Let us help you find the information you need.
Our Benefits4Me program offers a range of medical options, so you can choose the plan that’s best for you. All employees have access to three plans administered by Blue Cross Blue Shield of Massachusetts (BCBSMA).
If you’re in California, you also have access to a Kaiser HMO.
The Core, Buy-Up, and Consumer Choice Plans include prescription drug benefits through Rightway. Kaiser HMO participants receive prescription drug benefits through Kaiser.
Check out the Comparing Coverage tab to learn more about the differences among the plans.
Medical ID Cards
If you enroll in a Company medical plan, your medical and prescription drug ID card (a single card for both plans) will arrive by mail in 7–10 days. You can also access digital ID cards on the My Health Toolkit website and mobile app and your prescription drug information is available in the Rightway mobile app.
The 24-Hour Nurse Line Can Help You Get the Care You Need
Call 1-888-344-7088, 24 hours per day, to speak to a registered nurse who can help with:
There are some easy ways to save money on healthcare.
Use in-network providers. These providers have agreed to negotiated rates for services and supplies.
To find BCBSMA in-network providers, visit My Health Toolkit > Find Care > Doctor & Hospital Finder. Click PPO or EPO to begin.
Visit Blue Distinction Centers. These facilities offer bariatric surgery, spine surgery, and knee/hip replacements from trusted providers for discounted costs. When you visit one of these facilities, you won’t pay any coinsurance after you meet your annual deductible.
If you live in California and enroll in the Kaiser HMO, you are required to use in-network providers for non-emergency care. To find Kaiser in-network providers, contact Kaiser at 1-800-464-4000 or visit kp.org.
My Health Toolkit puts important details at your fingertips, including:
Note for Employees in Hawaii and Puerto Rico
Employees in Hawaii and Puerto Rico have different medical plans available; the descriptions in this section do not apply to employees in Hawaii and Puerto Rico. See your plan’s Summary of Benefits and Coverage (SBC) posted on the Additional Resources page.
Worldwide Coverage, Wherever You Go
Your BCBSMA medical plan gives you access to top doctors and hospitals worldwide. Review the Worldwide Coverage Brochure.
Each medical plan option offers:
The way you receive care and pay for coverage varies with each option, as does the tax-advantaged account you can use to pay for eligible expenses.
|
Core Plan |
Buy-Up Plan |
Consumer Choice Plan |
|
|---|---|---|---|
|
Consider this coverage if |
You expect to needa a moderate amount of care and prefer paying moderate premiums taken from your paychecks and moderate out-of-pocket expenses throughout the year. |
You expect to need more care and |
You expect to need a lower or moderate amount of care and prefer paying lower premiums taken from |
|
Pay-per-period rates |
$$ |
$$$ |
$ |
|
Annual deductibles and out-of-pocket maximums |
$$ |
$ |
$$$ |
|
Costs for an office visit |
— Flat copay (deductibles don’t apply) |
— Flat copay (deductibles don’t apply) |
~ Once you meet the annual deductible, |
|
Coinsurance (percentage of the cost |
$$ (typically 20% for |
$ (typically 20% for |
$ (typically 10% for |
|
Tax-Advantaged Account (The account you are eligible to use depends on the medical coverage option you enroll in) |
Health Care FSA |
Health Care FSA |
Health Savings Account with Company contribution:
Limited Purpose Health Care FSA |
Learn more about the Health Savings Account and Flexible Spending Accounts to understand how these accounts may influence the medical plan you choose.
How Well Do Your Benefits Fit Today?
