Medical Plan Options
Option 1: PPO
Option 2: PPO NN (Narrow Network)*
Option 3: HSA (Health Savings Account)
Preferred Provider Organization (PPO)
Although you have the flexibility to see any doctor or visit any hospital of your choice, you will pay significantly less money out of your pocket if you use a doctor or hospital that is in the network. For most doctor visits and preventative care visits, you simply pay a copayment at the time of service. You have a great deal of flexibility and choice with a PPO and can manage your out-of-pocket costs by remaining in network.
Health Savings Account (HSA)
Although you have the flexibility to see any doctor or visit any hospital of your choice, you will pay significantly less money out of your pocket if you use a doctor or hospital that is in the network. Preventative care services are covered at 100%. For other services, including prescription drugs, no benefits will be paid until you have met your annual deductible. The HSA is a bank account paired with your HDHP that allows you to save money on a tax-free basis to pay your deductible and other out-of-pocket medical expenses in the current year or in the future. Qualified medical expenses that can be paid using this account include doctor visits, prescription drugs, and even dental and vision expenses. You own the money in your HSA account, and it is yours to keep – even when you change plans or retire. The funds can roll over from year to year and you do not pay tax on withdrawals used for qualified medical expenses.
Spousal Surcharge
A surcharge of $50 per pay period will be added to your medical plan contribution if your spouse is currently employed and eligible for health coverage through their employer and you elect to cover your spouse on a Brightpoint
health plan instead.
In order to enroll your spouse / domestic partner in the medical plan, you will need to complete and return the
Spouse Group Coverage Certification.
*The PPO NN uses Blue Choice PPO [BCS] a select, more affordable network than the larger PPO network. In order to determine whether your hospital or provider is in network, please use the provider finder.
PLAN FEATURES | IN-NETWORK (PPO) (What you pay) | OUT-OF-NETWORK (What you pay) |
Deductible | ||
Individual Family | $1,000 $2,000 | $2,000 $6,000 |
Out-of-Pocket (including deductible) | ||
Individual Family | $3,500 $7,000 | $8,150 $20,000 |
Office Visit – Primary Care | $30 | 30% after deductible |
Office Visit – Specialist | $40 | 30% after deductible |
Virtual Visit Mental Health | Virtual visits through MDLive $10 Mental Health Complete No Cost through Teladoc | |
Diagnostic Test | 20% after deductible | 30% after deductible |
Emergency Room | $300 copay (waived if admitted) | $300 copay (waived if admitted) |
Urgent Care | $50 copay | 30% after deductible |
Inpatient Facility Fee | $250 + 20% after deductible | $300 + 30% after deductible |
Prescription Drugs Through CVS / Caremark Retail (Generic/Preferred/Non-Preferred) 30-Day Supply Mail Order (Generic/Preferred/Non-Preferred) 90-Day Supply | Generic Retail: $10 Mail order $25 Preferred Brand Retail: 35% coinsurance: minimum $25, maximum $100 Mail order 35% coinsurance: minimum: $62.50, maximum $250 Non-Preferred Brand Retail: 50% coinsurance: minimum $50, maximum $125 Mail Order: 50% coinsurance: minimum $125, maximum $312.50 Specialty 20% Coinsurance | For out of network drug provider, retail claims will reject at pharmacy. You can submit receipts as a paper claim, which will be reimbursed at the contracted rate less the applicable cost share or deductible. |
PLAN FEATURES | IN-NETWORK (BCS) (What you pay) | OUT-OF-NETWORK (What you pay) |
Deductible | ||
Individual Family | $2,000 $4,000 | $4,000 $12,000 |
Out-of-Pocket (including deductible) | ||
Individual Family | $7,000 $14,000 | $16,300 $40,000 |
Office Visit – Primary Care | $40 | 30% after deductible |
Office Visit – Specialist | $60 | 30% after deductible |
Virtual Visits Mental Health | Virtual visits through MDLive $10 Mental Health Complete No Cost through Teladoc | |
Diagnostic Test | 20% after deductible | 30% after deductible |
Emergency Room | $400 Copay waived if admitted | $400 Copay waived if admitted |
Urgent Care | $50 Copay | 30% after deductible |
Inpatient Facility Fee | $500 + 20% after deductible | 30% after deductible |
Prescription Drugs Through CVS / Caremark Retail (Generic/Preferred/Non-Preferred) 30-Day Supply Mail Order (Generic/Preferred/Non-Preferred) 90-Day Supply | Generic Retail: $10 Mail order $25 Preferred Brand Retail: 35% coinsurance: minimum $25, maximum $100 Mail order 35% coinsurance: minimum: $62.50, maximum $250 Non-Preferred Brand Retail: 50% coinsurance: minimum $50, maximum $125 Mail Order: 50% coinsurance: minimum $125, maximum $312.50 Specialty 20% Coinsurance | For out of network drug provider, retail claims will reject at pharmacy. You can submit receipts as a paper claim, which will be reimbursed at the contracted rate less the applicable cost share or deductible. |
PLAN FEATURES | IN-NETWORK (PPO) (What you pay) | OUT-OF-NETWORK (What you pay) |
Deductible | ||
Individual Family | $3,400 $6,800 | $5,000 $10,000 |
Out-of-Pocket (including deductible) | ||
Individual Family | $5,000 $10,000 | $10,000 $20,000 |
Office Visit – Primary Care | 10% after deductible | 40% after deductible |
Office Visit – Specialist | 10% after deductible | 40% after deductible |
