My HEALTH
Medical PLANS
You have three plans to choose from: two Exclusive Provider Organization (EPO) plans and one High Deductible Health Plan (HDHP). All three plans include access to providers in the BCBS PPO National Network.
The EPOs — Buy-up Plan and Base Plan — offer care through a network of local doctors and clinics. This helps us keep your monthly premiums low; however, you won’t be able to go out-of-network for care. You can access an extensive list of network providers directly from the BCBS website under Find a Doctor or Hospital.
The two EPO plans available to you differ in terms of how much you will pay for health care and premiums. The Buy-up Plan has a higher premium but a lower deductible and out-of-pocket maximum. The Base Plan has a lower monthly cost, but you may pay more for health care.
The HDHP has the lowest premium, meaning you will have more money in your paycheck, and the lowest out-of-pocket maximum. However, the HDHP's deductible is higher than the other plans (meaning you will likely pay more for any medical expenses). Enrolling in an HDHP also enables you to save money tax-free in a Health Savings Account (HSA).
COACH Clinic
We know that the cost of health care can be a barrier to our employees and their families. That’s why we offer a clinic to you and your dependents. The City of Abilene Clinic for Health offers non-emergency medical treatment for free or at a steep discount, depending on your insurance coverage:
- Employees enrolled in the City's EPO plans receive free care at the clinic.
- Employees enrolled in the City's HDHP plans - HDHP plans do not allow for most free services until the deductible is reached so there will be a $35 fee for this service. This fee will go towards the deductible.
- Employees who are not enrolled in our medical plan can still visit the clinic for a $35 fee. Regardless of your coverage, don’t forget your insurance card! Even if you are not charged, the clinic uses it as proof that you’re eligible for care.
To schedule an appointment, call 325-437-4611
Medical Plan Overview
Medical Plan Monthly Overview
Virtual VISITS
Did your child wake up with a sudden fever? Is your spouse complaining of headaches? Are you debating whether you have pink eye or just allergies?
Call MDLIVE. They’re available 24 hours a day and can help you with a wide variety of common ailments, including colds, fevers, allergies, aches, pains and more. You’ll be connected to a board-certified doctor via video conference from the comfort of your own home by tablet, phone, or computer.
The MDLIVE physician can diagnose non-emergency situations, saving you the time and the cost of a trip to urgent care or the ER. MDLIVE physicians can even prescribe medication.
Best of all—it’s only a $10 copay for a visit!
Prescription
DRUGS
Please note that no out-of-network coverage is provided for EPO plans.
Members electing to purchase preferred/non-preferred brand name drugs when “Brand Medically Necessary” is not indicated and a generic equivalent is available will be required to pay the difference between the cost of the generic and preferred/non-preferred brand name drug, plus the generic copay.
Prescription Drug Plan Overview
Use your
SAVINGS & SPENDING ACCOUNTS
How a Health Care FSA can BENEFIT YOU & YOUR WALLET
A Health Care Flexible Spending Account lets you set aside pre-tax funds from your paycheck to help pay for out-of-pocket health care expenses throughout the year. FSAs require enrollment every year and have forfeiture provisions—meaning you have a specified amount of time to use your funds or you will lose them. You'll want to spend down this account every year based on your plan's rules.
Translation: FSA funds are pre-tax, so your tax-savings are like a discount every time you use your money on medical-related expenses!
IRS Annual Health FSA Contribution Limit: $3,050*
*Listed contribution limit is for 2023. The 2024 limit, which has not yet been released, will apply to your 2024 FSA.
FSATimeline
As mentioned, FSAs have “use it or lose it” forfeiture provisions. You must use your FSA funds on qualified expenses in the year in which you contribute them or during a short grace period after that or they will be forfeited.
Please note: You cannot use your FSA debit card to pay for 2024 expenses incurred during the grace period in 2025. You must instead pay with another method and request reimbursement (a detailed receipt will be required). If you use your FSA debit card for charges incurred during the grace period, the charges will be applied toward your 2025 balance. Here’s a timeline you can follow for your FSA account:
- New Hire Enrollment: Elect if you want to participate in an FSA in 2024 during New Hire Enrollment. You must choose how much you want to set aside in this fund, up to the IRS contribution limit.
- December 31, 2024: The day the FSA Plan year ends.
- March 15, 2025: Last day of the grace period to incur expenses for your 2024 elections. Any unused funds after this date will be forfeited.
