1. Selecting Benefit Coverage that is Right for Your Needs
Okaloosa County School District

2. 2019 Benefit Updates
In-Network Benefits (Your Cost)
Base Plan (Individual/Family)
Copay Plan (Individual/Family)
Buy-Up Plan Employee Only
Buy-Up Plan Family
Deductible
$1,250/$2,500
$2,000/$4,000
$1,500
$3,000
Out-of-Pocket Maximum
$5,000/$5,000
Primary Care Physician
Deductible + 20% Coinsurance
$40 Copayment
Specialist
Hospital
Emergency Room
Tier 1 – Rx (Retail – 30 days)
Deductible + $15 Copayment
Tier 2 – Rx (Retail – 30 days)
Deductible + 30% Coinsurance
Deductible + $40 Copayment
Tier 3 – Rx (Retail – 30 days)
Deductible + 50% Coinsurance
Medical Plans will have four tiers of coverage to choose from
Employee Only
Employee and Spouse
Employee and Child(ren)
Employee and Family
A new Copay Plan will be added
UnitedHealthcare will have a representative at District locations two days per week
Beginning January 1, 2019, Quest Diagnostics will be In-Network
There are some enhancements coming to your 2019 employee benefits offered by the Okaloosa County School District, these include the addition of premium tiers for Employee and Spouse and Employee and Children. For those who have been enrolled in Family coverage and only covering a spouse or children, this will allow you to choose what is right for your situation.
The benefits for the current Base Plan and Buy Up plan will not see any changes, however to allow for more options, you will see an option for a new copay plan. For those employees who do not utilize a lot of specialty services or prescription drugs, this will allow a lower cost option while still providing in the event those services are needed.
You may see a new face around the Okaloosa County School District in 2019, two days per week United Healthcare will have a representative on-site to support you with questions about coverage and for assistance with you benefits. More details will be coming in the next few months as far as days and locations to find this person, so be on the lookout.
Finally, we are happy to announce that UnitedHealthcare and Quest Diagnostics have been able to come to an agreement and Quest will be returning as an option for lab services beginning January 1, 2019.

3. Out-Of-Pocket Costs
Determining how much you would pay in a worst case scenario means adding both the premium and the out-of-pocket maximum within the benefit design for each plan, an example is shown below. Not everyone will meet their maximum out-of-pocket expense for the year, some may not even reach their deductible, every experience is personal and unique. When planning your annual cost, it is important to understand what your normal expenditures include and compare that for each plan.
Based on Family coverage for each plan:
Base Plan
Annual Employee Premium: $14,836
Maximum Out-of-Pocket: $5,000
Total: $19,836
Copay Plan
Annual Employee Premium: $14,028
Total: $19,028
Buy-up Plan
Annual Employee Premium: $18,184
Maximum Out-of-Pocket: $3,000
Total: $21,184
With the addition of a new plan, you may be asking which plan is right for you. This is a very personal decision and there are many factors that may impact that decision for you.
The first thing to look at is overall cost. Your personal cost will vary by plan, but if you are curious in a worst case scenario, what you would spend, this will help you in finding that number.
Taking the Maximum Out Of Pocket, which includes Deductibles, Coinsurance and Copayments, and adding the annual amount that would come out of your paycheck in premium, you can see in the outline and table how much that would be under each plan.

4. Common Service Costs
The following examples are for estimation purposes based on the average UnitedHealthcare approved amount for similar services in your area. For specific costs, you will need to contact your provider of service for an estimate prior to treatment.
Primary Care Office Visit – Based on an approved charge of $150, your cost would be:
Base Plan: $150 (Deductible)
Copay Plan: $40 (Copayment)
Buy-Up Plan: $150 (Deductible)
MRI – Based on an approved charge of $1,500, your cost would be:
Base Plan: $1,300 (Deductible + 20% Coinsurance)
Copay Plan: $1,500 (Deductible)
Buy-Up Plan: $1,500 (Deductible)
Specialist Office Visit – Based on an approved charge of $300, your cost would be:
Base Plan: $300 (Deductible)
Copay Plan: $300 (Deductible)
Buy-Up Plan: $300 (Deductible)
Emergency Room – Based on an approved charge of $5,000, your cost would be:
Base Plan: $2,000 (Deductible + 20% Coinsurance)
Copay Plan: $2,600 (Deductible + 20% Coinsurance)
Buy-Up Plan: $1,500 (Deductible)
Now that you know a worst case scenario, let’s take a look at some common services and their average charges to better help you in narrowing down your decision. Now keep in mind, these are averages and it is best to ask your service provider for more specific costs based on their billed charges.
Some other things to consider are prescription drugs, with the fluctuation of the cost of medications it is best to look at the prescriptions you are taking and the cost for each. Keep in mind that the prescription drug formulary changes semi-annually and these could fluctuate. It is also important to remember that some prescription drugs, especially generics, can be obtained at lower costs by utilizing pharmacy discounts. For example, Publix offers many generic antibiotics at no cost. A good tool that you can use is your myuhc.com prescription finder or go to GoodRx.com and you can find valuable information on cost, alternatives and recommended uses.
Hospitalization – Based on an approved charge of $25,000, your cost would be:
Base Plan: $5,000 (Deductible + 20% Coinsurance up to the Maximum Out of Pocket)
Copay Plan: $5,000 (Deductible + 20% Coinsurance up to the Maximum Out of Pocket)
Buy-Up Plan: $1,500 (Deductible up to the Maximum Out of Pocket)