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A low-cost medical plan option available only to employees making $25,000 or less per year
Medical coverage options
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COMPARE ALL CONSUMER PLANS OPTIONS
| District contribution |
|---|
| Rates | |
|---|---|
| Based on 24 pay periods | |
| Employee | $2.50 |
| Employee + spouse | $95.28 |
| Employee + child(ren) | $91.66 |
| Employee + family | $164.79 |
| Plan limits | |
|---|---|
| Annual deductible - Individual/family | |
| Annual out-of-pocket maximum - Individual/family | |
| Your cost for covered services | |
|---|---|
| Preventive care exams | Free |
| Primary care (PCP) | 30% |
| Non-designated specialists (NDS) * | 30% |
| Designated specialists | 30%* |
| HISD clinics | Free |
| Platinum physician | $50 office visit copay + 50% labs |
| Inpatient - hospital * | 30% plus $100 copay per day* |
| Outpatient - hospital * | 30%* |
| Outpatient - freestanding and surgical center * | 30% |
| Emergency care | 30% plus $300 copay (waived if admitted) |
| Non-emergency care in an emergency room | Not covered |
| Urgent care facility | 30% |
| Lab, X-ray, diagnostic mammogram | 30% |
| Diagnostic scans (MRI, MRA, CAT, PET) | 30% plus $100 copay |
| Maternity - delivery | 30% |
| Mental health & substance abuse - inpatient | 30% plus $100 copay per day |
| Mental health & substance abuse - outpatient | 30% |