You can change your benefits each year (or when needed due to a Qualifying Life Event—review Making Mid-Year Benefit Changes Due to Life Events). It’s a good idea to consider your lifestyle, your health, and your finances as you choose your coverage. The Decision Support Tool on Benefits4MeEnroll.com is an easy-to-use online tool that helps you make informed decisions about which plan best meets your needs and preferences. In the meantime, review the Coverage Chart for a summary of what’s covered under each plan and how much you may need to pay out of pocket
|
Core Plan |
Buy-Up Plan |
Consumer Choice Plan |
Kaiser HMO Plan |
|||||
|---|---|---|---|---|---|---|---|---|
|
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
In-Network |
Out-of-Network |
|
|
Annual Deductible |
||||||||
|
Individual1 |
$500 |
$1,000 |
$200 |
$600 |
$1,700 |
$3,400 |
$0 |
N/A |
|
Family1 |
$1,000 |
$2,000 |
$400 |
$1,200 |
$3,400 |
$6,800 |
$0 |
N/A |
|
Coinsurance |
||||||||
|
20% |
40% |
10% |
30% |
10% |
30% |
0% |
N/A |
|
|
Annual Out-of-Pocket Maximum |
||||||||
|
Individual2 |
$3,000 |
$6,000 |
$2,000 |
$4,000 |
$3,500 |
$7,000 |
$1,500 |
N/A |
|
Family2 |
$6,000 |
$12,000 |
$4,000 |
$8,000 |
$7,000 |
$14,000 |
$3,000 |
N/A |
|
Covered Services |
||||||||
|
Preventive services |
Covered in full |
Deductible, then 40% |
Covered in full |
Deductible, then 30% |
Covered in full |
Deductible, then 30% |
Covered in full |
Not covered |
|
Emergency room (waived if admitted) |
$150 |
$150 |
$150 |
$150 |
Deductible, then 10% |
Deductible, then 10% |
$75 |
$75 |
|
Urgent care |
$25 |
$50 |
$20 |
$40 |
Deductible, then 10% |
Deductible, then 20% |
$20 |
Not covered |
|
Primary care physician office visit |
$25 |
Deductible, then 40% |
$20 |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$20 |
Not covered except when temporarily outside service area |
|
Telehealth primary, urgent, and mental healthcare visit |
Covered in full through MDLive |
Not covered |
Covered in full through MDLiv |
Not covered |
Covered in full through MDLive |
Not covered |
Explore options on kp.org |
N/A |
|
Specialist office visit |
$40 |
Deductible, then 40% |
$30 |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$20 |
Not covered |
|
Inpatient admission |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$250 |
Not covered |
|
Outpatient surgery |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$20 |
Not covered |
|
Diagnostic X-rays, lab tests, and other tests at an independent lab or outpatient facility3 |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
Covered in full |
Not covered |
|
Allergy injections |
Covered in full |
Deductible, then 40% |
Covered in full |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
Covered in full |
Not covered |
|
Hearing aid (once every 3 years) |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$2,000 allowance per ear |
Not covered |
|
Vision exam (one routine exam per member per calendar year) |
Covered in full |
Deductible, then 40% |
Covered in full |
Deductible, then 30% |
Covered in full |
Deductible, then 30% |
Covered in full |
Not covered |
|
Short-term, outpatient rehabilitation therapy visit |
$40 |
Deductible, then 40% |
$30 |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$20 |
Not covered |
|
Chiropractic services |
$40 |
Deductible, then 40% |
$30 |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$15 |
Not covered |
|
Speech, hearing, language disorder treatment |
$40 |
Deductible, then 40% |
$30 |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$20 |
Not covered |
|
Durable medical equipment4 |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
Covered in full |
Not covered |
|
Prosthetic devices |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
Covered in full |
Covered in full |
|
Home healthcare and hospice care |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
Covered in full; 100 visit limit per year |
Not covered |
|
Inpatient skilled nursing facility (100 days) |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
Covered in full |
Not covered |
|
Inpatient mental health and substance abuse |
Deductible, then 20% |
Deductible, then 40% |
Deductible, then 10% |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$250 per admission |
Not covered |
|
Outpatient mental health and substance abuse |
$25 at physician’s office; 20% for other outpatient services |
Deductible, then 40% |
$20 at physician’s office; 10% for other outpatient services |
Deductible, then 30% |
Deductible, then 10% |
Deductible, then 30% |
$20 |
Not covered |
|
Tax-advantaged Account The account you are eligible to use depends on the medical coverage option you enroll in. |
||||||||
|
Health Care FSA |
Health Care FSA |
Health Savings Account with Company contribution:
Limited Purpose Health Care FSA |
Health Care FSA |
|||||
1 For the Consumer Choice Plan, both medical and prescription drug claims apply toward the medical deductible.
2 Out-of-pocket maximum includes the deductible, coinsurance, and all copays.
3 Diagnostic X-ray/lab/tests performed in physician’s office are covered in full after office visit copay.
4 For Core Plan, Buy-Up Plan, and Consumer Choice Plan, purchase or rentals of $500 or more require pre-authorization. Orthopedic shoes and foot orthotics are limited to $300/calendar year, up to $2,000/lifetime.
The way expenses are counted toward the deductible and out-of-pocket maximum work one way for the Core and Buy-Up Plans, and a different way for the Consumer Choice Plan. Understanding these differences can help you decide which plan may pay more toward the care you and your dependents receive, especially if one person is likely to have higher expenses than the rest of the family.
