Page 4 - 2020 McLennan County Benefits Enrollment Guide

Medical Plan Benefits Options

Providing medical coverage at a reasonable cost is a challenge for all US employers. McLennan County acknowledges
that having plan options is helpful to meet our diverse employee medical needs.

Plan 1: Base Health Plan

This plan is based on a classic style where you have a set deductible and copays, and then you pay a % of the overall
medical costs once the deductible has been met, if such services are needed, until you have paid the annual Out-of-
Pocket Maximum.

Plan 2: Consumer Driven Health Plan

This plan is designed to meet all your medical costs once the deductible has been met. The plan does have a higher
deductible value. On this plan you will incur the expense of every medical appointment until the deductible is met, with
the exception of preventive care as defined by the Affordable Care Act. Thus, you can expect to pay the entire
contracted cost of the physician’s office appointment if you are in-network, instead of the copay until you’ve met the
deductible for the plan year. Prescriptions are also subject to the deductible with the EXCEPTION of prescriptions that
are considered preventive in nature for a chronic condition. Some of those chronic conditions include diabetes, high
blood pressure, elevated cholesterol, asthma and contraceptives. These drug categories would be subject to the
associated copay and not the deductible.

No Out of Network Benefits except for Emergency Care

The Network Health Care Provider shall mean a Health Care Provider who has contracted with the Network to provide
treatment or services to Covered Persons under the Plan and to accept Negotiated Rates as payment in full for such
treatment and services. Out-of-Network Health Care Providers shall mean a Health Care Provider who has not
contracted with the Network to provide treatment or services to a Covered Person under the Plan. Neither plan offers
out of network benefits except for emergency care. Refer to the FAQ for information on obtaining referrals for out of
network care when appropriate.

Prescription Drug
The prescription drug plan is based upon the Health Plan you select.

Note:
In order to compare the two plan options, we’ve provided a few details regarding the plan summary. For a full
explanation of the benefits plan summary, please contact your HR Team member or refer to
https://mclennan.swhp.org/ or contact customer service at 800-299-8640.

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