Compare Your 2019 Medical Plan Options

All three medical plan options offered cover similar services. There's a difference in how much comes out of your pay and how much you pay when you need care. And with PPO1, the Company makes an annual contribution to your HRA to help you meet your deductible. Both Aetna and Highmark offer all three medical plan options.

Learn how your 2019 medical plan options work

PPO1

PPO2

PPO3

Your biweekly cost
Individual
Teammate/Spouse
Parent/child(ren)
Family


After tax premiums:
Domestic partner* Domestic partner and child(ren)*

 
$17.88
$54.35
$33.59
$68.82



$36.47
$50.94

 
$41.97
$121.50
$76.55
$148.79



$79.53
$106.82

 
$111.12
$306.45
$196.96
$381.22



$195.33
$270.10

*Premiums listed for domestic partners do not include Teammate premiums. You pay your individual pretax teammate premium plus domestic partner premium when covering domestic partners.

Note: DICK'S portion of the premium for domestic partner coverage will be taxed to you as imputed income.

Primary doctor office visit copay

$25

$25

$25

Specialist visit copay

$40

$40

$40

Preventive Care

Covered at 100%

Lifetime Maximum

Unlimited

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Deductible
Individual
Family

$3,500
$7,000

$6,600
$13,200

$1,500
$3,000

$2,550
$5,100

$950
$1,900

$1,450
$2,900

Annual Company contribution to your HRA

$500 individual
$1,000 family

*Prorated for new hires
based on hire date

N/A

N/A

Out-of-Pocket
Maximums

Individual
Family



$4,100
$8,200



$13,200
$26,400



$3,100
$6,800



$5,000
$10,700



$2,500
$5,500



$3,800
$8,500

Coinsurance
(after you meet deductible)

You pay
20%
Plan pays 80%

You pay
40%
Plan pays 60%

You pay
20%
Plan pays 80%

You pay
40%
Plan pays 60%

You pay
20%
Plan pays 80%

You pay
40%
Plan pays 60%

Emergency Services

Emergency Room Services

$200 copay, then 80% after in-network deductible (copay waived if admitted)

Ambulance

80% after deductible

Hospital Services

Inpatient/Outpatient

80% after deductible

60% after deductible

80% after deductible

60% after deductible

80% after deductible

60% after deductible

Maternity Services

80% after deductible

60% after deductible

80% after deductible

60% after deductible

80% after deductible

60% after deductible

Most other medical
services

80% after deductible

60% after deductible

80% after deductible

60% after deductible

80% after deductible

60% after deductible

Mental Health and Substance Abuse

Inpatient

80% after deductible

60% after deductible

80% after deductible

60% after deductible

80% after deductible

60% after deductible

Outpatient

100% after $25 copay

60% after deductible

100% after $25 copay

60% after deductible

100% after $25 copay

60% after deductible

Other

Infertility Counseling, Testing and Treatment

80% after deductible

60% after deductible

80% after deductible

60% after deductible

80% after deductible

60% after deductible

Assisted Fertilization Procedures

Not covered

Not covered

80% after deductible

60% after deductible

6 attempts lifetime limit

Prescription Drug Coverage Through Express Scripts

PPO1

PPO2

PPO3

Prescription drug benefits are provided through Express Scripts at network pharmacies. To find a network pharmacy, go to express-scripts.com/DCSG.

Retail (30 day supply)

Generic

$10 copay

Formulary brand

$30 copay

Non-formulary brand

$65 copay

Mail order (90 day supply)

Generic

$20 copay

Formulary brand

$60 copay

Non-formulary brand

$130 copay

Prescription Drug
Out-of-Pocket Maximum
Individual
Family


$1,000
$2,000

Smarter is easier with the right tools

Being a wise medical consumer is a lot simpler when you use the tools that the carriers provide to help you make good health care decisions and save money.

  • For Aetna plans: aetna.com – search for providers in the Choice POS II Open Access network
  • For Highmark plans: highmarkbcbs.com – search for providers in the PPO Blue (Western PA) or BCBS PPO (all others) networks
  • Review plan information
  • Estimate how much a specific medical treatment will cost with different facilities and providers
  • See how much is remaining in your health reimbursement account (HRA)
  • Review your Explanations of Benefits (EOBs)

Another way to look at it....

You've seen the three PPO plans side by side. You have the premium rates. Hopefully you used "Alex" to help with your decision. But what else is out there?

Here's one more way to look at your medical plan choices. Imagine the worst case scenario under all three plans. What would your out-of-pocket costs look like? How do they compare?

PPO1 PPO2 PPO3

Individual

$4,064.88

$4,191.22

$5,389.12

Teammate/Spouse

$8,613.10

$9,959.00

$13,467.70

Parent/Child(ren)

$8,073.34

$8,790.30

$10,620.96

Family

$8,989.32

$10,668.54

$15,411.72

How did we calculate that? All you have to do is take the annual premium that will come out of your pay and add the out-of-pocket maximum for the plan and tier you're considering. And don't forget—for PPO1 subtract the dollars in the HRA account.

Note: Copays for prescriptions are not included in the above calculations. Copays for prescription drugs are included in a separate out-of-pocket maximum.

Still have questions? Contact Benefits at 1-800-690-7655, ext. 3012, option 5.