CDHP Plan
Administered by: UnitedHealthcare
Take charge of your spending through lower premiums, higher deductibles, and a tax-free /Health/Savings-Spending-Accounts#HealthSavingsAccount (with contributions from Acme) that you own for life.
Our benefits program includes medical plan options with a range of coverage levels and costs, so you can choose the one that’s best for you. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event. To see your premiums and enroll, log in to the Acme Enrollment website.
Administered by: UnitedHealthcare
Take charge of your spending through lower premiums, higher deductibles, and a tax-free /Health/Savings-Spending-Accounts#HealthSavingsAccount (with contributions from Acme) that you own for life.
Administered by: UnitedHealthcare
Reduce your out-of-pocket costs when you need care through a lower deductible and higher premiums.
Administered by: UnitedHealthcare
Enjoy greater predictability of costs through copays for doctor’s visits and prescriptions, along with a low deductible and higher premiums.
Administered by: Kaiser Permanente
Receive coverage for in-network care only, coordinated by your primary care provider (PCP).
All our medical plans provide:
for a wide range of health care services. Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in supplemental medical coverage.
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
included with each medical plan. Prescription benefits are provided by OptumRx.
through annual out-of-pocket maximums that limit the amount you’ll pay each year.
[Table Format Option A]
CDHP Plan | PPO Plan | PPO2 Plan | HMO Plan | |
---|---|---|---|---|
HSA features | ||||
HSA-eligible | Yes | No | No | No |
Company contribution to HSA | $500 | None | None | None |
Annual deductible (individual/family) | ||||
In-network | $2,850/$5,700 | $900/$1,800 | $750/$1,500 | $400/$800 |
Out-of-network | $5,700/$11,400 | $1,800/$3,600 | $1,500/$3,000 | N/A |
Coinsurance | ||||
In-network | You pay 30%, plan plays 70% | You pay 20%, plan plays 80% | You pay 10%, plan plays 90% | You pay 10%, plan plays 90% |
Out-of-network* | You pay 40%, plan pays 60% | You pay 40%, plan pays 60% | You pay 40%, plan pays 60% | N/A |
Annual out-of-pocket maximum (individual/family) | ||||
In-network | $5,500/$11,000 | $3,000/$6,000 | $3,000/$6,000 | $2,000/$4,000 |
Out-of-network | $11,000/$22,000 | $6,000/$12,000 | $6,000/$12,000 | N/A |
Medical care: Your costs | ||||
Preventive care | Covered at 100% in-network, so you pay nothing | |||
Office visit (primary care) | ||||
In-network | You pay 30% after deductible | You pay 20% after deductible | $30 copay | $20 copay |
Out-of-network | You pay 40% after deductible | You pay 40% after deductible | You pay 40% after deductible | N/A |
Office visit (specialist) | ||||
In-network | You pay 30% after deductible | You pay 20% after deductible | $40 copay | $20 copay |
Out-of-network | You pay 40% after deductible | You pay 40% after deductible | You pay 40% after deductible | N/A |
Telemedicine visit (in-network only) | ||||
You pay 30% after deductible | You pay 20% after deductible | $20 copay | $20 copay | |
Urgent care visit | ||||
In-network | You pay 30% after deductible | You pay 20% after deductible | $50 copay | $30 copay |
Out-of-network | You pay 40% after deductible | You pay 40% after deductible | You pay 40% after deductible | N/A |
Emergency room visit (in- and out-of-network) | ||||
In- and out-of-network | You pay 30% after deductible | You pay 20% after deductible | $150 copay | $50 copay |
Prescriptions: Your costs | ||||
30-day supply (retail pharmacy) | ||||
Generic | 30% after deductible (deductible waived for some medications) | 20% after deductible (deductible waived for some medications) | 20% (min $10/max $20)** | $10** |
Formulary | 30% after deductible (deductible waived for some medications) | 20% after deductible (deductible waived for some medications) | 20% (min $25/max $50)** | $30** |
Nonformulary | 30% after deductible (deductible waived for some medications) | 20% after deductible (deductible waived for some medications) | 45% (min $40/max $80)** | $60** |
90-day supply (mail order or retail pharmacy) | ||||
Generic | 30% after deductible (deductible waived for some medications) | 20% after deductible (deductible waived for some medications) | 30% (min $25/max $50)** | $25** |
Formulary | 30% after deductible (deductible waived for some medications) | 20% after deductible (deductible waived for some medications) | 30% (min $62.50/max $125)** | $75** |
Nonformulary | 30% after deductible (deductible waived for some medications) | 20% after deductible (deductible waived for some medications) | 45% (min $100/max $200)** | $150** |
*Out-of-network benefits are based on reasonable and customary charges.
