1. WLISD EMPLOYEE ORIENTATION
HEALTH PLANS
TWO HEALTH PLANS AVAILABLE
HCA M9203R
BUY-UP MM02

2. WLISD HEALTH PLAN $500 DEDUCTIBLE $1,500 FAMILY HCA M9203R
BUY-UP MM02
HCA M9203R
$500 DEDUCTIBLE $1,500 FAMILY
$1500 DEDUCTIBLE
(*$750 HCA/$750)
$3000 FAMILY
(*$1500 HCA/$1500)
*prorated for Sept.1st effective date

3. WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R
COINSURANCE AFTER DEDUCTIBLE SATISFIED $3000 EMPLOYEE $6000 MAX FOR FAMILY
COINSURANCE AFTER DEDUCTIBLE SATISFIED $2500 EMPLOYEE $7500 MAX FOR FAMILY

4. WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R
100% OF PREVENTATIVE CARE IS COVERED BY PLAN
100% OF PREVENTATIVE CARE IS COVERED BY PLAN

5. WLISD HEALTH PLAN BUY-UP MM02 HCA M9203R PRESCRIPTIONS PRESCRIPTIONS
$15 GENERIC
$30 BRAND FORMULARY
$45 BRAND NON-FORMULARY
MAIL: 3 TIMES RETAIL COPAY FOR 90 DAY SUPPLY BRAND
$25 GENERIC COPAY
PRESCRIPTIONS
RETAIL:
Plan pays 80% employee pays 20% OF ALLOWABLE AMOUNT AFTER CALENDAR YEAR DEDUCTIBLE
MAIL:

6. WLISD HEALTH PLAN BUY-UP HCA PREMIUMS PREMIUMS EMPLOYEE ONLY $211.38
EMPLOYEE & CHILDREN $380.49
EMPLOYEE & SPOUSE $486.18
EMPLOYEE & FAMILY $655.28
PREMIUMS
EMPLOYEE ONLY $0
EMPLOYEE & CHILDREN $250
EMPLOYEE & SPOUSE $250
EMPLOYEE & FAMILY $250
MARRIED BOTH WLISD $135

7. FLEXIBLE SAVINGS ACCOUNT
WLISD HEALTH PLAN
BUY-UP MM02
HCA M9203R
FLEXIBLE SAVINGS ACCOUNT
HEALTH CARE ACCOUNT

8. Employee Only BUY-UP $211.38 $2536.56
Monthly Annual
Employee Only BUY-UP $ $
Employee Only HCA $ $ ________________________________________
Deductible & Annual Premium Total Cost
Coinsurance
BUY-UP $2, $2, $5,036.56
HCA $4,500 -$750 HCA $ $3,

9. Employee & FAMILY BUY-UP $655.28 $7863.36
Monthly Annual
Employee &
FAMILY BUY-UP $ $
FAMILY HCA $ $ _____________________________________________
Deductible & Annual Premium Total Cost
Coinsurance
BUY-UP $9, $ $16,863.36
HCA $9,000 -$1500HCA $ $10,500.00

10. Monthly Annual. Employee & FAMILY BUY-UP $655. 28 $7863
Monthly Annual Employee & FAMILY BUY-UP $ $ Married WLISD FAMILY HCA $ $
Deductible & Annual Premium Total Cost
Coinsurance
BUY-UP $6, $ $13,863.36
HCA $6,000 -$1500HCA $ $6,120.00

11. SCENARIO Suzie, Jim, Katie, and Jake with HCA Family coverage.
$ $750 HCA Deductible ($ $1500 HCA total for family) $1500 Coinsurance each, Max $3000 For Family. HCA $750 individual or $1500 Family.
January Katie annual check-up – 100% covered, no cost
Jake annual check-up – 100% covered, no cost
March Jim gets flu - Doctor’s visit $100, Prescription $100
No out of pocket. Covered by HCA
May Suzie – Annual exam – 100% covered, no cost
June Jake gets sick - Doctor’s visit $100, Prescription $100
July Jim – Annual exam – 100% covered, no cost
August Katie allergies – Doctor’s visit $150, shots $150
No out of pocket, $300 from HCA
October Suzie sick – Doctor $85, Prescription $100
No out of pocket, $185 from HCA
December Jim sick - Doctor $100, Prescription $100
No out of pocket. Covered by HCA
TOTAL PAID FROM HCA ACCOUNT $1085
TOTAL $415 in HCA rolls to next year.