- March 31, 2025: Last day to submit a reimbursement request for your 2024 expenses.
To access your FSA, go to benefitsolver.com and click on the MyChoice Accounts button on the homepage.
Health Savings Account HSA
How a Health Savings Account CAN HELP YOU SAVE FOR THE FUTURE & REDUCE TAXES
A Health Savings Account (HSA) is a type of savings account that lets you set aside money tax-free to pay for qualified health care expenses. You can use the money in an HSA to pay for deductibles, copayments, coinsurance, and other eligible health care expenses. The money in your HSA rolls over year to year and any interest earned is tax-free. You also have the ability to invest a portion of the funds in your HSA account, making it a great tool to pay for health care expenses now and in the future, including after retirement. The amount you can contribute to an HSA is set annually by the IRS, and differs based on whether you are covering yourself only or your family. An additional contribution can be made if you are 55+. Please note: You must be enrolled in a HDHP medical plan to participate in the HSA. IRS Annual HSA Contribution Limit: Self-only $4,150 Family $8,300 55+ $1,000
Limited-Purpose Flexible Spending Account LPFSA
How a LPFSA can help you BOOST YOUR SAVINGS
A Limited-Purpose Flexible Spending Account (LPFSA) lets you set aside additional pre-tax funds from your paycheck for eligible vision and dental expenses. An LPFSA can be paired with a Health Savings Account (HSA) so you can maximize your pre-tax savings. However, it is recommended that only employees who are making the maximum contribution to their HSA utilize the Limited Purpose FSA as HSA funds will roll over if unused at the end of the plan year and can be utilized on medical, dental and vision expenses. Contributions to an LPFSA do not roll over; funds must be used by the end of the calendar year or you will lose them. Please note: You must be enrolled in a HDHP medical plan to participate in the LPFSA. IRS Annual Limited-Purpose Flexible Spending Account Limit: $3,050*
To access your FSA, go to benefitsolver.com and click on the MyChoice Accounts button on the homepage.
DENTAL Insurance
Dental insurance can be an investment in your oral health and your overall health because a comprehensive dental exam can detect a variety of health problems.
The City of Abilene offers employees the choice of two dental plan options: the Low Plan and the High Plan. Both plans are administered by BCBS and allow you to go in- and out-of-network. You will pay less when you stay in network as in network dentists provide services at discounted rates.
VISION Insurance
Many adults consider vision to be their most important sense. Yet one in five people are at risk for vision loss, which can often be caused by problems that could be addressed through preventive care.
Regular comprehensive eye exams can not only help correct vision problems, they can also help detect serious health problems such as high blood pressure, heart disease and diabetes. No matter what your age, regular eye exams are important to your productivity and health, and should be an important part of your routine.
The City of Abilene offers vision coverage through CEC. The vision plan can help cover the costs of exams, eyeglasses, contact lenses and frames.
CRITICAL ILLNESS Insurance
When you develop a serious illness, your most important task is to focus on getting better. That can be hard if you’re worried about the financial impact of your care.
That’s why Critical Illness Insurance is so helpful. It pays out a lump sum when you develop one of the covered illnesses, which you can then use as you see fit. You can pay for care that’s not covered by your medical plan, meet a deductible, pay bills or even take a trip someplace with a climate better suited to your current condition. Critical Illness coverage is separate from your medical plan and covers conditions such as:
- Heart attack
- Stroke
- Cancer (cancer that has spread beyond initial tissue)
- End stage renal (kidney) failure
- Major organ failure
- Coma
- Paralysis of two or more limbs
- Loss of sight
- Occupational HIV
- Occupational Hepatitis
Please refer to the policy for complete details about these covered conditions. You can also opt for coverage for your spouse, and your child(ren) are automatically covered at 25% of the benefit amount at no additional cost.
ACCIDENT Insurance
If you have an accident, you’ll soon realize that your medical expenses are not the only bills that can pile up quickly. For example, if you were in a car crash, you may have to pay your auto policy’s deductible. If you fell down a ski slope, you might have to buy new skis. You may also have a shortfall resulting from lost wages while you recuperate.
That’s where Accident Insurance comes in. When you have a qualified accident, it pays you a lump sum that you can use as you see fit. Whether that’s paying bills, replacing your favorite skis, or getting your car back on the road it’s there for you when the unexpected happens.
