Anchor Choice with HSA Plan. Each member that enrolls in the Anchor Choice Plan with HSA shall receive an HSA contribution from the State in the amount of $1,500 for individuals or $3,000 for families. Fifty percent (50%) of each State HSA contribution shall be deposited on January 1st and 50% shall be deposited on July 1st during each year of the collective bargaining agreement. The State will not pro-rate its HSA contributions for members enrolling after January 1st or July 1st. In Network Deductible* $1,500 ($3,000 family) In network Out of Pocket Max** $3,000 ($6,000 family) Out of Network Deductible* $2,250 ($4,500 family) Out of Network Out of Pocket Max** $4,500 ($9,000 family) In-Network Coinsurance 10% Out of Network Coinsurance 30% *The family deductible is cumulative, meaning any combination of items covered by the deductible paid by family members counts toward the deductible until the full amount of the deductible has been met. The in-network and out of network deductibles and out-of-pocket maximums are combined deductibles and out-of-pocket maximums with the pharmacy deductibles and out-of-pocket maximum. The following in-network copays shall be in effect for the Anchor Choice HSA Plan:
1) Preventative care office visits are covered in full;
2) Office visit (non-preventative) PCP- coinsurance after deductible;
3) Specialist office visit copay- 10% /30% after deductible. (Higher specialist coinsurance applies without referral under PCP Coordination of Care);
4) Chiropractic care- coinsurance after deductible;
5) Diagnostic tests (X-rays, blood work) – coinsurance after deductible;
6) Imaging (CT/PET Scans, MRIs) – coinsurance after deductible. (Covered in full after deductible if an imaging center is used);
7) Inpatient hospital- coinsurance after deductible;
8) Outpatient surgery-coinsurance after deductible;
9) Mental Health/Substance Use Disorder – in-patient: coinsurance after deductible, outpatient: coinsurance after deductible;
10) Emergency room copay- coinsurance after deductible;
11) Ambulance: coinsurance after deductible;
12) Urgent care copay-insurance after deductible;
13) Physical therapy, occupational therapy and speech therapy copay-coinsurance after deductible. Employee Drug Copay: Effective January 1, 2019, the following in-network copays shall be in effect:
Anchor Choice with HSA Plan. On the Anchor Choice Plan with HSA, members shall pay the full retail rate for most prescriptions prior to meeting the deductible. However, if the medication is listed on the pharmacy benefit manager’s preventive therapy drug list, the applicable copay amount shall apply instead of the full retail rate. For all covered drugs, after the deductible is met, the applicable copay amount shall apply until the applicable OOPM is met. The drug copay after deductible for a 31-day supply shall be as follows: Tier 1 Tier 2 Tier 3 Tier 4 $10.00 $35.00 $60.00 $100.00 The drug copay after deductible by mail order shall be as follows: Tier 1 Tier 2 Tier 3 $20.00 $70.00 $120.00 Mail order network pharmacies: 3-month supply of a prescription drug for two (2) copayments. Maximum fill is a 3-month supply. The State will provide a vision/optical care program for the employee. Dental and Vision Programs:
Anchor Choice with HSA Plan. On the Anchor Choice Plan with HSA, members shall pay the full retail rate for most prescriptions prior to meeting the deductible. However, if the medication is listed on the pharmacy benefit manager’s preventive therapy drug list, the applicable copay amount shall apply instead of the full retail rate. For all covered drugs, after the deductible is met, the applicable copay amount shall apply until the applicable OOPM is met. The drug copay after deductible for a 31-day supply shall be as follows: $10.00 $35.00 $60.00 $100.00 The drug copay after deductible by mail order shall be as follows: $20.00 $70.00 $120.00 Mail order network pharmacies: 3 month supply of a prescription drug for two (2) copayments. Maximum fill is a 3-month supply.
Anchor Choice with HSA Plan. On the Anchor Choice Plan with HSA, MBUs shall pay the full retail rate for most prescriptions prior to meeting the deductible. However, if the medication is listed on the pharmacy benefit manager’s preventive therapy drug list, the applicable copay amount shall apply instead of the full retail rate. For all covered drugs, after the deductible is met, the applicable copay amount shall apply until the applicable OOPM is met. Tier 1 Tier 2 Tier 3 Tier 4 $10.00 $35.00 $60.00 $100.00 The drug copay after deductible by mail order shall be as follows: Tier 1 Tier 2 Tier 3 $20.00 $70.00 $120.00 Mail order network pharmacies: 3-month supply of a prescription drug for two (2) copayments. Maximum fill is a 3-month supply.
Anchor Choice with HSA Plan. On the Anchor Choice Plan with HSA, members shall pay the full retail rate for most prescriptions prior to meeting the deductible. However, if the medication is listed on the pharmacy benefit manager's preventive therapy drug list, the applicable copay amount shall apply instead of the full yretail rate. For all covered drugs, after the deductible is met, the applicable copay amount shall apply until the applicable OOPM ia met, The drug copay after deductible for a 31-day supply shall be as follows: Tier i Tier 2 Tier 3 Tier 4 $10.00 $35,00 $60.00 $100.00 The drug copay after deductible by mail order shall be as follows: Tier 2 Tier 2 Tiex 3 $20.00 $70.00 $120.00 Mail order network pharmacies: 3-month supply of a prescription drug for two (2) copayments. Maximum fill is a 3+-month supply. for the employee,
(1) Dental: Effective January 1, 2019, the State will provide a dental plan for employees and their families, The coverage shall be $1,500 per calendar year, in addition to the enhancements below.
(a) The State will offer benefit enhancements, including two buy-up options. Said modified plan enhancements shall include: Add sealants as a preventive benefit for children under age 14, dovered at 100% Remove the $400 inside maximum for periodontal services Increase the lifetime maximum for orthodontic services from $850 to $1,500 Extend coverage to dependent children to age 26 {2) Visien: The State will provide a vision plan for employees and their families. Effective January 1, 2019, the State will offer benefit enhancements, including buy-up option(s). Said modified plan enhancements shall include: Increase retail frame allowance from $65 to $100 Increase elective contact lens allowance from $18 to $30 Add a contact lens exam copay of up to $30 Extend coverage to dependent children to age 26
