Medical Plan
What you need to know
Because of the importance of preventive care, in-network preventive care is covered at 100% with no deductible. You must meet an annual deductible before the plan begins to help cover the cost of all other care. The plan allows for out-of-network care, but you save money when you use in-network doctors and facilities. To help protect you in the case of a serious medical situation, the plan has an annual out-of-pocket maximum.
How the Medical Plan Works
You pay nothing for preventive care.
In-network preventive care is covered at 100%. You do not have to meet the deductible first.
Having annual physicals and getting the suggested screenings and vaccinations helps you maintain good health and identify potential health issues as soon as possible.
For all other services, you must meet your annual deductible before the plan helps cover the cost of your care.
This includes doctor visits, hospital stays, and prescription drugs.
If you enroll in an eligible health plan, you can use your health savings account to help pay your out-of-pocket costs, including your deductible.
Once you meet your deductible, you and the plan share the cost of services through coinsurance.
You pay less when you visit in-network providers, because they provide services at lower negotiated rates, and the percentage of the coverage is greater.
After you reach the out-of-pocket maximum, the plan pays 100% of the cost of services for the rest of the year.
The annual deductible and the amount you pay out-of-pocket for coinsurance all count toward your out-of-pocket maximum.
For additional information, please review the Summary Plan Description (SPD) which can be found in Workday or the company intranet.
Networks
Each year during the Annual Open Enrollment, you have the opportunity to choose the provider network you prefer for the following year.
It’s important to check regularly whether your doctor is in network, because it can change throughout the year.
Aetna and BCBS participants who are looking for a new doctor are strongly encouraged to compare the cost and quality of providers across the country. It’s easy to do on Garner. Note: You will need to register if you haven’t already.
HealthJoy provides advocacy when you need it
When you need help navigating the complexities of modern healthcare, turn to HealthJoy. They can help you understand the medical plans, look for savings with prescriptions, benefits, procedures, and more. Plus, with their bill review feature, you can make sure you’re not overpaying due to billing errors.