Medical & Prescription Drug Coverage

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).

Core
Buy-Up
Consumer Choice Plan with Health Savings Account (HSA)

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 Express Scripts. Kaiser HMO participants receive prescription drug benefits through Kaiser.

Check out the Comparing Coverage tab to learn more about the differences among the plans.

Did you know?

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. And, 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 BCBSMA in-network providers, contact Included Health at 1-833-938-9948 or:

Search for a provider yourself at this BCBSMA website: myfindadoctor.bluecrossma.com/?ci=Benefits4Me
Click “Select your network to continue (not logged in)” then select “PPO or EPO”
If you live in any of the following locations, choose the specific local network listed below before starting your search:
- PPO New Hampshire
- PPO Missouri/Kansas City
- PPO Missouri/St. Louis
- PPO Wisconsin

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.

Visit Blue Distinction Centers. These facilities offer bariatric surgery, spine surgery, and knee/hip replacements. When you visit one of these facilities, you won’t pay any coinsurance after you meet your annual deductible.

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Medical ID Cards

If you enroll in a Company medical plan, your medical ID card will arrive by mail in 7–10 days. Call the carrier if you have any questions. Note: You can also access digital ID cards on the Included Health app.

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 you. For basic features of these plans, see the plan’s Summary of Benefits and Coverage (SBC) posted on the Additional Resources page.

Comparing Coverage

Each medical plan option offers comprehensive coverage, including prescription drug coverage, preventive care at no cost to you (when you use in-network providers), and financial protection in the event of a serious illness or injury. However, 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.

As you decide which medical option best suits your needs, consider how the options differ in their costs:

The Buy-Up Plan generally offers more coverage in return for higher per paycheck premiums. You can contribute to a Health Care Flexible Spending Account to help pay for your out-of-pocket expenses.
The Core Plan has lower per paycheck premiums than the Buy-Up Plan, but you incur greater out-of-pocket costs when using the plan. You can contribute to a Health Care Flexible Spending Account to help defray some of those expenses.
The Consumer Choice Plan has the lowest premiums, but you must meet the annual deductible before the plan begins paying benefits for medical and prescription drugs (with the exception of preventive care, which is covered at 100% when you use in-network providers). Once you meet the deductible, you pay a portion of the cost—called coinsurance—for eligible expenses. To help pay for out-of-pocket expenses, the Company makes a contribution to a special tax-advantaged Health Savings Account, and you can also contribute to your account on a pre-tax basis. The savings in your account roll over each year and are yours to keep even if you leave the Company.

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 Changes Due to a Life Event). 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.

Coverage Chart

When choosing your medical plan option, consider your typical medical needs and what changes, if any, you and/or your family may experience in the coming year. For example, if you plan to expand your family or know you will be having specific medical procedures, you will want to consider which coverage best suits your needs. There’s more to your medical plan options than your per paycheck cost. Depending on how you use your coverage, you may see significant tax savings in one option versus another.

Here are the key differences among the plans:

	Core Plan		Buy-Up Plan		Consumer Choice Plan		Kaiser HMO Plan (California only)
	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
Annual Deductible The amount you must pay each year before the plan begins paying benefits (for most expenses)
Individual¹	$500	$1,000	$200	$600	$1,650	$3,300	$0	N/A
Family¹	$1,000	$2,000	$400	$1,200	$3,300	$6,600	$0	N/A
Coinsurance Share of the cost you pay after you meet the deductible
	20%	40%	10%	30%	10%	30%	0%	N/A
Annual Out-of-Pocket Maximum The most you are required to pay in a single year (including your deductible, coinsurance and copays) for covered expenses. Once you have paid this amount, the plan takes over and pays 100% of covered expenses for the rest of the calendar year.
Individual²	$3,000	$6,000	$2,000	$4,000	$3,500	$7,000	$1,500
Family²	$6,000	$12,000	$4,000	$8,000	$7,000	$14,000	$3,000
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
Telehealth primary and mental healthcare visit through Firefly Health and Well Connection	Covered in full	Not covered	Covered in full	Not covered	Deductible, then covered in full	Not covered	Not applicable	Not applicable
Specialist office visit	$35	Deductible, then 40%	$35	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 device	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	$35	Deductible, then 40%	$30	Deductible, then 30%	Deductible, then 10%	Deductible, then 30%	$20	Not covered
Chiropractic services	$35	Deductible, then 40%	$30	Deductible, then 30%	Deductible, then 10%	Deductible, then 30%	$15	Not covered
Speech, hearing, language disorder treatment	$35	Deductible, then 40%	$30	Deductible, then 30%	Deductible, then 10%	Deductible, then 30%	$20	Not covered
Durable medical equipment	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	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: $500 for Employee Only coverage $1,000 for all other coverage levels 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.

