Page 5 - 2020 HEICO Enrollment
P. 5
2020
The Heico Companies, LLC Benefits Enrollment
MEDICAL AND PRESCRIPTION DRUG PLANS
BCBS/Prime Therapeutics
Heico offers health insurance through BlueCross BlueShield of Illinois (BCBSIL). As a part of a Preferred
Provider Organization (PPO), you and your eligible dependents have the freedom to choose which provider
you seek services from. You are encouraged to use a provider in the BCBSIL network to receive the most cost-
effective beneits. If you use a provider that is not in-network, your out-of-pocket costs will be greater.
The plan is a Consumer Driven Health Plan (CDHP), combining lower premium costs with a higher annual
deductible. However, in-network preventative care visits are always provided at no cost to you!
Preventative Health Benefits PrimeMail by Walgreens
Health Education/Counseling Routine Colonoscopy Prime Therapeutics partners
Immunizations Routine Colorectal Cancer with Walgreens Mail Service
Preventive Care Services Screening (X-Ray or Lab) for all mail order prescriptions.
Routine Bone Density Test Routine Digital Rectal Exam When you are ready for your
next ill, be sure to go online at
Routine Breast Exam Routine Gynecological Exam Walgreens.com/PrimeMail
Routine Lab Procedures or call the number on your
CDHP Plan Design In-Network Out-of-Network prescription label. Additionally, be
Deductible sure that your doctor sends your
Employee $1,500 $2,500 prescription to Walgreens Mail
Family $3,000 $4,000
Coinsurance Levels (Plan Pays) 80% 50% Service electronically.
NEW Calendar Year Out-of-Pocket Maximum (applies to Medical and Rx)
Employee $5,000 $6,000 2020 Employee
Family $6,850 $12,000 Medical Contributions
Preventive Services Plan pays 100%— No beneit Monthly
no deductible
Plan pays 50%
Plan pays 80%
Physician Oice Visit after deductible after deductible Employee $124
Plan pays 80%
Plan pays 50%
Inpatient Hospital after deductible after deductible Employee + 1 $300
Family
$365
Plan pays 80%
Plan pays 50%
Outpatient Hospital after deductible after deductible
Plan pays 80%
Plan pays 80%
Emergency Care after deductible after deductible Important
Prescription Drugs There is a tobacco surcharge of
Retail (30-day supply) Plan pays 80% after deductible $75 per month for tobacco users,
Mail-Order (90-day supply) Plan pays 80% after deductible and a working spouse surcharge of
$75 per month for any spouse on
Plan pays 80%
Specialty (30-day supply)* after deductible No beneit the Heico plan who is eligible for
* The maximum charge is $250 per script . coverage through their employer .
Want to use tax-free money?
To ofset your deductible, Heico ofers employees the option to enroll in the
Company’s Health Savings Account (HSA) . Please see page 8 for more details .
5
The Heico Companies, LLC Benefits Enrollment
MEDICAL AND PRESCRIPTION DRUG PLANS
BCBS/Prime Therapeutics
Heico offers health insurance through BlueCross BlueShield of Illinois (BCBSIL). As a part of a Preferred
Provider Organization (PPO), you and your eligible dependents have the freedom to choose which provider
you seek services from. You are encouraged to use a provider in the BCBSIL network to receive the most cost-
effective beneits. If you use a provider that is not in-network, your out-of-pocket costs will be greater.
The plan is a Consumer Driven Health Plan (CDHP), combining lower premium costs with a higher annual
deductible. However, in-network preventative care visits are always provided at no cost to you!
Preventative Health Benefits PrimeMail by Walgreens
Health Education/Counseling Routine Colonoscopy Prime Therapeutics partners
Immunizations Routine Colorectal Cancer with Walgreens Mail Service
Preventive Care Services Screening (X-Ray or Lab) for all mail order prescriptions.
Routine Bone Density Test Routine Digital Rectal Exam When you are ready for your
next ill, be sure to go online at
Routine Breast Exam Routine Gynecological Exam Walgreens.com/PrimeMail
Routine Lab Procedures or call the number on your
CDHP Plan Design In-Network Out-of-Network prescription label. Additionally, be
Deductible sure that your doctor sends your
Employee $1,500 $2,500 prescription to Walgreens Mail
Family $3,000 $4,000
Coinsurance Levels (Plan Pays) 80% 50% Service electronically.
NEW Calendar Year Out-of-Pocket Maximum (applies to Medical and Rx)
Employee $5,000 $6,000 2020 Employee
Family $6,850 $12,000 Medical Contributions
Preventive Services Plan pays 100%— No beneit Monthly
no deductible
Plan pays 50%
Plan pays 80%
Physician Oice Visit after deductible after deductible Employee $124
Plan pays 80%
Plan pays 50%
Inpatient Hospital after deductible after deductible Employee + 1 $300
Family
$365
Plan pays 80%
Plan pays 50%
Outpatient Hospital after deductible after deductible
Plan pays 80%
Plan pays 80%
Emergency Care after deductible after deductible Important
Prescription Drugs There is a tobacco surcharge of
Retail (30-day supply) Plan pays 80% after deductible $75 per month for tobacco users,
Mail-Order (90-day supply) Plan pays 80% after deductible and a working spouse surcharge of
$75 per month for any spouse on
Plan pays 80%
Specialty (30-day supply)* after deductible No beneit the Heico plan who is eligible for
* The maximum charge is $250 per script . coverage through their employer .
Want to use tax-free money?
To ofset your deductible, Heico ofers employees the option to enroll in the
Company’s Health Savings Account (HSA) . Please see page 8 for more details .
5
