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Commonwealth Maximum Choice

Eligibility

Current employees, beneficiaries, classified or certified school employees and COBRA participants are eligible to participate. See your insurance coordinator/human resource generalist for specifics. 
Retirees are not eligible for this plan.

​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

​Health Reimbursement Account

​ ​​Single $1,000;Parent-Plus$1,500; 
​Couple $1,500; Family $2,000; Cross-Reference $2,000​

Deductible

​$2,450 Single $3,650 Family​ ​$2,450 Single ​$3,700 Family

Out-of-pocket Max

​$3,700 Single ​$5,400 Family ​$4,945 Single ​$7,400 Family

​Co-Insurance

90% Plan / 10% Member​ ​ 60% Plan / 40% Member​ ​

​Doctor's Office Visit

Deductible then 10% Deductible then 40%​ ​

​Pharmacy Benefits

Download the RX Summary Plan Description
 View the formulary drug listing

​30-day supply

​​​​In Network ​​Out of Network

​Generic

Deductible then 10% Deductible then 40%

​Formulary

Deductible then 10% Deductible then 40%

​Non-Formulary

Deductible then 10% Deductible then 40%
       ​90-day supply** ​ ​

​Generic

Deductible then 10% ​Not Covered

​Formulary

Deductible then 10% ​Not Covered

​Non-Formulary

Deductible then 10% ​Not Covered

View a list of maintenance drugs
​View a list of participating local retail pharmacies offering 90-day supplies

  **Retail or mail-order maintenance drugs only​ ​ ​

            
 

Commonwealth Maximum Choice

How does the deductible accumulate?​

If you have more than one family member covered under your plan, one family member may satisfy the individual $2,450 deductible and the remaining $1,200 family deductible may be met by any combination of the remaining family member's claims up to the $3,650 family deductible maximum.

Guidelines​

        • No single family member will pay more than $2,450 in deductible;
        • No single family member can contribute more than $2,450 to the family deductible maximum; and
        • Of the $3,650 family maximum deductible, $2,450 can be met by a family member and the remaining $1,200 can be met by a combination of additional family members; or
        • All family members' services can be combined and applied to meet the family $3,650 deductible.
        • Deductibles and out-of-pocket maximums accumulate separately and do not cross apply.


 

 

Non-Smoker Rates

Commonwealth Maximum Choice

​Total Premium​Employer Contribution​Employee Contribution*
​Single​$629.56​$598.68​$30.88
​Parent Plus​$912.62​$772.62​$140.00
​Couple​$1,273.08​$877.08​$396.00
​Family​$1,451.30​$981.30​$470.00
​Family Cross Reference**​$715.20​$669.96​$45.24

 

Smoker Rates

Commonwealth Maximum Choice

​Total Premium​Employer Contribution​Employee Contribution*
​Single​$629.56​$572.80​$56.76
​Parent Plus​$912.62​$718.82​$193.80
​Couple​$1,273.08​$822.74​$450.34
​Family​$1,451.30​$927.10​$524.20
​Family Cross Reference**​$715.20​$644.82​$70.38

*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.