2016-10-11-minutes-hr-study-session

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MFLOYER NAME: KITTITAS COUNTY MEDICAL PLANS Directions: Enter X for 4 -tiered rates or C for composite rate (subject to carrier approval). If offering both Premera Blue Cross and Group Health plans, the SAME rate structure must be used. Note: All medical plans are bundled with base long term disability and an Employee Assistance Program (EAP). 1. PREMERA BLUE CROSS ......................................... ® CHECK TO DECLINE COVERAGE The number of plans available to an organization is based on the group's total number of eligible employees. Employer groups may offer one Health Savings Account (HSA) plan in addition to the number of plan choices. a) Under 50 eligible employees: Up to 2 plan choices b) 50 - 150 eligible employees: Up to 3 plan choices c) 150+ eligible employees: Up to 4 plan choices Select Network Option: F1WCIF 200* ❑ LEOFF I Active l WCIF 200 LEOFF I Retiree <65 LI Heritage FWCIF 500 FWCIF 2000 ❑ Prime ❑ WCIF 750 ❑ WCIF 3000 WCIF 1250 ❑ WCIF 5000 J WCIF HSA** * Only available to groups with enrollment prior to 1/1/2014. ** Groups may offer a Health Savings Account (HSA) with the WCIF HSA Plan. This is a Qualified High Deductible Health Plan (QHDHP). 11. GROUP HEALTH ................................................ ® CHECK TO DECLINE COVERAGE The number of plans available to an organization is based on the group's total number of eligible employees. Employer groups may offer plan choices as allowed under the Group Health matrix. ACCESS PPO PLANS: u Access 200 Access 3000 FlAccess 500 1-1 Access 5000 L7 LEOFF I Retiree < 65 Access 1000 F-� Access HSA* Access 2000 * Groups may offer a Health Savings Account (HSA) with the HSA Plan. This is a Qualified High Deductible Health Plan (QHDHP). HMO PLANS: 1-1 HMO 250 F-1 HMO 500 1-1 HMO 750 F_ HMO 2000 LEOFF I Retiree < 65 2017GMA2 Page 4 of 9 (0921161sw)