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El Paso Independent School District Health Care Trust Medical Plan

As an employee of El Paso Independent School District, you are offered an array of benefits to meet your needs. This website provides you with a comprehensive look at your options to assist you in making an informed decision when selecting your benefits.  For specific detail on plan coverage, please view the Medical Plan Document.
The El Paso Independent School District Health Care Trust Medical Plan is administered by Aetna. You are eligible to participate in this Plan if you are a regular full-time employee or half-time employee.  Coverage is effective on the first of the month following a 30-day waiting period from the date of hire.
Two medical plan options are available to choose from, the Classic Option and the Standard Option. Each option includes two levels of benefit:
In-Network Benefits apply if you use a provider from the group of physicians, hospitals and other providers contracted through Aetna’s National Provider Network (Aetna Choice POS II). 
Out-of-Network Benefits apply if you choose a healthcare provider; receive a service and/or supplies from a provider who is not part of Aetna’s National Provider Network..

 

 

Medical Plan Benefits

 

Classic Option

Standard Option

Maximum Lifetime Benefit

$2,000,000

$2,000,000

 

In-Network

Out-Of-Network

In-Network

Out-Of-Network

General Percentage Payment Rule

90%

50%

80%

50%

Annual Deductibles

 

 

 

 

Individual

None

$500

$1,000

$2,000

Family

None

$1,500

$3,000

$6,000

Hospital (per admission)

None

$200

None

$500

Deductibles do not cross apply. Co-Pays may not be used to satisfy Deductibles, Out-of-Pocket Maximums or Co-Insurance Limits

Out-of-Pocket Annual Maximums

 

 

 

 

Individual

$1,000

Unlimited

$2,000

Unlimited

Family

$3,000

Unlimited

$6,000

Unlimited

Excludes Co-Pays or any penalty for non-compliance with pre-certification procedures.



Co-Pays

Service

Classic Option

Standard Option

Physician Office Visit

$10

$25

 

Prescriptions
Retail – limited to 30 day supply

 

Aetna Mail Order – limited to 90 day supply

 

$5 Generic
$20 Preferred – Formulary
$30 Non – Preferred

 
$10 Generic
$40 Preferred – Formulary
$60 Non – Preferred

 

$10 Generic
$35 Preferred – Formulary
$50 Non – Preferred

 

$20Generic
$70 Preferred – Formulary
$100 Non – Preferred

Each plan option includes prescription drug benefits. There are different co-pay amounts depending on the option you choose and whether you purchase generic or brand-name medications at retail or use Aetna’s Rx Home Delivery for mail order service.

Emergency Room Charges (Only)

ER Room charges covered at 100%. Each visit is subject to $100 Co-Pay.
Waived if the participant is admitted directly from the Emergency Room.

ER Room charges covered at 100%. Each visit is subject to $100 Co-Pay.
Waived if the participant is admitted directly from the Emergency Room.

Additional Expenses related to an Emergency Room Visit are processed according to the general rule of coverage. These other expenses might include but are not limited to Emergency Room Doctor, Radiologist, Pathologist, etc.

Hospital Indemnity Plan
A Hospital Indemnity Plan Option is available for those employees who choose to waive the two medical plan options.  The hospital indemnity option provides a stipulated daily benefit of $75 during a hospital confinement up to a maximum of 365 days per Plan year.  An added benefit of the Hospital Indemnity Plan is the provision of additional term life in the amount of $25,000.  This plan does not have medical coverage and is designed for those employees who may have coverage under another group health plan (i.e., spouse’s employer plan or military plan).  The Hospital Indemnity Plan is not available for dependents.


Employee Monthly Rates

Classic Option

Standard Option

Hospital Indemnity

Employee Only

$43.60

$0

$0

Employee + Spouse

$361.00

$262.00

Not Available

Employee + Child(ren)

$271.00

$186.00

Not Available

Employee + Family

$593.00

$459.00

Not Available

When You Can Enroll

  • As a new employee, you must enroll for benefits within 30 days of your hire date.
  • Current employees, whose employment status changes from part-time to full-time, must enroll within 30 days of becoming full-time.
  • Changes in family status, within 30 days of the qualifying event.  See EPISD’s Medical Plan document for additional information.
  • During annual enrollment (fall of each year), you have the opportunity to enroll or change your benefit elections.

For more information on your Medical Plan, you may:
Visit the Aetna website at www.aetna.com,
Call the Aetna Customer Service Department at 1-888-235-3847,
Contact Employee Benefits at (915) 881-2670, or
Email us at hrbenefits@episd.org