2025-26 Employee Benefits Plan Options With Increased District Contributions

PPO 4 RX-A

Individual Calendar Year OOPM: $1,250

Medical Plan Information

Co-Insurance: 90%
Co-Pay: $20
Deductible: $100

Prescription Plan

Retail (30-day supply): $5 Generic; $22 Brand
Mail Order (90-Day Supply): $10 Generic; $44 Brand

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$14,904	$14,904	$11,100	$3,804	$317.00	$380.40
Employee+Spouse	$1,174	$217	$31,320	$31,320	$17,083	$14,237	$1,186.42	$1,423.70
Employee+Children	$1,174	$217	$28,332	$28,332	$15,758	$12,574	$1,047.83	$1,257.40
Employee+Family	$1,174	$217	$47,712	$47,712	$24,314	$23,398	$1,949.83	$2,339.80

PPO 6 RX-A

Individual Calendar Year OOPM: $2,000

Medical Plan Information

Co-Insurance: 80%
Co-Pay: $20
Deductible: $250

Prescription Plan

Retail (30-day supply): $5 Generic; $22 Brand
Mail Order (90-Day Supply): $10 Generic; $44 Brand

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$13,728	$13,728	$11,100	$2,628	$219.00	$262.80
Employee+Spouse	$1,174	$217	$28,848	$28,848	$17,083	$11,765	$980.42	$1,176.50
Employee+Children	$1,174	$217	$26,100	$26,100	$15,758	$10,342	$861.83	$1,034.20
Employee+Family	$1,174	$217	$43,956	$43,956	$24,314	$19,642	$1,636.83	$1,964.20

PPO 8 RX-A

Individual Calendar Year OOPM: $3,250

Medical Plan Information

Co-Insurance: 80%
Co-Pay: $30
Deductible: $500

Prescription Plan

Retail (30-day supply): $5 Generic; $22 Brand
Mail Order (90-Day Supply): $10 Generic; $44 Brand

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$12,432	$12,432	$11,100	$1,332	$111.00	$133.20
Employee+Spouse	$1,174	$217	$26,124	$26,124	$17,083	$9,041	$753.42	$904.10
Employee+Children	$1,174	$217	$23,628	$23,628	$15,758	$7,870	$655.83	$787.00
Employee+Family	$1,174	$217	$39,792	$39,792	$24,314	$15,478	$1,289.83	$1,547.80

PPO 9 RX-A

Individual Calendar Year OOPM: $5,000

Medical Plan Information

Co-Insurance: 80%
Co-Pay: $35
Deductible: $1,000

Prescription Plan

Retail (30-day supply): $5 Generic; $22 Brand
Mail Order (90-Day Supply): $10 Generic; $44 Brand

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$11,100	$11,100	$11,100	$0.00	$0.00	$0.00
Employee+Spouse	$1,174	$217	$23,304	$23,304	$17,083	$6,221	$518.42	$622.10
Employee+Children	$1,174	$217	$21,084	$21,084	$15,758	$5,326	$443.83	$532.60
Employee+Family	$1,174	$217	$35,508	$35,508	$24,314	$11,194	$932.83	$1,119.40

PPO 10 RX-A

Individual Calendar Year OOPM: $6,350

Medical Plan Information

Co-Insurance: 80%
Dr. Visits: Paid at 80% after deductible is met
Deductible: $2,000

Prescription Plan

Retail (30-day supply): $5 Generic; $22 Brand
Mail Order (90-Day Supply): $10 Generic; $44 Brand

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$9,600	$9,600	$11,100	$0.00	$0.00	$0.00
Employee+Spouse	$1,174	$217	$20,172	$20,172	$17,083	$3,089	$257.42	$308.90
Employee+Children	$1,174	$217	$18,240	$18,240	$15,758	$2,482	$206.83	$248.20
Employee+Family	$1,174	$217	$30,732	$30,732	$24,314	$6,418	$534.83	$641.80

HDHP 1

Individual Calendar Year OOPM: $5,000

Medical Plan Information

Co-Insurance/Co-Pay: 90% after deductible is met (see plan summary document)
Deductible: $1,700

Prescription Plan

Paid at 90% after deductible is met (see summary plan document)

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$9,288	$9,288	$11,100	$0.00	$0.00	$0.00
Employee+Spouse	$1,174	$217	$19,488	$19,488	$17,083	$2,405	$200.42	$240.50
Employee+Children	$1,174	$217	$17,640	$17,640	$15,758	$1,882	$156.83	$188.20
Employee+Family	$1,174	$217	$29,700	$29,700	$24,314	$5,386	$448.83	$538.60

HDHP 2

Individual Calendar Year OOPM: $6,000

Medical Plan Information

Co-Insurance/Co-Pay: 80% after deductible is met (see plan summary document)
Deductible: $2,600

Prescription Plan

Paid at 80% after deductible is met (see summary plan document)

Employee Group	Dental (100% District Paid)	Vision (100% District Paid)	Medical	Total Medical Plan Premium	Total District Contribution	Total Employee Cost Share	Monthly Employee Cost Share for 12-Month Employee	Monthly Employee Cost Share for 10-Month Employee
Employee Only	$1,174	$217	$8,292	$8,292	$11,100	$0.00	$0.00	$0.00
Employee+Spouse	$1,174	$217	$17,412	$17,412	$17,083	$329.00	$27.42	$32.90
Employee+Children	$1,174	$217	$15,756	$15,756	$15,758	$0.00	$0.00	$0.00
Employee+Family	$1,174	$217	$26,544	$26,544	$24,314	$2,230	$185.83	$223.00