Understanding How the Family Deductibles and Out-of-Pocket Maximums Work

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.

Deductible — the amount you must pay each year before the plan begins paying its share of expenses (through coinsurance and copays).
Out-of-pocket maximum — the most you can be required to pay before the plan begins paying 100% of covered services for the rest of the calendar year.

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	Out-of-Pocket Maximum
When the plan begins paying its share of expenses depends on the coverage option you choose and if you cover eligible dependents.	This is the most you’ll pay during a plan year. Regardless of the medical coverage option you enroll in, 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. 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 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.

Annual Deductible

Out-of-Pocket Maximum

When the plan begins paying its share of expenses depends on the coverage option you choose and if you cover eligible dependents.

This is the most you’ll pay during a plan year. Regardless of the medical coverage option you enroll in, 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. 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

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.

In-Network Examples

The Core Plan

Juan is enrolled in family coverage in the Core Plan. He covers himself, his wife, Clare, and their daughter, Sarah.

The in-network annual deductibles for the Core Plan are:
- $500 for an individual
- $1,000 for the family
The in-network annual out-of-pocket maximums are:
- $2,400 for an individual
- $4,800 for the family
Early in the year, Clare needs an MRI that costs $500. With this expense, she meets the individual deductible of $500 and the Core Plan begins paying a portion of any additional costs of Clare’s covered medical services through the remainder of the year.
Although Clare has met the individual deductible, the Core Plan is still not sharing in the cost of medical expenses for Juan or Sara.

Later in the year, Sarah needs medical tests that cost just over $500. Sarah’s medical expenses also meet the $500 individual deductible.
The total combined medical expenses for Clare and Sarah has reached the family deductible amount of $1,000. From this point on, the Core Plan will share the cost of expenses for all covered family members (with coinsurance and copays), including Juan, who hasn’t had any medical expenses yet this year.

Similarly, once Clare’s share of expenses reaches the individual out-of-pocket maximum, the Core Plan begins paying 100% of her eligible expenses for the rest of the year.
When Clare’s and Sara’s combined expenses reach the family out-of-pocket maximum, the Core Plan begins paying 100% of eligible expenses for all covered family members for the rest of the year.

The Consumer Choice Plan

Katrin is enrolled in the Consumer Choice Plan. She covers herself and her two sons, Joseph and Eli.

The in-network annual deductibles for the Consumer Choice Plan are:
- $1,650 for an individual
- $3,300 for the family
The in-network out-of-pocket maximums are:
- $3,500 for an individual
- $7,000 for the family
Early in the year, Eli needs to have his appendix removed. He incurs $15,000 in expenses. His surgery exceeds the family deductible:
- Katrin is responsible for paying the first $3,300 (the family deductible).
- The Consumer Choice Plan begins sharing in the cost of care for the amount in excess of the family deductible ($15,000 total cost – $3,300 family deductible = $12,000 shared cost).
- Of the remaining $11,700, Katrin will pay 10% ($1,170) and the plan will pay 90% ($10,530)
Since the family is enrolled in the Consumer Choice Plan and the deductible has been met, the plan will share the cost of covered expenses for all covered family members for the remainder of the year.

