Human Resources

Medical plans

Eligibility

All regular (non-temporary) full-time and part-time employees who work at least half time (.5 FTE) are eligible for coverage on the first of the month following date of hire. If hired on the first day of the month, benefits begin immediately. Coverage is available for spouses, domestic partners and dependent children of eligible employees.

Description

The college, at its sole discretion, may offer more than one plan. At this time there are three medical plans: Kaiser HMO, Kaiser Added Choice and Regence/Blue Cross Blue Shield (offered through the Pioneer Educators Health Trust) PPO plan.

Contribution

Each year during the budgeting process, the college determines the amount it will contribute to the cost of employees' health insurance. Reed pays 100% of the cost of the Kaiser plan for employee-only coverage and 50% of the Kaiser cost for eligible dependents. Reed pays this same dollar amount towards the Kaiser Added Choice and Regence plans and employees pay the difference. Employees who select two-party or family coverage with the Kaiser plan will not be expected to contribute more than 9.5% of the full-time equivalent of their base salary/wage on the first date of the benefit plan year. Any changes in salary/wages during the year will not affect Reed's contribution until the following benefit plan year.

Employees pay their portion of the cost of their heath insurance by pre-tax paycheck deductions. Note that coverage for domestic partners is taxable i.e. cannot be paid pre-tax.

Cost

Medical cost per pay period as of April 1, 2018

Plan Coverage Reed contribution per pay period Cost to employee per pay period
Kaiser** Individual $302.82 $0
Two-party $454.24 $151.40
Family $575.36 $272.53
Kaiser Added Choice Individual $302.82 $62.21
Two-party $454.24 $275.82
Family $575.36 $446.72
PEHT (Regence) Individual $302.82 $116.03
Two-party $454.24 $383.58
Family $575.36 $597.59

Medical Plans Comparison

Reed College Medical Plan Comparison

Services Kaiser HMO/
Kaiser Provider Network HMO/
Specialist referral required
Kaiser Added Choice PEHT Plan/Regence Blue Cross Blue Shield PPO/
No specialist referral required
Network In-network only Tier 1 Tier 2 Tier 3 In-network Out-of-network
Annual out of pocket limit $1,500/
member
$3,000/
family
$2,250/
member
$4,500/
family
$3,000/
member
$9,000/
family
$8,000/
member
$24,000/
family
$4,000/
member
$12,000/
family
$8,000/
member
$24,000/
family
Annual deductible $0 $750/
member
$2,250/
family
$1,000/
member
$3,000/
family
$3,000/
member
$9,000/
family
member: $1,500
family: $4,500
member: $3,000
family: $9,000
Preventive care 100% covered/
no co-pay
100% covered 100% covered 40% cost share after deductible 100% covered 40% cost share
Primary & specialty care $20 $15 $25 co-pay $50 co-pay $25 for primary and $50 for specialty 40% cost share
Lab & x-ray $10 $15 20% cost share 40% cost share after deductible 20% cost share 40% cost share
Inpatient surgery 15% cost share subject to deductible subject to deductible subject to deductible 20% cost share 40% cost share
Outpatient surgery $20 per visit 20% cost share after deductible 20% cost share after deductible 20% cost share after deductible 20% cost share 40% cost share
Urgent care $20 $35 $50 40% cost share after deductible $25 co-pay $25 co-pay
Emergency room $150 $250 $250 $250 20% cost share after
a $150 co-pay
Ambulance services $75 20% cost share after deductible 20% cost share after deductible 20% cost share after deductible 20% cost share
Alternative care (chiropractic, acupuncture, massage, naturopath) $20 ($25 for massage) using network providers $20 ($25 for massage) using network providers $20 ($25 for massage) using network providers $20 ($25 for massage) using network providers not covered
Osteopathic spinal manipulations Covered with $20 co-pay if done by a DO (doctor of osteopathy) at Kaiser $20 using network providers $20 using network providers $20 using network providers Covered with $50 co-pay with an annual benefit limit of $1,500
Rx $15 generic/
$30 preferred brand/
$50 non-preferred brand
$15 generic/
$30 preferred brand/
$50 non-preferred brand
At MedImpact Pharmacy: $20 generic/
$40 preferred brand/
$60 non-preferred brand
At MedImpact Pharmacy: $20 generic/
$40 preferred brand/
$60 non-preferred brand
generic: $20
preferred brand: $40
non-preferred brand: $60
Rx mail order generic:
up to 90 day supply for $30
preferred brand:
up to 90 day supply for $60
$30 generic/
$60 preferred brand/
$100 non-preferred brand (up to 90 day supply)
At MedImpact Pharmacy: $60 generic/
$120 preferred brand/
$180 non-preferred brand (up to 90 day supply)
At MedImpact Pharmacy: $60 generic/
$120 preferred brand/
$180 non-preferred brand (up to 90 day supply)
generic
$30 for a 90 day supply
preferred brand
$60 for a 90 day supply
Vision $20 co-pay for eye exams plus $150 hardware allowance per 24 months $15 co-pay for eye exam. Hardware not covered $25 co-pay for eye exam. Hardware not covered 40% cost share after deductible Dependent children 18 years of age and under: 1 exam per year, 1 frame and one lens order per year not covered
Annual limit of what the plan pays No limit No limit No limit No limit No limit No limit

Kaiser self-referred alternative care benefit

As of April 1, 2017 Reed Kaiser plan members have access to chiropractic, massage, acupuncture and naturopathic medicine. To find a provider in their network, visit CHPGroup.com. Read more about this benefit here or call Kaiser at 800-813-2000.

Kaiser Added Choice

Kaiser Added Choice members have access to all the services and facilities that Kaiser members have, plus the option to seek services from providers outside of Kaiser.

Added Choice website
Overview of Added Choice
List of contacts for Added Choice members
Transition of care to Added Choice
Added Choice summary of benefits

Kaiser has set up a dedicated concierge team to answer your questions and to help you make the transition to Added Choice:

Bonnie Pasko and Clydie J. King
Ph: 503-813-1299 or 503-813-3613
kpconcierge-nw@kp.org

Websites

Kaiser
Kaiser Added Choice
Regence

Forms

Affidavit of marriage/domestic partnership
Medical, dental, FSA enrollment/change online form
Regence OptumRx mail order form effective April 1, 2016
Regence transition of care form
Form for submission of claim to Kaiser for care outside of Kaiser

Plan documents

Kaiser Portland Clinic partnership
Kaiser summary of benefits and coverage as of April 1, 2017
Kaiser summary of benefits as of April 1, 2017
Kaiser evidence of coverage
Kaiser Added Choice summary of benefits as of April 1, 2018
PEHT Regence summary of benefits and coverage as of April 1, 2017
PEHT Regence summary of benefits and coverage as of April 1, 2018
PEHT Regence summary plan description
PEHT member guide