Medical

	Individual/Family In-Network	Individual/Family ​Out-of-Network
Deductible	$3,000 / $6,000	N/A
Co-Insurance	100% after Deductible	N/A
Out-of-Pocket Max	$3,000 / $6,000	N/A

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Prescriptions

	In-Network	Out-of-Network
Tier 1	Subject to Medical Deductible (100% after Deductible)	N/A
Tier 2	Subject to Medical Deductible (100% after Deductible)	N/A
Tier 3	Subject to Medical Deductible (100% after Deductible)	N/A
Tier 4	Subject to Medical Deductible (100% after Deductible)	N/A
Tier 5	Subject to Medical Deductible (100% after Deductible)	N/A

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Bi-Weekly Payroll Deductions

Election Tier	Amount Deducted From Each Paycheck	Max HSA Funding per Year
Employee Only​	$14.18  ​($196.49 Employee Only - $182.31 paid by Carillon)	$3,500​
Employee + Spouse​	$201.16 ​($524.24 Emp + Spouse - $323.08 paid by Carillon)	$7,000​
Employee + Child(ren)	​$122.67 ​($353.44 Emp + Child(ren)  - $230.77 paid by Carillon	$7,000​
Employee + Family​	$201.16 ​($524.24 Emp + Spouse - $323.08 paid by Carillon)	$7,000​

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Find a Provider

Click on the FirstCare Logo to search for doctors on the FirstCare Select Plus HMO Network

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Waiting Period

The health insurance benefit begins on the first day of the month after 60 days from your hire date unless you waive that benefit.

Enrollment

Once an employee is eligible for group health insurance, there is a 31-day period in which you can enroll.  After that, you can sign up only during open enrollment meetings which begin in August and are effective in September of each year.  If you have a change in status (such as marriage, birth or adoption), you have 31 days to adjust your insurance plans without waiting for the open enrollment period.  If you choose not to participate in the health plan, you will still need to sign the paperwork indicating that you decline.

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Plan Documents:

Below is a summary of medical benefits offered to full-time employees through Carillon.  The employee may add spouse and/or children at employee's expense.  The plan is an HSA Qualifying Health Insurance Plan.  This plan uses the FirstCare Select Plus HMO Network.  You may click here to download a pdf of the Summary of Benefits and Coverage (SBC). ​

Contacts:

​​​Galbraith Group          806.993.1015
   Zach Galbraith          [email protected]
​   Shonda Smith           [email protected]
Carillon HR                   806.281.6144
   Haley Byrd                 [email protected]

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Disclaimer: Galbraith Group is providing the domain and hosting this Employee Benefits Center (EBC) to the benefit of Carillon, its employees, and its participants.  The content available through this EBC is the property of Carillon and Carillon remains solely responsible for content information, accuracy, and completeness.  This EBC only explains the general purposes of the insurance described, but in no way changes or affects the policy as actually issued. In the event of any discrepancy between any of these documents and the policy, the terms of the policy apply.  Complete coverage information is in the certificate of insurance booklet issued to each insured individual. Please read it carefully and keep it in a safe place with your other important papers.

NOTE: Links to external websites are provided as a convenience for our employees and do not imply our company's sponsorship or approval of these sites, their products, and/or services.