Medical 2025
This page contains an overview of medical plans available in Plan Year 2025. Once you are ready to select your plans, visit the Open Enrollment Portal in FlashLine to complete Plan Year 2025 enrollment.
Medical Mutual will continue as administrator of Â鶹ÊÓƵ’s Employee health insurance plans for 2025. They have provided a , where you can search for in-network providers, read frequently asked questions, watch videos regarding Medical Mutual online tools and resources and more.
As a full-time, benefits-eligible employee you have a choice of the 85/60 PPO or the High Deductible Health Plan (HDHP) for 2025. As in 2024, both plans include Prescription and Vision coverage in their premiums, and both plans include preventive care covered at 100% with in-network providers – NO COST to you! Some examples of preventive care services (PDF) are annual exams, immunizations and preventive screenings.
85/60 Health Plan
The 85/60 health insurance plan offers a lower deductible, but a higher monthly premium. The plan covers preventive annual exams, immunizations, and preventive screenings at no cost to the employee. Other in-network inpatient, outpatient, and diagnostic services are covered at 85% after the deductible is satisfied. Out-of-network coverage for these services is covered at 60% after the deductible has been satisfied.
With the 85/60 plan, preventive care is covered at 100% with in-network providers. There is a $300 dollar deductible for single coverage and $600 deductible for family coverage for non-preventive services. After the initial deductible of $300 is met, then this plan will begin to cover services at 85% of the costs for in-network services and 60% costs for out-of-network services.
You will need to continue paying 15% of the health care services until you meet the annual co-insurance maximum. The co-insurance maximum is $1,500 for single coverage or $3,000 for family coverage when using in-network providers. Also, with the 85/60 plan, there is a $15 copay for a primary care physician and a $30 copay for a specialist. The copays do not go towards your deductibles.
High Deductible Health Plan (HDHP)
You probably noticed that the High Deductible Health Plan (HDHP) has a higher deductible and lower monthly premiums than a typical health plan like the university’s 85/60 PPO plan. If you would typically choose your health plan by premium cost, be sure you understand the tradeoff for a lower monthly premium.
The HDHP requires you or your family to pay the full cost of your health care, including your medications, until you reach a fixed dollar amount. This is called your plan’s annual deductible.
With the HDHP, non-preventive medication drugs must be paid for in full until the deductible is met. Once your annual deductible has been met, covered medical expenses are covered at 100% and prescription drugs are covered at the coinsurance levels.
The HDHO is a non-grandfathered health plan and must cover routine immunizations and other services required by healthcare reform (the Patient Protection and Affordable Care Act (ACA).
If these services are performed by an in-network provider, members cannot be charged a copayment, coinsurance or deductible. Out-of-network charges may apply if the services are performed by a non-network provider.
Like all university medical plans, preventive care is covered at 100%. This means when you receive annual physicals, mammograms, colonoscopies and well-child care, there is no deductible or coinsurance. Remember, immunizations are covered by the medical plan only.