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Commonwealth Capitol Choice

Eligibility

Current employees, retirees and/or beneficiaries, classified or certified school employees and COBRA participants are eligible to participate. See your insurance coordinator/human resource generalist for specifics.

​Download the Summary of Benefits and Coverage

Effective Date

Coverage for new employees will become effective on the first day of the second calendar month following your date of hire. Example: If you begin any time in August, you are eligible for coverage Oct. 1. New employees may make their elections online in KHRIS or may complete an enrollment application within the first 35 calendar days of employment.

If you fail to make your health insurance election or waive coverage within the designated time frame, you will not have coverage and will not be allowed to enroll until the next open enrollment period, unless an appropriate qualifying event occurs. 

​​Medical Benefits

Download the Summary Plan Description

​​In Network ​Out of Network

Benefit Allowance

$500 per family member Not applicable

Deductible

​$615 Single $1,850 Family​ ​$1,230 Single ​$3,700 Family

Out-of-pocket Max

​$2,470 Single ​$7,400 Family ​$4,900 Single ​$9,000 Family

​Co-Insurance

80% Plan / 20% Member​ ​ 60% Plan / %40 Member​ ​

​Doctor's Office Visit

$21 PCP / $26 Specialist​ ​ Deductible then 40%​ ​

​Pharmacy Benefits​

​ ​ ​  ​     30-day supply
​​In Network ​Out of Network

​Generic

$11 ​Not Covered

​Formulary

​$26 ​Not Covered

​Non-Formulary

​$48 ​Not Covered
​       ​90-day supply 

You may receive a 90-day supply of maintenance drugs through Expres Scripts mail order or through participating local retail pharmacies. Purchasing a 90-day supply of maintenance drugs allows you to pay for a 90-day supply at a reduced cost.

​Generic

​$16 ​Not Covered

​Formulary

​$46 ​Not Covered

​Non-Formulary

​$95 ​Not Covered
View a list of maintenance drugs
View a list of participating local retail pharmacies offering 90-day supplies


 

Commonwealth Capitol Choice

Benefit Allowance

​The benefit allowance is a $500 benefit per person, per year that is used to cover the first $500 of eligible in-network medical expenses before you start paying toward your deductible. You do not control how the $500 is used. It is based on how your claims are received by Humana. Co-payments and prescription benefits do not apply toward the benefit allowance.

How does the deductible accumulate?​

If you have more than one family member covered under your plan, one family member may satisfy the individual $615 deductible and the remaining $1,235 family deductible may be met by any combination of the remaining family member's claims up to the $1,850 family deductible maximum.

Guidelines

        • No single family member will pay more than $615 in deductible;
        • No single family member can contribute more than $615 to the family deductible maximum; and
        • Of the $1,850 family maximum deductible, $615 can be met by a family member and the remaining $1,235 can be met by a combination of additional family members; or
        • All family members' services can be combined and applied to meet the family $1,850 deductible.
        • If only two family members are covered under this plan (employee and spouse or employee and one child), each covered member will have a $615 deductible. You will not have to satisfy the family deductible.
        • Deductibles and out-of-pocket maximums accumulate separately and do not cross apply.


 

 

Non-Smoker Rates

​Commonwealth Capitol Choice ​ ​

​Total Premium​Employer Contribution​Employee Contribution*
​Single​$650.22​$612.94​$37.28
​Parent Plus​$961.42​$782.42​$179.00
​Couple​$1,457.90​$939.90​$518.00
​Family​$1,613.74​$1,003.74​$610.00
​Family Cross Reference**​$798.70​$745.94​$52.76

 

Smoker Rates

​Commonwealth Capitol Choice ​ ​

​Total Premium​Employer Contribution​Employee Contribution*
​Single​$650.22​$587.12​$63.10
​Parent Plus​$961.42​$728.94​$232.48
​Couple​$1,457.90​$885.78​$572.12
​Family​$1,613.74​$949.74​$664.00
​Family Cross Reference**​$798.70​$720.66​$78.04

 

*All employee contributions are per employee, per month.
**If either employee in a family cross-reference payment option is a smoker, both employees are subject to the monthly smoker rates. See the guidelines ​for choosing the cross-reference payment option.