We offer you a choice of 3 medical plan options—the ElevateHealth HSA Plan, the ElevateHealth HRA Plan, and the Choice Health Plan. Deciding which plan to choose is a personal and financial decision. To help you choose, we have outlined some similarities and differences between the plans.
The following sections describe the benefits available for each plan.
Bi-weekly premiums shown here are for non-tobacco users with the ElevateHealth Plan with HSA and HRA Choice Health Plans. Additional premiums or premium adjustments may apply.
| Salary range | Covered | Cost |
|---|---|---|
| Base salary $0 to $49,999 | Employee | $42.45 |
| Employee and children | $63.65 | |
| Employee and spouse | $89.10 | |
| Family | $117.50 | |
| Base salary $50,000 to $99,999 | Employee | $59.40 |
| Employee and children | $89.10 | |
| Employee and spouse | $124.75 | |
| Family | $164.50 | |
| Base salary $100,000 to $149,999 | Employee | $63.15 |
| Employee and children | $94.75 | |
| Employee and spouse | $132.70 | |
| Family | $175.00 | |
| Base salary $150,000 or greater | Employee | $94.55 |
| Employee and children | $141.80 | |
| Employee and spouse | $198.55 | |
| Family | $261.85 |
| Covered | Cost |
|---|---|
| Employee | $137.40 |
| Employee and children | $210.30 |
| Employee and spouse | $291.50 |
| Family | $383.20 |
Premiums shown are for FTE 0.5 to 1.0.
| Covered | Basic | Enhanced |
|---|---|---|
| Employee | $2.62 | $5.77 |
| Employee and children | $11.01 | $21.99 |
| Employee and spouse | $11.01 | $21.99 |
| Family | $20.96 | $41.39 |
These tables summarize the costs associated with each medical plan. "Single" = Employee only coverage. "Family" = all other coverage levels.
| Plan features | Preferred providers | ElevateHealth network |
|---|---|---|
| Deductible | Single: $1,500 Family: $3,000 | Single: $1,500 Family: $3,000 |
| Co-insurance | 10% after deductible | 30% after deductible |
| Preventive care | Covered 100% | Covered 100% |
| Out-of-pocket maximum | Single: $2,400 Family: $4,800 (Includes RX drugs) | |
| Employer annual HSA or HRA contribution | Employees earning less than $150,000 that are enrolled in, and eligible for, the HSA or HRA will receive an employer contribution. The contribution amount is based on your salary tier and HSA or HRA effective date. | |
| Plan features | Preferred providers | ElevateHealth network |
|---|---|---|
| Deductible | Single: $1,500 Family: $3,000 | Single: $1,500 Family: $3,000 |
| Co-insurance | 10% after deductible | 30% after deductible |
| Preventive care | Covered 100% | Covered 100% |
| Out-of-pocket maximum | Single: $2,400 Family: $4,800 (Includes RX drugs) | |
| Employer annual HSA or HRA contribution | Employees earning less than $150,000 that are enrolled in, and eligible for, the HSA or HRA will receive an employer contribution. The contribution amount is based on your salary tier and HSA or HRA effective date. | |
| Plan features | In-network | Out-of-network |
|---|---|---|
| Deductible | Single: $2,000 Family: $4,000 | Single: $4,000 Family: $8,000 |
| Co-insurance | 30% after deductible | 50% after deductible |
| Preventive care | Covered 100% | 50% after deductible |
| Out-of-pocket maximum | Single: $3,400 Family: $6,800 (Includes RX drugs) | Single: $5,600 Family: $11,200 (Includes RX drugs) |
| Employer annual HSA or HRA contribution | Employees earning less than $150,000 that are enrolled in, and eligible for, the HSA or HRA will receive an employer contribution. The contribution amount is based on your salary tier and HSA or HRA effective date. | |
These tables show the costs, deductibles and relevant pharmacy location information for pharmacy benefits. "Single" = Employee-only coverage. "Family" = all other coverage levels.
We offer vision coverage for eyewear through DeltaVision. DeltaVision is supported by the EyeMed Vision Care network, with over 88,000 providers at over 27,000 locations nationwide, including private practitioners and the most popular optical retail outlets. You can search for providers at EyeMed. (On the Find an eye doctor page, choose Access Network in the Network box.)
Our medical plan continues to cover your routine eye exams under preventive services, and the DeltaVision plan can be used to cover your frames and lenses, as well as eye exams if you are not enrolled in the medical plan. The plan provides the following in-network benefits:
| Members | Cost |
|---|---|
| Employee only | $2.39 |
| Employee and children | $4.52 |
| Employee and spouse | $4.66 |
| Family | $7.05 |
We offer 2 dental options for you and your eligible dependents through Northeast Delta Dental.
| Plan features | Basic | Enhanced |
|---|---|---|
| Deductible | Single: $50 Family: $150 | Single: $25 Family: $75 |
| Preventive care | 100%, no deductible (2 annual cleanings) | 100%, no deductible (2 annual cleanings) |
| Basic restorative care: Fillings, extractions, root canals | Plan pays 50%, after deductible | Plan pays 80%, after deductible |
| Major restorative care: crowns, dentures, bridges | Plan pays 50%, after deductible | Plan pays 50%, after deductible |
| Orthodontia | Plan pays 50%, no deductible, lifetime maximum benefit of $2,000 per covered member | Plan pays 50%, no deductible, lifetime maximum benefit of $2,000 per covered member |
| Annual maximum benefit | $1,000 per covered member | $1,500 per covered member |
We offer reimbursement accounts to help employees cover health care costs.
The HCRA is a pre-tax savings account available to employees who waive health care coverage or enroll in the ElevateHealth HRA plan. The HCRA can be used to pay for eligible health care, dental, or vision care expenses that are not covered by insurance, for you and your eligible dependents. The maximum amount you may contribute to your HCRA is $2,850 each calendar year. Once you sign up for the HCRA, you will receive a personalized debit card from HealthEquity to use when paying for your eligible health care expenses.
Note: You may not use your HSA, HRA, or HCRA to pay for, or be reimbursed for, over-the-counter medications unless prescribed by a provider.
The DCRA is a pre-tax savings account that may be used to pay for eligible elder and child care expenses. You may only use this account if you utilize day care or elder care services so that you and your spouse can work, obtain gainful employment, or attend school full time. It is important to note that your day care or elder care provider must furnish you with his/her Social Security Number (SSN) or Tax Identification Number (TIN) in order to receive reimbursement for your expenses. IRS regulations limit the amount you may contribute to any DCRA to $5,000 for your family (or $2,500 if married and filing separate tax returns) per calendar year.
In order to qualify for reimbursement, expenses must be incurred for the care of “eligible dependents,” who the IRS defines as:
Note: You can only participate in the DCRA if you earn less than the highly compensated limits. For the 2023 plan year, an employee who earns more than $135,000 is considered a highly compensated employee.