Learn about the plan | Premera Blue Cross

Learn about the plan

Making health care work better

The Health Connect Plan, offered through Premera, provides personalized, coordinated care and cost predictability to help simplify managing your health.

The Health Connect network

The Health Connect Plan is built around a select group of providers on the Eastside, primarily located in Redmond/Bellevue/Kirkland and other areas on the east side of Lake Washington. Health Connect Plan providers share Microsoft’s goal of delivering a more personalized health care experience in an effort to help you achieve improved health outcomes over time. Since Health Connect network providers are primarily concentrated on the Eastside, the Plan is only offered to employees who live in King and Snohomish counties.

A personalized and coordinated approach to your health care

In the Health Connect Plan, you are encouraged to work closely with a Health Connect network primary care provider (PCP) of your choice. Your PCP gets to know your health care needs and goals and helps coordinate your care. Learn more about PCPs

Predictable out-of-pocket costs when you see Health Connect network providers

You pay a convenient copay for many basic services, such as office visits and prescription medications, making your out-of-pocket costs predictable. When you see a provider in the Health Connect network, your out-of-pocket costs for other services, like lab work and inpatient care, are also lower. Plus, you do not have to pay an annual deductible.

The flexibility of no referrals

Even though you have a PCP, and one benefit of this plan is to coordinate care through your PCP, you still have the freedom to see any provider, including specialists, in the Health Connect network without a referral. You can also see any provider in the Extended network, but your out-of-pocket costs will be higher.

Less administrative work to save you time

When you see Health Connect network providers, there may be fewer claims to review or bills to reconcile because you pay copays for many services. Copays are typically due at the time of service, so there is no need to send you another bill after your service.

Maternity Bundle

We’ve simplified the paperwork for maternity care with the Maternity Bundle. You will pay a single $500 copay for your routine maternity care, including professional prenatal and delivery care. This benefit is available to employees, their enrolled spouses/domestic partners, and eligible dependent children. In addition, the Health Connect Plan offers a $1,000 allowance, per pregnancy, for doula services. More information is on the FAQ.

A dedicated service center for all your questions

Call 800-676-1411 and select Health Connect Navigator for personalized service, such as help with finding providers, answering plan questions, making appointments, and much more.

How you pay for care

Your out-of-pocket costs depend on the type of provider you use and whether that provider is in the Health Connect network. Your out-of-pocket costs are lower and more predictable when you see a Health Connect network provider. If you see providers in the Extended network, you are still covered by the Plan, but your out-of-pocket costs may be higher.

There are certain types of services, such as chiropractic and acupuncture, where your costs are the same whether you see a provider in the Health Connect or Extended network. This gives you access to a wide range of these providers.

Access the Provider Finder tool for a complete list of providers. For more information about plan benefits, see Health Connect Plan at a glance below.

Costs based on network

You pay nothing for these services:

Preventive care
Preventive prescription medications (generic)
Routine vision exam
Vision hardware (Under age 19: one pair of glasses or one year of contacts; age 19+: up to $350 per calendar year)

You only pay a copay for many common services, including:

Office visits for PCPs and specialists, including chiropractors, acupuncturists, and massage therapists
Non-preventive prescription medications
Urgent care visits
Emergency room visits
Mental health and chemical dependency outpatient visits
Physical, occupational, and speech therapy
Telehealth
Maternity
Nutrition therapy
Hearing exams
Vision therapy

For most other services you pay 10% coinsurance and Premera covers the rest:

Hospital inpatient care
Hospital outpatient care/ASC (surgery)
Diagnostic testing such as lab tests and X-rays

Remember: If you use Health Connect network providers, you don't have to pay an annual deductible.

You pay nothing for these services:

Preventive care
Preventive prescription medications (generic)
Routine vision exam
Vision hardware ( < age 19: one pair of glasses or one year of contacts; age 19+: up to $350 per calendar year)

40% coinsurance after you meet your annual deductible for most services such as:

Office visits for PCPs and specialists
Hospital stays

Copays for certain services, including:

Emergency room visits
Mental health and chemical dependency outpatient visits

Note: Certain services are covered at the Health Connect network level even when you visit an Extended network provider, which means lower out-of-pocket costs for you. Examples include:

Applied Behavior Analysis (ABA)
Audiology
Chiropractic, acupuncture, and massage therapy
Diagnostic services such as lab tests and X-rays
Durable medical equipment
Hearing aids
Mental health and chemical dependency treatment
Naturopathic care
Optometry
Physical, occupational, and speech therapy
Nutritional therapy

You pay the annual deductible and then 50% of the allowable charges for most out-of-network services. Out-of-network providers may not accept the allowable charge as payment in full. You are responsible for paying the difference between the allowable charge and the amount your out-of-network provider charges.