Later in the year, Katrin received medical care totaling $700. Since the family deductible has already been met, the Consumer Choice Plan will share in the cost of Katrin’s care through coinsurance. She will pay 10% ($70) and the plan will pay 90% ($630).

Note: If Eli’s medical expenses had not met the family deductible, the plan would not share in the cost of care until the family’s combined medical expenses reached $3,300 (the family deductible). The individual deductible only applies to Employee Only coverage.
The out-of-pocket maximums for the Consumer Choice Plan work like the annual deductibles. The combined expenses for Katrin, Eli, and Joseph must meet the family out-of-pocket maximum before the plan begins paying 100% of eligible expenses for the rest of the year.

Coverage to Note

Prescription Drug Coverage

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 Express Scripts and is included in your medical coverage. Express Scripts offers services through a network of retail pharmacies, convenient home delivery and a specialty pharmacy.

Visit Express-Scripts.com to learn more and call Express Scripts at 1-800-396-2256 with any questions.

The amount you pay for each prescription depends on the medical plan you enroll in, whether you fill it at a retail location or through mail-order, and whether it is a generic, brand name, or non-preferred brand name drug. Each year, Express Scripts updates its Preferred Prescription formulary and medications may be added or removed. To review the formulary:

Before you are enrolled: Visit express-scripts.com/benefits4me
After you are enrolled: Register at Express-Scripts.com to create an account.

Did You Know?

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, Gonal-F, Gonal-F RFF, Gonal-F RFF Rediject, Mavenclad, Ovidrel, Rebif, Rebif Rebidose, Saizen, Saizen-Saizenprep, Serostim, Tepmetko, Xalkori, and Zorbtive.

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 Express Scripts guidelines.

Coverage Chart

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 drugs¹	$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)²
Generic	$30 copay³	$30 copay³	10% after deductible	$20 copay
Brand-name	$70 copay³	$70 copay³	10% after deductible	$40 copay
Non-preferred brand-name	$125 copay³	$125 copay³	10% after deductible	$40 copay

1 Refer here for a list of preventive medications covered by the Consumer Choice Plan and available at no cost.

2 Express Scripts offers a 90-day supply through the mail-order program. In addition, you have access to Walgreens90, a service that allows Walgreens customers the option of having their 90-day prescriptions either mailed to their homes or delivered for pick up from their neighborhood Walgreens.

3 30-day and 60-day supplies may be available through mail-order, with lower copays. Please consult the Summaries of Benefits and Coverage for details.

Note

If your doctor prescribes a specialty medication for a serious medical condition, such as Multiple Sclerosis, Rheumatoid Arthritis, or Hepatitis C, your prescriptions will be filled through Accredo^®, the Express Scripts specialty pharmacy. Specialty medications not filled by Accredo will not be covered; however, two fills at a retail network pharmacy will be permitted for specialty medications that are of an urgent nature and must be started immediately. If you have an urgent specialty prescription filled at a retail network pharmacy, you will receive a letter from Express Scripts about how to get started with Accredo.

Refer to the Accredo brochure for more information on the specialty pharmacy and see the Save Money on Prescriptions tab for information on an opportunity to save money on expensive specialty prescriptions.

Save Money on Prescriptions

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Paying for Coverage

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, if you do not have a paycheck for a period (or the paycheck is insufficient), coverage will continue as elected, but you are required to make up missed deductions out of future paychecks until the full amount has been repaid. The Company will not deduct more than two times the standard pay-period deduction from any one paycheck.

2025 Rates

Coverage Level	Core Plan	Buy-Up Plan	Consumer Choice Plan	Kaiser HMO Plan (CA only)
Employee Only	$73.66	$87.26	$44.77	$62.44
Employee + Spouse/Domestic Partner	$169.41	$200.70	$102.97	$143.62
Employee + Child(ren)	$120.84	$143.15	$77.70	$112.49
Employee + Family	$224.65	$266.14	$136.55	$190.44

Medical & Prescription Drug Coverage

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Medical & Prescription Drug Coverage

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Paying for Coverage

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