Medical Plan Option C

2020 Plan Year Information

Option C Coverage Under the Medical Plan

Option C, consumer-driven coverage, works a lot like coverage under Options A and B, but with some important differences. Option C has the lowest paycheck contribution rates (up to 50% less than Option A, depending on your pay band). However, as a tradeoff for lower upfront contributions, Option C has the highest annual deductible and out-of-pocket-maximum amounts, so you may have higher out-of-pocket costs depending on the amount of non-preventive care and prescription drugs you need throughout the year. Whether Option C is the right medical coverage for you will depend on a variety of factors. Be sure to review the resources on this website or speak with a Benefits Advocate for personalized guidance.

Note: The amounts shown below apply to in-network care. Generally, out-of-network amounts are double the amounts for in-network services.

Option C
Preventive Care

In-network preventive care, such as annual physicals and age-appropriate cancer screenings, are covered at no cost to you.
You pay: 0% / Plan pays: 100%

Deductible

You pay the full cost of any non-preventive service until your total medical and prescription drug costs meet your deductible amount.

2019 & 2020

  • Single: $2,300
  • Family: $4,600
Coinsurance

After you’ve met your family deductible, you and the Medical Plan share a percentage of the cost of services until you meet your out-of-pocket maximum.
You pay: 20% / Plan pays: 80%

Out-of-Pocket Maximum

Once your combined deductible and coinsurance costs for medical and prescription drugs hits this number, the Medical Plan begins to pay 100% of the cost of eligible services for the rest of the year.

2019 & 2020

  • Single: $5,500
  • Family: $11,000
Health Savings Account (HSA)

How Option C Works

Like Options A and B, Option C uses the same Cigna and UnitedHealthcare networks and covers the same services, and you can see any provider you like (but you will pay more if you go out of network). There are a few key differences, primarily in how you pay for care.

What the Medical Options Have in CommonHow Option C Differs from Options A and B
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  • Cover the same medical services and prescription drugs
  • Same network of providers
  • Same coinsurance — or amount you pay for in-network services after you meet your deductible — of 20%
  • In-network preventive care is covered at 100%
  • Provide coverage for in- and out-of-network services, though your costs will be lower if you use in-network providers
  • Protection from high medical costs with the out-of-pocket maximum
  • Amount you pay out of your paycheck in contributions is lower
  • Your deductible and out-of-pocket maximum are higher
  • Option to set aside money, tax-free, to pay for health care expenses now and in the future — even in retirement — with the HSA
  • Cannot contribute to an FSA; however, you can contribute to a Limited Purpose FSA (LPFSA) to pay for dental and vision expenses
  • Combined medical and prescription drug deductible means you’ll pay the full cost of non-preventive prescription drugs until you meet your deductible

What Is an HSA and What Are Its Advantages?

A Health Savings Account, or HSA, is a tax-advantaged savings account you can use to pay for eligible health care expenses now and in the future. The HSA is a savings account—meaning you can save the money until you need it most. Whether you need it now, a few years down the road or after you retire, the money in your HSA is yours to use for eligible health care expenses whenever you choose.

The account is triple-tax advantaged, which means that:

  • Pre-tax contributions lower your taxable income.
  • Tax-free growth, even on investment earnings.
  • Tax-free distribution means you don’t pay taxes when you use HSA dollars to pay for eligible health care expenses.

The HSA is similar to a Health Care Flexible Spending Account (HCFSA), but there are a few important differences. While the funds in an HCFSA are meant to be used during the Plan year, the unspent funds in an HSA remain in your account from year to year, so you can save the money until you need it—even into retirement. You can also use the funds in your HSA account if you switch coverage or leave the Firm. As long as you use the funds for eligible health care expenses, there is no limit on how or when you use the money in your account. When you fund an HCFSA, the full amount of your election is available to you at the beginning of the year; with an HSA, only the amount you have already funded is available.

The Morgan Stanley HSA is only available to employees enrolled in Option C.