Health Connect Plan at a glance

The table below provides an overview of the Health Connect Plan benefits. For more information, check the Summary Plan Description.

Feature	Health Connect network	Extended network	Out-of-network
Annual deductible Annual deductible When you see providers in the Extended network, each dependent only needs to meet the individual deductible before the Plan starts paying coinsurance for that family member. And, once you meet the family deductible, the Plan pays coinsurance for the whole family, even those who haven't met their individual deductible, up to the out-of-pocket maximum. Your out-of-pocket maximum works in the same way: each family member can reach their individual out-of-pocket max, and you can reach the family out-of-pocket max without reaching each individual's out-of-pocket max. Once you reach your out-of-pocket max, the Plan pays for the full cost of care.	None	$1,000 per person; $3,000 per family, shared with Out-of-network	$1,000 per person; $3,000 per family, shared with Extended network
Copayments	$20 PCP visit; $40 specialist/other office visit	Not applicable	Not applicable
Annual out-of-pocket maximum	$2,000 per person; $6,000 family
Amount plan pays for covered services
Ambulance	90%	90%, deductible does not apply	90%, deductible does not apply
Autism/ABA therapy	90%	90%, deductible does not apply	50% of allowable charges, after deductible
Chiropractic, massage, and acupuncture services (when medically necessary)	100% after $40 copay; deductible does not apply		50% of allowable charges, after deductible
	Combined 24-visit limit per year for Health Connect, Extended, and Out-of-network
Contraception	100%	100%, deductible does not apply	50% of allowable charges, after deductible
Diabetes health education	100%	100%, deductible does not apply	50% of allowable charges, after deductible
Emergency room care & professional services	100% after $250 copay (waived if admitted)
Home health care	90%	60% after deductible	50% of allowable charges, after deductible
Hospice care	90%	60% after deductible	50% after deductible
Hospital inpatient and outpatient	90%	60% after deductible	50% of allowable charges, after deductible
Infertility	90% of covered benefits, within the Progyny provider network	Not applicable	Not applicable
Lab tests and X-rays	90%	90%, deductible does not apply	50% of allowable charges, after deductible
Maternity care	90%	60% after deductible	50% of allowable charges, after deductible
Maternity care bundle (Routine pregnancy and delivery care received within the Health Connect network)	$500 copay	Not applicable	Not applicable
Doula services	Maximum benefit of $1,000 per pregnancy
Medical equipment and supplies	90%	90%, deductible does not apply	50% of allowable charges, after deductible
Mental health, attention deficit disorder, and substance use disorder treatment *In no event will the outpatient copay exceed 40% of the allowed amount.	Inpatient: 90% Outpatient: 100% after $20 copay per visit	Inpatient: 90%, deductible does not apply Outpatient: 100% after $20 copay* per visit, deductible does not apply	Inpatient: 90% of allowable charges, deductible does not apply Outpatient: 90% of allowable charges, deductible does not apply
Office visit	PCP visit: 100% after $20 copay Specialist/other office visit: 100% after $40 copay	Office visit: 60% after deductible Specialist/other office visit: 60% after deductible	Office visit: 50% of allowable charges, after deductible Specialist/other office visit: 50% of allowable charges, after deductible
Prescription drugs—Retail	Generic maintenance: 100% after $10 copay; deductible does not apply Generic (all other): 100% after $20 copay; deductible does not apply Brand preferred: 100% after $30 copay, deductible does not apply Brand non-preferred: 100% after $60 copay, deductible does not apply Check the Health Connect Plan drug formulary		Generic: 50% of allowable charges, deductible does not apply Brand preferred: 50% of allowable charges, deductible does not apply Brand non-preferred: 50% of allowable charges, deductible does not apply
Prescription drugs—Mail order (90-day supply)	Generic: 100% after $20 copay, deductible does not apply Brand preferred: 100% after $60 copay, deductible does not apply Brand non-preferred: 100% after $120 copay, deductible does not apply Check the Health Connect Plan drug formulary		Not covered
Preventive care	Preventive services: 100%, deductible does not apply Preventive generic prescription drugs: 100%, deductible does not apply Check the preventive care services list Check the preventive drug list		Preventive services: 50% of allowable charges, after deductible Preventive generic prescription drugs: 50% of allowable charges, deductible does not apply
Routine hearing exam and hardware	Exam: 100% after $40 copay	Exam: 100% after $40 copay	Exam: 50% of allowable charges, after deductible
Routine hearing exam and hardware	Hardware: 90% up to $10,000 maximum benefit per member in a period of three consecutive calendar years
Skilled nursing facility (120-day maximum per calendar year)	90%	60% after deductible	50% of allowable charges, after deductible
Urgent care	100% after $40 copay	60% after deductible	50% of allowable charges, after deductible
Virtual care	Mental health and substance use disorder treatment: 100% Other services: 100%	Mental health and substance use disorder treatment: 100% Other services: 60% after deductible	Mental health and substance use disorder treatment: 100% of allowable charges, deductible does not apply Other services: 50% of allowable charges, after deductible
Vision care	Exam: 100%, deductible does not apply for 1 routine visit per calendar year		Exam: 50% of allowable charges, after deductible for 1 routine visit per calendar year
	Vision hardware: Under age 19 – 1 pair of glasses or one-year supply of contacts; Age 19 and up – $350 maximum per calendar year
	Lasik: $1,000 lifetime benefit maximum		Not applicable

