Medical & Prescription Drug

Find the Right Plan for You

Consider the following to help you select the plans that fit your lifestyle and needs:

- - - Do you have specific prescription medication needs?
    - Are you anticipating surgery or non-preventive dental care?
    - Did you experience a Qualified Life Event this year?
    - Do your current plans provide the coverage you need?

Our medical plan options through UnitedHealthcare (UHC) and Surest have a range of coverage levels and costs so you can select the option that’s best for you. These plans provide in- and out-of-network coverage and prescription drug coverage through OptumRx.

Note: Both are available in all states except Hawaii.

	UnitedHealthcare PPO Core	UnitedHealthcare $3,300 HDHP w/Optional HSA	Surest PPO
HSA Eligible	No	Yes	No
Company Matching Contribution to HSA	N/A	• $300 (teammate only) • $425 (teammate + spouse/domestic partner/child(ren)) • $600 (teammate + family) • See HSA page for details You must contribute to your HSA in order to receive the company match	N/A
In-network Care: Your Costs
Preventive Care	$0; plan pays 100%	$0; plan pays 100%	$0; plan pays 100%
Individual/Family Deductible	$2,000/$4,000	$3,300/$6,600	$0/$0
Individual/Family Out-of-Pocket Maximum (Includes deductible)	$6,000/$12,000	$6,550/$13,100	$6,000/$12,000
Your Coinsurance	20% after deductible	30% after deductible	N/A
Office Visit (Primary Care/ Specialist)	$30 copay/$60 copay	30% after deductible	$40-$140 copay¹
Telemedicine Visit	$30	30% after deductible	$0-$160 copay
Emergency Room Visit	20% after deductible	30% after deductible	$850 copay²
Prescriptions: Your Costs
Retail: 30-day Supply Generic Formulary Non-formulary Specialty	Deductible does not apply: Tier 1—$15 Tier 2—$60 Tier 3—$75 Tier 4—50% Coinsurance up to $125 max*	30% after deductible*	Tier 1—$10 copay Tier 2—$90 copay Tier 3—$160 Tier1—$440/Tier 2—$480/ Tier 3—$530
Mail order: 90-day Supply Generic Formulary Non-formulary Specialty	Deductible does not apply: Tier 1—$38 Tier 2—$125 Tier 3—$188 Tier 4—N/A	Tier 1—30% after deductible Tier 2—30% after deductible Tier 3—30% after deductible Tier 4—N/A	Tier 1—$25 copay Tier 2—$225 copay Tier 3—$400 copay Not covered
Preventive maintenance drugs are covered at 100% on all three plans.

¹Costs vary depending on type of treatment.

² Copay waived if admitted within 24 hours.

* Specialty must be filled through Optum Specialty Pharmacy (Mail Order only).

For more info, visit the UnitedHealthcare and Surest websites:

UnitedHealthcare
Surest

Regional Medical Plan Options

Depending on where you live, you may also be eligible to select Kaiser Medical for your medical care coverage.

1. Kaiser Medical:

Kaiser offers a High-Deductible Health Plan (HDHP) option for teammates in California, Colorado, Georgia, Washington, and in the Northwest (Oregon and Southern Washington) and Mid-Atlantic (District of Columbia, Maryland, and Virginia). If you choose this plan, you can also enroll in a Health Savings Account (HSA).

Hawaii teammates may enroll in the Point of Service (POS) 405 Plan. If you choose this plan, you can enroll in a Health Care Flexible Spending Account (FSA).

Click here for more information.

*Per Senate Bill 1529: Primary care visit — $5 copay (after plan deductible) for first three visits per year. First three visits are any combination of primary care non-specialty medical services, mental health outpatient services, naturopathic medicine visits, substance use disorder outpatient services, or telemedicine services.

This Benefits Website provides general information for our benefit eligible employees; however, more detailed information is available within the plan documents and legal contracts between our company and the insurance providers. In case of any discrepancy between this Benefits Website and the plan documents, the plan documents always govern and determine your exact benefits. In addition, the company reserves the right to modify or terminate any benefit plan at any time. Benefits are not a guarantee of employment.