Plus Choice
Higher premiums, lower deductibles, access to both LocalPlus and OAP networks
Medical coverage options
Choice Plans
Two options, Basic or Plus, with access to both the LocalPlus and OAP networks. Here's how they work:
COMPARE ALL CONSUMER PLANS OPTIONS
| District contribution |
|---|
| Rates | |
|---|---|
| Based on 24 pay periods | |
| Employee | $61.48 |
| Employee + spouse | $204.84 |
| Employee + child(ren) | $197.70 |
| Employee + family | $332.21 |
| Plan limits | |
|---|---|
| Annual deductible - individual/family | |
| Tier I | $1,750/$3,500 |
| Tier II | $2,000/$4,000 |
| Annual out-of-pocket maximum - individual/family | |
| Tier I | $5,150/$10,300 |
| Tier II | $5,400/$10,800 |
| Your cost for covered services | |
|---|---|
| Preventive care exams | Free |
| Primary care (PCP) | 20% (all PCPs are Tier I) |
| Non-designated specialists (NDS) * | 20% (all NDSs are Tier I) |
| Designated specialists Tier I/Tier II | |
| Tier I/Tier II | Tier I 20% / Tier II 35% |
| HISD clinics | Free |
| Platinum physicians | N/A |
| Inpatient - hospital * | |
| Tier I/Tier II | Tier I 20% / Tier II 35% plus $500 copay per admission |
| Outpatient - hospital * | |
| Tier I/Tier II | Tier I 20% / Tier II 35% |
| Outpatient - freestanding and surgical center * | 20% |
| Emergency care | 20% plus $300 copay (waived if admitted) |
| Non-emergency care in an emergency room | Not covered |
| Urgent care facility | 20% |
| Lab, X-ray, diagnostic mammogram | |
| Tier I/Tier II | Tier I 20% / Tier II 35% * |
| Diagnostic scans (MRI, MRA, CAT, PET) | |
| Tier I/Tier II | Tier I 20% / Tier II 35% * |
| Maternity - delivery | |
| Tier I/Tier II | Tier I 20% / Tier II 35% |
| Mental health & substance abuse - inpatient | 20% (no Tier II facilities) |
| Mental health & substance abuse - outpatient | 20% (no Tier II facilities) |
Basic Choice
Lower premiums, higher deductibles, LocalPlus and OAP network
| District contribution |
|---|
| Rates | |
|---|---|
| Based on 24 pay periods | |
| Employee | $30.54 |
| Employee + spouse | $158.80 |
| Employee + child(ren) | $152.77 |
| Employee + family | $274.65 |
| Plan limits | |
|---|---|
| Annual deductible - individual/family | |
| Tier I | $2,500/$5,000 |
| Tier II | $2,750/$5,250 |
| Annual out-of-pocket maximum - individual/family | |
| Tier I | $6,900/$13,800 |
| Tier II | $7,150/$14,300 |
| Your cost for covered services | |
|---|---|
| Preventive care exams | Free |
| Primary care (PCP) | 25% (all PCPs are Tier I) |
| Non-designated specialists (NDS) * | 25% (all NDSs are Tier I) |
| Designated specialists | |
| Tier I/Tier II | Tier I 25% / Tier II 45% |
| HISD clinics | Free |
| Platinum physicians | N/A |
| Inpatient - hospital * | |
| Tier I/Tier II | Tier I 25% / Tier II 45% |
| Outpatient - hospital * | |
| Tier I/Tier II | Tier I 25% / Tier II 45% |
| Outpatient - freestanding and surgical center * | 25% |
| Emergency care | 25% plus $300 copay (waived if admitted) |
| Non-emergency care in an emergency room | Not covered |
| Urgent care facility | 25% |
| Lab, X-ray, diagnostic mammogram | |
| Tier I/Tier II | Tier I 25% / Tier II 45%* |
| Diagnostic scans (MRI, MRA, CAT, PET) | |
| Tier I/Tier II | Tier I 25% / Tier II 45%* |
| Maternity - delivery | |
| Tier I/Tier II | Tier I 25% / Tier II 45% |
| Mental health & substance abuse - inpatient | 25% (no Tier II facilities) |
| Mental health & substance abuse - outpatient | 25% (no Tier II facilities) |