Note: In-network and out-of-network deductibles and out-of-pocket maximums are tracked separately. Only the cost for care received from in-network providers will count toward meeting in-network deductibles and out-of-pocket maximums.
|
Annual Deductible When the plan begins paying its share of expenses depends on the coverage option you choose and if you cover eligible dependents. |
|
|---|---|
|
Core and Buy-Up Plans |
If one person meets the individual annual deductible, the plan begins to pay its share of expenses for just that person; the rest of the family must continue to pay for services until the family deductible is met. If two or more family members have costs that combine to meet the family deductible, the plan begins to pay its share of expenses for everyone in your family on the plan. This plan design is called an embedded deductible. |
|
Consumer Choice Plan |
Expenses from one or more family members must combine to meet the family annual deductible before the plan begins to pay its share of expenses. This plan design is called a non-embedded deductible. |
|
Out-of-Pocket Maximum This is the most you’ll pay during a plan year. Any out-of-pocket expenses used to meet an individual out-of-pocket maximum are also counted toward the family out-of-pocket maximum. |
|
|
Core and Buy-Up Plans |
When you or a family member reaches the individual out-of-pocket maximum, the plan begins to pay 100% of covered expenses for the remainder of the year for that person. If the total costs by two or more covered family members meet the family out-of-pocket maximum, the plan will begin to pay 100% of covered expenses for the remainder of the year for everyone in your family. |
|
Consumer Choice Plan |
If the total costs by two or more covered family members meet the family out-of-pocket maximum, the plan will begin to pay 100% of covered expenses for the remainder of the year for everyone in your family. |
In partnership with BCBSMA, the Company makes the following benefits available under the Core, Buy-Up, and Consumer Choice Plans to enhance the overall well-being of you and your family:
Concierge Customer Service and Clinical Advocacy
Navigating healthcare is challenging for all of us. When you have questions about your healthcare or are dealing with a complex health condition, you need someone who will help you—a real person who knows how healthcare and your benefits work.
When you enroll in Company medical coverage through BCBSMA, you automatically have access to Care Connected. You get a dedicated phone number to connect with your personal nurse for real-time assistance with:
You have access to a team of physicians, pharmacists, social workers, maternity and neonatal intensive care nurses, and behavioral health specialists.
Get the help you need. Call Care Connected today at 1-888-344-7088.
If you live in California and enroll in the Kaiser HMO, prescription drug coverage is included in your Kaiser HMO plan.
If you enroll in the Core Plan, Buy-Up Plan, or Consumer Choice Plan, prescription drug coverage is provided by Rightway and is included in your medical coverage.
Rightway offers a personalized way to manage your prescriptions, with an easy-to-use app and expert support on demand.
You can price shop to save money. Through the app, enter your ZIP code and prescription information to understand how much local pharmacies charge for a specific medication. If you want to move to a new pharmacy to get the best cost, Rightway will help you transfer your prescriptions!
Rightway’s customer service team is made up of certified pharmacists and pharmacy technicians, available 24 hours per day, 7 days per week, 365 days per year.
Refer to these Frequently Asked Questions to learn more about Rightway.
The amount you pay for each prescription depends on the medical plan you enroll in, the medication you’re prescribed, and how you fill your prescription.
Note: Rightway maintains a formulary, or list of covered, preferred drugs. This list is designed to drive toward the best clinical outcomes at the lowest net cost. The formulary changes throughout the year as more generic drugs become available. For a list of preferred formulary drugs or to check for updates throughout the year, visit joinrightway.com/rx > Search Coverage > 2026 Standard Formulary Search > Start. Type the name of the drug in the search box, use the A – Z list to search by the first letter, or click the therapeutic class to search. If you have any questions, email rwrx@rightwayhealthcare.com or call 1-833-419-5291 to talk to someone live, 24 hours per day.
Ways your Rightway pharmacy guide can help
Discuss your medications and advise on possible side effects
Contact your provider’s office to request an alternative medication on your behalf
Explain your coverage and help you find the most affordable option
Other things Rightway can help you do
Connect with a pharmacist to perform a medication review
Find the best price on prescriptions
Access your prescription ID card
EMD Serono drugs marketed in the U.S. are covered at 100% in BCBSMA medical plans. For the Core and Buy-Up Plans, this means there is no copay. For the Consumer Choice Plan, this means there will be no coinsurance after the applicable deductible has been met. EMD Serono drugs include: Bavencio, Cetrotide, Corbtvie, Gomekli, Gonal-F RFF, Gonal-F RFF Rediject, Mavenclad, Ogsiveo, Ovidrel, Rebif, Rebif Rebidose, Saizen, Saizen-Saizenprep, Serostim, Tepmetko, and Xalkori.
This is an exciting way for employees in the U.S. to proudly share in the advantages of being associated with the companies of Merck KGaA, Darmstadt, Germany.
In addition, under all our medical plans, preventive drugs — such as aspirin, folic acid, smoking-cessation drugs, vaccines, and certain others — are covered at 100% with no coinsurance or copay required. They must be prescribed by a physician and in accordance with Rightway’s guidelines.
