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Odessa R-VII School District 2017
The Medical Plan chart above is for illustrative purposes only and does not include all benefits, plan limitations,
and/or exclusions. This represents in-network benefits only. Please refer to the Humana summary for greater
detail. In the event there is a discrepancy in benefits, the carrier benefit summary/SPD will always govern.
Medical Plan Cost
Below are the employee costs for each plan per month. These rates assume your participation in the District’s
wellness program requirements. Employees that did not complete the wellness program requirements will
contribute an additional $20 in monthly premium for all plan options.
QHDHP
BASE PPO
BUY-UP PPO
Employee Cost
District HSA
Contribution
Employee Cost
Employee Cost
Employee Only
$0
$91.50
$0
$55.03
Employee + Spouse
$497.20
$91.50
$588.71
$698.78
Employee + Child(ren)
$522.06
$91.50
$618.15
$730.97
Family
$904.91
$91.50
$1,071.46
$1,226.65