** Deductible does not apply.
[Table Format Option B]
PPO Plan | CDHP Plan | HMO Plan | |||
---|---|---|---|---|---|
In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network Only | |
Annual deductible (calendar year) | $250 individual
$500 family |
$500 individual
$1,000 family |
$1,350 individual
$2,750 family |
$2,750 individual
$5,000 family |
None |
Coinsurance | 80% | 60% | 90% | 70% | None |
Annual out-of-pocket maximum (calendar year) | $2,000 individual
$4,000 family |
$4,000 individual
$8,000 family |
$2,600 individual
$5,000family |
$5,000 individual
$10,000 family |
$2,000 individual
$4,000 family |
Acme contribution to HSA | N/A | $500/year for individual coverage
$1,000/year for family coverage |
N/A | ||
Physician services: Your costs | |||||
Preventive care | Covered 100%* | You pay 40% | Covered 100%* | You pay 30% | Covered 100% |
Primary care office visit | $15 copay* | You pay 40% | You pay 40% | You pay 30% | $20 copay |
Specialist office visit | $15 copay* | You pay 40% | You pay 10% | You pay 30% | $20 copay |
Telemedicine visit | $15 copay* | You pay 40% | You pay 10% | You pay 30% | $20 copay |
Lab/X-ray | $15 copay* | You pay 40% | You pay 10% | You pay 30% | No copay |
Imaging (CT/MRIs) | $15 copay* | You pay 40% | You pay 10% | You pay 30% | $100 copay per type of scan |
Physical therapy — up to 20 visits/calendar year | $15 copay* | You pay 40% | You pay 10% | You pay 30% | $20 copay |
Chiropractic — up to 20 visits/calendar year | $15 copay* | You pay 40% | You pay 10% | You pay 30% | $15 copay |
Durable medical equipment | You pay 20% | You pay 40% | You pay 10% | You pay 30% | No copay |
Hospital services: Your costs | |||||
Inpatient | You pay 20% | You pay 40% | You pay 10% | You pay 30% | $100 per day (5-day maximum)** |
Outpatient | You pay 20% | You pay 40% | You pay 10% | You pay 30% | $250 copay |
Emergency room | $150 copay | $150 copay | You pay 10% | You pay 10% | $100 copay (waived if admitted) |
Ambulance | You pay 20% | You pay 20% | You pay 10% | You pay 10% | No copay |
Urgent care | $25 copay* | $25 copay* | You pay 10% | You pay 10% | $25 copay |
Mental health care: Your costs | |||||
Inpatient | You pay 20% | You pay 40% | You pay 10% | You pay 30% | $100 per day (5-day maximum)** |
Outpatient | $15 copay* | You pay 40% | You pay 10% | You pay 30% | $25 copay |
Prescription drugs: Your costs | |||||
Retail pharmacy (30-day supply) | |||||
Generic | $10* | Not covered | $15 | Not covered | $10 |
Formulary | $20* | Not covered | $40 | Not covered | $20 |
Nonformulary | $40* | Not covered | $60 | Not covered | $40 |
Mail order (90-day supply) | |||||
Generic | $20* | Not covered | $30 | Not covered | $20 |
Formulary | $40* | Not covered | $80 | Not covered | $40 |
Nonformulary | $80* | Not covered | $120 | Not covered | $80 |
*Deductible does not apply
**Semi-private room
***Pre-authorization required
The Acme Enrollment website will clearly show the costs and coverage for each plan, making it easy to decide which one fits your needs and budget. And, if you want to receive expert guidance, you can answer a few simple questions to see a personalized "best match" package of benefits based on your needs and preferences.
