Your health is everything. Acme provides valuable benefits that help you and your family stay healthy and pay for care if you get sick or injured.

 

Overview

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.

2020 medical plans

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.

PPO Plan

Administered by: UnitedHealthcare

Reduce your out-of-pocket costs when you need care through a lower deductible and higher premiums.

PPO2 Plan

Administered by: UnitedHealthcare

Enjoy greater predictability of costs through copays for doctor’s visits and prescriptions, along with a low deductible and higher premiums.

HMO Plan

Administered by: Kaiser Permanente

Receive coverage for in-network care only, coordinated by your primary care provider (PCP).

Key features at a glance

All our medical plans provide:

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Comprehensive, affordable coverage

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.

Free in-network preventive care,

with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.

Prescription drug coverage

included with each medical plan. Prescription benefits are provided by OptumRx.

Financial protection

through annual out-of-pocket maximums that limit the amount you’ll pay each year.

 

Plan Comparison

[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

Find your best match

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.

 

CDHP Plan

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.

How the CDHP Plan works

You pay the plan premium from your paycheck to have coverage.

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HSA

You can set aside tax-free money from your paycheck and receive company contributions to help cover your costs — now, or in the future.

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Deductible

You pay 100% of your medical and prescription costs until you meet the annual deductible.*

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Coinsurance

After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.**

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Use your HSA to save money and plan ahead!

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!*

Keep in mind:
  • The CDHP Plan costs you less from your paycheck, so you may have extra money available to put in your HSA.
  • You can only spend HSA money that’s actually been deposited into your account. If you don’t have enough money in your HSA when you need it, you can pay another way and reimburse yourself later so you take full advantage of your HSA’s tax savings.
  • You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses or want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time.
  • You can change your HSA contribution amount throughout the year as needed to keep up with any changes in your situation.
  • You can pair your HSA with a tax-free Combination Flexible Spending Account (FSA) to save even more.

*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.

 

PPO Plan

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.

How the PPO Plan works

You pay the plan premium from your paycheck to have coverage.

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Deductible

You pay 100% of your medical costs until you meet the annual deductible. (The deductible does not apply to prescriptions.)

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Coinsurance

After meeting the deductible, you and the plan share the cost of covered services, with the plan paying the majority. Your prescriptions have no deductible — you simply pay the coinsurance.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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Save money with an FSA!

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.

 

PPO2 Plan

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.

How the PPO2 Plan works

You pay the plan premium from your paycheck to have coverage.

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Copay

You pay a small fee at the time of service for doctor visits and prescriptions. Copays do not count toward your deductible.

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Deductible

For care that doesn’t charge a copay, such as hospital services, you pay 100% of your medical costs until you meet the annual deductible.

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Coinsurance

After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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Save money with an FSA!

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.

 

HMO Plan

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.

How the HMO Plan works

You pay the plan premium from your paycheck to have coverage.

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Copay

You pay a small fee at the time of service for doctor visits and prescriptions. Copays do not count toward your deductible.

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Deductible

For care that doesn’t charge a copay, such as hospital services, you pay 100% of your medical costs until you meet the annual deductible.

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Coinsurance

After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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Do you have a PCP?

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

Save money with an FSA!

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.

 

Prescription Drugs

When you enroll in an Acme medical plan, you automatically receive prescription {DRUG} benefits through OptumRx.

Drug tiers

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.

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Generic drugs

Same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

You pay: $

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Preferred drugs

Same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

You pay: $$

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Non-preferred drugs

Brand-name medications not preferred by your carrier. They may still be covered, but may require prior authorization and cost more.

You pay: $$$

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Check the formulary

See how medications are covered by logging in to your prescription account on the OptumRx website or the Kaiser Permanente website.

Save money on your prescriptions!

The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.

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Ask your doctor about generic medications.

Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.

Use the home delivery feature.

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.

Why use home delivery?
  • Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
  • You save money with a reduced cost for a three-month supply.
  • You can set up automatic refills.

Specialty drugs

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.

Prescription management programs

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.

 

Programs & Resources

Take advantage of these valuable programs and resources to better manage your health and financial well-being.

Teladoc

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.

Nurseline

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.

Health Advocate

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.

Castlight

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.

Best Doctors®

You have access to the best medical minds in the world through Best Doctors. At no cost to you, you can request:

  • An in-depth review of your medical case by an experienced specialist.
  • Expert advice about medical treatment.
  • Assistance finding specialists near you.

If you’re facing a medical challenge, contact Best Doctors at 1-800-123-4567 or visit the Best Doctors website.

Livongo

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.

Medical plan tools

Visit your medical plan website to find a doctor, compare costs, manage claims, and more.

