Medical

Employees who work 30 or more hours a week can choose from five different medical plan options to fit different budgets, lifestyles, and health care needs—from comprehensive coverage to just the basics. Explore your choices and pick the plan and coverage level that best fits your and your family’s needs.

Option A: Core PPO Plan

A PPO (Preferred Provider Organization) provides care through a group (network) of preferred doctors, hospitals, labs, and other health care providers who have agreed to charge less for their services. So when you need care, you’ll save money by seeing an in-network provider.

How it works

For most routine in-network care (such as doctors’ office visits), you pay only a copayment. For other services (such as lab work outside of annual preventive care), you have to meet a deductible before the plan pays benefits.

Once you meet the deductible, you pay part of the cost of covered services, and the plan pays the rest. The part you’re responsible for is called coinsurance.

The plan helps to protect you from extremely high medical costs through an out-of-pocket maximum. That’s a limit on how much money you have to pay in any plan year. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the rest of the plan year.

Please see the Summary of Benefits and Coverage for more detail about the Option A: PPO Core Plan.

This plan includes prescription drug coverage.

Option B: Buy-Up PPO Plan

Like the Core PPO Plan, the Buy-Up PPO provides care through a group (network) of preferred doctors, hospitals, labs, and other health care providers who have agreed to charge less for their services. So when you need care, you’ll save money by seeing an in-network provider.

How it works

For most in-network routine care (such as doctors’ office visits), you pay only a copayment. For other services (such as lab work outside of annual preventive care), you have to meet a deductible before the plan pays benefits.

Once you meet the deductible, you pay part of the cost of covered services, and the plan pays the rest. The part you’re responsible for is called coinsurance.

The plan helps to protect you from extremely high medical costs through an out-of-pocket maximum. That’s a limit on how much money you have to pay in any plan year. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the rest of the plan year.

Please see the Summary of Benefits and Coverage for more detail about the Option B: Buy-Up Core Plan.

This plan includes prescription drug coverage.

Option C: High Deductible Health Plan

A High Deductible Health Plan (HDHP) provides care through a group (network) of preferred doctors, hospitals, labs, and other providers who have agreed to charge less for their services.

In exchange for lower weekly premiums (than either the Core or Buy-Up PPO options), you pay out of pocket for all care (except preventive care, which is covered at 100%) until you reach the plan’s annual deductible amount.

How it works

Once you meet the deductible, you pay part of the cost of covered services, and the plan pays the rest. The part you’re responsible for is called coinsurance.

The plan helps to protect you from extremely high medical costs through an out-of-pocket maximum. That’s a limit on what you have to pay in any plan year. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the rest of the plan year.

Please see the Summary of Benefits and Coverage for more detail about the Option C: High-Deductible Plan.

This plan includes prescription drug coverage.

Save for health care expenses tax free with a Health Savings Account

If you enroll in the HDHP, you can contribute to an HSA, which lets you save money for health care expenses on a before-tax basis. You can use the money in your HSA to pay for your current health care expenses, build a reserve to protect against future out-of-pocket expenses, or save for health care expenses in retirement.

How the plans compare

Core PPO
Administered by Horizon Blue Cross Blue Shield
In-network
Annual Checkups (Preventive Care) Plan pays 100%
Primary Care Physician Office Visit $30 copayment
Specialist Office Visit $50 copayment
Plan-Year Deductible* $1,000 individual coverage/ $2,000 family coverage
Coinsurance Plan pays 70% after deductible
Plan-Year Out-of-Pocket Maximum* $5,250 individual coverage/ $10,500 family coverage
Hospitalization $100 copayment per day
For More Details Download the Summary of Benefits and Coverage
Buy-Up PPO
Administered by Horizon Blue Cross Blue Shield
In-network
Annual Checkups (Preventive Care) Plan pays 100%
Primary Care Physician Office Visit $20 copayment
Specialist Office Visit $40 copayment
Plan-Year Deductible* $750 individual coverage/ $1,500 family coverage
Coinsurance Plan pays 80% after deductible
Plan-Year Out-of-Pocket Maximum* $3,250 individual coverage/ $6,500 family coverage
Hospitalization $75 copayment per day
For More Details Download the Summary of Benefits and Coverage
High Deductible Health Plan
Administered by Horizon Blue Cross Blue Shield
In-network
Annual Checkups (Preventive Care) Plan pays 100%
Primary Care Physician Office Visit You pay the full cost until you reach the annual deductible, then plan pays 75%
Specialist Office Visit You pay the full cost until you reach the annual deductible, then plan pays 75%
Plan-Year Deductible* $1,500 individual coverage/ $3,000 family coverage
Coinsurance Plan pays 75%** after deductible
Plan-Year Out-of-Pocket Maximum* $6,350 individual coverage/ $12,700 family coverage
Hospitalization Plan pays 75%** after deductible
For More Details Download the Summary of Benefits and Coverage

*Claims you accumulate from July 1 to June 30 each year count toward the deductible and out-of-pocket maximum.


