El Paso Independent School District Health Care Trust Medical Plan
Plan Year 2010

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. 

Three medical plan options are available to choose from, the Classic 500, Standard 1000, and Consumer Driven Health Plan (CDHP) 3000.
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 Network.

 

Medical Plan Highlights Comparison

Services	Classic 500	Standard 1000	CDHP 3000
Physician Office Visit Co-Pay	$20	$35	100%, after deductible
RX Co-Pay (30 day - Retail)	$5 Generic $30 Preferred $60 Non-Preferred	$10 Generic $40 Preferred $65 Non-Preferred	Preventive Medication List $10 Generic $40 Preferred $65 Non-Preferred
Aetna RX Mail Order (90-day supply)	$10 Generic $60 Preferred $120 Non-Preferred	$20 Generic $80 Preferred $130 Non-Preferred	$20 Generic $80 Preferred $130 Non-Preferred
	$100 Annual Deductible applies to Preferred & Non-Preferred Medication	$100 Annual Deductible applies to Preferred & Non-Preferred Medication
In-Network Benefits	90%, after annual $500 Deductible	80%, after annual $1,000 Deductible	100%, after annual $3,000 Deductible
Out-of-Network Benefits	50%, after annual $1,000 Deductible	50%, after annual $2,000 Deductible	100%, after annual $6,000 Deductible
Hospital Emergency Room	100%, subject to a $100 Co-Pay Waived if the participant is admitted directly from the ER	100%, subject to a $100 Co-Pay Waived if the participant is admitted directly from the ER	100%, after annual $3,000 Deductible
Diagnostic Laboratory	100%, with preferred provider	100%, with preferred provider	100%, after annual deductible
Maximum Annual Out-of-Pocket (In-Network)	$1,500 Individual $4,500 Family	$2,500 Individual $7,500 Family	$3,000 Individual $6,000 Family
Maximum Lifetime Benefit	$2,000,000	$2,000,000	$2,000,000

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.
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 the mail order service.
Hospital Indemnity Plan
A Hospital Indemnity Plan Option is available for those employees who choose to waive the three 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 insurance 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
Monthly Premiums
IF YOU CHOOSE TO ENROLL, YOU CAN SELECT COVERAGE FOR:

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.

When You Can Change Elections
If you elected to pre-tax the premiums for your eligible benefit elections, you may make changes to your elections as follows: 

• During annual enrollment (fall of each year), you have the opportunity to change your benefit elections.
• On account of a change in family status and consistent with the event.  Changes in family status constitute a change that affects eligibility under the EPISD Health Care Trust Medical Plan, for example
• Divorce
• Death
• Marriage of Dependent
• Dependent turning of age
• Dependent eligible for group health coverage sponsored by his or her employer
• Loss of guardianship

It is the responsibility of every employee to inform Employee Benefits, in writing and within 30 days, of any changes in family status.

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
This information merely highlights the EPISD Health Care Trust Medical Plan Document.  All Claims will be paid in accordance with the EPISD Medical Plan.