Page 6 - On Locaiton 2023 Benefit Guide
P. 6

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 26.
                                                                   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.”

                6
   1   2   3   4   5   6   7   8   9   10   11