Premium Plan

The Premium Plan offers mostly copayments (a set dollar amount) rather than coinsurance (a percentage of the cost), so you know what your expenses will be ahead of time. Your out-of-pocket expenses are kept low by choosing in-network providers; however, you have the flexibility to choose out-of-network care for a higher cost.

The City pays 95% of the cost of the employee premium and subsidizes a portion of dependent care premiums.

Plan highlights include (for in-network providers):

  • No deductible

  • $25 copay for primary care visits/$50 copay for specialists

  • $0 copay for diagnostic tests (such as x-rays and blood work) and imaging (CT/PET scans, MRIs, etc.)

  • $0 copayment for outpatient surgery

  • $50 copay per day for in-patient hospital stays

Out-of-Pocket Maximums: These are the limits for the most you will pay during a coverage period (usually one year) for your share of the costs of covered services. If you reach this limit in a plan year, any remaining service costs will be covered 100% by the plan (not including premiums).

  • $2,000 individual / $4,000 family for in-network care;

  • $4,000 individual / $8,000 family for out-of-network care;

  • Prescription Expenses: $1,000 individual / $3,000 for family.