The CDHP Plan pairs low-premium, high-deductible coverage with a tax-free /Health/Savings-Spending-Accounts#HealthSavingsAccount that helps you save money and plan ahead for future medical expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.
As an added bonus, Acme will contribute to your HSA — $500 for employee-only coverage or $1,000 if you cover dependents. With this plan, you can see any provider you wish, but you will pay less when you stay in network.
You pay the plan premium from your paycheck to have coverage.
Contributing to your HSA is a great way to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free!*
*Contributions are not subject to federal tax. However, HSA contributions are currently subject to state tax in AL, CA, and NJ. Consult with your tax advisor to understand the potential tax consequences of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you will pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.
The PPO Plan offers slightly lower out-of-pocket costs in exchange for higher premiums. With this plan, your costs are more predictable, but you’ll likely still have out-of-pocket expenses. You can see any provider you wish, but you will pay less when you stay in network.
You pay the plan premium from your paycheck to have coverage.
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully: you can only carry over up to $500 of unused money in your FSA to the next year; you will forfeit any remaining amount above $500.
The PPO2 Plan offers lower out-of-pocket costs and the predictability of copays for doctor visits and prescriptions, in exchange for higher premiums. With this plan, you can see any provider you wish, but you will pay less when you stay in network.
You pay the plan premium from your paycheck to have coverage.
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully: you can only carry over up to $500 of unused money in your FSA to the next year; you will forfeit any remaining amount above $500.
The HMO Plan plan provides coverage only when you receive care from providers within the HMO network. Your primary care provider (PCP) will coordinate your care to help manage costs.
You pay the plan premium from your paycheck to have coverage.
With an HMO, you’re required to select a primary care provider (PCP) who will manage your care and provide referrals if you need to see a specialist. Find a doctor
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully: you can only carry over up to $500 of unused money in your FSA to the next year; you will forfeit any remaining amount above $500.
When you enroll in an Acme medical plan, you automatically receive prescription {DRUG} benefits through OptumRx.
The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred, or non-preferred. All prescription carriers have a formulary, or list of preferred drugs based on effectiveness and cost.
See how medications are covered by logging in to your prescription account on the OptumRx website or the Kaiser Permanente website.
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.
Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
If you take maintenance medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — the convenience and cost savings of the home delivery prescription programs through OptumRx and Kaiser Permanente will save you time and money.
All prescriptions for specialty medication, such as those used to treat complex conditions like rheumatoid arthritis, multiple sclerosis, or psoriasis, must be filled through the OptumRx or Kaiser Permanente Specialty Pharmacy. You’ll have access to a dedicated team led by a pharmacist and nurse who are specialists in your condition to help you with your medication regimen. Learn more on the OptumRx or Kaiser Permanente website or call 1-800-123-4567 or 1-800-123-4567.
Your pharmacy benefits include several programs aimed at ensuring your safety and making sure you receive the most clinically appropriate and cost-effective medication.
Formulary – Your pharmacy plan has an extensive listing of generic and brand-name prescription medications that offer the greatest overall value. This list will determine how your prescription will be covered. Keep in mind that the medications on the formulary may change as the result of regular reviews and updates.
Dispense as Written – When available, your prescription will be filled with a generic alternative to a brand-name medication. Generic drugs have the same primary medication ingredient, are equally safe and effective, and are taken at the same dose, but cost significantly less than brand-name medications. If you request a brand-name drug when there is a generic equivalent available, you will pay the brand copay or coinsurance, plus the cost difference between the brand and generic drug. However, if your doctor indicates “Dispense as Written/DAW” on the prescription, you will not pay the cost difference, and will pay only the brand copay or coinsurance.
Prior Authorization – Some medications may require prior authorization. This means that OptumRx needs more information from your doctor to determine if the medication is the best option for you and will be approved for coverage. You can find medications that require prior authorization on OptumRx website.
Step Therapy – Step Therapy encourages you to try the most cost-effective and appropriate medications available to treat your condition. Typically, these medications are generics or lower-cost brand-name medications. You need to try these first, before more expensive medications are approved for coverage. At any time, if your provider feels a first-line medication isn’t right for you due to medical reasons, he or she can request authorization for coverage of a different medication.
