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Human Resources - Health & Dental Insurance Summary
 
 
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Eligibility: Full-time faculty status (5/7 load), administrative staff who work at least 3/4 time, and support staff who work at least 1486 hours per year

Providers: United Health Care River Valley for Health; Delta Dental for Dental

HEALTH INSURANCE

PPO MCO HSA
  • Office visit in network: $20
  • Inpatient hospital in network: 80/20
  • Prescriptions: 10/20/35

Deductible/calendar year 

  • $1000/$2,000

Maximum out-of-pocket/calendar year

  • $2,000/$4,000

PPO Summary OMZL (PDF)

  • Office visit in network: $15
  • Inpatient hospital in network: 90/10
  • Prescriptions: 10/20/30

Deductible/calendar year 

  • $750/$1,500

Maximum out-of-pocket/calendar year

  • $1,500/$3,000

MCO Summary OMZK (PDF)

  • Office visit: Subject to deductible
  • Inpatient hospital: Subject to deductible
  • Prescriptions: Subject to deductible

Deductible/calendar year 

  • $2,500/$5,000 (in network)

Maximum out-of-pocket/calendar year

  • $2,500/$5,000 (in network)

HSA Single Summary OMZM (PDF)
HSA Family Summary OMZN (PDF)

DENTAL INSURANCE

Delta Dental - Core Plan  Delta Dental - Buy-Down Plan 
Deductible/calendar year 
  • Waived for checkups
  • Employee: $50
  • Employee + 1: $100
  • Family: $150
  • Orthodontia for dependents: 50%
  • Cavity repair, extractions, gum diseases: 15%
  • Delta Dental Core Summary (PDF)
  • Delta Dental - (800) 544-0718
Deductible/calendar year 

Additional information: Jane Juchems, Director, HR or 352-8431. Office: 203 Luther Hall

 

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