Common use of Anchor Choice with HSA Plan Clause in Contracts

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. 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 In-Network Deductible* $1,500 ($3,000 family) In network Out of In-Network Out-of-Pocket Max** $3,000 ($6,000 family) Out of Out-of-Network Deductible*, ** $2,250 ($4,500 family) Out of Out-of-Network Out of Out-of-Pocket Max** $4,500 ($9,000 family) In-Network Coinsurance Co-insurance 10% Out of Out-of-Network Coinsurance Co-insurance 30% *The family deductible is cumulative, meaning any combination of items covered by the deductible paid by family family-members counts toward the deductible until the full amount of the deductible has been met. **The in-network and out of 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 co-pays 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 PCP - co-insurance after deductible; 3) Specialist office visit copay- 10% /30co-pay – 10%/30% after deductible. (Higher specialist coinsurance co-insurance applies without referral under PCP Coordination of Care); 4) Chiropractic care- coinsurance care - co-insurance after deductible; 5) Diagnostic tests (X-rays, blood work) – coinsurance - co-insurance after deductible; 6) Imaging (CT/PET Scans, MRIs) – coinsurance co-insurance after deductible. (Covered in full after deductible if an imaging center is used); 7) Inpatient hospital- coinsurance hospital – co-insurance after deductible; 8) Outpatient surgerysurgery – co-coinsurance insurance after deductible; 9) Mental Health/Substance Use Disorder – in-patient: coinsurance co-insurance after deductible, outpatient: coinsurance co-insurance after deductible; 10) Emergency room copay- coinsurance co-pay – co-insurance after deductible; 11) Ambulance: coinsurance co-insurance after deductible; 12) Urgent care copayco-pay – co-insurance after deductible; 13) Physical therapy, occupational therapy and speech therapy copayco-coinsurance pay – co-insurance after deductible. Employee Drug Copay: Effective January 1, 2019, the following in-network copays shall be in effect:.

Anchor Choice with HSA Plan. Each member MBU 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. 1st In Network Deductible* $1,500 ($3,000 family) In network 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** In- Network Coinsurance Out of Network Coinsurance $1,500 ($3,000 family) $3,000 ($6,000 family) $2,250 ($4,500 family) $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- PCP - coinsurance after deductible; (3) Specialist office visit copay- 10% /3010%/3 0% after deductible. (Higher specialist coinsurance applies without referral under PCP Coordination of Care); (4) Chiropractic care- care - coinsurance after deductible; (5) Diagnostic tests (X-rays, blood work) – - coinsurance after deductible; (6) Imaging (CT/PET Scans, MRIs) – MRIs)- coinsurance after deductible. (Covered in full after deductible if an imaging center is used); (7) Inpatient hospital- hospital - coinsurance after deductible; (8) Outpatient surgery-surgery - coinsurance after deductible; (9) Mental Health/Substance Use Disorder – in-in-patient: coinsurance after deductible, outpatient: coinsurance after deductible; (10) Emergency room copay- copay - coinsurance after deductible; (11) Ambulance: coinsurance after deductible; (12) Urgent care copay-insurance copay- coinsurance after deductible; (13) Physical therapy, occupational therapy and speech therapy copay-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. Each member MBU 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. 1st In Network Deductible* $1,500 ($3,000 family) In network 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** In- Network Coinsurance Out of Network Coinsurance $1,500 ($3,000 family) $3,000 ($6,000 family) $2,250 ($4,500 family) $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- PCP - coinsurance after deductible; (3) Specialist office visit copay- 10% /30copay - 10%/3 0% after deductible. (Higher specialist coinsurance applies without referral under PCP Coordination of Care); (4) Chiropractic care- care - coinsurance after deductible; (5) Diagnostic tests (X-rays, blood work) – - coinsurance after deductible; (6) Imaging (CT/PET Scans, MRIs) – MRIs)- coinsurance after deductible. (Covered in full after deductible if an imaging center is used); (7) Inpatient hospital- hospital - coinsurance after deductible; (8) Outpatient surgery-surgery - coinsurance after deductible; (9) Mental Health/Substance Use Disorder – in-in-patient: coinsurance after deductible, outpatient: coinsurance after deductible; (10) Emergency room copay- copay - coinsurance after deductible; (11) Ambulance: coinsurance after deductible; (12) Urgent care copay-insurance copay- coinsurance after deductible; (13) Physical therapy, occupational therapy and speech therapy copay-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. 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 prorate its HSA contributions for members enrolling after January 1st or July 1st. In Network Deductible* $1,500 ($3,000 family) In network Network Out of Pocket Max** $3,000 ($6,000 family) Out of Network Deductible* Deductible $2,250 ($4,500 family) Out of Network Out of Pocket Max** 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 HSA has been met. **The in-network and out of network deductibles and out-of-pocket maximums are maximum is combined deductibles and out-of-pocket maximums maximum with the pharmacy deductibles and out-of-pocket maximum. The following in-network copays shall be in effect for the Anchor Choice HSA Plus Plan: 1) Preventative care office visits are covered in full; 2) Office visit (non-preventative) PCP- PCP – coinsurance after deductible; 3) Specialist office visit copay- 10% /30– 10%/30% after deductible. deductible (Higher higher specialist coinsurance copay applies without referral under PCP Coordination of Care); 4) Chiropractic care- care - coinsurance after deductible; 5) Diagnostic tests (X-rays, blood work) – coinsurance after deductible; 6) Imaging (CT/PET Scans, MRIs) – coinsurance applies after deductible. deductible (Covered covered in full after deductible if an imaging center is used); 7) Inpatient hospital- hospital – coinsurance after deductible; 8) Outpatient surgery-surgery - coinsurance after deductible; 9) Mental Health/Substance Use Disorder – in-in patient: coinsurance after deductible, outpatient: coinsurance after deductible; 10) Emergency room copay- - coinsurance after deductible; 11) Ambulance: Ambulance – coinsurance after deductible; 12) Urgent care copay-insurance copay - coinsurance after deductible; 13) Physical therapy, occupational therapy and speech therapy copay-– copay coinsurance after deductible. Employee Drug CopayEligible employees shall contribute toward the cost of the health care coverage based on a percentage of premiums for either the individual or family plan as set forth below for medical insurance, dental benefits and/or vision/optical benefits. Said co-share percentages shall apply based on the employee’s annualized total rate and shall be via payroll deductions. Premium sharing increases shall become effective 1/1/2019, and will be indexed by subsequent salary increases: Effective January July 1, 20192019 and July 1, 2020: Individual Less than $110,595 20% $110,595 and over 25% Family Less than $55,297 15% $55,297 to less than $110,595 20% $110,595 and above 25% A) Anchor Plus Plan and Anchor Plan: The drug copay for a 31 – day supply shall be as follows: $10.00 $35.00 $60.00 $100.00 The drug co-pay 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. B) Anchor Choice with HSA Plan: On the Anchor Choice Plan with HSA, members shall pay the full retail rate for most prescriptions prior to deductible. However, if the medication is listed on the pharmacy benefit manager’s preventive therapy drug list, the following inapplicable 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. $10.00 $35.00 $60.00 $100.00 The drug co-network copays pay by mail order shall be in effect: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. The State will provide a vision/optical care program for employees.