PFT Special Enrollment
PFT NEW CONTRACT CHANGES
As you are aware, the Philadelphia Federation of Teachers (PFT) recently ratified a new Union contract on 6/19/2017. As a result, please note the following changes to the benefit plans effective 10/1/2017. Please check out our Frequently Asked Questions (FAQs)
Special Enrollment Period
The Special Enrollment Period is August 1 to August 31 for all PFT represented employees. This will be your opportunity to change medical plans, add or remove a dependent(s), complete a spousal letter of attestation or change Wage Continuation elections. Changes will be effective October 1, 2017.
Member Payroll Contributions:
The sections below outlines the bi-weekly premium contributions. Regardless of your benefit election, if you are enrolled in the SDP Medical coverage, you are charged a salary contribution of 1.25% of your salary. Deductions occurs on every paycheck throughout the year. Deductions are made on a pre-tax basis. Philadelphia Federation of Teachers (PFT) who have four years of full time service are eligible to switch from Keystone Health Plan East to Personal Choice. A 5% Premium Co-share applies in addition to the 1.25% of salary.
You may see two deductions on your pay check.
- You will see a deduction that is 1.25% of your salary.
- You may have an additional deduction if you elected Personal Choice. Currently enrolled employees will pay their current premium percentage in addition to the 1.25% salary contribution.
- If you are subject to the $50 per month spousal surcharge*, your premium (if applicable) will reflect an additional amount.
Please refer to the following chart for the per pay premium contributions:
|Salary Contribution||Per Pay Premium||Per Pay Premium||Per Pay Premium||Per Pay Premium||Per Pay Premium|
|Total with Spousal Surcharge||$23.07||$23.07|
|Personal Choice 5 % Premium Contribution – all new enrollments||1.25%||$15.37||$21.52||$27.67||$30.74||$46.12|
|Total with Spousal Surcharge||$53.81||$69.19|
|Personal Choice 3 % Premium Contribution – closed to new enrollments||1.25%||$9.22||$12.91||$16.60||$18.45||$27.67|
|Total with Spousal Surcharge||$41.52||$50.74|
|Personal Choice no premium Contribution – closed to new enrollments||1.25%||$0.00||$0.00||$0.00||$0.00||$0.00|
|Total with Spousal Surcharge||$23.07||$23.07|
*To provide a consistent deduction on your check, this surcharge will be spread over all 26 pays.
Effective 10/01/2017, employees covering a spouse or domestic partner will be subject to a $50 monthly surcharge if their spouse/domestic partner is eligible for employer group coverage and continues to be enrolled in District medical coverage.
If they are not eligible for employer coverage or your spouse is a District employee, you must sign and submit an attestation to waive the surcharge by August 31, 2017. This attestation is on the reverse side of the special enrollment application available on the Benefits website.
Plan Design Changes
The $20/$30/70% Personal Choice plan has been amended to reflect changes in specific co-pays and out of network coinsurance. The new plan is the $25/$35/50% Personal Choice plan.
The In-Network copay changes are as follows:
Primary care co-pays that were formerly $20 will now be increased by $5 to $25 . Additionally, Specialist co-pays that were formerly $30 will be increased to $35.
The Emergency Room co-pay has been increased from $40 to $100. In keeping with the current plan administration, the emergency room co-pay will be waived if you are admitted to the hospital.
The Out-of-Network (OON) changes are as follows:
The OON deductibles formerly $500 Single /$1,000 Family will be increased to $2,000 Single/$6,000 Family.
The OON coinsurance has been reduced from 70% to 50%.
Please note if you are currently enrolled in the $20/$30/70% plan, you will be automatically enrolled in the $25/$35/50% plan and NO FURTHER ACTION IS REQUIRED ON YOUR PART UNLESS YOUR SPOUSE/LIFE PARTNER IS NOT ELIGIBLE FOR EMPLOYER COVERAGE. YOU MUST COMPLETE A PFT SPECIAL ENROLLMENT APPLICATION TO WAIVE THE SURCHARGE.
The Keystone 15 plan has been amended to reflect changes in specific co-payments. The new plan is the Keystone 20 plan.
All routine Primary Care Office Visits co-pays that were formerly $15 will now be increased by $5 to $20. Additionally, Referred Specialist co-pays, co-pays for home visits by your Primary Care Doctor, Non-Routine after hours visits and Urgent Care visits that were formerly $25 will be increased by $5 to $30.
The Emergency Room copay has been increased from $35 to $100. In keeping with the current plan administration, the emergency room copay will be waived if you are admitted to the hospital.
Please note if you are currently enrolled in the Keystone 15 plan, you will be automatically enrolled in the Keystone 20 plan and NO FURTHER ACTION IS REQUIRED ON YOUR PART UNLESS YOUR SPOUSE/LIFE PARTNER IS NOT ELIGIBLE FOR EMPLOYER COVERAGE. YOU MUST COMPLETE A PFT SPECIAL ENROLLMENT APPLICATION TO WAIVE THE SURCHARGE.
If you are eligible and wish to elect the new $25/$35/50% Personal Choice plan as described above, you will be required to submit a PFT Special Open Enrollment form. Applicable Personal Choice premiums will apply in addition to your 1.25% salary cost. The deadline to select the $25/$35/50% plan is August 31, 2017.
Wage Continuation’s benefit period is changing from 52 weeks to 26 weeks of coverage. Existing PFT employees will only be allowed to enroll or cancel coverage during the Special Election period in August 2017 or during the annual Open Enrollment period held May 1 to May 31.
You may purchase Wage Continuation coverage to protect yourself from sustained salary loss due to an approved health related absence that extends beyond your sick time. PFT employees new to SDP or returning after a year of separation from the SDP may enroll at any time during their first year of service. New employees who elect wage continuation are not eligible for and are not charged until the conclusion of 5 months of service.
If you are unable to work because of an approved health related absence, you must exhaust all banked personal illness days, and at the conclusion of a short waiting period(“corridor”), you will be compensated a daily amount consistent with 75 percent of your salary for up to 6 months, pursuant to SDP approval.
Employees may only cancel Wage Continuation coverage during the annual Open Enrollment period.
The cost of the program is dependent upon your amount of accumulated personal illnessleave, number of years of service, and salary.
The premium rates for this plan are as follows:
Wage Continuation Premium Rates*
|Accumulated Sick Leave||Total Annual Waiting Period||After 3 years of Employment||First 3 years of Employment|
|Less than 10 days||7 work days||$4.43||$2.95|
|10 but less than 30 days||6 work days||$3.15||$2.10|
|30 but less than 60 days||5 work days||$0.31||$0.31|
|60 but less than 90 days||4 work days||$0.00|
|90 but less than 120 days||3 work days||$0.00|
|120 but less than 150 days||2 work days||$0.00|
|150 but less than 180 days||1 work day||$0.00|
|180 days and over||0 work days||$0.00|
*Rates are based upon every $100 gross per pay.
If you have any questions, please contact email@example.com or 215-400-4630.
Example: Based on an annual salary of $45,000 the deduction would be approximately $36.35 per paycheck at the $2.10 rate for a new employee who has 10 personal illness days in their bank. If any sick days are used during the 5 month waiting period, the associated deduction will be approximately $51.06 per paycheck at the $2.95 rate.
|÷ 100 X||
Rate listed in the
|=||Total biweekly premium|
|Less than 10 days||$2,200.00||÷ 100 X||$2.95||=||$64.90 per pay|
|10 but less than 30 days||$2,200.00||÷ 100 X||$2.10||=||$46.20 per pay|
|30 or more days||$2,200.00||÷ 100 X||$0.31||=||$ 6.82per pay|