Due to Welborn's decision to leave the healthcare market,
employees in Welborn plans will need to choose an Anthem plan for 2013.
Welborn HMO
Introduction - Coverage -
2012 Rates - 2011 Rates -
Forms/Documents
The
Welborn HMO Plan is available to regular full-time employees working on at
least a 75 percent academic or fiscal year appointment. Contact Human Resources
for information on those benefits applicable to temporary, part-time, or other
employee groups.
Coverage
Welborn HMO Plan Highlights
*
100% Preventive Care Coverage only Plan Design Change for 2011
- Beginning 1/1/2011, 100% Preventive Care Coverage
- Must use WHP provider (Deaconess Only); no out-of-network benefits.
- Deductible - $250 individual and $500 family
- Out-of-pocket maximum - $1,500 individual and $3,000 family
- Co-Insurance
- Network - 80%/20%
- Non-network co-insurance - 60%/40%
- Prescription Co-Payments:
- Retail Pharmacies (30-day supply) - $15 generic; $35 brand formulary; $50
non-formulary
- Mail Order (90-day supply) - $30 generic; $70 brand formulary; $100
non-formulary
Beginning January 1, 2011, Welborn will waive the annual deductible for the
purchase of Diabetic Testing Supplies.
View the full
announcement.
Welborn HMO 2012 Summary of Benefits
Welborn HMO 2011 Summary of Benefits
Welborn HMO 2011 Plan Certificate
(top of page)
Welborn Rates for Plan Year 2012
Welborn HMO Plan - The premium is inclusive of medical, prescription drug, and dental insurance coverage.
|
2012 Rates |
Employee's Bi-weekly Premium |
Employee's Monthly Premium |
|
Single Plan |
$80.42 |
$160.84 |
|
Employee + Child(ren) |
$157.61 |
$315.22 |
|
Employee + Spouse |
$172.70 |
$345.40 |
|
Family Plan |
$243.26 |
$486.52 |
For Retiree and COBRA Rates, contact Brandy Smith
(top of page)
Welborn Rates for Plan Year 2011
Welborn HMO Plan - The premium is inclusive of medical, prescription drug, and dental insurance coverage.
|
2011 Rates |
Employee's Bi-weekly Premium |
Employee's Monthly Premium |
|
Single Plan |
$62.30 |
$124.60 |
|
Employee + Child(ren) |
$122.60 |
$245.20 |
|
Employee + Spouse |
$133.86 |
$267.72 |
|
Family Plan |
$188.75 |
$377.50 |
For Retiree and COBRA Rates, contact Brandy Smith
(top of page)
Forms and Documents
2012 Welborn
Enrollment and Change Form
(top of page)