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MedicalCustomer Service: 855-333-1012Visit Allegiance Online: www.askallegiance.com/ccpsOnsite Representative:Heather Stiegler855-333-1012 ext. 3703
The District’s medical plan is a Preferred Provider Organization (PPO), not an HMO. You may use a provider (physician, hospital, etc.) of your choice; however deductibles, out-of-pocket expenses, co-insurance and co-payments are higher when an out-of-network provider is used.Allegiance is the District’s Third Party Administrator (TPA) that processes all medical claims. Premiums for full-time employees are paid by The District School Board of Collier County. Premiums for your dependents or for eligible part-time employees are paid by the employee. Deductions are taken over 20 pay periods. Detailed benefits for each plan can be found in the Summary Plan Description (SPD) and Summary of Benefits and Coverage (see each Pathway below). These documents provide plan participants with information on how the medical plan operates, when an employee and his or her dependents can begin to participate in the plan, how services and benefits are paid, covered benefits and exclusions, deductibles, co-pays and co-insurance. The “benefit year” is January 1 to December 31. To submit a claim, mail your itemized statement to the address listed on the back of your medical ID card. No claim forms are required.In-Network/Out-of-Network: An in-network provider is a physician or medical facility that is part of the group of contracted providers. Using an in-network provider offers cost-savings advantages because a covered person pays only a percentage of the scheduled fee for services provided. A covered person who goes to an out-of-network provider will pay more for the services rendered and his or her share of the cost may not apply to the out-of-pocket maximum.Permissible Benefit Enrollment Event: For midyear changes, review the Permissible Benefit Enrollment Event guidelines and process HERE.Pathways to Enhanced Health: The Pathways plan is a behavior-based health plan providing a covered person three different levels of coverage or “Pathways.” Under the Pathways plan, you qualify for better coverage by participating in wellness activities. These activities are designed to improve health awareness, to maintain good health and address chronic disease or serious medical conditions. Covered persons who choose not to participate in the activities will be placed in the Basic Pathway for the subsequent plan year. Covered dependents will be enrolled in the same Pathway as the employee.
The three Pathways of coverage are: 1) Basic Pathway - provides coverage for catastrophic Illness, 2) Custom Pathway - provides excellent coverage, 3) Enhance Pathway - provides the most comprehensive coverage. To view more information regarding the Pathways program and how to upgrade your pathway, click here.
Benefits
Basic Pathway
Custom Pathway*
Enhanced Pathway
*New Hires and those with newly elected coverage will begin in the Custom Pathway.
The amounts and percentages listed are what the EMPLOYEE pays.
Annual Deductible
Individual 1
In-Network
$3,750
$1,250
$500
Individual 1
Out-of-Network
$6,000
$1,300
$800
Family 2
In-Network
$7,500
$2,500
$1,000
Family 2
Out-of-Network
$12,000
$2,600
$1,600
Maximum Out-of-Pocket 3
Individual
In-Network
$5,500
$5,000
$3,000
Individual
Out-of-Network
$16,000
$8,500
$4,800
Family
In-Network
$11,000
$10,000
$6,000
Family
Out-of-Network
$32,000
$17,000
$9,600
Primary Care Physician 4
In-Network
40% after CYD*
$50 Copay 5
$30 Copay 5
Out-of-Network
50% after CYD*
45% After CYD*
40% After CYD*
Specialist Office Visit 4
In-Network
40% after CYD*
$75 Copay 5
$50 Copay 5
Out-of-Network
50% after CYD*
45% After CYD*
40% After CYD*
Inpatient Facility Charges 4
In-Network
Deductible then 40%
Deductible then 30%
Deductible then 20%
Out-of-Network
Deductible then 50%
Deductible then 45%
Deductible then 40%
Outpatient Facility Charges 4
In-Network
Deductible then 40%
Deductible then 30%
Deductible then 20%
Out-of-Network
Deductible then 50%
Deductible then 45%
Deductible then 40%
MRI, CT Scans, PET Scans/X-Ray 4
In-Network
Deductible then 40%
Deductible then 30%
Deductible then 20%
Out-of-Network
Deductible then 50%
Deductible then 45%
Deductible then 40%
Prescriptions
Deductible
$400
$250
$100
Maximum Out- of-Pocket Individual
$2,150
$2,150
$2,100
Maximum Out- of-Pocket Family
$4,300
$4,300
$4,200
Generic
40% 4
30% 4
20% 4
Brand
40% 4
30% 4
20% 4
Brand Non-Preferred
60% 4
50% 4
40% 4
- Annual individual deductible is the dollar amount the covered person must pay during the calendar year before covered expenses are payable under the health insurance plan. The out-of-network deductible is separate from the in-network deductible.
- Annual family deductible is the accumulative deductible which can be met by one or multiple family members. There is no limit on the number of covered dependents.
- The annual maximum out-of-pocket is the maximum amount of covered expenses a covered person must pay during the calendar year. The Out-of-Pocket Maximum includes amounts applied towards the Deductible and any applicable Medical Copayments. After the Out-of-Pocket Maximum is satisfied, no further Deductible is required and Copayments are waived for the remainder of the Benefit Period.
- Co-insurance is the percentage paid by the employee after the annual deductible is met.
- Co-pay/co-payment is the flat dollar amount paid for medical services by a covered person per office visit. Services for which co-payments apply are covered at 100% after the covered person pays the co-payment. Applies to in-office services not to exceed $500 per visit.
