Risk Management Employee Benefits

Employee Benefits

The San Elizario Independent School District’s (SEISD) health plan is self-funded. This means the plan is funded solely by employee premiums and the District’s contribution. AETNA administers the medical, dental and prescription coverage’s. Superior Vision administers the vision coverage. The plan offers coverage to all full time employees, part time bus drivers and their eligible dependents based on specific guidelines outlined in the summary plan document.

SEISD also offers voluntary benefits such as supplemental life insurance and disability insurance. Supplemental life insurance is administered by Dearborne National Life Insurance and disability insurance is administered by AETNA.

Medical

***Starting on September 1, 2024,  employees will no longer be covered for OUT-OF-NETWORK providers***

***Please provide your new ID Card to your medical provider after September 1, 2024 ***

Finding an Aetna Provider
Health Plan Information Effective September 1, 2024

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CORE PLAN TIER 1 ACO

Individual annual deductible: $1,250 Family annual deductible: $2,500
Coinsurance: 20%
Payment Limit: Individual: $6,000 Family: $12,000
Office visit co-pay: Primary $40 Specialist $65
Prescription co-pay: Generic: $10 Preferred: $40 Non-Preferred: $60

TIER 2 PPO
Individual annual deductible: $1,500 Family annual deductible: $3,000 Coinsurance: 40%
Payment Limit: Individual: $7000 Family: $14,000
Office visit co-pay: Primary: $50 Specialist: $75
Prescription co-pay: Generic: $10 Preferred: $40 Non-Preferred $60

MONTHLY RATES
EE: $278
EE/S: $1,198
EE/C: $976
EE/F: $2,452

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CDHP TIER 1 ACO

Individual annual deductible: $3,500
Family annual deductible: $7,000
Coinsurance: $0 after deductible
Payment Limit: Individual: $3,500 Family: $7,000
Office visit co-pay: Negotiated rate then $0 after deductible
Prescription co-pay: Negotiated rate then $0 after deductible
Maintenance medications: Generic $10 Preferred: $35 Non-preferred: $55 for preventive drugs, all other drugs subject to deductible

TIER 2 PPO
Individual annual deductible: $4,000
Family annual deductible: $8,000
Coinsurance: 20%
Payment Limit: Individual: $5,000 Family: $10,000
Office visit co-pay: Negotiated rate than $0 after deductible
Prescription co-pay: Negotiated rate than $0 after deductible
Maintenance medications: Generic $10 Preferred: $35 Non-Preferred $55 for preventive drugs, all other drugs subject to deductible

MONTHLY RATES
EE: $48
EE/S: $787
EE/C: $663
EE/F: $1,498

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Dental

Dental Insurance Information

DENTAL PLANS

Dental Core Plan Monthly Rates:
EE: $23.10
EE/S: $41.52
EE/C: $52.25
EE/F: $60.62

Dental Buy-Up Plan Monthly Rates:
EE: $28.05
EE/S: $55.00
EE/C: $67.11
EE/F: $83.00
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Vision

Vision Insurance Information

GOLD 125

MONTHLY RATES
EE $6.36
EE+1 $10.85
EE/F $15.95

PLATINUM 150

MONTHLY RATES
EE $8.11
EE+1 $13.80
EE/F $20.30