Prescription tools

Visit your prescription plan website to order or refill prescriptions, sign up for home delivery, and more.

HSA/FSA tools

Visit your tax-advantaged account website to manage your HSA or FSA accounts online, use calculators, and more.

 

Find a Doctor

Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.

UnitedHealthcare

  • Visit the UnitedHealthcare website.
  • Click on “Find a Provider” and follow the prompts.

Kaiser Permanente

  • Visit the Kaiser Permanente website.
  • Click on “Find a Provider” and follow the prompts.

Look up providers on the Acme Enrollment website

Beginning [date], you can also use the Provider Lookup tool on the Acme Enrollment website to easily find in-network doctors.

  • Follow the enrollment prompts until you get to the Choose your Medical plan page.
  • Click on Find a Doctor or Hospital on the left side of the page. This launches the Provider Lookup tool.
  • Enter your ZIP code.
  • Enter your search criteria to find the type of provider you're looking for.
  • You can narrow your results by choosing a specific distance, network, specialty, language, hospital affiliation, group affiliation, city, county, or gender. You can also choose to show only providers who are accepting new patients.
Don’t have a personal doctor? You should. Here’s why.
  • Better health. Getting the right health screenings each year can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it.
  • A healthier wallet. Having a doctor you can call helps you avoid costly trips to the emergency room and decide when you really need to see a specialist.
  • Peace of mind. Advice from someone you trust ... it means a lot when you’re healthy, but it’s even more important when you’re sick. Your personal doctor gets to know you and your health history and can help coordinate any care you need.
 

365+ HUB

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.

How can 365+ HUB help you?

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:

  • Finding the right doctors
  • Comparing costs and doctor quality ratings
  • Detangling medical bills and claims issues
  • Getting expert second opinions
  • And more

Click the features below to learn more about 365+ HUB services.

Get a health advocate

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:

  • Find the right doctors
  • Schedule appointments quickly
  • Resolve health care billing and insurance claims disputes
  • Secure elder care with confidence, including answering Medicare questions
  • Work seamlessly with insurance providers
  • Transfer medical records promptly and securely
Compare prices

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:

  • Knee replacement: $15,800–$42,363+
  • MRI: $660–$4,250+
  • Colonoscopy: $769–$5,660+
Compare doctor quality

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:

  • Physician performance scores
  • Quality analysis
  • Experience and outcomes ranking
  • Evaluations based on billions of doctor-patient interactions
Get expert medical opinions

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:

  • An in-depth review of your medical case by an experienced specialist
  • Expert advice about medical treatment to help you make confident decisions
  • Assistance finding specialists near you
 

Money-Saving Tips

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:

  1. Use in-network providers. They’ve agreed to charge only up to negotiated rates and bill your insurance company directly, which saves you money and time. Also, check with your insurance company to ensure that a service is covered before you receive care. Note: If you’re enrolling in an HMO plan (if available in your area), the plan only pays benefits for care received in network.
  2. Keep up with preventive care. It’s covered in full by all of our medical plans and can help detect and prevent potentially costly health issues early. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.
  3. Use tax-free money to pay for eligible health expenses. Contributing to a Health Savings Account (HSA) or a Health Care Flexible Spending Account (FSA) is easy and saves you money. You can set aside before-tax dollars from your paycheck to use for out-of-pocket costs. Keep in mind that with an HSA, you can only spend contributions that have actually been deposited into your account. And with an FSA, you can only carry over up to $500 of unused money in your FSA to the next year; you will forfeit amounts above $500.
  4. Shop smart for prescriptions. Using generic alternatives will almost always save you money — and they’re just as effective as brand-name prescriptions. Also, try calling a few local pharmacies to compare prices before deciding where to fill a prescription. For your ongoing prescriptions, use the home-delivery service to save money and time.
  5. Take advantage of the Acme wellness program. It offers valuable resources to help you improve your health, which could prevent the need for costly care. Plus, you’ll earn rewards when you participate in wellness activities!
  6. Use your plan’s website. Log in to the UnitedHealthcare website to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.
  7. Choose the right place to get care. Facilities charge different amounts for the same services, so think about your options when you or a family member needs medical attention. Use the guide below to help you save money and choose the most appropriate care for your situation.
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
  • Colds and allergies, flu/cough
  • Ear infections, pink eye
  • Behavioral health
  • Sore throat, fever
  • Routine exam, screening
  • Checkup, vaccine, prescription refill
  • Broken bone, severe sprain or strain
  • Cut requiring stitches
  • Anxiety attack
  • Sudden weakness, dizziness, or loss of consciousness
  • Uncontrollable bleeding
  • Chest pain, difficulty breathing
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