• Health Plans

    Mapleton Public Schools is committed to providing you and your family with high-quality, affordable, benefits options. We care about your health and well-being and want you to have the tools and resources to make the best choices for your medical care. 

     

    Mapleton Public Schools offers two medical plan options through Kaiser Permanente (Kaiser): the HMO plan and the DHMO plan. 

    The table below summarizes the key features of the medical plans. The co-insurance amounts listed reflect the amount you pay. Please refer to the official plan document for additional information about coverage and exclusions.

  • Kaiser plans

  • What's the difference?

    Understanding your benefits and knowing how to use them is just as important as having them. Refer to the plan pages throughout the guide for more information about the sample elections. 

  • Definitions:

    Premiums: Premiums are what you (and Mapleton Public Schools) pay for your health care plans. Premiums are what you see deducted from your paychecks for your benefit plans.

     

    Copay: A copay is a fixed amount charged for a specific covered medical service. You may not need to reach your deductible before paying your copay.

     

    Coinsurance: Coinsurance is the percentage you are required to pay, once you have met your deductible.

     

    Out of Pocket Maximum: Out of pocket maximum is the most you will pay “out-of-pocket” during your policy year. This is made up of your copays + deductible + coinsurance. Once you have paid your out-of-pocket max, any other medically necessary services are covered by the health plan at 100%.

  • Traditional HMO Employee Plan with Kaiser 

    With an HMO plan, services with copays do not need to meet a deductible first. Those who consider an HMO plan typically expect to need medical care or medical treatment. Choosing health insurance with no deductible potentially means paying higher monthly costs. 

    Your benefits include:

    • Copays for most covered services, including office visits
    • No paperwork to fill out, no bills, and no deductibles
    • No referrals are needed for certain specialties, like optometry and obstetrics/gynecology
    • Copay for prescription drugs from a Kaiser Permanente pharmacy
    • Vision coverage includes simple copay for vision exams (coverage for contact lenses and glasses varies by plan)

  • Kaiser Permanente Deductible HMO Plan 

    A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. A plan with lower premiums and a deductible may be a good choice if your overall health is good and you don't expect to use many services. Services may cost more out of pocket with a DHMO plan, but the monthly premium may be lower. 

    Your benefits include:

    • Copays or coinsurance for most covered services after you meet your deductible
    • Prescription coverage for brand-name and generic drugs
    • No referrals are needed for certain specialties, like optometry and obstetrics/gynecology
    • An out-of-pocket maximum that limits how much you'll spend on most services each year