You have options
Spend a few minutes reviewing your medical plan choices. You have three medical plan options—and two networks (Aetna or Highmark BCBS)—to choose from. Each plan has a different deductible, out-of-pocket maximum and premium deduction.
PPO1 also comes with a Health Reimbursement Account (HRA). The Company contributes money to your HRA each year, and that money is used to help you meet your deductible.
For Aetna medical options,visit: aetna.com (or call Aetna at 877-535-2128) and search for providers in the Choice POS II Open Access network.
For Highmark medical options, visit highmarkbcbs.com (or call Highmark at 1-800-572-1460) and search for providers in the PPO Blue (Western PA) or BCBS PPO (all others) networks.
Key things to know about your medical plan options
They're a lot alike because all three plans...
- Are PPO (Preferred Provider Organization) plans. That means their network of doctors, hospitals and other providers has agreed to provide care at reduced rates. You always pay less by using network providers.
- Put you in charge of your care. You don't need referrals to see specialists – you decide which provider to use each time you need care.
- Pay 100% of the cost of in-network preventive and wellness care, including annual physical checkups, women's preventive health services, recommended screenings for your age, and immunizations.
- Require you to pay a flat copay for in-network primary care and specialist office visits.
- Require you to meet a deductible before the plan pays for services like hospitalization.
- Have an out-of-pocket maximum to protect you from high-cost claims.
- Include prescription drug benefits.
- Have no lifetime limits on benefits.
- Offer a maternity management program free of charge to you.
But not exactly because there are some differences...
- PPO1 has the lowest deduction from your pay and the highest deductible. Plus the Company gives you free money each year to help you meet your deductible. (See below.)
- PPO3 has the highest deduction from your pay and the lowest deductible.
- PPO2 is right in the middle.
Teladoc is like a virtual house call
Teladoc is great for those times when you can't get to the doctor, like in the middle of the night, on the weekends, or while traveling. It's a video chat service that gives you super convenient access to a doctor right from your computer, phone or tablet. When you log on or call, you'll talk with a board certified, state licensed doctor. You'll pay a $20 per visit charge by credit card. And if you need a prescription, your Teladoc doctor can write one for you.
The doctors treat non-emergency conditions, like bronchitis, allergies, ear infections, the flu and a lot more! Learn more and sign up by visiting teladoc.com/dsg or call 1-800-teladoc (835-2362).
Your prescription drug benefits
No matter which of our medical plans you choose, you'll receive the same pharmacy benefits through Express Scripts. You'll also have the same formulary, which is the list of generic and brand-name drugs covered by your pharmacy benefits. That's important if you switch medical plans in the future.
Here are some key features of your pharmacy benefits:
|Copayment||You pay a fixed copayment for your prescription when you fill it at one of the thousands of pharmacies in the Express Scripts network. Keep in mind, there is no coverage if you use an out-of-network pharmacy. To make sure your local pharmacy is part of the Express Scripts network, visit the Express Scripts website.|
|Generics||You always save more by asking your doctor to prescribe generic drugs. If no generic is available, ask your doctor to prescribe a brand-name drug on the formulary. To see if your medication is on the Express Scripts formulary, visit the Express Scripts website.|
|Express Scripts ID Card||You'll need to use your Express Scripts ID card for prescription drugs.|
|Accredo||Accredo is the Express Scripts Specialty Pharmacy and is your source for specialty prescription drugs. Please be sure to let your doctor know that, in order to receive your specialty medication, you must order through Accredo. If you have any questions, you can call Accredo toll free at 1-800-501-7210 Monday through Friday, 8 a.m. to 8 p.m. Accredo is for specialty medications only.|
|Drug Quantity Management Program||This prescription drug program is designed to make sure the quantity of prescription drugs you receive is considered safe. If you are prescribed a prescription drug that's covered by this program, you will receive only the amount needed to last you a certain number of days. For instance, you would receive only 30 pills in one month for a medication that's prescribed to be taken once a day.|
|Prior Authorization Program||A prior authorization will be needed if you are prescribed a new medicine that is not on your formulary. To find out if your medicine requires a prior authorization, log in to Express-Scripts.com. Select “Price a Medication” from the drop-down menu under “Manage Prescriptions.” After you look up a medicine's name, click “View coverage notes” or call the number on your member ID card. Your doctor can initiate a request for a prior authorization by calling Express Scripts.|
|Step Therapy Program||This program is designed for people who regularly take prescription drugs to treat ongoing medical conditions such as arthritis, asthma or high blood pressure. Step one medications are generic drugs that provide the same health benefits as higher-cost, step two brand drugs. If a step one drug does not work for you, your doctor can request a prior authorization for a step two brand drug to determine if that will be covered by your plan. For more information on step therapy in your benefit plan, visit Express-Scripts.com or call the number on our member ID card.|
Want to save some cash?
If you take maintenance prescription drugs for an ongoing illness or condition, such as high blood pressure or diabetes, the mail order prescription program will save you money. You can order a 90-day supply for the cost of just two copays—that's one-third less than retail cost.
So, about that free money with PPO1...
Each year you enroll in PPO1 (a Consumer Driven Health Plan, or CDHP), the Company adds money in your name to a Health Reimbursement Account, or HRA. You don't contribute to it; there's nothing you need to do--you are automatically enrolled.
How much money? $500 if you cover just yourself; $1,000 if you cover one or more dependents. If you are a new hire, this amount will be prorated based on your hire date. (This is prorated for new hires based on your hire date)
What's it used for? When you have a health care expense that requires a copay (like a doctor visit or prescription), you must pay the copay out of pocket. But if the expense is subject to the deductible (like an X-ray or a hospital stay), it will be automatically paid from your HRA. If you don't use all of the money in your HRA by the end of the year, it stays in your HRA for the next year if you re-enroll in the PPO1.
If you do spend all the money in your HRA, then you will be responsible for any additional expenses subject to the deductible. But don't forget—if you contribute to the Health Care Flexible Savings Account (FSA), you can also use this tax-free money to help you pay for (among other things) expenses subject to the deductible once your HRA funds are depleted.
Need help with your decisions?
What's happening with Health Care Reform?
See how health care reform affects you and your benefits. Learn more.
Summary of Benefits and Coverage (SBC). SBCs are a requirement of the Affordable Care Act. They are standardized documents that compare your medical plan options. See your Playbook for your SBC, or click here to review online.