Option C
Individual Deductible

In-Network:
$2,300 (includes prescription drugs)

Out-of-Network:
$4,600 (includes prescription drugs)

Family Deductible

In-Network:
$4,600 (includes prescription drugs)

Out-of-Network:
$9,200 (includes prescription drugs)

Individual Out-of-Pocket Maximum

In-Network:
$5,500 (includes prescription drugs)

Out-of-Network:
$11,000 (includes prescription drugs)

Family Out-of-Pocket Maximum

In-Network:
$11,000 (includes prescription drugs)

Out-of-Network:
$20,000 (includes prescription drugs)

Diagnostic and Preventive Care

In-Network:
100% (no annual deductible)

Out-of-Network:
100% up to a maximum of $250 (no annual deductible) then 60% of eligible expenses (no annual deductible)

Most other services, including inpatient and outpatient hospital and specialist visits

In-Network:
80% after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

Out-of-Network:
60% of eligible expenses after annual deductible

Prior proof of medical necessity may apply for certain services. Check with your health plan administrator to verify coverage and if preauthorization is required.

Cancer Support Program

In-Network:
100% covered after annual deductible if enrolled in program within 30 days of diagnosis. 80% after annual deductible if not enrolled in program.

Out-of-Network:
60% after annual deductible

Bariatric Surgery

In-Network:
Cigna: 100% after annual deductible at Cigna Certified Hospitals for bariatric surgery; 80% after annual deductible at other in-network facilities.

UHC: Surgery must be received at a UHC designated Center of Excellence (COE) and will be covered at 100% no annual deductible; all other services related to the surgery covered at 80% after annual deductible.

Out-of-Network:
Cigna: 60% of eligible expenses after annual deductible

UHC: No coverage

Maternity

In-Network:
80% after annual deductible

Out-of-Network:
60% of eligible expenses after annual deductible

Fertility Coverage (includes cryopreservation, artificial insemination, IVF, GIFT and ZIFT)

In-Network:
Cigna: 80% after annual deductible

UHC: Members must enroll in the Fertility Solutions program and treatment must be received at UHC’s Centers of Excellence; 80% after annual deductible.

Out-of-Network:
Cigna: 60% of eligible expenses after annual deductible

UHC: No coverage

Concerned About the High Deductible?

You may be worried that an unexpected illness or injury can mean major medical bills if you are covered under Option C. When deciding what medical coverage is right for you, consider:

  • The money you save in paycheck contributions can be saved in your HSA (up to IRS limits) and used to pay for eligible health care or prescription drugs.
  • If you schedule a surgery or other expensive medical procedure, you may elect to contribute more money to your HSA (up to the IRS maximum contribution limits) at any point during the year.
  • The out-of-pocket maximum limits the amount you will be responsible to pay in a given year.
  • If you elect supplemental Critical Illness, Accident and/or Hospital Indemnity Insurance, you can receive lump-sum payments to help offset high medical bills in the event of serious illness or injury.
  • Visit the UHC or Cigna sites to compare costs before you need to see a doctor or undergo a procedure. The cost of services and surgeries can vary, even in the same ZIP code. Comparing costs before selecting your provider can help you avoid overpaying for care, without sacrificing quality.
  • Use 2nd.MD to have medical experts review your case and recommend treatment options, which can potentially save you from unnecessary, high-cost treatments.
  • Talk to your doctor about generics, preferred-brand drugs and mail order prescriptions. Because non-preventive medications are subject to the combined annual deductible under Option C, using lower-cost options can save you serious cash.

Maximize Your Savings with a Limited Purpose FSA

A Limited Purpose FSA is like a traditional FSA, but may be used only for eligible dental and vision expenses. If you enroll in Option C, you may elect to contribute to an LPFSA in addition to, or instead of, your HSA. If you use your LPFSA for dental and vision expenses, you can save your HSA money for health care expenses in the future. You may not elect to contribute to an LPFSA if you enroll in Options A or B under the Medical Plan (but you can contribute to a Health Care FSA).

The 2020 annual LPFSA contribution limit is $2,750.

Note: If you do not elect to contribute to a LPFSA, you may pay for dental and vision expenses from your HSA. When making your election on the benefits election website, note that this option will appear as “Health Care FSA.”

Remember to Keep Your Receipts When You Visit the Doctor

You may be asked for proof when you seek reimbursement from your HSA. If asked, you will need to provide proof that you used the money for eligible expenses, or you may owe income taxes on the amount and pay a 20% penalty if you are under the age of 65.

A Note About HSA Expenses

You can withdraw HSA funds for non-qualified medical expenses, but you will be taxed at your income tax rate plus a 20% tax penalty if you are under age 65. If you are age 65 or older, you may use your HSA funds toward non-health care expenses and will be taxed at your normal tax rate.