Medical and Rx Overview

The High Deductible HSA Plan works similarly to other WSI medical plan options, but with some important differences. If you enroll in this plan, you are able to contribute pretax dollars to an HSA. An HSA is an individual custodial account that eligible individuals may use to pay out-of-pocket qualified health care expenses, including medical, dental, vision and prescription drug costs.

With the High Deductible HSA plan, eligible expenses, such as a doctor’s visit when you are sick or a prescription drug, will be paid in full by you until you meet your “coverage level” deductible. Unlike the Standard and Premium plans, if you have any dependents covered on your medical plan, you must meet the “family” deductible amount before the plan pays any eligible expenses. You can use your HSA to help you pay for care. Just like the other medical plan options from WSI, the High Deductible with HSA plan will pay for certain preventive services, screenings and drugs at 100% with no deductible when you see an in-network provider.

The out-of-pocket maximum is the most you will have to pay in the plan year for covered health care expenses and protects you from financial risk. The medical plan pays 100% of all remaining covered expenses for the rest of the plan year once you have met your out-of-pocket maximum. The out-of-pocket maximum includes your deductible, coinsurance and covered prescription drug expenses.

Like the Standard and the Premium plans, with the High Deductible HSA plan, if you have any dependents covered on our medical plan, each member can meet the single (or individual) out-of-pocket maximum until the overall family out-of-pocket maximum is met before the plan pays 100% of all remaining covered expenses for the rest of the plan year.

With the Standard Care and Premium Care plans:

• You pay higher premiums in exchange for a lower deductible and out-of-pocket maximum than the High Deductible HSA.
• There’s no company Health Savings Account (HSA) with these plans.
• You pay copays for some services and cost sharing (coinsurance) for other services.

In selected ZIP code areas, your Cigna plan options may include both the Open Access Plus Network plan and a Local Plus Network option. The LPN plans cover the same services and have the same deductibles, coinsurance, out-of-pocket maximums, etc. as the broad network plan options. The LPN has a limited list of participating providers chosen for having met certain measures of medical care quality and efficiency, such as:

• Lower hospital readmission rates
• Fewer complications
• Treatments proven to show positive results

The LPN option will cost less in premium contributions (deductions from your pay). If an LPN is available in your area, you will see this option included when you enroll on the Benefits Portal.

The Open Access Plus Network plan may be a better fit if:

• Your current providers are not in the Local Plus Network and you prefer not to change providers.
• You have dependents who live elsewhere (like at college).
• You travel frequently.

A Local Plus Network plan may be a good choice if:

• You want to make the most of your health care dollars.
• Your current providers are in the network, or you’re fine with changing providers.

Depending on where you live, you may be able to choose Kaiser Permanente for your medical and prescription drug coverage. If available, you’ll see this option when you log in to the Benefits Portal.

You must use providers and facilities in the Kaiser Permanente network. There’s no out-of-network coverage, except for emergencies.

The High Deductible HSA, Standard Care and Premium Care plan all offer a network of hospitals and physicians for in-network services. You can find participating providers and in-network facilities on your carrier’s website. You can access your carrier’s website via the Benefits Portal.

The Kaiser HMO plan uses its own network of doctors and facilities. Find participating providers and in-network facilities at kp.org.

• High Deductible HSA, Standard Care and Premium Care
• Kaiser HMO

By spending just a few dollars less on your regular prescriptions, you can enjoy considerable savings in the long run. Here are some tips for getting the greatest value on your prescriptions if you’re enrolled in a WSI medical plan.

By using a mail order pharmacy service, you can get larger quantities of your prescriptions, often at the same price you’d pay for a smaller quantity at your traditional pharmacy.

Most commonly used prescription drugs are available in less expensive generic forms. If a generic form isn’t available, ask the pharmacist if there’s an equivalent drug that has a generic form.