Benefits Plans

The Trust offers you a variety of medical plan designs ranging from traditional preferred provider (PPO) plans with a lower deductible to high deductible, consumer-driven Health Savings Account (HSA) health plans. If you’re a smaller community with less than 50 employees, we now offer our Small Group Program designed for small municipalities. UnitedHealthcare is the network provider for all of our medical plans.

Participating municipalities can also buy optional dental and vision coverage at competitive rates through the Aim Medical Trust. Cigna is our partner for group dental and vision coverage providing easy and cost-effective care. Members also have the option to buy group life insurance through our partnership with MetLife.

Medical and Prescription Plans

Medical plans for communities with more than 50 employees include PPO, HSA and HRA options.
PLAN HIGHLIGHTS $500 PPO
Plan B 		$750 PPO
Plan C		 $1,000 PPO
Plan D		 $1,500 PPO
Plan E		 $2,700 HDHP
Plan F		 $2,700 HDHP
Plan H		 $3,500 HDHP
Plan I		 $5,000 HRA
Plan J
Network Provider: UnitedHealthcare In-Network In-Network In-Network In-Network In-Network In-Network In-Network In-Network
Deductible
Individual
Family		 $500
$1,000		 $750
$1,500		 $1,000
$2,000		 $1,500
$3,000		 $2,700
$5,200		 $2,700
$5,200		 $3,500
$7,000		 $5,000
$10,000
Coinsurance (applied after deductible is met)
Paid by Insurance
Paid by Individual		 80%
20%		 80%
20%		 80%
20%		 80%
20%		 100%
0%		 80%
20%		 80%
20%		 100%
0%
Out-of-Pocket Maximum (includes deductible and medical/prescription copays)
Individual
Family		 $3,000
$6,000		 $3,250
$6,500		 $3,500
$7,000		 $4,000
$8,000		 $2,700
$5,200		 $4,100
$8,200		 $4,500
$9,000		 $6,000
$12,000
Co-Payments (paid by individual)
PCP Office Visit (PP/Non-PP)
SCP Office Visit (PP/Non-PP)
Urgent Care
Emergency Room
Inpatient Hospital		 $15/$25
$15/$25
$75
$175
20%*		 $15/$25
$15/$25
$75
$175
20%*		 $15/$25
$15/$25
$75
$175
20%*		 $15/$30
$15/$30
$75
$175
20%*		 0%*
0%*
0%*
0%*
0%*		 10%/20%
10%20%*
20%*
20%*
20%*		 10%/20%
10%20%
20%*
20%*
20%*		 0%*
0%*
0%*
0%*
0%*
Prescriptions (paid by individual)
Tier 1
Tier 2
Tier 3		 $10
$30
$40		 $10
$30
$50		 $15
$30
$50		 $20
$40
$60		 0%*
0%*
0%*		 20%*
20%*
20%*		 20%*
20%*
20%*		 $10
$30
$60
Lifetime maximum is unlimited for all plan options

Small Group Medical and Prescription Plans

Small group health plans for communities with less than 50 employees include PPO and HSA options.
PLAN HIGHLIGHTS $500 PPO
Plan 1 		$750 PPO
Plan 2		 $750 PPO
Plan 3		 $750 PPO
Plan 4		 $1,500 PPO
Plan 5		 $1,500 PPO
Plan 6		 $1,500 PPO
Plan 7		 $2,700 HDHP
Plan 8		 $3,000 HDHP
Plan 9
UnitedHealthcare Choice Plus In-Network In-Network In-Network In-Network In-Network In-Network In-Network In-Network In-Network
Deductible
Individual
Family		 $500
$1,000		 $750
$1,500		 $750
$1,500		 $750
$1,500		 $1,500
$3,000		 $1,500
$3,000		 $1,500
$3,000		 $2,700
$5,200		 $3,000
$6,000
Coinsurance (applied after deductible is met)
Paid by Insurance
Paid by Individual		 80%
20%		 80%
20%		 80%
20%		 80%
20%		 80%
20%		 80%
20%		 80%
20%		 100%
0%		 80%
20%
Out-of-Pocket Maximum (includes deductible and medical/prescription copays)
Individual
Family		 $3,000
$6,000		 $3,500
$7.000		 $3,500
$7,000		 $3,500
$7,000		 $5,000
$10,000		 $5,000
$10,000		 $5,000
$10,000		 $2,700
$5,200		 $6,000
$12,000
Co-Payments (paid by individual)
PCP Office Visit (PP/Non-PP)
SCP Office Visit (PP/Non-PP)
Urgent Care
Emergency Room
Inpatient Hospital		 $15/$25
$15/$25
$75
$175
20%*		 $15/$30
$30/$60
$75
$175
20%*		 $15/$30
$30/$60
$75
$175
20%*		 $15/$30
$30/$60
$75
$175
20%*		 $15/$30
$30/$60
$75
$175
20%*		 $15/$30
$30/$60
$75
$175
20%*		 $15/$30
$30/$60
$75
$175
20%*		 0%*
0%*
0%*
0%*
0%*		 10%/20%*
10%/20%*
20%*
20%*
20%*
Prescriptions (paid by individual)