New to Microsoft? Compare medical plans

Microsoft provides three industry leading medical plan options for Puget Sound employees:

Health Connect Plan

This plan is designed to provide a personalized health care experience with access to a select group of providers who coordinate your care for you and the added bonus of predictable costs. This plan may be ideal for Microsoft members whose providers are primarily based in Bellevue, Redmond, and Kirkland.

Health Savings Plan

This plan is all about flexibility. It has a broad, nationwide network of providers and a Health Savings Account (HSA) with free money from Microsoft to help you save tax-free for future health care expenses.

Health Maintenance Organization (HMO) Plan

This plan simplifies the health care experience with one place to go for all of your needs, making it easy to coordinate your care.

Here are some tools to help you decide if the Health Connect Plan is right for you.

Determine if the Health Connect Plan meets your needs

What are your priorities when choosing a medical plan?

You can continue to see your current providers.
Your out-of-pocket costs are as predictable as possible, including prescription medications.
You have a complex health issue and want to make managing it as easy as possible.
You have covered family members who live outside the Puget Sound area that need access to care.
Others?

See how the Health Connect Plan might work for you based on your priorities.

Compare plan benefits

Although the plans all provide comprehensive coverage, the plans work differently and the amount you pay out-of-pocket for the same covered services may vary. Learn more about the key features and important differences between plans before deciding which plan is right for you.

See a detailed plan comparison or watch a video.