Take advantage of these valuable programs and resources to better manage your health and financial well-being.
You have access to medical advice from board-certified physicians 24/7, 365 days a year through your plan’s telemedicine service. Teladoc offers you fast, convenient diagnosis and treatment for many common conditions through video consult on your smartphone or computer. Visit the Teladoc website to enroll or learn more.
Nurses are available to answer your health questions and help you get the most out of your medical plan — confidentially and at no cost to you. Your nurse can guide you to the right care for a health problem; coordinate services before, during, and after a hospital stay; or support you while you work toward a health goal. Call 1-800-123-4567 to reach a nurse.
Get free, personalized assistance to help you navigate the health care system, from understanding claims to choosing providers and negotiating fees. Available to you and your family members, this service can save you time and money. Visit the Health Advocate website or call 1-800-123-4567.
This online health care resource helps you shop for doctors, prescriptions, and medical services. Using Castlight, you can compare costs and quality information before you book an appointment, which helps you find the best care at the best price. You also can use Castlight to review your past medical spending and save on future care by receiving customized tips. Visit the Castlight website or call 1-800-123-4567.
You have access to the best medical minds in the world through Best Doctors. At no cost to you, you can request:
If you’re facing a medical challenge, contact Best Doctors at 1-800-123-4567 or visit the Best Doctors website.
The Livongo diabetes management program is available to medical plan members diagnosed with diabetes. Receive a smart touchscreen glucose meter that automatically uploads readings and provides personalized tips, as well as unlimited test strips and support from coaches.
Visit your medical plan website to find a doctor, compare costs, manage claims, and more.
Visit your prescription plan website to order or refill prescriptions, sign up for home delivery, and more.
Visit your tax-advantaged account website to manage your HSA or FSA accounts online, use calculators, and more.
Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.
Beginning [date], you can also use the Provider Lookup tool on the Acme Enrollment website to easily find in-network doctors.
If you enroll in an Acme medical plan for 2021, you may also choose to enroll in the Mercer Marketplace 365+ HUBSM — an optional benefit that can help you get the care you need at a fair price.
365+ HUB is like a concierge service for health care! It provides one-on-one support, online and by phone, to assist you with your health care needs and help you make informed decisions year-round. You can get help with things like:
Click the features below to learn more about 365+ HUB services.
365+ HUB has a team of registered nurses, medical directors, and benefits and claims specialists who work together to assist you and your covered family members. A personal health advocate who knows your benefits can help you:
If you enroll in 365+ HUB, you’ll have access to an easy-to-use online tool called Health Cost Estimator+. Use this tool to see what you can expect to pay for medical procedures at different locations, based on the medical plan you’re enrolled in. It helps you compare prices so you can make the right choice for your needs and budget.
Why does this matter? The cost of health care services can vary widely, even within the same geographic area and health plan. Here are a few examples:
Choosing the right doctor is easier with 365+ HUB, which lets you review quality scores of doctors in your area based on your condition and needs. Scorecards include:
When you’re faced with a serious or complex health issue, it helps to get a second opinion and learn more about your condition as well as your options. You and your covered family members have access to experts through 365+ HUB. You can get:
When you think about the financial impact of your health care choices, you can help lower costs for yourself and the entire company. Get the most from your medical benefits by following these tips to be well and buy smart:
Telemedicine | Doctor’s office | Urgent care clinic | Emergency room |
---|---|---|---|
Use it for | |||
A common, non-emergency medical issue that can be diagnosed by phone or online | A condition that doesn’t need immediate attention and can wait until the next day | A condition that needs immediate care but is not life- or limb-threatening | A life-threatening or potentially crippling condition that needs immediate attention |
Examples | |||
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Cost | |||
You pay: $ | You pay: $ | You pay: $$ | You pay: $$$ |
Find it | |||
Teladoc | Call your regular doctor or search for an in-network provider on your medical plan carrier’s website | Search for urgent care clinics near you at urgentcarelocations.com | Call 911 or search online for the nearest hospital |