Virtual Visit Mental Health | Virtual Visit through MDLive $49 Mental Health Virtual Visit no cost to enrolled members through Teladoc | |
Diagnostic Test | 10% after deductible | 40% after deductible |
Emergency Room | 10% after deductible | 10% after deductible |
Urgent Care | 10% after deductible | 40% after deductible |
Inpatient Facility Fee | 10% after deductible | 40% after deductible |
Prescription Drugs Through CVS / Caremark Retail (Generic/Preferred/Non-Preferred) 30-Day Supply Mail Order (Generic/Preferred/Non-Preferred) 90-Day Supply | 10% after deductible Some maintenance drugs are now covered at 100% | For out of network drug provider, retail claims will reject at pharmacy. You can submit receipts as a paper claim, which will be reimbursed at the contracted rate less the applicable cost share or deductible. |
|
PPO Plan |
PPO NN |
HSA Plan |
||||
|
Per Pay Period |
Monthly |
Per Pay Period |
Monthly |
Per Pay Period |
Monthly |
|
|
Employee |
$164.26 |
$355.91 |
$64.98 |
$140.79 |
$81.22 |
$175.98 |
|
Employee + Spouse |
$271.27 |
$587.74 |
$122.19 |
$264.74 |
$152.74 |
$330.94 |
|
Employee + Child(ren) |
$261.24 |
$566.02 |
$109.31 |
$236.84 |
$136.65 |
$296.08 |
|
Family |
$342.44 |
$741.96 |
$178.68 |
$387.13 |
$223.34 |
$483.91 |
Save time, keep costs down and stay on top of your prescriptions. Do it all at Caremark.com and CVSCaremark™ mobile app.
Please click the link below to see the new Preventive Drug List.
In order to get a 90-day supply of maintenance drugs, the prescription must be filled at a CVS pharmacy or CVSCaremark™ Mail Service. Members will no longer be able to get a 90-day supply at other pharmacies.
Specialty Overview Member Flyer
In order to provide a comprehensive and cost-effective prescription drug program for you and your family, Brighpoint has contracted with PrudentRx to offer the PrudentRx Copay Program for certain specialty medications.
The PrudentRx Copay Program assists members by helping them enroll in manufacturer copay assistance programs. Members who have the PPO or PPO NN Plan who enroll in PrudentRx, will have a $0 out-of-pocket responsibility for their prescriptions covered under the PrudentRx Copay Program. Members who have the HSA Plan who enroll in PreduentRx, will have a $0 out-of-pocket responsibility after the deductible has been met for their prescriptions covered under the PrudentRX Program.
If you currently take one or more medications included in the PrudentRx Program Drug List, you will receive a welcome letter and phone call from PrudentRx that provides specific information about the program as it pertains to your medication.
True Accumulator– Some specialty medications may qualify for third-party copayment assistance programs that could lower your out of-pocket costs for those products. For any such specialty medication where third-party copayment assistance is used, only the amount the member actually pays will be applied to the deductible and out-of-pocket max (the amount saved when a member uses the card will not be applied)
Brand Name Drugs
Drugs that have trade names and are protected by patents. Brand name drugs are generally the most costly choice.
Claim
The bill that you or your doctor or health care provider submit to the plan for payment.
Coinsurance
The percentage of a covered charge paid by the plan.
Copayment (Copay)
A flat dollar amount you pay for medical or prescription drug services regardless of the actual amount charged by your doctor or health care provider.
Deductible
The annual amount you and your family must pay each year before the plan pays benefits.
Explanation of Benefits (EOB)
A document available to you on myuhc.com after you have a health care service that was paid. The EOB provides information about how your insurance claim was paid on your behalf – useful information to help you track your expenditures and the medical services you received.
Generic Drugs
Generic drugs are less expensive versions of brand name drugs that have the same intended use, dosage, effects, risks, safety, and strength. The strength and purity of generic medications are strictly regulated by the Federal Food and Drug Administration (FDA).
Health Savings Account (HSA)
A tax-free savings account where funds are earmarked exclusively for medical expenses (including deductibles and coinsurance).You own and control the money in your HSA, and funds roll over from year to year – it’s yours to keep even if you leave the company.
High Deductible Health Plan (HDHP)
A medical plan that may be used in conjunction with a Health Savings Account (HSA).
In- And Out-of-Network
An in-network provider is someone who has a contract with health insurance carriers and agrees to charge lower fees for people enrolled in the plan. An out-of-network provider is someone who does not have a contract with health insurance carriers. The plan will cover more of the costs of services when you use in-network providers.
Mail Order Pharmacy
Mail order pharmacies generally provide a 90-day supply of a prescription medication for the same cost as a 60-day supply at a retail pharmacy. Plus, mail order pharmacies offer the convenience of shipping directly to your door.
Out-of-Pocket Maximum
The maximum amount you and your family must pay for eligible expenses each plan year. Once your expenses reach the out-of-pocket maximum, the plan pays benefits at 100% of eligible expenses for the remainder of the year.
Premium
The amount you pay for your share of the cost of the plan (deducted from your paycheck on a pre-tax basis).
