Health Insurance
Contact
Human Resources77 Macalester Street, Room 201 651-696-6280
651-696-6612 (fax)
hr@macalester.edu
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Hours
Health insurance coverage helps you and your family access routine and preventive health care at a reasonable cost and protects against the catastrophic costs of major illness or injury. Employees can choose between the HealthPartners High-Deductible Health Plan (HDHP) with HSA or the HealthPartners PPO Health Plan. Both plans use the Open Access Choice PPO Network and provide comprehensive coverage. The Open Access Choice PPO Network gives you the care and service you need, at your convenience. With more than 650,000 providers, you have access to one of the country’s largest networks.
Macalester employees with a 0.50 FTE or higher are eligible for coverage. Employees may add spouses, registered domestic partners, dependent children up to age 26, as well as other legal dependents. All plan participants must have the same level of coverage, either the HDHP plan or the PPO plan.
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A High Deductible Health Plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. High deductible health plans are a form of catastrophic coverage intended to cover for catastrophic illness. Participation in a qualifying HDHP is a requirement for Health Savings Accounts (HSA) and other tax-advantage programs.
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A Preferred Provider Organization (PPO) is a health insurance plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. The PPO plan has lower deductibles than the HDHP and participants will pay co-pays for most services. Participants in the PPO plan may elect to participate in a healthcare flexible spending account to set aside funds on a pre-tax basis for qualified expenses.
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2025 Plan Coverage Summary
Plan Service/Feature PPO
In‐network servicesHDHP with HSA
In‐network servicesAnnual Deductible $500/person;
$1,000/family$3,500/person;
$7,000/familyPreventive Care Services
Routine Health Exams, Cancer Screening, Eye and Hearing Exams, Immunizations, Prenatal & Postnatal Services, Well Child Care100 % of charges incurred 100% of charges incurred E-Visits
VirtuwellThe first 3 visits free, then
$10 co-pay per visit thereafterDeductible, then 100% Convenience Clinics
MinuteClinic$10 co-pay, then 100% Deductible, then 100% Allergy Injections No out of pocket cost Deductible, then 100% Primary Care Office Visits
MD Visits (includes ancillary services received in provider’s office and palliative care)$30 co-pay, then 100% Deductible, then 100% Behavioral Health/
Substance Abuse
Outpatient$30 co-pay, then 100% Deductible, then 100% Specialty Office Visits
Chiropractic, Physical Therapy, Speech Therapy, Occupational Therapy, Acupuncture, etc.$50 co-pay, then 100% Deductible, then 100% Urgent Care Visits $50 co-pay, then 100% Deductible, then 100% Emergency Room Visits
Coverage for emergency conditions only$100 co-pay, then 100% Deductible, then 100% Ambulance Services 80% of charges incurred Deductible, then 100% Inpatient Hospitalization 80% of charges incurred Deductible, then 100% -
2025 Out of Pocket Maximums
PPO
In‐network servicesHDHP with HSA
In‐network servicesSingle (Medical/Prescriptions) $3,500/person $3,500/person Family (Medical/Prescriptions) $7,000/family $7,000/family -
PPO
In‐network servicesHDHP with HSA
In‐network servicesGeneric Formulary Drugs
31 day supply$15 co-pay, then 100% Deductible, then 100% Brand Formulary Drugs
31 day supply$40 co-pay, then 100% Deductible, then 100% Specialty Drugs,
Brand Non-Formulary
31 day supply20% co-pay up to $300 per script, then 100% Deductible, then 100% Mail Order,
Generic Formulary Drugs
90 day supply$45 co-pay, then 100% Deductible, then 100% Mail Order,
Brand Formulary Drugs
90 day supply$120 co-pay, then 100% Deductible, then 100% Other Covered Services 80% of charges incurred Deductible, then 100% Lifetime Maximum Unlimited Unlimited Out-of-Network Services $2,000/person, $4,000/family
calendar year deductible, services are covered at 60% of charges incurred after deductible is met and until out-of-pocket maximum is reached.$14,000/person, $28,000/family
calendar year deductible, services are covered at 100% of charges incurred after deductible is met and until out-of-pocket maximum is reached. -
Full-Time Premiums (0.75 FTE and above)
Rates below are shown on a monthly basis.
