Summary of Benefits

Medical Benefits
 
County offers one PPO plan option with our network being Cigna. 
For Network Medical Provider:  Visit  http://www.cigna.com
Our plan runs on the fiscal year, but deductible and maximum out of pocket run on the calendar year (January – December).
Eligibility:  A new employee becomes eligible for coverage on the first day of the sixth full pay period employed.
We have a four tier premium breakout:
  • Employee Only - $58.43 per pay period
  • Employee plus Child(ren) - $116.80 per pay period
  • Employee plus Spouse - $122.63 per pay period
  • Family - $153.50 per pay period

Employee pays 21% of Medical Premium and County pays 79% of Medical Premium.

** Medical Premium includes Medical, Prescription, Group Life, and Short Term Disability Coverage.

Benefits are subject to deductible and maximum out of pocket each calendar year for each person covered by the Plan.  When three persons who are covered under one employee’s umbrella have met the annual deductible, the deductible will not apply for that families claims for the remainder of that year.  The medical plan deductible is $500.00; in-network out of pocket maximum is $2,000.00, and, out-of-network out of pocket maximum is $3,000.00.  The deductible applies to both in and out of network services.  The maximum out of pocket includes: deductible, co-insurance, medical and prescription co-pays.

Service Cost to member for in-network services Cost to member for out-of-network services   
General Practitioner Office Visit $20 co-pay (not all-inclusive) plan deductible and 40% co-insurance
Specialist Office Visit $30 co-pay (not all-inclusive) plan deductible and 40% co-insurance
Office services or Diagnostic testing      plan deductible and 20% co-insurance plan deductible and 40% co-insurance
Annual wellness/Preventive care No cost sharing if part of USPSTF Recommendations A&B plan deductible and 40% co-insurance
Walk-in care (not urgent) $25 co-pay (all-inclusive) @ San Juan Health Partners Aztec & Bloomfield ONLY    No Benefit
Urgent/Emergent Care Visit
$25 co-pay (all-inclusive @ contracted locations)
$150 co-pay @ Cigna providers
plan deductible and 40% co-insurance
Telemedicine $0 co-pay Not Applicable
Emergency Room $250 co-pay any location same as in-network

 

Prescription Benefits
Employee and dependents must be covered under the medical plan to be eligible for the prescription program, which is administered by RxEDO Pharmacy Benefit Managers.  Our prescriptions are filled as written with a three tier breakout of generic, preferred formulary, and non-preferred formulary.  Co-pays are $10, $20, $40 respectively.

 

Life Insurance  
We offer, with the medical plan, a group life benefit which includes $25,000 Basic and Accidental Death and Dismemberment for the employee and $5,000 for each qualifying dependent. An employee who waives medical coverage may opt to pay $0.43 per pay period to purchase basic Life and AD&D separately for themselves only.
 
 
Short Term Disability
Coverage is available to employees who waive medical coverage and opts to pay $0.51 per pay period. The short-term disability plan provides a $200/week benefit for employees who are disabled because of a non-job related illness or injury and who are unable because of the illness or injury to fulfill their duties.  An employee will be eligible to receive benefits beginning the 15th day of the illness or injury, and may continue to receive benefits for a maximum of 26 weeks. 
 
Dental Plan
San Juan County offers a competitive dental plan option.  Each member enrolled is eligible for $1,500 per calendar year.  The plan has a $50 deductible ($150 family max). Each member has two cleanings covered by participating providers at no cost. Basic and Restorative is covered at 80% after the $50 deductible.  Major services are covered at 50%.  Orthodontic services are available to youth up to age 19 years of age with a $1,000 lifetime maximum.  The plan has three tiers and has no County funding.
 
Vision Plan
San Juan County offers members access to the fee schedule for a minimum premium.  The plan has three tiers and has no County funding.  We pay $100 toward eye exams.  $75 toward frames every other year. Lens allotment depends on the type and contacts we are allotted $110 in lieu of frames and lenses. 
 
NOTE:  An employee may only make changes to plan benefits during an open enrollment period unless experiencing a life event.  A life event occurs when an employee experiences a change of family status, including: marital status; birth, adoption, or guardianship of a dependent; death of spouse or dependent; addition of other coverage or loss of other coverage. An employee must take appropriate steps to notify the Benefits Coordinator @ 505-334-4504 within 30 days of the change and provide the appropriate evidence of the change.