WHITE PLAINS CITY SCHOOL DISTRICT - DOC by 69WZX0s

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									                           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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