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Health Insurance

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.

Health Insurance Index

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.

PPO

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

Plan Service/FeaturePPO
In‐network services		HDHP with HSA
In‐network services
Annual Deductible$500/person;
$1,000/family		$3,500/person;
$7,000/family
Preventive Care Services
Routine Health Exams, Cancer Screening, Eye and Hearing Exams, Immunizations, Prenatal & Postnatal Services, Well Child Care		100 % of charges incurred100% 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 InjectionsNo out of pocket costDeductible, 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/
Substance Abuse
Outpatient		$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 Services80% of charges incurredDeductible, then 100%
Inpatient Hospitalization80% of charges incurredDeductible, then 100%

*For the PPO plan, in most cases, both the co-pay and Coinsurance amounts will go toward the out-of-pocket maximum but not the deductible.

Annual Out-of-Pocket Maximums

PPO
In‐network services		HDHP with HSA
In‐network services
Single (Medical/Prescriptions)$3,500/person$3,500/person
Family (Medical/Prescriptions)$7,000/family$7,000/family

*For the PPO plan, in most cases, both the co-pay and Coinsurance amounts will go toward the out-of-pocket maximum but not the deductible.

Prescription Drugs

PPO
In‐network services		HDHP with HSA
In‐network services
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,
Brand Non-Formulary
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 Services80% of charges incurredDeductible, then 100%
Lifetime MaximumUnlimitedUnlimited
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.		$14,000/person, $28,000/family
calendar year deductible, services are covered at 100% of charges incurred after deductible is met and until out-of-pocket maximum is reached.

*For the PPO plan, in most cases, both the co-pay and Coinsurance amounts will go toward the out-of-pocket maximum but not the deductible.

Plan Premiums

2025 Full-Time Premiums (0.75 FTE and above)

Rates below are shown on a monthly basis.

High DeductiblePPO
Tier LevelEmployee CostMac CostEmployee CostMac Cost
Employee Only$146.17$584.68$220.63$882.52
Employee + Child(ren)$326.68$762.24$497.40$1,160.60
Employee + Spouse/Domestic Partner$507.18$1,183.42$774.17$1,806.39
Employee + Family$641.68$1,497.26$980.68$2,288.26

2026 Full-Time Premiums (0.75 FTE and above)

High DeductiblePPO
Tier LevelEmployee CostMac CostEmployee CostMac Cost
Employee Only$160.77$643.08$242.67$970.68
Employee + Child(ren)$359.31$838.39$547.09$1,276.54
Employee + Spouse/Domestic Partner$557.85$1,301.65$851.51$1,986.85
Employee + Family$705.79$1,646.84$1,078.65$2,516.86

2025 Part-Time Premiums (0.50 – 0.74 FTE)

Rates below are shown on a monthly basis.

High DeductiblePPO
Tier LevelEmployee CostMac CostEmployee CostMac Cost
Employee Only$292.34$438.51$441.26$661.89
Employee + Child(ren)$544.46$544.46$829.00$829.00
Employee + Spouse/Domestic Partner$845.30$845.30$1,290.28$1,290.28
Employee + Family$1,069.47$1,069.47$1,634.47$1,634.47

2026 Part-Time Premiums (0.50 – 0.74 FTE)

High DeductiblePPO
Tier LevelEmployee CostMac CostEmployee CostMac Cost
Employee Only$321.54$482.31$485.34$728.01
Employee + Child(ren)$598.85$598.85$911.82$911.82
Employee + Spouse/Domestic Partner$929.75$929.75$1,419.18$1,419.18
Employee + Family$1,176.32$1,176.32$1,797.76$1,797.76

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:

    • marriage
    • divorce
    • 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

    HR 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?

    With self-funding, Macalester assumes the financial risk of providing health insurance to employees instead of purchasing a traditional group health insurance policy. This means that Macalester pays all of the medical claims incurred by employees and their dependents, after employees pay their deductibles, co-pays and co-insurance. Macalester contracts with HealthPartners to manage claims, coordinate provider networks and manage compliance obligation.
  • 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.

To get started, go to the healthpartners website

Help Comparing Plan Options

Some sort of introduction text about resources that HealthPartners offers to Mac employees.

To get started, go to the healthpartners website.

You may be able to save money with the HDHP plan that offers the HSA or the PPO plan that offers the Healthcare FSA. Go here and scroll down to step 4.

After enrollment you will receive your member ID that you can use to register to login to get estimated costs for care.