Cost of coverage

For cost information, go to the Benefits home page of the portal if you are an Office employee, or consult the paper enrollment form that was sent to all home care field employees.

Options D and E: Minimum Coverage Plans


The Minimum Coverage Plan is a limited coverage insurance plan that covers regular checkups (preventive care) through a national PPO network—First Health—administered by Nationwide. This plan meets the government requirement to have individual health care coverage. Enrolling in it means you avoid the government penalty ($695 per individual/$347.50 per child).

The Minimum Coverage Plan is actually three benefit plans:

  1. You get 100% coverage for regular checkups when you see a First Health network provider. This may include:
    • Blood pressure, cholesterol, and cancer screenings; gynecological exams and mammograms for women; vaccines for adults and children; and more.
    • See all the covered services.
  2. You get a Discount Health Savings Card that provides discounts on other services:
    • Up to 85% off the cost of prescriptions through the Neighborhood Pharmacy discount program, which includes more than 60,000 pharmacies in the U.S.
    • Discounts on lab services, dental, chiropractic advanced imaging, durable medical equipment, and more.
    • Help with lowering out-of-pocket costs on medical or dental bills over $400 through negotiation with your provider.

    Note: The Discount Health Savings plan is not available in Washington and Vermont.

  3. You and your dependents get free, 24/7 telephone or online care through Teladoc—a national network of U.S. board-certified physicians. Teladoc doctors can diagnose and treat many medical issues right over the phone, and even prescribe medications. You can request to see a doctor as soon as one is available (doctors usually respond within 16 minutes), or make an appointment. There are no limits on how many times you can use the service.

    To use the service, you’ll need to first set up an account with MyMemberPortal.com, then Teladoc:

    • On your first visit to MyMemberPortal.com, register as a new user and create a user ID and password. Then log in to MyMemberPortal to create your Teladoc account.
    • Click My Benefits > Doctors by Phone > Launch Program. Enter your name and member ID exactly as they appear on your Minimum Coverage Plan or Enhanced Minimum Coverage Plan ID card. Then create a user ID and password (different from your MyMemberPortal ID and password).
    • You’ll need to complete the Medical History Disclosure before requesting to speak with a doctor.
    • To speak with a doctor, click Request a Consult or call 855-847-3627.

  4. How it works

    Show your Minimum Coverage Plan ID and Discount Health Savings Card at your doctor’s (or other provider’s) office. They’ll apply any available discounts. Regular checkups (preventive care) from First Health providers are covered at 100%. For other care, you’re responsible for paying any costs after the discount (if applicable) is applied at the time of service.

How The Plans Compare

Minimum Coverage Plan
Administered by Nationwide
First Health Network
Annual Checkups (Preventive Care) Plan pays 100% for 15 preventive services for 22 preventive services for women, 26 preventive services for children
Primary Care Physician Office Visit No coverage for doctor’s office visits other than preventive care
Plan-Year Deductible None
Coinsurance None
Plan-Year Out-of-Pocket Maximum* None
Hospitalization Not Covered
For More Details Download details about covered services
Enhanced Minimum Coverage Plan
Annual Checkups (Preventive Care) Plan pays 100% for 15 preventive services for 22 preventive services for women, 26 preventive services for children
Primary Care Physician Office Visit Plan covers $75 per visit for up to 6 visits per calendar year
Plan-Year Deductible None
Coinsurance None
Plan-Year Out-of-Pocket Maximum* None
Hospitalization Plan pays $100 per day, 500 day lifetime maximum.
For More Details Download details about covered services

Please see the Summary of Benefits and Coverage for more detail about the Minimum Coverage Plans.


Cost of coverage

For cost information, go to the Benefits home page of the portal if you are an Office employee, or call the Benefits office at 877-291-3000.

Weekly Cost
Minimum Coverage Plan
Work Average of 30 or More Hours/Week
Employee $5.19
Employee + Spouse $8.42
Employee + Child(ren) $8.20
Family $12.01
Enhanced Minimum Coverage Plan
Work Average of 30 or More Hours/Week
Employee $15.29
Employee + Spouse $33.67
Employee + Child(ren) $26.38
Family $38.43
Annual Penalty for Not Having Health Coverage
$695 per adult $347.50 per child