*CYD refers to Calendar Year DeductibleEffective July 1, 2022: To access Allegiance's in-network rates, out-of-network allowed amounts and billed charges, click HERE. (These files are "machine readable" as required by the Transparency in Coverage mandate. Members may be unable to open the files due to low band-width.)
Note: To calculate the total cost for single and dependent coverage, add the two rates together.MEDICAL RATES Effective 1/1/2025
ANNUAL
MONTHLY
PER CHECK
(20 checks)
DAILY
EMPLOYEE ONLY Full-time employees
(100% paid by the District)
$11,528.00
$960.67
$576.40
(100% paid by the District)
$31.58
1 CHILD ONLY
$2,373.00
$197.75
$118.65
$6.50
2 CHILDREN ONLY
$4,749.00
$395.75
$237.45
$13.01
3 CHILDREN ONLY
$7,122.00
$593.50
$356.10
$19.51
DUAL SPOUSE (Two married employees with two or more children)
$3,741.00
$311.75
$187.05
$10.25
SPOUSE ONLY
$7,278.00
$606.50
$363.90
$19.94
FAMILY
$11,019.00
$918.25
$550.95
$30.19
Example: The annual single rate is $9,681 and the annual spouse rate is $7,278. The total single and spouse rate is $16,959.Note: Benefit premiums will be prorated when approved for a midyear Permissible Enrollment Event. The final calculation is based on the number of covered days left for the calendar year.Dependent Eligibility
Dependent Type
Definition
Required Documentation
Spouse
An individual to whom you are legally married
1. Marriage Certificate AND
2. Tax Return*
*If Tax Return is not available because you were recently married and haven't filed a tax return with your new spouse yet, proof of a current relationship (such as joint bank account, joint ownership of a residence, evidence of shared household expenses, or joint ownership of a loan or mortgage) may be substituted. Other exceptions may apply.
Dependent Child
Under Age 26
Your legal child married or unmarried
1. Birth Certificate listing the employee as parent, or
2. Court order dictating that the employee provides health insurance for the child, if applicable, or
3. Court issued paperwork establishing the employee as parent/guardian, if applicable.
Dependent Child
Age 26 to 30
Extended-Coverage Child**
1. Birth Certificate listing the employee as parent, or
2. Court order dictating that the employee provides health insurance for the child, if applicable, or
3. Court issued paperwork establishing the employee as parent/guardian, if applicable.
4. Affidavit of Dependent Eligibility
Stepchild
Your unmarried stepchild
1. Birth Certificate listing the employee's spouse as parent, and
2. Marriage Certificate
3. Divorce decree establishing employee's spouse as custodial parent, if applicable.
4. Divorce decree establishing employee's spouse must provide health insurance, if applicable.
*If providing your tax return, please provide your most recent federal income tax return, which will list your dependents. If you filed electronically, please provide the first page of your 1040 form and your E-file confirmation (conceal income amounts). If you did not file electronically, please provide both pages of your 1040 form (second page contains your signature and the date - conceal income amounts).
**An Extended-Coverage Child as defined by Florida Statute 627.6562 who is twenty-six (26) years of age but less than thirty (30) years of age may continue to be an eligible Dependent if the Dependent child was covered under this Plan on the last day of the Calendar Year after the Dependent child attains twenty-six (26) years of age and meets all of the following criteria required by Florida Statute:
1. Unmarried without Dependents of their own; and
2. A Florida resident or a full or part-time student; and
3. Not provided coverage under any other health plan or policy; and
4. Not entitled to coverage under Medicare
Medical/Pharmacy ID Card- New ID cards will be issued to members making certain enrollment changes, such as adding or removing a dependent, or switching Pathways
- Always use the most recent ID card and throw away your old card
- Always show your most recent ID card to all medical providers and pharmacies to minimize any delay or errors in claims processing
- Effective January 1, 2022, only electronic ID cards will be available (see iBriefing #13043)
- You can obtain a copy of your ID card:
- CCPS Portal
- Allegiance Mobile App
- Allegiance Website
Emergency Room ServicesCharges for Emergency Room Services for non-emergency use, including the facility and professional fees, are not covered.The definition of "Emergency" under our Plan is:Acute symptoms that a prudent layperson, possessing average knowledge of health and medicine, would expect that in the absence of medical attention would place the individual’s health in serious jeopardy, or seriously impair body functions, organs or parts."Emergency" will specifically exclude usual out-patient treatment of childhood diseases, flu, common cold, prenatal examinations, physical examinations and minor sprains, lacerations, abrasions, minor burns, and other medical conditions usually capable of treatment at a clinic or doctor's office during regular working hours.Urgent Care Center/Walk-In ClinicIf you are in a non-emergency situation, please consider using an Urgent Care Center or Walk-In Clinic that is In-Network. These facilities typically offer extended evening, weekend, and holiday hours.For a list of In-Network Urgent Care Centers and Walk-in Clinics, click HERE. Go to PROVIDER DIRECTORY, then select COLLIER COUNTY PUBLIC SCHOOLS DIRECTORY. Scroll down to the bottom of the document.- List of in-network facilities (as of June 1, 2023)
- Difference between urgent care center and walk-in clinic
- If something's not right, what should I do?
You may also choose to use the Recuro Health (WellVia) telemedicine benefit for more routine care. Click HERE for more information.