Page 5 - Nortek Open Enrollment
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Premium: The amount you contribute
Let’s take a look at the key features of each plan. each month from your paycheck for
insurance coverage.
Health Reimbursement
Arrangement Health Savings Account Deductible: A set dollar amount
In-Network Out-of- In-Network Out-of- you have to pay for your healthcare
Network Network
Calendar Year Deductible expenses before the company starts to
Individual $1,750 $3,500 $3,000 $6,000 share costs with you. Deductibles vary
Family $3,500 $7,000 $6,000 $12,000 by plan and by coverage levels.
Coinsurance 80% 60% 80% 60%
Out-of-Pocket Includes Deductible Includes Deductible Coinsurance: Once you’ve satisied
Maximum the deductible, this is a set percentage
Individual $3,500 $7,000 $6,000 $12,000 of the remaining costs which are your
Family $7,000 $14,000 $12,000 $24,000 responsibility, until you reach your out-
Preventive Care 100% Not Available 100% Not Available of-pocket max.
Ofice Visit Copay
Primary Care $30 copay Ded/60% Ded/80% Ded/60% Copay: A set dollar amount you pay
Physician for services every time you use them.
Specialist $60 copay Ded/60% Ded/80% Ded/60%
Emergency $200 copay; $200 copay; Ded/80% Ded/80% Out-of-pocket max: Generally, the
Room Ded/80% Ded/80% most you can spend on healthcare for
Urgent Care $60 copay Ded/60% Ded/80% Ded/60% the year, not including your monthly
Prescription Drugs premiums.
Pharmacy Out-of-Pocket Maximum HRA: A Health Reimbursement
Individual $3,100 N/A Pharmacy expenses are Arrangement includes an account that
included in your medical out
Family $6,200 N/A of pocket maximum the company establishes for you. HRAs
do not accept employee contributions.
Tier 1 $10 copay $10 copay Ded/80% Ded/60% HSA: A Health Savings Account is a
Tier 2 $30 copay $30 copay Ded/80% Ded/60% personal bank account you own and
Tier 3 $60 copay $60 copay Ded/80% Ded/60% is used to pay for qualiied medical
Tier 4 $90 copay Not Available Ded/80% Not Available expenses. Whatever money you
Mail Order contribute or accumulate is yours for
Tier 1 $20 copay Ded/80% life. Employees can make contributions
Tier 2 $60 copay Ded/80% to the account up to the allowed
Tier 3 $120 copay Not Available Ded/80% Not Available maximum contribution limits. The IRS
Tier 4 Not Available Not Available contribution limits for 2015 are $3,350
for individuals and $6,650 for families.
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits, These funds can be withdrawn at any
limitations, and exclusions. In the event of a conlict between the SPD and this description,
the terms of the SPD will prevail. time to cover qualiied medical
expenses as deined by the

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