Since 1982 the MSMA Group Insurance Trust has offered medical insurance coverage for school districts. The program offers four different plans designed to meet the differing individual health insurance needs of members and their dependents. Participating school districts may offer any or all of the four plans to their employees allowing for personal choice for medical insurance coverage. This program is underwritten by Aetna, a national leader in health care. For retirees over the age of 65 with Medicare A&B, we offer a new Medicare Advantage plan designed for their needs.

Portfolio of Health Products

We offer our school district members a wide variety of products to meet the insurance needs of their employees. Below is an outline of products available to schools:

 

Four Medical Plans

Point of Service: This plan offers both a provider network benefit as well as an out of network benefit. The in-network benefit requires the co-ordination of care through the selection of a primary care physician. Members pay a co-pay of $25 for services through their primary care physician or PCP. The member also has the flexibility of selecting any physician regardless of an Aetna network affiliation but will pay a deductible and co-insurance.

HMO-1 (Flex Plan): Under our most popular HMO plan, members select at PCP from a large network of participating physicians and only pay $20 for office visits and a flat co-pay for services such as outpatient surgeries and hospital inpatient stays. There is no deductible to meet. The most that any one family member would have to spend on co-pays in a calendar year is $1,500.

HMO-2 (Super Value): Similar to the HMO Flex Plan, but the member would have a $25 co-pay for many services and 20% co-insurance amount for services such as outpatient surgeries and hospital in-patient stays. $2,500 is the maximum that any one family member would have to pay out of pocket in any calendar year.

High Deductible PPO with HSA: Designed to have a much lower premium than HMOs. The concept of this plan is to take some of the premium savings and put them into your Health Savings Account (HSA). The HSA allows you to be reimbursed for any qualified expenses. (See Section 213 (D) of the Internal Revenue Code.) This plan covers 100% of routine preventive care. All other services are subject to the deductible, which can be reimbursed with any funds accumulated in your HSA. After meeting the deductible, the plan pays 90% for most services. There are no referrals needed under this plan.

Two Medicare Advantage Plans
For Retirees Age 65 and older with Medicare A&B

Medicare Advantage High Option: This is our most popular out of the two Medicare plans. Members have a $20 office visit co-pay with no deductible; most services have a flat co-pay. Prescriptions are covered under a three-tier system at co-pays of $5, $20 and $40.

Medicare Advantage Low Option: With this plan, office visits are covered at 90% after the $100 deductible has been met. Routine office visits and routine eye exams are covered at 100%. Most other services are covered at 90%  after deducible. A maximum out-of-pocket of $2,500 applies to this plan. Prescription co-pays are $15, $25 and $40 for the first $2,700; then only generic up to $4,350 of true out-of-pocket expenses; then 5 percent thereafter.

MAINE SCHOOL MANAGEMENT ASSOCIATION
49 Community Drive, Augusta ME 04330      Telephone: (207) 622-3473       Fax: (207) 626-2968