Both plans cover the same services - what varies are the monthly premiums and out of pocket costs for services rendered. Each plan has an annual maximums that limit your out of pocket costs if you have significant health care expenses during the year.
Our plan year runs from January 1st through December 31st.
The Select and Choice plan options provide:
- outpatient, inpatient, and major medical coverage
- preventive care
- prescription benefits
- vision benefits
For new hires, coverage is effective the first of the month following your date of hire. Employees enrolling for the first time ever in County medical insurance will receive a one-time benefit of the first month of coverage free! Non-benefits-eligible employees who subsequently become eligible and those who previously declined coverage will be treated the same as new employees regarding coverage start date and premium payments. Employees who are re-enrolling in County medical insurance will be required to pay the premium for the first month of coverage. Medical and dental premiums are paid in advance of the month of coverage.
Does your spouse also work for the County or County Schools? Two married benefits-eligible employees qualify for reduced or free health coverage! Please inform HR in order to receive your discount.
Summary of Options for the 2019 Plan Year
· Albemarle Select is a traditional PPO insurance plan that features co-pays for provider visits and pharmacy. For services like labs, xrays, procedures, ER visits and hospitalizations, the plan pays at 80% after you meet the plan year deductible
· Albemarle Choice is a Consumer Driven High Deductible plan that comes with an HSA (Health Savings Account). A Consumer Driven Health Plan gives you as a consumer more choice as to how you spend your health care dollars. This plan features lower monthly premiums than a traditional health insurance plan, but higher out of pocket costs when you seek services. The Health Savings Account that is offered with this Consumer Driven Health Plan is an account that can be used to pay those higher out of pocket costs. This account features an employer contribution, but you can also contribute to this plan – to pay eligible out of pocket costs, or to save for future retiree medical expenses.
If you’re not familiar with Consumer Driven High Deductible Plans or HSAs, here are some details:
Pay yourself first! Take your premium savings and put those funds into your HSA:
By selecting an HSA-powered plan with a higher deductible, you are qualified to contribute tax-free* money into a health savings account (HSA). Your HSA funds can then be used tax-free to pay for qualified medical expenses. In addition, your HSA deposits earn tax-free interest and carry over from year to year, even if you change jobs or retire. Because HSA-powered health plans cost less than traditional plans, the money saved can be used to contribute to your HSA.
To make tax-free* deposits to an HSA, the IRS requires that:
· you are covered by an HSA-qualified health plan
· you have no other health coverage (such as other health plan, Medicare, military health benefits, medical FSAs)
· you are not claimed as a dependent on another individual's tax return
Want to know more about HSAs? We’ve got a lot of great information on our HSA info page.
How to choose a plan
Click here for a short video on how to choose a medical plan.
Once you understand the plans and how they work, compare the plans’ out of pocket costs:
Next, compare the rates
The following rates (full-time, 12-pay schedule) will be effective as of October 1, 2018:
2017/2018 Plan Year (Medical)
Employee + Child
Employee + Children or Spouse
|* Rates shown for full-time employee on a 12-pay schedule. | NOTE: For COBRA, Retiree, Career Leave, and Leave of Absence rates, please see the appropriate rates document in the "Medical Documents" section (on the right-hand side of the page). If you are a part-time employee, use the Insurance Premium Estimator to calculate your rates. If you are newly enrolling in the plan, we suggest verifying your premium costs with payroll if you are not a full-time 12-month employee.
Now, decision time!
There’s no one plan that’s best for everyone. Deciding between your options doesn’t have to be difficult if you consider:
· Who are you planning on covering - just you, or others?
· How do you and your covered dependents use medical benefits – frequently, or not that often?
· What is the maximum annual out of pocket cost you’ll be responsible for?
· Do you prefer to pay higher monthly costs in order to pay lower out of pocket costs if/when you seek services OR do you prefer to pay lower monthly rates and then pay higher out of pocket costs if/when you seek services?
· Don’t forget to factor in any employer HSA contributions you might receive
One more thing…. FSA (Flexible Spending Accounts):
If you typically have medical or dental expenses during the year, an FSA (Flexible Spending Account) is a smart way to use pre-tax dollars to pay for those eligible expenses. With an FSA, you have a monthly voluntary pre-tax salary reduction contributed into your FSA and then you use those pre-tax dollars to pay for medical and dependent care expenses that would otherwise be paid for with after-tax dollars. Our medical FSAs feature a convenient debit card. Want to learn more? Visit our FSA info page HERE.
We offer medical and dental coverage to regular employee who work at least 50% of the full time schedule for their position (e.g., full-time teachers work 7.25 hours per day; a part-time teacher would need to work at least 3.63 hours per day to be eligible for medical/dental coverage. Definition of eligible dependents:
· Your spouse (to whom you are currently, legally married) who does not have access to affordable medical coverage under his/her own employer (See Below *)
· Your natural children, children of your current spouse, legally adopted children, or those for whom you have legal custody/guardianship (including eligible foster children) under the age of 26
· Certain disabled dependents over the age of 26 (subject to eligibility criteria)
*Spousal Eligibility: Spouses who have access to “affordable” medical coverage that provides "minimum essential value" under their own employer’s plan will no longer be eligible for coverage on our medical plan*. The only spouses who are eligible for coverage on our medical plan are those who:
- Do not have access to “affordable” coverage that provides “minimum essential value” through their own employers (see explanation below); or
- Are spouses who are employed by Albemarle County Schools or Local Government divisions
*Please note that the eligibility criteria does NOT apply to the following:
How do I figure out if my spouse has "affordable" medical coverage? Please visit our affordability calculator here. Check with your spouse’s employer to determine if their employer-sponsored coverage meets the "minimum essential value" standard. If either the affordability standard OR the minimum essential value standard is not met, your spouse remains eligible for coverage on the Albemarle County Plan.