Insurance Benefits
Medical and Life Insurance benefits for FUSD employees are provided through the Northern
Arizona Public Employees Benefit Trust with Blue Cross Blue Shield of Arizona. Dental
insurance is provided by the District through Delta Dental.
What is the Northern Arizona Public Employees Benefit Trust
(NAPEBT)?
NAPEBT is a group of five Northern Arizona public employers who
came together in 2002 to provide more comprehensive and cost-effective benefits for
employees and their families. Employers offering benefits through NAPEBT are:
Coconino County
The City of Flagstaff
Flagstaff Housing Authority
Flagstaff Unified School District
Coconino County Community College
Who can be covered under NAPEBT?
You are eligible for District paid coverage under
NAPEBT if you are an active certified employee working a minimum of .75 FTE , or an active
classifed employee working 30 hours or more a week . In addition, you may at your own
expense cover your husband or wife and your unmarried biological, adopted or step
children, who are under age 19 (23 if they are full time students) and dependent upon you
for financial support. Coverage generally starts the first day of the month following your
hire date. Coverage for your dependents starts on the same day your coverage starts.
NAPEBT medical coverage: "For your benefit."
NAPEBT offers you and your family comprehensive health care
coverage insured by Blue Cross Blue Shield of Arizona. To enhance your health care benefits, NAPEBT and Blue Cross Blue Shield
of Arizona worked together to create a Preferred Provider Organization (PPO). A PPO
is a group of doctors, hospitals, and other health care professionals who provide their
services at a reduced cost to those who are covered under NAPEBT. Generally, when you use
our PPO, In-Network; you save in two ways. First, you have lower charges from PPO
providers than from non-PPO providers (Out-of-Network), and the plan reimburses a higher
percentage of charges made by PPO providers.
General Information:
MEDICAL GROUP NO. 19676
For questions regarding benefits or claims, please call:
928-526-0232
OR 1-800-423-6484 EXT 0232
For prescription drug questions please call (602) 864-4273 or 1-800-232-2345,
ext. 4273
NAPEBT Medical Coverage Highlights
(see your plan booklet for all covered expenses or exclusions and limitations)
NORTHERN ARIZONA PUBLIC
EMPLOYESS BENEFIT TRUST
BLUE CROSS BLUE
SHEILD OF ARIZONA
SUMMARY OF BENEFITS |
|
Plan Design Effective 07/01/2002 |
|
|
Preferred Providers (PPO) |
Non-Preferred Providers (non-PPO) |
Deductible |
$250 individual
$500
family |
$350 individual
$700
family |
Coinsurance |
80% |
70% |
Out of Pocket Maximum excluding
deductibles and copayments |
$3,000 individual
$6,000 family |
$5,000 individual
$10,000
family |
Doctor Office Visits covered services
including lab and x-ray performed at the Doctor's office |
$15 copayment per visit, then 100%
deductible waived. |
70% |
Labortory Services Diagnostic services
rendered outside the doctor's office. |
100% |
70% |
| Other
Professional Services Diagnostic, surgical and anesthesia services rendered
outside the doctor's office. |
80% |
70% |
Hospital Services Impatient
precertification required |
80% |
70% |
Outpatient Surgery (Facility)
precertification required |
80% |
70% |
Outpatient Emergency Room Care (Facility) |
$50 additional copayment per visit; then 80%
Please Note:
Emergency room services are also subject to the calendar year deductible. |
Urgent Care at specially contracted network
facilities |
$25 copayment per visit, deductible waived,
then 100% deductible waived. |
70% |
Ambulance |
80%, deductible
waived |
| Well Care |
Preferred:
$15 copayment per visit. Children: Birth to 6 years (physical exam
including lab testing)
Women: annual
routine gynecological exam |
70%, after deductible |
| Routine Sigmoidoscopy or Colonoscopy |
One
per calendar year for annual screening for cancer age 50 or older (under age 50 if risk
factors). 100%, deductible waived |
Not Covered |
| Routine Physical Exams |
$15
copayment per visit, to a maximum of $300 per calendar year. |
Not Covered |
| Routine
Mammography Screening |
100%, deductible waived |
70 %, deductible waived |
Prescription Drugs a prescription drug
mail order service is available for maintenance drugs |
$
7 Generic
$20 Preferred Name Brand
$40 Non-Preferred Name Brand 'A' $80
Non-Preferred Name Brand 'B'
Mail Order Prescription Drugs:
2X applicable copayment level for a 90-day supply
of a maintenance drug.
When your prescription drug
price is less than your copayment: When a pharmacy's prescription drug price is
less than the copyament, the pharmacy may charge you its' usual and customary price.
This may not be the price charged to BCBSAZ, because in most cases the BCBSAZ price
is lower than the pharmacy's usual and customary price, which varies by pharmacy.
|
In addition to the applicable copayment per prescription,
you will be responsible for the difference between the non-participating pharmacy's billed
charged and BCBSAZ's allowed amount. |
| Behavioral/Mental
Health precertification required for Inpatient Services *Biodyne services are only available in Arizona
|
Inpatient: One admission (not to
exceed 30 day) per calendar year. Subject to calendar year deductible.
Coinsurance 80% PPO Provider/ 50% non-PPO
Provider. Outpatient:
You may choose the specially contracted "Behavioral Health Provider (Biodyne*) or
eligible PPO or non-PPO providers.
Biodyne*: unlimited
psychotherapy and counseling: $10 per visit for the first 10
visits per year. $100 calendar year copayment maximum per person; $200
calendar year copayment maximum per family.
Eligilble PPO/non-PPO Provider:
52 psychological sessions per calendar year
10 hours psychological testing per calendar year
Subject calendar year deductible and 50% coinsurance |
| Speech, Occupational and Physical Therapy |
80% |
70% |
| Any
combination of physical/occupational/speech therapy: A maximum of 60
visits* per calendar year *Covered
services are also subject to Home Health visit limitations if provided in the home. |
| Routine
Vision Care (Avesis) |
One
eye exam per calendar year: $15 copayment, available through the
Routine Vision Adminstrator. Discounts on frames, lenses and contacts. Avesis services are only available in Arizona. |
One
exam per calendar year: up to a $25 reimbursement. No eyewear
benefits: |
| Contract
Maximum |
$2,000,000
maximum benefits while contract is in force. Non-Preferred amounts accumulated with
Preferred amounts to apply toward the $2,000,000 maximum. |
|
| PRECERTIFICATION IS REQUIRED FOR SOME SERVICES: (If
precertification is not obtained, your benefits will be subject to an additional $300
deductible or denial of benefits. Your Provider must call for precertification
at (602) 864-4320 or 1-800-232-2345). Please refer to the precertification
requirements in your Benefit Plan Booklet. |
A
place to learn
