Page 6 - Impact XM 2023 Benefit Guide

Your Health

Care Coverage

Your health care coverage includes medical, dental and vision
plans. Detailed information about each plan is in this section.
If you have questions, please contact Human Resources.

YOUR MEDICAL PLAN
You have three medical plan options with Horizon BCBS:

• Direct Access 4
• Direct Access 3
• EPO HSA 13

OUT-OF-POCKET MAXIMUMS
IN/OUT-OF-NETWORK COVERAGE Out-of-pocket maximums apply to all of the plans. This is
The Direct Access 4 and Direct Access 3 medical plans feature the maximum amount you will pay for health care costs
in- and out-of-network coverage; individual and family during a plan year. Once you have reached the out-of-
deductibles; copays; coinsurance; and out-of-pocket pocket maximum, the plan will fully cover eligible medical
maximums. One offers a lower monthly cost, a higher expenses for the rest of the benefits plan year. If you see
deductible, and lower coinsurance amounts, while the other an out-of-network provider, you may be responsible for
costs more each month but offer a lower deductible and out-of-pocket costs that are considered above the
higher levels of coinsurance. If you don’t understand some of “reasonable and customary” fees.
these terms, please refer to the Glossary on page 27.
HEALTH SAVINGS ACCOUNT
You may use in- or out-of-network providers if you are If you are enrolled for family coverage in the plans using a
enrolled in the Direct Access 4 or Direct Access 3 options. You Health Savings Account (HSA), you must meet the full
will always pay less if you see a doctor or receive services family deductible before coinsurance would apply. One
within the provider network because the plan pays more for member of the family could satisfy the family deductible
“in-network services.” before the plan begins to pay coinsurance. The family’s
medical costs may be combined to meet the out-of-pocket
DEDUCTIBLE maximum.
You must meet an annual deductible before the medical plan
begins to cover a portion of your costs; however, your HSA You decide which medical plan will work best for you and
may pay for some of those expenses on your behalf. Once the your family based on the monthly cost of coverage, the
deductible is met, the medical plan begins to pay for a annual deductible, and the out-of-pocket maximum.
percentage of covered expenses (this is called coinsurance).
HOW TO FIND AN IN-NETWORK PROVIDER
Note that with the HSA, prescriptions are subject to the Visit www.horizonblue.com. Click “Find a Doctor” on the
deductible and out-of-pocket maximum. top right of the screen. Enter your Plan, and Search Criteria
and click “Search.”

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