Your medical plan is provided by Blue Cross and Blue Shield, with your prescription drug plan being provided by Express Scripts.
2021 Medical Plan Details
| Blue Plus Medical Plan | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Calendar Year Deductible Employee Only / Employee + Dependent(s) If you cover family members on the plan, the Employee Only deductible does not apply. | $1,500 / $3,000 | $3,000 / $6,000 |
| Coinsurance Plan Pays / Member Pays | 80% / 20% | 70% / 30% |
| Primary Care Office Visit | 20% after CYD | 30% after CYD |
| Specialist Office Visit | 20% after CYD | 30% after CYD |
| Routine / Preventive | 100% CYD does not apply | 30% after CYD |
| Urgent Care Visit | 20% after CYD | 30% after CYD |
| Emergency Room Visit | 20% after CYD | 20% after CYD |
| Inpatient Services | 20% after CYD | 30% after CYD |
| Outpatient Services | 20% after CYD | 30% after CYD |
| Independent Diagnostic Labs | 20% after CYD | 30% after CYD |
| Prescriptions Generic / Preferred Brand / Non-Preferred Brand | CYD then $10 / $35 / $60 | N/A |
| Calendar Year Out-of-Pocket Maximum Individual / Family | $6,000 / $12,000 | $12,000 / $24,000 |
Prescription Plan Details
Your pharmacy benefit is administered through Express Scripts (ESI). You can manage your medications anywhere, any time with the Express Scripts mobile app, or on express-scripts.com.
Choose Generic Medication When Possible
Choosing a generic medication is a great way to help save on costs. Ask your doctor if there is a generic option for any medication you are currently taking, or the next time the doctor is writing you a new prescription.
You can also use your pharmacist as a resource to uncover possible generic substitutes.
Save With Home Delivery
By choosing a 90-day supply of your long-term maintenance medication, you will save both time and money. No-cost home delivery can save you time with fewer trips to the pharmacy. Prior to your medicine shipping, a pharmacist will review all prescriptions to ensure they are accurate. All medication arrives in a private, tamper-resistant package.
Medical Plan Rates
Full-Time Employee
Rates shown are per pay period for 24 pay periods (you will have 2 pay periods without a contribution).
| IP/OP/Halifax/Corporate | Homecare & Aging | |
|---|---|---|
| Employee Only | $35.00 | $20.00 |
| Employee & Spouse | $209.00 | $209.00 |
| Employee & Child(ren) | $170.00 | $170.00 |
| Employee & Family | $300.00 | $300.00 |
Part-Time Employees
Rates shown are per pay period for 24 pay periods (you will have 2 pay periods without a contribution).
| IP/OP/Halifax/Corporate | Homecare & Aging | |
|---|---|---|
| Employee Only | $77.64 | $77.64 |
| Employee & Spouse | $376.05 | $376.05 |
| Employee & Child(ren) | $329.53 | $329.53 |
| Employee & Family | $540.25 | $540.25 |
HSA Funding
Below are the contributions that employees enrolled through October 1st will receive. If you are effective after 1/1/2021 it will be a prorated amount each month after. To check your HSA balance please create an account at My HSA Bank Account, if you have trouble logging in you can call them directly at 800-357-6246. Please note, effective 1/1/2021, you will no longer be able to check your HSA balance through My Health Toolkit.
| Election | January | July |
|---|---|---|
| Employee Only | $375 | $375 |
| Employee & Child(ren) | $500 | $500 |
| *Employee & Spouse *Employee & Family | $375 | $375 |
*When your covered spouse completes the Health Assessment, you will earn the extra $250.
| Month Benefits Become Effective | Initial Employer HSA Contribution | Initial Employer HSA Contribution Employee + Child(ren) |
|---|---|---|
| February 01, 2021 | $312.50 | $416.67 |
| March 01, 2021 | $250.00 | $333.33 |
| April 01, 2021 | $187.50 | $250.00 |
| May 01, 2021 | $125.00 | $166.67 |
| June 01, 2021 | $62.50 | $83.33 |
| July 01, 2021 | $375 | $500.00 |
| August 01, 2021 | $312.50 | $416.67 |
| September 01, 2021 | $250.00 | $333.33 |
| October 01, 2021 | $187.50 | $250.00 |
Downloadable Resources
Stay Connected With Your Medical Benefits On-the-Go
My Health Toolkit
Download your ID card, check the balance of your HSA, and access Rally to take your Health Assessment Survey to earn wellness points and rewards
Express Scripts
Access Rx card, refill mail service prescriptions, and check drug coverage and cost under your plan
PlanSource
View your current FSA balance and take photos of your receipts to file a claim right in the app.
Learn the Basics of How to Use Your Benefits With These Short Videos
FAQs About Your Medical Plan
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