• Pathways to Enhanced Health

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    Pathways to Enhanced Health is the District's wellness plan. In the Pathways plan, you may qualify for lower deductibles and out-of-pocket expenses by participating in wellness activities (blood draw, biometric screening, preventative screenings, etc.)
     
    All activities are designed to promote good health and minimize or manage chronic or serious medical conditions. Pathways to Enhanced Health has three pathways: BasicCustom and Enhanced.
     
    The goal is simple - improving the health of our plan participants. The Pathways plan applies to all covered employees, COBRA participants and retirees.
     
     
     
     
    Requirements & Deadlines Quest
    Coaches Preventative Screenings Nicotine
     
     
     

    Pathway Comparison

    Basic Pathway

    Custom Pathway

    Enhanced Pathway

    The amounts and percentages are what the employee pays.  

    Annual Deductible

    Individual 1

    In-Network

     $3,000

    $1,000

    $400

    Individual 1

    Out-of-Network

    $6,000

    $1,300

    $800

    Family 2

    In-Network

    $6,000

    $2,000

    $800

    Family 2

    Out-of-Network

    $12,000

    $2,600

     $1,600

    Maximum Out-of-Pocket 4 

    Individual

    In-Network

    $4,700

    $4,450

    $2,400

    Individual

    Out-of-Network

    $16,000

    $8,500

    $4,800

    Family

    In-Network

    $9,400

    $8,900

    $4,800

    Family

    Out-of-Network

    $32,000

    $17,000

    $9,600

    Primary Care Physician 3

    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 3

    In-Network 

    40%

    $75 Copay 5

    $50 Copay 5

    Out-of-Network 

    50% after CYD*

    45% After CYD*

    40% After CYD*

    Inpatient Facility Charges

    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

    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

    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% 3

    30% 3

    20% 3

    Brand

    40% 3

    30% 3

    20% 3

    Brand Non-Preferred

    60% 3

    50% 3

    40% 3

     

    1. 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.
    2. 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.
    3. 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.
    4. Co-insurance is the percentage paid by the Plan after the annual deductible is met.
    5. 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 Deductible