Page 16 - 2021 Team Member Benefit Guide - English
P. 16
Medical Plan Choices
Standard PPO Plan Consumer HDHP Plan
$ 0 You pay nothing for $ 0 You pay nothing for
eligible in-network
eligible in-network
preventive care
preventive care
You pay your non-
For certain health care preventive medical and
services, you pay only a prescription expenses out-
copay and that’s it! The
copay applies to your out-of- of-pocket until you reach
your annual deductible.
pocket maximum.
2
0%
Certain services, like 20% Once the deductible is
surgery, apply to your met, you pay coinsurance
deductible. Once you meet of 20% for non-preventive
the deductible, you will medical and prescription
pay 30% for in-network expenses.
services.
If your out-of-pocket If your out-of-pocket
costs reach the annual costs reach the annual
maximum, the plan pays maximum, the plan
for the remainder of the 100% care for the remainder 100%
100% for eligible care
pays 100% for eligible
plan year. of the plan year.
TIP: If you contribute to a Health Flexible TIP: If you open a Health Savings Account
Spending Account with WageWorks, you through Fidelity, you can use the money
can use the money in your FSA to help pay in your HSA to help pay your out-of-
your out-of-pocket costs, including your pocket costs, including your deductible,
deductible, coinsurance and prescriptions. coinsurance & prescriptions.
This plan might be for you if... This plan might be for you if...
You/your dependents
You/your dependents expect only expect the usual
to have moderate to numerous preventive care services
non-preventive doctor’s office each year.
visits every year.
You want to allocate the
You have limited cash flow premium savings into an
HSA to pay the full cost of
and you like the security of set discounted non-preventive
office visit copay amounts for services up to the in-network
non-preventive services. deductible and out-of-pocket
maximums, should something
You take several generic unexpected occur.
maintenance medications that You can afford to pay the
are free to you in a 90-day full cost of medications up
supply through Mail Order or to the deductible and 20%
pick up at the CVS store. coinsurance thereafter
(deductible waived if drug is
on Preventive Therapy List).
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