WHITE PLAINS CITY SCHOOL DISTRICT Administrator Benefits (7/11) HEALTH INSURANCE: Effective 7/1/11-6/30/12 employee contributes 12% of health insurance premium. Health Plan Individual 2/Person Family SWSCHP $79.83 $168.44 $178.82 OXFORD $93.96 $198.26 $211.42 HIP $80.18 $146.65 $233.26 Choice of health plans PPO: State Wide Schools Cooperative Health Plan/Alicare/BCBS Participating providers - $10 co-pay for PCP; $15 co-pay Specialist with referral; $25 co-pay Specialist without referral Non-participating providers $300/individual - $900/family deductible, 70% Reasonable & Customary; Rx - $7.50/$30/$50 co-pay; No referrals needed. HMO’S: Oxford Freedom Participating providers - $20 co-pay Rx - $5/$15/$25 co-pay; no referrals needed. HIP Participating providers - $0 co-pay; Rx - $0 co-pay; Referrals needed. DENTAL………………………………Individual $31.23/month; Family $45.82/month Maximum benefit is $1,500 per person per calendar year. Individual deductible $50; Family deductible $150. Delta Dental of New York LIFE INSURANCE……………………No cost to employee. Policy 1 - 180% of salary Policy 2 - $10,000 (ASA) LONG TERM DISABILITY………….No cost to employee. Your montly Benefit shall be 60% of Your Salary or $2,500, whichever is the lesser amount minus any qualifying reductions. J. J. Stanis & Company, Inc. VISION Coverage only available through the Teachers’ Association under Excess Major Medical (an optional benefit) OPTIONAL BENEFITS AFLAC EXCESS MAJOR MEDICAL Flexible Spending Account for Medical *For SWSCHP Members Only* Flexible Spending Account for Dependent Day Care Individual $14.45/month; Family $35.60/month Cancer Plan This benefit is offered through the Teachers’ Association Supplemental Dental Insurance 761-5187. Short Term Disability Insurance Accident Insurance Life Insurance Hospitalization BUY-OUT Employee receives 40% of premium minus applicable fringes for not taking health insurance.
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