Tier 1
Tier 2
Tier 3
$10
$30
$40
$10
$30
$60
$15
$45
$90		 $200 Ded
$15
$45
$90
$10
$30
$60
$15
$45
$90		 $200 Ded
$15
$45
$90
0%*
0%*
0%*
20%*
20%*
20%*
Lifetime maximum is unlimited for all plan options

Dental and Vision Plans

Choose from two optional dental plans from Delta Dental and three optional vision plans through VSP. Dental and vision coverage can be contributory, non-contributory or voluntary. Coverage is available to municipalities participating in the medical plan.
Delta Dental
Option 1 Option 2
Deductible (Single/Family)
Coinsurance (Preventive/Basic/Major/Ortho Services)
Annual Dental Maximum (per insured)
Lifetime Child Ortho Maximum (to age 19)
Out-of-network
Endodontics & Periodontics		 $50/$150
100/80/50/50
$1,500
$1,500
Fee Schedule
Basic		 $50/$150
100/80/50/50
$1,000
$1,000
Fee Schedule
Basic
Monthly Premium Rates (Guaranteed through December 31 2019)
Employee Only
Employee/Spouse
Employee/Child(ren)
Family 		$26.92
$53.86
$72.75
$109.33 		$24.97
$49.93
$66.16
$99.86

VSP Vision Care
Option 1 Option 2 Option 3
Exam Copay
Materials Copay
Frequency (Exam/Lenses Frames)		 $10
$20
12/12/24		 $15
$25
12/24/24		 $10
$20
12/12/24*
Monthly Premium Rates (Guaranteed through December 31 2019)
Employee Only
Employee/Spouse
Employee/Child(ren)
Family 		$5.94
$11.90
$12.71
$20.33 		$4.43
$8.88
$9.49
$15.16		 $6.84
$13.67
$14.63
$23.37

*Includes KidsCare Plan – 2 exams and 1 pair of glasses every year

Basic Life and AD&D Plans

Choose from four basic Life/AD&D plans with MetLife.
PLAN HIGHLIGHTS Plan 1 Plan 2 Plan 3 Plan 4
Class Description All FTA Employees All FTA Employees All FTA Employees All FTA Employees
Life Benefit $25,000 $50,000 1 x Basic Annual Earnings to $50,000 Max 2 x Basic Annual Earnings to $100,000 Max
AD&D Benefit $25,000 $50,000 1 x Basic Annual Earnings to $50,000 Max 2 x Basic Annual Earnings to $100,000 Max
Age Reduction Schedule 35% @ 65
50% @ 70
65% @ 75
Terminate @ retirement		 35% @ 65
50% @ 70
65% @ 75
Terminate @ retirement		 35% @ 65
50% @ 70
65% @ 75
Terminate @ retirement		 35% @ 65
50% @ 70
65% @ 75
Terminate @ retirement
Guaranteed Issue $25,000 $50,000 $50,000 $100,000
Dependent Life: Spouse / Child(ren)
Option 1		 $2,500 / $2,500
(14 days to 6 mos $250)		 $2,500 / $2,500
(14 days to 6 mos $250)		 $2,500 / $2,500
(14 days to 6 mos $250)		 $2,500 / $2,500
(14 days to 6 mos $250)
Dependent Life: Spouse / Child(ren)
Option 2		 $10,000 / $10,000
(14 days to 6 mos $1,000)		 $10,000 / $10,000
(14 days to 6 mos $1,000)		 $10,000 / $10,000
(14 days to 6 mos $1,000)		 $10,000 / $10,000
(14 days to 6 mos $1,000)
Employee Contributions Non-contributory Non-contributory Non-contributory Non-contributory
Minimum Participation 100% 100% 100% 100%
Premium Rates
Life Rate per $1,000 of Benefit $0.166 $0.166 $0.166 $0.166
AD&D Rate per $1,000 of Benefit $0.020 $0.020 $0.020 $0.020
Monthly Premium Per Person $4.65 per month
$9.30 per month"
Dependent Life Rate per Family Unit
Option 1		 $1.50 $1.50 $1.50 $1.50
Dependent Life Rate per Family Unit
Option 2		 $6.00 $6.00 $6.00 $6.00
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