medical

two plans - because one size doesn’t fit all

You have two medical plans to choose from: the PPO plan and the CDHP plan. Coverage under each plan is the same; you simply decide if you want to pay a monthly premium and low co-pays, deductibles, and out-of-pocket expenses OR if you prefer paying a $20 monthly premium and higher deductibles and out-of-pocket expenses when you access health care.

The CDHP plan comes with an employer contribution into your HRA VEBA account to help offset your deductible. Prescription coverage is included in your medical plan. As a self-insured medical plan, you will have access to Premera’s extensive network of doctors.

Monthly Premium

compare plans

Enrollment

who can enroll?

You - if you are a regular and active employee and you work a minimum of 30 hours per week or 130 hours per month. If it’s unclear how many hours you will be working per week at the time of hire, you may qualify later. Find out if you can enroll here.

If you qualify for medical insurance coverage, you will have to enroll in one of the two medical plans.

Your family - your spouse or qualified domestic partner, your dependent children up to age 26 or longer if your child is disabled. Learn more about who can enroll here.

changing medical plans later?

You can make a change during the annual open enrollment (typically October/November) or if you experience a “qualifying event” (marriage, divorce, new child, or if your spouse/children experience a loss of other coverage). For additional information, visit the “Life Happens” web page from your home page.

Are you going through a divorce or legal separation? Please let us know as soon as the divorce or legal separation is final (no later than 30 days of your divorce or legal separation date). Your ex-spouse cannot be covered under our plan after the last day of the month in which your separation is legal or your divorce is finalized. If we don’t hear from you, you may become responsible for your ex-spouse’s health care claims.

HRA VEBA contributions - cdhp plan

Your utility will make a contribution to your HRA VEBA account to help offset the CDHP plan deductible. The annual contribution amount depends on the number of dependents you enroll:

Employee Only: $500 Employee & Spouse: $1,000
Employee & Child(ren): $750 Employee & Family: $1,250

To learn more about HRA VEBA, visit the “HRA VEBA” web page from your home page.

Sign me up!

Visit your home page and navigate to “Forms” to get enrolled.

using your benefit

when does my benefit kick in?

You can access care from the first day you start work or when you first become eligible for coverage.

Where do I go for care?

Premera offers an extensive network of providers. Any doctors that are part of Premera’s Heritage & Heritage Plus 1 network are considered in-network providers. Visit Premera’s website to find a doctor. TIP: Health care costs vary depending were you go for care. Find out how you can get appropriate care and save money.

I have more questions - where do I find the answers?

Healthcare can be complicated. The plan comparison provides you with a quick side by side comparison of the two medical plans. You may find your answers there. If not, take a look at the Summery Plan Description or contact your friendly HR staff.

Prescription drug coverage

Prescription drugs are covered through your medical plan. If you are enrolled in the PPO plan, you pay a $10 - $50 copay depending on the drug tier. If you are enrolled in the CDHP plan, deductible and co-insurance applies (shared with medical deductible and co-insurance). Some medication is covered under the preventive benefit (see PREVENTION).

Tip: Get your medication delivered to your door by using the mail-order option through Express Scripts Pharmacy. You will get a 90 day supply at a lower out-of-pocket cost than an equal supply at a retail pharmacy. Learn more here.

Telehealth

Access to Care 24/7

Sometimes you can’t or don’t want to leave the house to go to the doctor. Virtual care provides you with access to care via phone, text, or video-chat - 24/7 at no or low cost to you and your covered family members. From general health, dermatology, to behavioral health and addiction treatment, these virtual care providers are ready when you need them:

24-Hour NurseLine - call 800.841.8343 — FREE
Doctor on Demand (general medical, dermatology, behavioral health) — $10 copay
98.6 (general medical health) — $10 copay
Talkspace (behavioral health) — $10 copay
Boulder Care (addiction treatment) — $10 copay

$10 copay applies to both medical plans (PPO and CDHP plan)!

TIP: Sign up before you need it! That way you are ready to go when you are feeling unwell.

Your doctor may also provide telehealth medical consultations. Check with your doctor to find out. Virtual visits with your provider are covered the same as an office visit.

premera’s Video series:

crunch the numbers!

The health care cost calculator allows you to estimate your out-of-pocket costs that you may experience in a calendar year. Go ahead and play with it. Plug in your “normal” utilization, estimate a best case and worst case scenario, and find out which plan works best for you.

DOWNLOAD 2024 Health care Cost Calculator

prevention

Getting timely preventive care is one way to detect potential health issues before they become serious. Preventive care is covered in full regardless if you are enrolled in the PPO plan or CDHP plan. Preventive care includes screenings, tests, medication, and supplements. Take a look at the list of preventive care to find out what is covered in full.

If you are enrolled in the CDHP plan, you can also fill prescriptions from the PV Core Plus drug list for free!

Schedule your preventive visit
with your doctor today!

CENTERS OF EXCELLENCE

Premera's Designated Centers of Excellence or COEs are hospitals that meet high quality standards, have highly skilled healthcare providers, use advanced technologies and treatments, provide excellent patient experience, and have great surgical outcomes. Basically, they are best at what they do. Your out-of-pocket costs are significantly less if you receive care at a COE, plus you can receive a travel benefit if the nearest COE is 50+ miles away from your home.

Learn more

MENTAL HEALTH RESOURCES

KNOWING WHERE TO TURN TO,
WHEN LIFE COMES AT YOUR SIDEWAYS ….

You and your covered dependents have access to numerous resources connecting you with mental health professionals. You can go see someone in person, call, video chat, text … whatever works best for you and your family!

Learn more