	Health Connect Plan	Health Savings Plan	Health Maintenance Organization (HMO) Plan
Plan type	Accountable Care Organization	High-Deductible Health Plan with a Health Savings Account	Health Maintenance Organization
Availability	Residents in Washington’s King and Snohomish counties	Residents in all states	Residents in Washington and California
Getting care	Work closely with the primary care provider (PCP) of your choice who gets to know you and your health needs and goals and helps coordinate your care with other providers Referrals are not required to see a provider, but you will pay less out-of-pocket if you see a provider in the Health Connect network Most services provided outside the Health Connect and Extended networks are covered at 50% of the allowable charges after the deductible.	Choose any provider you like, but you typically pay less when you use a provider in the Premera Blue Cross network You are generally responsible for coordinating your health care needs	You and your primary care provider coordinate your care with other providers within the Kaiser Foundation Health Plan of Washington network Generally, you can self-refer for specialty care within the Kaiser network In most cases, services provided outside the Kaiser network are not covered, with the exception of emergency care
Getting care	Includes coverage for prescription medications and vision
Preventive care	100% covered
Out-of-pocket costs	No premiums, no payroll deductions for employees and eligible dependents
Out-of-pocket costs	Health Connect Network: Copays for many common health care services, such as office visits and prescription medications, except for preventive care (covered at 100%) No deductible and limited coinsurance The maximum out-of-pocket cost per year is $2,000 individual and $6,000 family (including out-of-pocket costs incurred under the Extended network). Extended network: A deductible Deductible When you see providers in the Extended network, each dependent only needs to meet the individual deductible before the Plan starts paying coinsurance for that family member. And, once you meet the family deductible, the Plan pays coinsurance for the whole family, even those who haven’t met their individual deductible, up to the out-of-pocket maximum. Your out-of-pocket maximum works in the same way: each family member can reach their individual out-of-pocket max, and you can reach the family out-of-pocket max without reaching each individual’s out-of-pocket max. Once you reach your out-of-pocket max, the Plan pays for the full cost of care. applies before the plan begins to pay for most services, except preventive care (covered at 100%) The maximum out-of-pocket cost per year is $2,000 individual and $6,000 family* (including out-of-pocket costs incurred under the Health Connect network)	A deductible Deductible Individual (Subscriber-Only) Deductible The “Individual Deductible” is a fixed amount the subscriber must incur and satisfy before benefits of this plan are provided. Family Deductible The “Family Deductible” is the amount the entire family (subscriber plus one or more enrolled dependents) must incur and meet in total each calendar year before benefits are provided. The family deductible is an “aggregate” amount, meaning that it can be met by one family member, or all family members in combination. Benefits are not provided for any family member until the total family deductible has been reached. ($1,750-$4,375) applies before the plan begins to pay for services, except for preventive care (covered at 100%) The maximum out-of-pocket cost per year is $2,750 individual and $6,875 family. The Microsoft contribution (and any additional employee contributions) to your HSA may be used toward at least a portion of these expenses.	Copays for most outpatient services except for preventive care (covered at 100%) No deductible and limited coinsurance The maximum cost per year is $1,500–$4,500*
Provider network	Health Connect Network: Eastside Health Network EvergreenHealth Overlake Medical Center & Clinics Independent physician practices Allegro Pediatrics Living Well Health Center (Redmond campus) Extended network: Premera Blue Cross (nationwide)	Premera Blue Cross (nationwide), including Eastside Health Network, Allegro Pediatrics, and broader Blue Cross and Blue Shield Living Well Health Center (Redmond campus)	Kaiser Permanente (Washington, and during travel to other Kaiser Permanente states) Living Well Health Center (Redmond campus) Allegro Pediatrics
Cash from Microsoft	None	Microsoft contributes tax-free money to an HSA: $1,000-$2,500* for employees in levels 40-49 and 59 and above roles†	None
Tax-free savings opportunities for health care	Flexible Spending Account	Health Savings Account Dental & Vision Flexible Spending Account	Flexible Spending Account

*Based on coverage tier

†For employees in levels 30-39 and 50-58 roles, the Microsoft HSA contribution is $1,500-$3,750.

Review your Summary Plan Description (SPD) to better understand benefit coverage and eligibility requirements. You can find The SPD by visiting aka.ms/benefits and clicking Guide to Benefits, and then Summary Plan Description.

Explore which plan someone with similar health care priorities might choose

Sometimes it helps to see which plan others with similar life or health situations might choose. Click on the scenario that is most relevant to you to see additional considerations for choosing a medical plan.

Balancing family needs

Managing the health care needs of your family can be complex. Find out which plan can help simplify your health care experience.

Balancing needs

New to U.S. health care

Find out which plan can help ease the burden of learning a new health care system.

New to U.S. health care

Managing a complex or chronic health condition

Learn which plan can help you manage multiple health care providers and unpredictable out-of-pocket costs.

Complex health care needs

Low health care needs

Learn what you should consider, even if you don't use much health care right now.

Fewer health care needs

Get answers to your questions

Check the FAQs for answers to common questions. For personalized service, call the Microsoft-dedicated customer service team at (800) 676-1411 (TTY: 711), 5:00 a.m. to 8:00 p.m. Pacific Time, Monday through Friday, or email Microsoft@premera.com.

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