Medical coverage helps you and your family with the costs of maintaining good health and treating illness or injury. Schneider Electric offers you three options to choose from, or you can decline medical coverage:
- Core Consumer-Directed Health Plan (CDHP) + HSA
- Buy-up Consumer-Directed Health Plan (CDHP) + HSA*
- Core Preferred Provider Organization (PPO)
* If you are not eligible for an HSA, you can enroll in the Buy-up CDHP option with NO HSA.
Learn about your plan options.
- Free, in-network preventive care such as annual physicals, wellness exams, cancer screenings and immunizations;
- The same BCBSIL network of providers; and
- Prescription drug coverage through Express Scripts.**
** If you live in Puerto Rico, your medical and prescription drug coverage is administered by Triple S (Blue Cross and Blue Shield of Puerto Rico). You will receive a separate insert regarding coverage details and cost.
Below are some key differences for you to consider.
CDHP + HSA Options: best value at any ageYoung and healthy? Nearing retirement? Or somewhere in between? No matter where you are in your health journey, the CDHP + HSA options can save you money on health care. Though they have higher deductibles, you get:
- Health Savings Account (HSA), which lets you pay for eligible health care expenses with tax-free money. Schneider Electric contributes to your HSA to help offset the deductible — that’s free money for you.
- Lower costs from your paycheck. Consider contributing to your HSA the difference in your cost for medical coverage between the Core PPO and a CDHP option to use toward the higher deductible or to save and invest in your HSA.
- Choice. The HSA empowers you to decide when to use your money: now or save it for later.
The Core PPO option has higher employee contributions per pay period but a lower annual deductible than the CDHP + HSA options. And since this option doesn’t include an HSA, you will not receive a Company HSA contribution.
Meeting the deductibleIn the Core CDHP + HSA and Core PPO…
- Once one person’s claims reach the single deductible amount, that person can then begin receiving benefits and just pay the coinsurance amount.
- Once one person reaches the single out-of-pocket maximum, the plan will pay 100% for that person for the remainder of that calendar year.
- All of the family’s eligible expenses added together must reach the family deductible amount before paying coinsurance for any family member.
- The family deductible can be met by one family member or a combination of family members.
- All of the family’s eligible expenses added together must reach the family out-of-pocket maximum before the plan will pay 100% for any family member for the remainder of that calendar year.
Is your provider/pharmacy in the network?
BCBSIL provider network
To see if your provider is in the network, or to find a new provider, go to bcbsil.com and click on the Find a Doctor or Hospital link. Seach as a guest > enter the location where you would like to search for care and then:
- Select the Participating Provider Organization (PPO) network.
- For Florida, Georgia, Kansas City area, New Hampshire, New Jersey, St. Louis area, Tennessee, the Washington D.C./Maryland/Virginia area and Wisconsin, select the appropriate network.
For help finding a network provider, call BCBSIL. Your health advocate will help you find skilled providers who are proven to be high performers.
If you use a provider outside of your network, your claim will be processed as out-of-network and subject to a separate out-of-network deductible and out-of-pocket maximum.
Brand-name drug cost when generic is available
If you or your doctor requests a brand-name medication and indicates “dispense as written” when a generic equivalent is available, you will pay the generic copay plus the cost difference between the brand and the generic. You or your doctor may request a coverage review to waive the cost difference between the brand and generic medication by contacting Express Scripts.
Comparing medical plan options
|Plan provision||Core CDHP + HSA||Buy-up CDHP + HSA||Core PPO|
|Health Savings Account|
|Single||Company contributes $700||NA|
|Family||Company contributes $1,400||NA|
|Preventive care||Free||Not covered||Free||Not covered||Free||Not covered|
|Primary care physician||Subject to deductible and coinsurance||$30 copayment||Subject to deductible and coinsurance|
|Specialist||Subject to deductible and coinsurance||$50 copayment||Subject to deductible and coinsurance|
|Telehealth through MDLIVE||$44; subject to deductible and coinsurance||No coverage||$44; subject to deductible and coinsurance||No coverage||$30 copayment||No coverage|
|Urgent care||Subject to deductible and coinsurance||$50 copayment|
|Emergency room||Subject to in-network deductible and coinsurance|
|Hospital admission||Subject to deductible and coinsurance|
|Retail (up to 30-day supply)|
|Generic||20% (after you meet the annual deductible)||40% (after you meet the annual deductible)||20% (after you meet the annual deductible)||40% (after you meet the annual deductible)||$10 copayment|
|Preferred brand||20% coinsurance
($30 min / $60 max)
($60 min / $120 max)
|Mail order , CVS or Walgreens (90-day supply)|
|Generic||20% (after you meet the annual deductible)||No coverage||20% (after you meet the annual deductible)||No coverage||$25 copayment|
|Preferred brand||20% coinsurance
($75 min / $150 max)
($150 min / $300 max)
- The out-of-pocket maximum includes expenses paid toward your deductible, as well as medical and prescription drug copayments and coinsurance amounts.
- The coinsurance is calculated based on the allowed amount under the medical plan. For out-of-network care, you may be responsible for any amount billed in excess of the allowed amount. The coinsurance for bariatric surgery and certain organ transplants, as well as cardiac, knee, hip, maternity and spine services is 10% if treatment received at a BCBSIL Blue Distinction Centers+ facility.
- For prescription drug coverage:
- For preventive drugs in the CDHP + HSA options, the deductible does not apply. You pay 20% coinsurance for preferred brand and brand name drugs, nothing for generics.
- Specialty drugs under the Core PPO: Certain specialty drugs may be at no cost to you through SaveonSP, which helps coordinate manufacturer-sponsored copay assistance.