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Your medical options also provide comprehensive coverage for prescription drugs. The cost of your prescription will differ based upon whether it is a generic, preferred, non-preferred brand, or specialty.
Whenever possible, consider using a generic medication. With generics, you will save money on your cost of the prescription.
Mail Order Program
For medications you use on a day-to-day basis, you may wish to use the mail order option with Express Scripts, Inc. (ESI) to receive up to a 90-day supply (vs the typical 30-day supply at retail). Some examples of day-to-day prescriptions include those you or your covered dependent may take for high blood pressure, high cholesterol, or diabetes.
You will pay more for long-term drugs unless prescriptions are ordered through the mail using the Express Scripts Pharmacy. After you refill a prescription two times, your third fill will need to go to ESI mail order--otherwise you will pay 15% more coinsurance if you continue to purchase specific long-term drugs at retail. This program applies to a specific list of drugs. You should either check express-scripts.com or call Customer Service at (877) 554-3093 to verify the status of your drug. The specific list of drugs can also be found on the Company website.
• Mail your prescription, order form, and payment in the mail order envelope (available from Customer Service), or ask your doctor to fax your prescription by calling 1-888-327-9791 for instructions.
• Automatic refills: Call the phone number on your Rx bottle or go to express-scripts.com > ESI username / password sign-in or register now as first-time user >Prescriptions > Automatic Refills > start Automatic Refills.
2023 PLAN DESIGN In-Network
(You Pay) Out-of-Network
(You Pay) In-Network
(You Pay) Out-of-Network
(You Pay)
Employer-Funded HSA
Benefit Reimbursement Schedule Based upon Aetna Contracted Fee N/A
Based upon 70th percentile of Fair Health. Potential balance billing may apply. $500 per single/ $1,000 per family 2
Based upon Aetna Contracted Fee
Based upon 70th percentile of Fair Health. Potential balance billing may apply.
Calendar Year Deductible (Employee/Family) Non-Embedded 1 Non-Embedded 1 $1,500 / $3,000 $4,000 / $8,000 $2,750 / $5,500 $6,000 / $12,000
Calendar-Year Out-of-Pocket Maximum (Employee/Family) Non-Embedded 1 Non-Embedded 1
$4,500 / $7,000 $8,000 / $16,000 $6,650 / $7,350 $8,000 / $16,000
Coinsurance Levels (You Pay) Preventive Services
Physician Office Visit
Specialist Office Visit
Inpatient Hospital Outpatient Hospital
Emergency Care
RX PLAN
Calendar Year Deductible
Calendar-Year Out-of-Pocket Maximum (Employee/Family) Retail Pharmacy 3 • Generic • Formulary Brand-Name (Preferred) • Non-Formulary Brand-Name (Nonpreferred) • Specialty Mandatory Mail Order Pharmacy • Generic • Formulary Brand-Name (Preferred) • Non-Formulary Brand-Name (Nonpreferred) • Specialty
VISION PLAN
Exam (1x every 12 months)
Lenses & Frames including contacts (1x every 24 months) 20% after deductible 40% after deductible 20% after deductible 40% after deductible
No Charge 40% after deductible No Charge
40% after deductible 20% (Deductible waived) 40% after deductible 20% after deductible 40% after deductible 20% (Deductible waived) 40% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after deductible 40% after deductible 20% after $200 copay for true emergencies (Deductible waived)
IN-NETWORK ONLY - EXPRESS SCRIPTS
$200 per family 20% after deductible for true emergencies
IN-NETWORK ONLY - EXPRESS SCRIPTS The medical/rx deductible does not apply to prescription drugs that are used for preventive care. 3
Included in Medical OOP Included in Medical OOP
$10.00 minimum copay 25% after deductible 35% after deductible 45% after deductible 25% after deductible 35% after deductible 45% after deductible
50% after deductible $10.00 minimum copay 25% after deductible 35% after deductible 45% after deductible 50% after deductible
25% after deductible 35% after deductible 45% after deductible
50% after deductible Meritain
In-Network Out-of-Network
100% no deductible or copay (covered under medical plan) Subject to Plan deductible and coinsurance (covered under medical plan) 50% after deductible
Meritain
In-Network Out-of-Network
100% no deductible or copay (covered under medical plan) Subject to Plan deductible and coinsurance (covered under medical plan)
Plan pays up to $100 Plan pays up to $100 Plan pays up to $100 Plan pays up to $100
1 Please see page 10 for “What is a Non-Embedded Deductible and Out-of-Pocket Maximum?” 2 New hire employer-funded HSA amounts are prorated based upon the month benefits begin. If you are enrolled in Medicare Part A, your employer funded contribution will be provided to you through a healthcare FSA 3 Copy of full preventive list can be found on Benefits.HonGrp.com (password: Benefits) or by calling ESI at 1-877-554-3093 4 Additional 15% coinsurance copay penalty applies on the 3rd fill of a maintenance drug at retail pharmacy covered under the Exclusive Mail Order Program
WEEKLY CONTRIBUTIONS (BEFORE WELLNESS INCENTIVES)
ANNUAL SALARY RANGE
Employee
Employee + Child(ren)
Employee + Spouse
Plan A (POS II) Plan B (HSA)
Up to $49,999 $50,000 - $74,999 $75,000 - $149,999 $150,000 + Up to $49,999 $50,000 - $74,999 $75,000 - $149,999 $150,000 +
$31.63 $42.56 $51.69 $62.57 $20.56 $27.16 $32.85 $39.63
$40.41 $57.95 $71.29 $86.30 $24.12 $35.86 $41.76 $50.37
$60.84 $86.85 $105.87 $128.13 $35.44 $51.85 $63.67 $76.80
Your points-based wellness program will continue to be available through Virgin Pulse. All Non-Union employees (medicalenrolled and those not enrolled in the Honickman medical plan) and medical-enrolled spouses can participate. The Honickman Total Wellness program provides many resources to support your physical, social, emotional, and financial wellbeing, including an engaging app, interactive challenges, fitness device integration, online and telephonic health coaching, health and wellness tips and content, mindfulness, resiliency and financial well-being resources and more!
