2020 and 2021 Plan Year Information
What factors should I consider when choosing a Medical Plan option?
All of the Firm’s Medical Plan options offer comprehensive coverage and access to the highest quality of care through robust provider networks. The options differ in the level of benefits provided, how you pay for services and the types of tax-favored savings accounts you can use to pay for eligible health care expenses.
Some factors to consider are:
- Your cost of coverage (through paycheck contributions)
- Your cost of care (deductibles, coinsurance, copays and out-of-pocket maximums)
- Prescription drug coverage
- Preferred tax-favored savings accounts to help you pay for eligible health care expenses (Health Savings Account and Limited Purpose Flexible Spending Account for Option C or Health Care Flexible Spending Account for Options A and B)
What are the main differences between Option A, Option B and Option C?
The three Medical Plan options work similarly in that:
- They all cover the same medical services and generally the same prescription drugs, and you have access to the same network of providers.
- You must first meet a deductible before coinsurance or cost-sharing begins.
- For in-network preventive care, you do not need to meet the deductible and the services are covered at 100%.
- All options provide coverage for in- and out-of-network services, though your costs will be lower if you use in-network providers.
The biggest difference among the options is when and how you pay for care.
- With Option A, you’ll pay the most through your paycheck contributions, and the least when you need care.
- With Option C, you pay the least out of your paychecks, but potentially more when you need care due to the high deductible and out-of-pocket maximum.
- Option B falls in the middle of Options A and B in terms of when you pay.
If I enroll in Option C this year, do I have to enroll in Option C again next year?
No. Each year, you will have the opportunity to assess your health care needs during Annual Enrollment and decide whether you want to continue your coverage or elect a different option.
Why are the paycheck contributions lower for Option C than for the other options?
The consumer-driven design of Option C puts you in greater control of the health care dollars you spend. Your cost of coverage — what you pay through paycheck contributions whether you use care or not — is lower, but your annual deductible and out-of-pocket maximum are higher, meaning you will spend more money when you actually need care. You can use resources provided by the Firm to help you evaluate the cost and quality of services. Additionally, when you participate in Option C, you can contribute to a Health Savings Account to pay for — and even save for — eligible health care expenses now or in the future.
Does the annual deductible work the same way for all three options?
No. Option C has a combined medical and prescription drug deductible that is a “true family” deductible. This means that you and your covered dependents must meet the entire Family deductible before coinsurance begins for any covered individual.
Under Option A and Option B, covered dependents’ coinsurance begins once he or she reaches the individual deductible, or coinsurance will begin for any covered member of your family once the family deductible is met.
Does the annual out-of-pocket maximum work the same way for all three options?
Yes, the out-of-pocket maximums work the same way for all three Medical Plan options. Once you reach the individual out-of-pocket maximum, the Medical Plan begins to pay 100% of the cost of eligible services for the rest of the year, even if as a family the family maximum has not been reached.
What are preventive medications?
Preventive medications include any drugs prescribed to help prevent a condition or illness, such as drugs to prevent diabetes or high-blood pressure. If you already have a diagnosis, your medications are not considered preventive.
View the current Express Scripts preventive prescription drug list.
Do Options A, B and C use the same prescription drug administrator?
Yes. Express Scripts is the prescription drug administrator for the Firm’s national medical plans through Cigna and UHC.
Does Option C cover prescription drugs in the same way as other plans?
No. With Option C, you do not have to meet your annual deductible before the plan begins to share in the cost of preventive medications. However, you will be responsible for the entire cost of non-preventive prescription drugs until you reach your combined medical and prescription drug annual deductible.
What tools and resources are available to help me choose medical coverage?
Type “benefits” into your browser to visit the Benefit Center website and access tools to help make your Medical Plan elections:
- Compare your Medical Options to consider the detailed benefits coverage up to three plan options.
- Find a Doctor to check if your doctor, hospital or other provider participates in a network.
You can also:
- See Which Medical Plan Is Right for You? for an overview of the Medical Plan options.
- Call a Benefits Advocate for assistance and support to help you make the right choices for you and your family.
What happens if I do not enroll or if I waive Medical Plan coverage during Annual Enrollment?
If you do not enroll or if you waive Medical Plan coverage during Annual Enrollment, you will automatically be enrolled in your previous year’s election, except for HSA, FSA and Limited Purpose FSA elections. Details are available on the Default Benefits Coverage page.
Is there a difference in the network of doctors for the medical plan options?
No. For all three medical plan options, you may choose from two national health plan administrators, Cigna and UnitedHealthcare (UHC) (not available in Hawaii).
- For UHC, they are part of the UHC Choice Plus Network
- For Cigna, they are part of the Cigna Open Access Plus Plan Network.
It is recommended that you confirm that your doctors and providers will continue to participate in your plan’s network in the coming year.
If I’m unhappy with my Medical Plan coverage, can I change it during the plan year?
No. Benefits elections are typically irrevocable for the entire calendar year. However, there are special situations in which you may change your elections during the year called Qualified Life Events (such as getting married or divorced, having a child).
Why is there a difference in cost between in-network and out-of-network providers?
When you use in-network providers, fees for eligible services have been negotiated in advance by your Medical Plan administrator, generally resulting in lower costs. Out-of-network providers have not agreed to negotiated rates and can charge any amount they choose. Additionally, your Medical Plan administrator will impose a Reasonable & Customary (R&C) limit for services, which is the average rate for services in a geographic location. If your out-of-network provider charges more than R&C, you will be responsible for the amount over the R&C limit, in addition to a greater percentage of coinsurance.
If I’m using in-network providers, why should I check the cost of services in advance?
The cost of medical services varies even when using in-network providers in the same ZIP code. The cost of an MRI in New York City ranges from $400 to over $3,000.* By researching costs before you go, you have the opportunity to save yourself and the Firm money.
*Amounts included are for illustration purposes only.