Retirees: 2019 Medical Plus Plan

  • The Medical Plus Plan is a preferred provider organization (PPO) plan that provides protection against major health care costs and provides full preventive care benefits. It has a higher deductible than traditional medical plans but offers you an opportunity to contribute to a health savings account (HSA). The HSA allows you to save tax-deductible money in a special bank account to help you pay eligible out-of-pocket health care expenses. Funds in your HSA continue from one year to another.

  • Deductible

    $1,350 You

    $2,700 You + 1*

    $3,350 You + 2 or more**

    Out-of-Pocket Maximum

    (in-network services)

    $3,425 You

    $6,850 You + 1*

    $7,500 You + 2 or more**

    * Individual + 1 - the aggregate deductible and aggregate out-of-pocket maximum will apply. This means that any combination of family members' expenses can satisfy the aggregate deductible and out-of-pocket maximum.
    ** Individual + 2 or more - the aggregate deductible will apply. This means that any combination of family members' expenses can satisfy the aggregate deductible. The out-of-pocket maximum for any individual each year is $6,850. Once an individual has reached this amount, the out-of-pocket max will be considered met for that individual. The balance of the family deductible must be reached by other covered family members for the out-of-pocket max to be considered met for all enrolled family members

    Preventive Care

    Preventive Care Guidelines

    Routine physical exams, well-child visits and sports physicals

    In-network: Covered in full

    Out-of-network: Deductible then 35%

    Preventive Screenings

    Cancer screenings: mammograms, PAP smears, colonoscopies, prostate PSA screenings and more

    General blood tests: cholesterol, triglycerides, thyroid and more

    Other: bone density studies, type 2 diabetes and sexual health screenings

    In-network: Covered in full

    Out-of-network: Deductible then 35%

    Medical Office Visits

    In-network: Deductible, then 15%

    Out-of-network: Deductible, then 35%

    In-network Pharmacy

    Medical Plan deductible applies

    Retail pharmacy, specialty drugs and mail-service:

    15% after medical deductible.

    Certain preventive generic prescription drugs for the prevention or recurrence of heart disease are covered in full and not subject to the annual deductible. These include medications for high cholesterol, high blood pressure and cholesterol, high blood pressure and diabetes.

    Emergency Room Care

    Deductible, then 15%

    Note: Emergency room care is always covered at the highest benefit level, regardless of whether or not the hospital is part of the BlueCard PPO network. However, if you receive emergency care at a non-preferred hospital, you may be responsible for any amount that exceeds the allowed cost.

    Chemical Dependency

    In-network: Deductible, then 15%

    Out-of-network: Deductible, then 35%

    Search for a Preferred Provider in the Premera Find a Doctor tool.

    Mental Health

    In-network: Deductible, then 15%

    Out-of-network: Deductible, then 35%

    Search for a Preferred Provider in the Premera Find a Doctor tool.

    BlueCard® Program Access to an extensive nationwide network of doctors, hospitals and other medical-care providers through the BlueCard® program. In-network benefits, when you're away from home in the Unites States and in more than 200 countries. 

    Benefits for routine vision exam, one per calendar year, is covered in full up to the allowable charge – no deductible.

    Benefits for vision hardware or contact lenses:

    • Adults – covered up to $200 every two calendar years -- no deductible
    • Pediatric (age 0-18) – frames are limited to one pair every two calendar years and lenses are limited to one pair per calendar year OR one year supply of contact lenses.

    You are no longer eligible to contribute to an HSA if any of the following apply during the plan year:

    • You are enrolled in other medical coverage that is not considered by the IRS to be a Qualified High-Deductible Health Plan*,
    • You are enrolled in Medicare,
    • You are claimed as a dependent on someone else's tax return*,
    • Your spouse has a FSA or health reimbursement arrangement (HRA), even if you disclaim coverage,
    • You have received Veterans Affairs (VA) benefits within the last three months.

    If you are receiving VA benefits for a service-connected disability, and are currently not on TRICARE, you may be eligible to contribute to an HSA.

    *For more detailed information, refer to IRS Publication 969, "Health Savings Accounts and Other Tax-Favored Health Plans," which you can download from the IRS web site or order by calling 800-TAX-FORM.

    Your HSA is offered through HSA Bank, an independent provider of health savings account products and services. It's an account you own, which allows you to save for health care expenses. Keep the money in your account to earn interest, pay for future health care expenses or use the money to pay for current expenses.

    To determine your eligibility for an HSA, refer to the "Am I Eligible for an HSA?" accordion.

    Contribution limits for 2019 for individuals 55 and older

    With an HSA, you can contribute as much money as you want, up to the yearly maximum.

    2019 MPP Coverage Level Total 2019 HSA Annual Limit
    Individual Only $3,500
    Individual +1 or More Dependents $7,000
    HSA Catch-up Contributions (age 55 or older)* $1,000

    *Catch-up contributions can be made any time during the year in which the HSA participant turns 55.

    Note: Maximums are adjusted for inflation annually by the IRS.

    Using Your Funds

    The money in your HSA is yours to keep. You take the money with you. And, you don't have to use the money by a certain date. The longer you leave money in your account, the more interest it will earn.

    In general, your HSA can be used for:

    • Expenses applied to your health plan deductible
    • Dental care services
    • Vision care services
    • Prescription services
    • Over-the-counter medications prescribed by your doctor*
    • Certain medical equipment

    Your HSA may not be used for over-the-counter drugs, unless you have a written prescription from your provider.

    For more information about your health savings account, please read HSA Bank Annual IRS Contribution Limits or Standard HSA Rates & Fee Schedule.

    Investing your health savings account

    You can increase the potential future value of your health savings account by investing money from your account in mutual funds. Your account with HSA Bank gives you access to investing with TD AmeriTrade or Devenir Financial. There's no minimum HSA balance required, so you can choose how much you want to invest, none, some or all of the money in your Health Savings Account.

    TD AmeriTrade offers self-directed investing with access to stocks, bonds and over 11,000 mutual funds. Devenir Financial offers managed accounts with access to a variety of mutual funds. Please note, there may be transaction fees or annual fees associated with these accounts.

    For more information about investment options, visit HSA Bank.