#7802: St. Joseph Montessori School Illustrative Quote Ready

Final Proposals Due 7/4/25 Plan Effective 8/1/2025 Census Used Census St Joseph Motesorri.xlsx (71 members)

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St. Joseph Montessori School
933 Hamlet Street
Columbus, OH 43201
SIC/NAICS
Elementary and Secondary Schools (611110) / Elementary and Secondary Schools (8211)
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Policy Effective Date
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Policy Termination Date
The end date of the benefit plan.
Final Proposals Due
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Requested Stop Loss Plan Designs
Change Stop Loss Options
Prescription Drug Coverage Options
Specific Includes Rx Coverage? - Yes
Aggregate Includes Rx Coverage? - Yes
Plan Name Spec Deductible Spec Contract Aggregating Spec Deductible Agg Contract Agg Corridor Commission
35k: 12-12 $35,000 12/12 $0 12/12 1.20 0.00%
35k: 12-18 $35,000 12/18 $0 12/18 1.20 0.00%
40k: 12-12 $40,000 12/12 $0 12/12 1.20 0.00%
40k: 12-18 $40,000 12/18 $0 12/18 1.20 0.00%
45k: 12-12 $45,000 12/12 $0 12/12 1.20 0.00%
45k: 12-18 $45,000 12/18 $0 12/18 1.20 0.00%
50k: 12-12 $50,000 12/12 $0 12/12 1.20 0.00%
50k: 12-18 $50,000 12/18 $0 12/18 1.20 0.00%
55k: 12-12 $55,000 12/12 $0 12/12 1.20 0.00%
55k: 12-18 $55,000 12/18 $0 12/18 1.20 0.00%
60k: 12-12 $60,000 12/12 $0 12/12 1.20 0.00%
60k: 12-18 $60,000 12/18 $0 12/18 1.20 0.00%
65k: 12-12 $65,000 12/12 $0 12/12 1.20 0.00%
65k: 12-18 $65,000 12/18 $0 12/18 1.20 0.00%
75k: 12-12 $75,000 12/12 $0 12/12 1.20 0.00%
75k: 12-18 $75,000 12/18 $0 12/18 1.20 0.00%
Requested Employee Benefit Plans
Plan Name Deductible Coinsurance OOP Maximum OOP Includes
Deductible?		 Rx Copay
(Generic)		 Rx Copay
(Formulary)		 Rx Copay
(Non-Formulary)		 Rx Covers
Specialty?		 Rx Copay
(Specialty)
Plan 1 In: $250
Out: $500		 In: 80%
Out: 60%		 In: $2,000
Out: $4,000		 In: Yes
Out: Yes		 $0 $25 $50 Yes $200
Plan 2 In: $500
Out: $1,000		 In: 80%
Out: 60%		 In: $3,000
Out: $6,000		 In: Yes
Out: Yes		 $0 $25 $50 Yes $200
Plan 3 In: $1,500
Out: $3,000		 In: 80%
Out: 60%		 In: $3,500
Out: $7,000		 In: Yes
Out: Yes		 $0 $25 $50 Yes $200
Plan 4 In: $2,000
Out: $4,000		 In: 80%
Out: 60%		 In: $5,000
Out: $10,000		 In: Yes
Out: Yes		 $0 $35 $70 Yes $300
Plan 5 In: $3,500
Out: $7,000		 In: 80%
Out: 60%		 In: $5,000
Out: $10,000		 In: Yes
Out: Yes		 $0 $0 $0 Yes $300
Plan 6 In: $5,000
Out: $10,000		 In: 70%
Out: 50%		 In: $6,000
Out: $12,000		 In: Yes
Out: Yes		 $0 $0 $0 Yes $300
Plan 7 In: $0
Out: $2,000		 In: 100%
Out: 75%		 In: $5,000
Out: $5,000		 In: Yes
Out: Yes		 $10 $25 $50 Yes $200
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