Don’t Miss Out — Earn Your 2024 Wellness Credit & Rewards!
Medical-enrolled employees may earn up to $520 total, up to $130 per quarter, towards the Honickman 2024 Wellness Incentive. The Honickman Total Wellness Program includes four quarterly games in 2023. Employees must earn at least 15,000 points in each quarter to reach Level 4 to earn $130 for that quarter ($520 total, if at least 15,000 points are earned each of the four quarters). Medical-enrolled spouses may also participate and can earn up to $130 per quarter when they earn 15,000 points and reach Level 4 (up to $520 total). The incentive will be applied as a wellness credit to your paycheck starting January 2024. As an alternative option, you can earn the full incentive ($520 employee, $520 spouse) if you (and spouse) each earn at least 60,000 points total in 2023 by December 31, 2023.
Earning points on the Virgin Pulse platform is easy! We encourage you to access Virgin Pulse daily -- the more you log in, the easier it is to earn points geared to your specific health and well-being interests. Here are just some ways you can earn your points:
Activity Complete the Health Check survey Well Adult Office Visit Create a personal challenge Join a personal challenge Complete a Journey (up to 3; 150 Points each) Complete a Biometric Screening Track your Healthy Habits Track your Healthy Habits 20 days in a month Do your Daily Card Complete 10 cards in a month Complete a RethinkCare program (50 Points/week) Steps & Activity (up to 140 Points/day) 20-Day Triple Tracker: Reach 7,000 steps/15 active minutes/15 workout minutes Participate in a Company-wide Challenge
Frequency One-time in 2023 Annually Monthly Monthly Quarterly One-time in 2023 Daily Monthly Daily Monthly Weekly Daily
Monthly
Offered quarterly Total Points Per Quarter 500 250 150 300 450 1,000 2,700 900 3,600 300 600 12,600
1,200
50-850+ (based on participation)
Employees not enrolled in the Honickman medical plan are also eligible to earn raffle prizes.
On the Virgin Pulse platform, refer to the Rewards section for details.
SPECIAL CONSIDERATIONS FOR RECENT HIRES
If your date of hire is between July 1, 2023 - December 31, 2023, you will automatically receive the 2024 wellness incentive*. If your spouse is also covered on the medical plan, you will automatically receive the spousal credit.* It’s that simple.
*The 2024 wellness premium credit will be applied in January 2024 or on your date of benefits eligibility, if later.
Sign up now at join.virginpulse. com/honickmantotalwellness
Already a member? Sign in at member.virginpulse.com/ honickmantotalwellness
Engage In Some Healthy Competition
Rally your coworkers for the latest company step challenge! Or gather a small group of Rally your coworkers for the latest company step coworkers or friends, and challenge one another to start a new healthy habit.challenge! Or gather a small group of coworkers or friends, and challenge one another to start a new healthy habit.
• Company challenges: Stay tuned for company-wide challenges where you can go head-
Company challenges
Stay tuned for company-wide challenges where you can go head-to-head with friends and rivals across your organization. Post comments to cheer each other on.
• Healthy Habit Challenges: Challenge your coworkers and friends to track a healthy
Healthy Habit Challenges
Challenge your coworkers and friends to track a healthy habit for 5 out of 7 days. Use the chat feature to share your strategy for achieving the healthy habit each day.
• Personal Step Challenges: Challenge your coworkers and friends to a step-off. You
Personal Step Challenges
Challenge your coworkers and friends to a step-off. You choose the type (1 day, weekday or weekend) and then invite your coworkers and friends. Use the chat feature to share your strategy and motivation.
Have you ordered your FREE fitness device yet?
Every Non-Union employee and medical-enrolled spouse who joins Honickman as a new hire in 2023 can receive a Max Buzz fitness
device at no cost to you or may choose to redeem their Pulse Cash for another item* in the Virgin Pulse store! Once registered for Virgin Pulse, go to the online store to redeem your Pulse Cash.
You can also connect other compatible devices and apps to the Virgin Pulse platform for free to track your daily steps. On the Virgin Pulse platform, go to the Devices & Apps section to review your options.
Have questions? Virgin Pulse is here to help!
Check out support.virginpulse.com
Live chat on member.virginpulse.com Monday–Friday, 2:00 am–9:00 pm EST
Give Virgin Pulse a call: 888-671-9395 Monday–Friday, 8:00 am–9:00 pm EST
*Note: Member will be required to pay any difference in the cost of the item selected via credit card.
Send Virgin Pulse an email: support@ virginpulse.com
Not sure if you can fully participate in this program because of a disability or medical condition? Check out the support page for answers at support.virginpulse.com.