2025
High Deductible PPO Tier Level Employee Cost Mac Cost Employee Cost Mac Cost Employee Only $146.17 $584.68 $220.63 $882.52 Employee + Child(ren) $326.68 $762.24 $497.40 $1,160.60 Employee + Spouse/Domestic Partner $507.18 $1,183.42 $774.17 $1,806.39 Employee + Family $641.68 $1,497.26 $980.68 $2,288.26 Part-Time Premiums (0.50 – 0.74 FTE)
Rates below are shown on a monthly basis.
2025
High Deductible PPO Tier Level Employee Cost Mac Cost Employee Cost Mac Cost Employee Only $292.34 $438.51 $441.26 $661.89 Employee + Child(ren) $544.46 $544.46 $829.00 $829.00 Employee + Spouse/Domestic Partner $845.30 $845.30 $1,290.28 $1,290.28 Employee + Family $1,069.47 $1,069.47 $1,634.47 $1,634.47 -
How do I pay for my insurance coverage?
Eligible employees’ paychecks are reduced on a pre-tax basis by the amount of their health insurance premiums. This pre-tax plan is governed by IRS regulations and, as a result, there are certain limitations on an enrollee’s ability to make changes to coverage levels during the year.
This means that we’ll reduce your paycheck by the amount of your premiums, and then you’ll be taxed on your income on the lesser amount in your check. The IRS regulates this, and because of their restrictions, you can only make changes to your coverage levels at certain times of the year, namely during open enrollment or if you have a Qualified Life Event (see below for definition).
When can I elect/change coverage?
There are two times you can change your benefits: during Open Enrollment or within 30 days of a Qualified Life Event.
Open Enrollment occurs annually in early November and elections will be effective on January 1 of the following calendar year.
A Qualified Life Event (QLE) allows you to make changes to your benefit elections outside of open enrollment, and you have 30 days from the event date to provide related documentation.
Examples of a QLE are:
- marriage
- divorce
- the birth/adoption of a child
- commencement or separation of your spouse’s employment
- a change on the part of you or your spouse from full-time to part-time employment status or vice versa that results in a change in benefit eligibility
- taking an unpaid leave of absence
- change in benefit elections on the part of you or your spouse during open enrollment
HR will meet with you to review the documentation you provide related to the life event change and open a special enrollment in the benefit enrollment system for changes to be made to your benefits.
Macalester’s health insurance program is self-funded. What does this mean?
With self-funding, Macalester assumes the financial risk of providing health insurance to employees instead of purchasing a traditional group health insurance policy. This means that Macalester pays all of the medical claims incurred by employees and their dependents, after employees pay their deductibles, co-pays and co-insurance. Macalester contracts with HealthPartners to manage claims, coordinate provider networks and manage compliance obligation.
What is the difference between in-network and out-of-network providers?
In-Network coverage typically provides the full benefit allowed under the plan (lower cost to you). Out-of-network coverage allows you to see any provider/doctor of your choosing, however at a lower benefit level (higher cost to you).
Where can I find if my prescription is covered under the HDHP or PPO plan?
Both plans use the PreferredRX formulary. This resource can help give you an idea of what is covered under your plan.
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- Visit www.healthpartners.com (Registering as a HealthPartners member gives the best results)
- Call 952-883-5000 or 800-883-2177 (Toll Free)
- virtuwell: How it Works and Conditions Treated (PDF)
- virtuwell: Summary
- How to use virtuwell video
- HealthPartners Informational Brochure (PDF)
- Prescription Cost Management Tool (PDF)
- Prescription Savings Tool (PDF)
Transparency in Coverage (TIC)
TIC is designed to help individuals have a clearer understanding of the cost of healthcare services. Visit the HealthPartners website for more information on TIC.
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HealthPartners offers an online tool that assists you in comparing your plan options and potential costs. We are in the Open Access Network
- Get definitions of key insurance terms
- Check to see if your doctor, clinic, or hospital is in the network
- Look up your current prescriptions in the plan’s drug list
- Search for pharmacies near you
- See if you can save money with the HDHP plan that offers the HSA or the PPO plan that offers the Healthcare FSA. Go here and scroll down to Step 4.
- Get more with additional discounts and perks
- Get an estimate of your out-of-pocket costs by calling HealthPartners 1-800-883-2177
- After enrollment you will receive your member ID that you can use to register to login to get estimated costs for care
To get started, go to the healthpartners website