77 Macalester Street, Room 201 651-696-6280
Health 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. Employees can choose between the HealthPartners High-Deductible Health Plan (HDHP) with HSA or the HealthPartners PPO Health Plan. Both plans use the Open Access Choice PPO Network and provide comprehensive coverage. 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.
Macalester employees with a 0.50 FTE or higher are eligible for coverage. Employees may add spouses, registered domestic partners, dependent children up to age 26, as well as other legal dependents. All plan participants must have the same level of coverage, either the HDHP plan or the PPO plan.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. High deductible health plans are a form of catastrophic coverage intended to cover for catastrophic illness. Participation in a qualifying HDHP is a requirement for Health Savings Accounts (HSA) and other tax-advantage programs.
A Preferred Provider Organization (PPO) is a health insurance plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. The PPO plan has lower deductibles than the HDHP and participants will pay co-pays for most services. Participants in the PPO plan may elect to participate in a healthcare flexible spending account to set aside funds on a pre-tax basis for qualified expenses.
Plan Coverage Summaries
2023 Plan Coverage Summary
Plan Service/Feature PPO
HDHP with HSA
Annual Deductible $500/person;
Preventive Care Services
Routine Health Exams, Cancer Screening, Eye and Hearing Exams, Immunizations, Prenatal & Postnatal Services, Well Child Care
100 % of charges incurred 100% of charges incurred E-Visits
The first 3 visits free, then
$10 co-pay per visit thereafter
Deductible, then 100% Convenience Clinics
$10 co-pay, then 100% Deductible, then 100% Allergy Injections No out of pocket cost Deductible, then 100% Primary Care Office Visits
MD Visits (includes ancillary services received in provider’s office and palliative care)
$30 co-pay, then 100% Deductible, then 100% Behavioral Health/
$30 co-pay, then 100% Deductible, then 100% Specialty 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
2023 Out of Pocket Maximums
HDHP with HSA
Single (Medical/Prescriptions) $3,500/person $3,500/person Family (Medical/Prescriptions) $7,000/family $7,000/family
Prescription Drugs PPO
HDHP with HSA
Generic Formulary Drugs
31 day supply
$15 co-pay, then 100% Deductible, then 100% Brand Formulary Drugs
31 day supply
$40 co-pay, then 100% Deductible, then 100% Specialty Drugs,
31 day supply
20% co-pay up to $300 per script, then 100% Deductible, then 100% Mail Order,
Generic Formulary Drugs
90 day supply
$45 co-pay, then 100% Deductible, then 100% Mail Order,
Brand Formulary Drugs
90 day supply
$120 co-pay, then 100% Deductible, then 100% Other Covered Services 80% of charges incurred Deductible, then 100% Lifetime Maximum Unlimited Unlimited Out-of-Network Services $2,000/person, $4,000/family
calendar year deductible, services are covered at 60% of charges incurred after deductible is met and until out-of-pocket maximum is reached.
calendar year deductible, services are covered at 100% of charges incurred after deductible is met and until out-of-pocket maximum is reached.
>.75 FTE and above >.75 FTE and above >.50-.74 FTE >.50-.74 FTE PPO HDHP PPO HDHP Employee $163.03 $108.23 $321.07 $211.45 Employee + 1 $494.94 $325.26 $820.24 $537.44 Employee + 2 or more $722.69 $473.19 $1,199.82 $783.98
Frequently Asked Questions
How do I pay for my insurance coverage?
Eligible employees’ paychecks are 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.
This means that we’ll reduce your paycheck by the amount of your premiums, and then you’ll be taxed on your income on the lesser amount in your check. The IRS regulates this, and because of their restrictions, you can only make changes to your coverage levels at certain times of the year, namely during open enrollment or if you have a Qualified Life Event (see below for definition).
When can I elect/change coverage?
There are two times you can change your benefits: during Open Enrollment or within 30 days of a Qualified Life Event.
Open Enrollment occurs annually in early November and elections will be effective on January 1 of the following calendar year.
A Qualified Life Event (QLE) allows you to make changes to your benefit elections outside of open enrollment, and you have 30 days from the event date to provide related documentation.
Examples of a QLE are:
- the birth/adoption of a child
- commencement or separation of your spouse’s employment
- a change on the part of you or your spouse from full-time to part-time employment status or vice versa that results in a change in benefit eligibility
- taking an unpaid leave of absence
- change in benefit elections on the part of you or your spouse during open enrollment
Employment Services will meet with you to review the documentation you provide related to the life event change and open a special enrollment in the benefit enrollment system for changes to be made to your benefits.
Macalester’s health insurance program is self-funded. What does this mean?
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 healthcare insurance program, Macalester effectively serves as its own insurance company. Macalester does not price the health plans to make a profit. Employees who elect to participate in Macalester’s plans pay a portion of the cost through deductibles and coinsurance. Macalester pays the remainder of the claim costs.
What is the difference between in-network and out-of-network providers?
In-Network coverage typically provides the full benefit allowed under the plan (lower cost to you). Out-of-network coverage allows you to see any provider/doctor of your choosing, however at a lower benefit level (higher cost to you).
Where can I find if my prescription is covered under the HDHP or PPO plan?
Both plans use the PreferredRX formulary. This resource can help give you an idea of what is covered under your plan.
- Visit www.healthpartners.com (Registering as a HealthPartners member gives the best results)
- Call 952-883-5000 or 800-883-2177 (Toll Free)
- virtuwell: How it Works and Conditions Treated (PDF)
- virtuwell: Summary
- How to use virtuwell video
- HealthPartners Informational Brochure (PDF)
- Prescription Cost Management Tool (PDF)
- Prescription Savings Tool (PDF)
Transparency in Coverage (TIC)
TIC is designed to help individuals have a clearer understanding of the cost of healthcare services. Visit the HealthPartners website for more information on TIC.
Over-the-counter COVID-19 testing
Under the new federal guidelines, you are eligible to get no-cost over-the-counter (OTC) COVID-19 tests.
- OTC tests must have been purchases on January 15, 2022, or later
- Our plans cover up to eight swabs (1 swab = 1 test) per member per month
- Coverage applies for the length of the COVID-19 public health emergency
You have two way to get OTC COVID-19 tests at no cost:
- From an in-network pharmacy: Pick up an OTC test at the pharmacy counter, just like you would any other prescription. Your plan will cover the purchase, and you won’t pay anything out of pocket. Note: Purchases must happen at the pharmacy counter. If you buy tests at another counter in the store, see option two for reimbursement instructions.
- Submit a receipt after purchase: If you purchase an OTC test out of pocket, you can submit a request for reimbursement online. You will be asked to submit photos of receipt(s) and test box barcode(s) for yourself or any dependents on your plan. Reimbursement will be issued by mail to the plan policyholder. We appreciate your patience as this process typically takes several weeks. If you have questions, call Member Services using the number on the back of your member ID card, and our team can walk you through the process.