Medical insurance coverage helps you and your family access routine and preventive health care at a reasonable cost and protects against the catastrophic costs of major illness or injury.

Macalester’s medical insurance program is self-funded.  This means that Macalester pays the total costs of medical claims made against its health care plans.  It does not transfer the claims costs or the risk of claims to a third-party insurer.  However, Macalester has retained the services of HealthPartners to provide third-party administrative services, such as access to a network of providers and claims processing.

By self-funding our health care insurance program, Macalester effectively serves as its own insurance company.  Macalester does not price the medical plan to make a profit.  Employees who elect to participate in the Macalester’s plans pay a portion of the cost through deductibles and coinsurance.  Macalester pays the remainder of the claim costs.

Eligible employees' paychecks are generally reduced on a pre-tax basis by the amount of their health insurance premiums. This pre-tax plan is governed by IRS regulations and, as a result, there are certain limitations on an enrollee's ability to make changes to coverage levels during the year.

Annual enrollment in Macalester’s medical insurance plan is held on a yearly basis during late Fall, at which time employees can change their medical plan and/or the level of coverage.

Employees can choose between the HealthPartners High Deductible Health Plan (HDHP) HSA or the HealthPartners PPO Health Plan. Both plans use the Open Access Choice PPO network and provide comprehensive coverage. Highlights of the plans include fully covered preventive health care (no deductible or co‐pay). The Open Access Choice PPO network gives you the care and service you need, at your convenience. With more than 650,000 providers, you have access to one of the country’s largest networks.

 

For More Information

Related Benefit Forms

Rates & Plan Design

Plan Service/Feature

PPO

IN-NETWORK SERVICES

HDHP with HSA
In‐network services
Annual Deductible None $2,600/person; $5,200/family

PREVENTIVE CARE SERVICES
Routine Health Exams
Cancer Screening
Eye and Hearing Exams
Immunizations
Pre- & Post-Natal
Well Child Care

100 % of charges incurred 100% of charges incurred
E-VISITS
virtuwell
The first 3 visits free, then
$10 co-pay per visit thereafter
Deductible, then 100%
CONVENIENCE CLINICS
MinuteClinic
$10 co-pay, then 100% Deductible, then 100%
ALLERGY INJECTIONS No out of pocket cost Deductible, then 100%
PRIMARY CARE OFFICE VISITS $30 co-pay, then 100% Deductible, then 100%
BEHAVIORAL HEALTH/
SUBSTANCE ABUSE

Outpatient
$30 co-pay, then 100% Deductible, then 100%
SPECIALITY OFFICE VISITS
Chiropractic
Physical Therapy
Speech Therapy
Occupational Therapy
Acupuncture, etc.
$50 co-pay, then 100% Deductible, then 100%
URGENT CARE VISITS $50 co-pay, then 100% Deductible, then 100%
EMERGENCY ROOM VISITS
coverage for
emergency conditions only
$100 co-pay, then 100% Deductible, then 100%
AMBULANCE SERVICES 80% of charges incurred Deductible, then 100%
INPATIENT HOSPITALIZATION 80% of charges incurred Deductible, then 100%
ANNUAL OUT-OF-POCKET MAXIMUMS
Single (Medical) $2,600/person $2,600/person
Family (Medical) $5,200/family $5,200/family
Single (Prescriptions) $2,600/person $2,600/person
Family (Prescriptions) $5,200/family $5,200/family
PRESCRIPTION DRUGS
Generic Formulary Drugs
31 day supply
$12 co-pay and then 100% thereafter Deductible, then 100%
Brand Formulary Drugs
31 day supply
$35 co-pay and then 100% thereafter Deductible, then 100%
Specialty Drugs, Brand Non-Formulary
31 day supply
20% co-pay up to $300 per
script, 100% covered thereafter
Deductible, then 100%
Mail Order, Generic Formulary Drugs
90 day supply
$24 co-pay and then 100% thereafter Deductible, then 100%
Mail Order, Brand Formulary Drugs
90 day supply $
$70 co-pay and then 100% thereafter Deductible, then 100%
OTHER COVERED SERVICES 80% of charges incurred Deductible, then 100%
LIFETIME MAXIMUM Unlimited Unlimited
OUT OF NETWORK
SERVICES
$300/person, $900/family
calendar year deductible, services
are covered at 60% of charges
incurred after deductible is met
and until out-of-pocket
maximum is reached.
$5,400/person, $10,800/family
calendar year deductible, services
are covered at 75% of charges
incurred after deductible is met
and until out-of-pocket
maximum is reached.

Note: The above table is a summary only. The certificate of coverage will be used in case of error and for all claims processing

Health Plan Employee Premiums

Rates Shown per Month
.75 FTE and above.50—.74 FTE
HDHPPPOHDHPPPO
Employee $90.19 $134.35 $177.39 $265.70
Employee + 1 $271.69 $408.85 $450.82 $679.41
Employee + 2 or more $396.90 $598.44 $659.50 $995.41