This chart details the amounts you will pay for different types of medications.
|
Core Plan |
Buy-Up Plan |
Consumer Choice Plan |
Kaiser HMO Plan (California only) |
|
|---|---|---|---|---|
|
You Pay |
||||
|
Preventive prescription drugs |
$0 |
$0 |
$0 |
$0 |
|
Retail Prescriptions (30-day supply) |
||||
|
Generic |
$12 copay |
$12 copay |
10% after deductible |
$10 copay |
|
Brand-name |
$30 copay |
$30 copay |
10% after deductible |
$20 copay |
|
Non-preferred brand-name |
$50 copay |
$50 copay |
10% after deductible |
$20 copay |
|
Speciality |
$100 copay |
$100 copay |
10% after deductible |
$20 copay |
|
Mail-Order Prescriptions (90-day supply)1 |
||||
|
Generic |
$30 copay2 |
$30 copay2 |
10% after deductible |
$20 copay |
|
Brand-name |
$70 copay2 |
$70 copay2 |
10% after deductible |
$40 copay |
|
Non-preferred brand-name |
$125 copay2 |
$125 copay2 |
10% after deductible |
$40 copay |
1 Rightway offers a 90-day supply of long-term medications through Walgreens Mail Service. Convert your prescriptions to home delivery by calling Rightway at 1-833-419-5291, available 24 hours per day.
2 30-day and 60-day supply may be available through mail-order, with lower copays. Please contact Rightway for details.
Note: If your doctor prescribes a specialty medication for a serious medical condition, you may be eligible for Rightway’s Patient Assistance Program. The Program is designed to guide members to programs that, if they are qualified, may cover the full cost of their specialty medication. The Rightway specialty pharmacy team will guide you through the application and enrollment into the program. During this transition, they will coordinate coverage of your specialty medication.
If you do not qualify for this program, Rightway will work to ensure you have continued coverage of your medication. However, if you qualify and choose not to participate, you will be responsible for 100% of the cost of your specialty medication. If you have any questions, email specialty@rightwayhealthcare.com or call 1-833-419-5291 to talk to someone live, 24 hours per day. Rightway will contact you with instructions for how to work with the specialty pharmacy.
Rightway will help you navigate the following requirements:
If you have any questions, email rwrx@rightwayhealthcare.com or call 1-833-419-5291 24 hours per day.
Use Generics
Though their names are different, generic and brand-names drugs are designed to work the same way. In fact, according to the FDA, generic drugs are just as effective as their branded counterparts. And, they typically cost approximately 80% to 85% less.
Talk to your provider about whether you can use a generic drug and save some money.
If your doctor thinks generics aren’t right for you, or they aren’t available, ask about a preferred brand-name drug. You might have higher copayments than with generics, but you’ll still pay less than you would for non-preferred brand-name drugs. For questions about generics, or to see what medicines are preferred by your plan, visit joinrightway.com/rx, email rwrx@rightwayhealthcare.com, or call 1-833-419-5291 24 hours per day.
Copay Assistance Program for Specialty Medications
Pharmacy benefit experts from PillarRx can help you find copay assistance programs that may be available from drug manufacturers for certain specialty medications, which are complex, expensive prescriptions. If eligible, PillarRx will contact you or your covered dependent over age 18. (PillarRx will contact you regarding any dependents under age 18.)
You’ll need to fill specialty medications through Walgreens Specialty Pharmacy. A Rightway Specialty Pharmacist will reach out to help you set up your account. Email specialty@rightwaycare.com.
Note: You may be asked to use a different pharmacy based on product availability. The Rightway Specialty Pharmacist will discuss your options with you, if needed.
Order a 90-day Supply of Maintenance Medications
Rightway offers a 90-day supply of long-term medications through Walgreens Mail Service. Convert your prescriptions to home delivery by calling Rightway at 1-833-419-5291, available 24 hours per day.
We are dedicated to providing affordable healthcare coverage for our employees. To ensure our coverage options accurately reflect your needs, we offer four tiers of coverage: Employee Only, Employee + Spouse/Domestic Partner, Employee + Child(ren), and Employee + Family.
The rates below show the cost you will pay for medical and prescription drug coverage per bi-weekly pay period.
Note: When you enroll in or change your benefits, you authorize the Company to deduct the amount you owe for benefits from each paycheck you receive. Please keep in mind: The amount you pay for coverage is based on the date coverage takes effect, not the date you enroll. If your paycheck doesn’t include enough money to cover the amount you owe or if you do not receive a paycheck (e.g., you’re on an unpaid leave of absence), the Company will continue your coverage and deduct missed payments from future paychecks until the amount you owe is repaid in full. Note: The Company will not deduct more than twice the standard pay-period deduction from any one paycheck to repay this amount.