
| Hospital Services (inpatient) In-Network |
90% |
| Surgeon, Anesthesia, Lab & X-rays | 90% |
| Hospital ER (facility only) | 90% |
| Ambulatory Surgical Facilities/Outpatient Surgery | 90% |
| Urgent Care | $30 Co-Pay |
| Physician Visits | $20 Primary / $30 Specialist |
| Maternity (physician only) | $30 Co-Pay |
| MRI/Cat Scan | 90% |
| Sonograms | 90% |
| Chemical / Radiation Therapy | 90% |
| Pre-admission Testing and Dialysis | 90% |
| Dialysis | 90% |
| Cardiac Rehabilitation Therapy | 90% |
| Physical and Occupational Therapy | 90% |
| Speech Therapy | 90% |
| Oral Surgery (impacted tooth removal only) | 90% |
| Routine PAP Test | 100% |
| Routine Mammogram | 100% |
| Routine PSA Screening | 100% |
| Ambulance (transportation only) Ground Licensed Air Ambulance |
90% |
| Durable Medical Equipment $50,000 Lifetime Maximum per person |
90% |
| Home Health Care Limited to 150 visits year |
90% |
| Hospice Care | 90% |
| Wellness Program Baby/ Child Routine exams, scheduled immunizations Adult Physical exam, lab, x-ray |
Plan covers at 100% |
| Prescription Drug Benefit In Network |
$10 Generic $35 Preferred Brand $50 Non-Preferred Brand |
| Mail Order Drug Program | Included - 2 copayments per 90 day supply |
| COVERED BENEFITS: OUT OF NETWORK | |
| Member resides in Louisiana | Plan covers 70% of billed charges after deductible |
| Member resides outside of Louisiana | Plan covers 70% of billed charges after deductible |
Employee/ Retiree Rates
RATES: |
Current |
Effective 1-1-2012 |
Active Employees: Single w/ Spouse Both Employees w/ Children Family Both Employees |
$38.50 $243.10 $0.00 $138.60 $250.80 $12.10 |
$50.00 $275.00 $60.00 $170.00 $295.00 $80.00 |
Retirees w/ No Medicare: Single w/ Spouse Both Employees w/ Children Family Both Employees |
$38.50 $243.10 $0.00 $138.60 $250.80 $12.10 |
$50.00 $275.00 $60.00 $170.00 $295.00 $80.00 |
Retirees w/ 1 Medicare Eligible: Single w/ Spouse Both Employees w/ Children Family Both Employees |
$5.78 $59.40 $0.00 $27.50 $111.10 $0.00 |
$15.00 $80.00 $25.00 $40.00 $150.00 $30.00 |
Retirees w/ 2 Medicare Eligible: w/ Spouse Both Employees Family Both Employees |
$38.50 $0.00 $88.00 $0.00 |
$50.00 $15.00 $95.00 $30.00 |
What is the reason for the proposed plan and benefit changes effective January 1, 2012?
To control plan cost. The group health plan cost has increased significantly over the last three (3) years.
What type of charges will be subject to the $500 ($300 retiree) calendar year deductible and 90% co-insurance?
Examples of services that would apply to the deductible and co-insurance would include in-patient hospital, out-patient hospital, surgeon, anesthesia, lab & x-ray, diagnostic, physical therapy, speech therapy, or occupational therapy services.
Will my co-payment benefits for preferred provider physician office visits and prescription drug benefits change?
The proposed plan effective January 1, 2012 will continue to provide co-payment benefits ($20 Primary / $30 Specialists) for preferred provider physician office visits. Co-payment benefits will also continue to be provided for prescription drugs ($10 Generic, $35 Preferred Brand, $50 Non-Preferred Brand). No deductible and co-insurance will apply for preferred provider physician office visits and prescription drugs.
What type of charges will be subject to the $500 ($300 retiree) calendar year deductible and 90% co-insurance?
Examples of services that would apply to the deductible and co-insurance would include in-patient hospital, out-patient hospital, surgeon, anesthesia, lab & x-ray, diagnostic, physical therapy, speech therapy, or occupational therapy services.
Will my co-payment benefits for preferred provider physician office visits and prescription drug benefits change?
The proposed plan effective January 1, 2012 will continue to provide co-payment benefits ($20 Primary / $30 Specialists) for preferred provider physician office visits. Co-payment benefits will also continue to be provided for prescription drugs ($10 Generic, $35 Preferred Brand, $50 Non-Preferred Brand). No deductible and co-insurance will apply for preferred provider physician office visits and prescription drugs.
How does the deductible and co-insurance work?
The member will be responsible for the first $500 ($300 retiree) of expenses for services applicable to the calendar year deductible. Once the deductible is met or satisfied, the plan will pay 90% for all in-network providers. The member is therefore responsible for the remaining 10% until the co-insurance maximum out-of-pocket of $1,000 is met or satisfied. Once the calendar year deductible and co-insurance out-of-pocket is met or satisfied, the plan pays 100% of covered services
Will members have access to the same network of doctors, hospitals, and healthcare providers?
Yes, the proposed plan effective January 1, 2012 will continue to utilize the current Blue Cross Blue Shield provider networks.
Other Questions?
Should you have any other questions regarding this information, please feel free to contact the St. Tammany Parish School Board via email at erin.oramous@stpsb.org or pete.jabbia@stpsb.org . Phone calls may be directed to Erin Oramous at (985) 898-6423 or Pete Jabbia at (985) 898-3223.
Please note that physicians office visit copayments and prescription drug benefits remain the same.