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Comparing Your 2020 Medical Plan Options

The chart below shows what you’ll pay for care:

 

SavingsPlus HSA

Traditional Choice Plus

Basic Plus

 

In network

Out of network

In network

Out of network

In network

HSA Employer Contributions
Individual
Family*

$500
$1,000


n/a

$500
$1,000

Annual Deductible
Individual
Family*

$1,800
$4,200

$2,500
$5,800

$900
$2,000

$1,400
$3,000

$4,000
$8,000

Out-of-Pocket Maximum
Individual
Family*

$3,900
$7,050

$7,800
$15,600

$3,000
$6,000

$6,000
$12,000

$4,000
$8,000

Coinsurance

You pay 20% after deductible

You pay 40% after deductible

You pay 20% after deductible

You pay 40% after deductible

You pay nothing after deductible

Preventive Care

No cost to you

You pay 40% after deductible

No cost to you

You pay40% after deductible

No cost to you

Office Visits

You pay 20% after deductible

You pay 40% after deductible

Primary care: $25
Specialist: $45

You pay 40% after deductible

Primary care: $25
Specialist: $50

Emergency Room

You pay 20% after deductible

You pay $200 copay, then 20% after deductible

You pay nothing after deductible

Inpatient Hospital

You pay 20% after deductible

You pay 40% after deductible

You pay 20% after deductible

You pay 40% after deductible

You pay nothing after deductible

Prescription Drugs

 

SavingsPlus HSA

Traditional Choice Plus

Basic Plus

Plan Specifics

Medical deductible applies and out-of-pocket maximum applies**

Separate deductible and out-of-pocket maximum apply

Medical deductible applies and out-of-pocket maximum applies**

Deductible

Associate Only

Family



$1,800

$4,200


$0

$0


$0

$0

Out-of-Pocket Maximum

Associate Only

Family


$3,900

$7,050


$3,750

$7,500


$3,900

$7,050

After the deductible

Retail (30-day supply)


Generic: 25% (minimum: $10; maximum: $50)

Brand Preferred: 25% (minimum: $35; maximum: $90)

Brand Non-Preferred: 45% (minimum $55; maximum: $150)


Generic: $10, no deductible

Brand Preferred: You Pay 100% before deductible

Brand Non-Preferred: You Pay 100% before deductible

Mail Order (90-day supply)

Generic: 25% (minimum: $25; maximum: $100)

Brand Preferred: 25% (minimum: $80; maximum: $200)

Brand Non-Preferred: 45% (minimum: $130; maximum: $250)

Generic: $25, no deductible

Brand Preferred: You Pay 100% before deductible

Brand Non-Preferred: You Pay 100% before deductible

*In this context, Family coverage includes the Associate + 1 and Associate + Family coverage tiers.

**Preventive medications are not subject to the deductible.

For complete plan details, see the Summary Plan Descriptions on the Total Rewards site.

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