Page 7 - 2019 Heico Core Benefits Guide
P. 7
2019 | The Heico Companies Enrollment Guide
Medical and Prescription Drug Plans
BCBS/Prime Therapeutics
Heico offers health insurance through Blue Cross Blue Shield 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 benefits� 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 Beneits PrimeMail by Walgreens
Health Education/Counseling Routine Colonoscopy Prime Therapeutics partners with
Immunizations Routine Colorectal Cancer Walgreens Mail Service for all mail order
Preventive Care Services Screening (X-Ray or Lab) prescriptions� When you are ready for
Routine Bone Density Test Routine Digital Rectal Exam your next fill, be sure to go online at
Routine Breast Exam Routine Gynecological Exam Walgreens.com/PrimeMail or call the
Routine Lab Procedures
number on your prescription label�
CDHP Plan Design In-Network Out-of-Network Additionally, be sure that your doctor
Deductible
Employee $1,500 $2,500 sends your prescription to Walgreens
Family $3,000 $4,000 Mail Service electronically�
Coinsurance Levels (Plan Pays) 80% 50%
Calendar Year Out-of-Pocket 2019 Employee
Maximum (applies to Medical and Rx) Medical Contributions
Employee $4,000 $6,000
Family $6,850 $12,000 Monthly
Preventive Services Plan pays 100%—no deductible No benefit Employee $117
Physician Office Visit Plan pays 80% after deductible Plan pays 50% Employee + 1 $275
after deductible Family $335
Inpatient Hospital Plan pays 80% after deductible Plan pays 50%
after deductible There is a tobacco surcharge of $75
Outpatient Hospital Plan pays 80% after deductible Plan pays 50% per month for tobacco users, and a
after deductible
Emergency Care Plan pays 80% after deductible Plan pays 80% working spouse surcharge of $75 per
after deductible month for any spouse on the Heico plan
Prescription Drugs who is eligible for coverage through
Retail (30-day supply) Plan pays 80% after deductible their employer�
Mail-Order (90-day supply) Plan pays 80% after deductible
Specialty (30-day supply)* Plan pays 80% after deductible No benefit
*The maximum charge is $250 per script.
To offset your deductible, Heico offers employees the option to enroll in the
Company’s Health Savings Account (HSA). Please see page 8 for more details.
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Medical and Prescription Drug Plans
BCBS/Prime Therapeutics
Heico offers health insurance through Blue Cross Blue Shield 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 benefits� 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 Beneits PrimeMail by Walgreens
Health Education/Counseling Routine Colonoscopy Prime Therapeutics partners with
Immunizations Routine Colorectal Cancer Walgreens Mail Service for all mail order
Preventive Care Services Screening (X-Ray or Lab) prescriptions� When you are ready for
Routine Bone Density Test Routine Digital Rectal Exam your next fill, be sure to go online at
Routine Breast Exam Routine Gynecological Exam Walgreens.com/PrimeMail or call the
Routine Lab Procedures
number on your prescription label�
CDHP Plan Design In-Network Out-of-Network Additionally, be sure that your doctor
Deductible
Employee $1,500 $2,500 sends your prescription to Walgreens
Family $3,000 $4,000 Mail Service electronically�
Coinsurance Levels (Plan Pays) 80% 50%
Calendar Year Out-of-Pocket 2019 Employee
Maximum (applies to Medical and Rx) Medical Contributions
Employee $4,000 $6,000
Family $6,850 $12,000 Monthly
Preventive Services Plan pays 100%—no deductible No benefit Employee $117
Physician Office Visit Plan pays 80% after deductible Plan pays 50% Employee + 1 $275
after deductible Family $335
Inpatient Hospital Plan pays 80% after deductible Plan pays 50%
after deductible There is a tobacco surcharge of $75
Outpatient Hospital Plan pays 80% after deductible Plan pays 50% per month for tobacco users, and a
after deductible
Emergency Care Plan pays 80% after deductible Plan pays 80% working spouse surcharge of $75 per
after deductible month for any spouse on the Heico plan
Prescription Drugs who is eligible for coverage through
Retail (30-day supply) Plan pays 80% after deductible their employer�
Mail-Order (90-day supply) Plan pays 80% after deductible
Specialty (30-day supply)* Plan pays 80% after deductible No benefit
*The maximum charge is $250 per script.
To offset your deductible, Heico offers employees the option to enroll in the
Company’s Health Savings Account (HSA). Please see page 8 for more details.
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