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Health Savings Account Medical Plan

Print PageAdministered by BlueCross BlueShield of South Carolina (BCBS)

The Baptist Easley Health Savings Account medical plan is a consumer-driven health plan that maximizes your benefits when using Baptist Easley facilities and MyHealthFirst hospitals and physicians. The plan’s provider network consists of two tiers: a primary tier and a secondary tier. The primary tier consists  of MyHealthFirst hospitals and physicians. The secondary network tier consists of all providers in BCBS’ national network that aren’t included in the primary tier. Please click here for a list of primary tier (MyHealthFirst) providers. Please click here for a list of secondary tier (BCBS) providers.

The Baptist Easley Health Savings Account medical plan is intended for relatively healthy individuals and families who anticipate needing only routine preventive and minor sick care. There are no out-of-pocket costs for preventive services. Preventive services include annual physicals, screening services, well-child care and child/adult immunizations.

By enrolling in a high deductible health plan, you are eligible to open a Health Savings Account (HSA) to assist you with out-of-pocket expenses. Baptist Easley will make quarterly contributions for employees who open an HSA with HSA Bank. Please see the HSA section of this guide for more information.

Click here for a 10-minute online tutorial about setting up an HSA with HSA Bank.

Class Active, Full-Time  Active, Part-Time 
Tier Under $15.23 $15.23 – $30.45 $30.46 – $50.55 Over $50.55 Under $15.23 $15.23 – $30.45 $30.46 – $50.55 Over $50.55
Bi-Weekly Contributions                
With Discount EE Only $30.00 $31.00 $32.00 $33.00 $43.00 $46.00 $47.00 $47.00
EE + Spouse $69.00 $72.00 $74.00 $75.00 $106.00 $111.00 $113.00 $117.00
EE + Child(ren) $69.00 $72.00 $74.00 $75.00 $106.00 $111.00 $113.00 $117.00
EE + Family $69.00 $72.00 $74.00 $75.00 $106.00 $111.00 $113.00 $117.00
Without Discount EE Only $59.00 $62.00 $63.00 $64.00 $80.00 $82.00 $85.00 $86.00
EE + Spouse $104.00 $110.00 $112.00 $114.00 $150.00 $158.00 $162.00 $165.00
EE + Child(ren) $104.00 $110.00 $112.00 $114.00 $150.00 $158.00 $162.00 $165.00
EE + Family $104.00 $110.00 $112.00 $114.00 $150.00 $158.00 $162.00 $165.00
Partial Discount EE Only $52.00 $54.00 $55.00 $56.00 $69.00 $72.00 $74.00 $75.00
EE + Spouse $96.00 $101.00 $103.00 $105.00 $140.00 $147.00 $150.00 $154.00
EE + Child(ren) $96.00 $101.00 $103.00 $105.00 $140.00 $147.00 $150.00 $154.00
EE + Family $96.00 $101.00 $103.00 $105.00 $140.00 $147.00 $150.00 $154.00
                   

 

Click here for a list of preventive medications.

Prescription Drug Benefits: Prescription drug benefits are a part of Baptist Easley’s group medical plans. Plan participants are eligible for 30-day or extended-day (90-day) supplies. There is no deductible for preventive drugs. Preventive drugs include those taken for a disease that has not yet manifested or to prevent recurrence of a disease. Examples include cholesterol-controlling medication and blood pressure medication.

All maintenance and specialty medications must be filled at the Palmetto Health Pharmacy in order to be covered under the plan. In addition, Step Therapy is required for medications prescribed to treat ongoing medical conditions.

The following chart is only an overview. You should refer to your Summary Plan Description for information on any exclusions or limitations that may apply to the specific benefits.

Pharmacy
  Preventive Non-Preventive
30 Day 90 Day 30 Day 90 Day
PH Pharmacy Caremark Network PH Pharmacy PH Pharmacy Caremark Network PH Pharmacy
Deductible none none none In-Network Plan Deductible
Generic $10 copay no deductible $15 copay no deductible $20 copay no deductible $10 copay, after deductible $15 copay, after deductible $20 copay, after deductible
Preferred $20 copay no deductible $35 copay no deductible $40 copay no deductible $20 copay, after deductible $35 copay, after deductible $40 copay, after deductible
Non-preferred $40 copay no deductible $65 copay no deductible $80 copay no deductible $40 copay, after deductible $65 copay, after deductible $80 copay, after deductible
Specialty n/a 80% ($100 max), after deductible – Specialty Network Only n/a
Infertility n/a 80% ($100 max), after deductible ($5,000 life max) n/a

Click here for a list of preventive medications.

1. Plan participants are eligible for a 30-day or an extended-day (90-day) supply.
2. All maintenance medications must be filled at the Palmetto Health Pharmacy in order to be covered under the plan.
3. Specialty drugs are only available through the Palmetto Health Pharmacy and require prior authorization.
4. Step Therapy is required for medications prescribed to treat ongoing medical conditions.
5.
The Palmetto Health Pharmacy doesn’t compound medications or mail controlled substances.

Caremark Pharmacy Network Directory: click here or call 800-760-9290.

Schedule of Benefits

The following chart is only an overview. You should refer to your Summary Plan Description for any exclusions or limitations that may apply to the specific benefits.

Deductibles and Out-of-Pockets Maximums
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Individual Deductible $2,000 $3,125 $4,000
Family Deductible $4,000 $6,250 $8,000
Individual Out-of-Pocket Max $4,000 $6,250 none
Family Out-of-Pocket Max $8,000 $12,500 none
Palmetto Health’s HSA Contributions
  Full-time Part-time
Individual $282 per quarter; $1128 per year $160 per quarter; $640 per year
Family $562.50 per quarter; $2,250 per year $320 per quarter; $1280 per year
Physician Office Visits
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Primary Care Preventive2 100%, no deductible 100%, no deductible 50%, after deductible
Primary Care Sick 100%, after deductible 70%, after deductible 50%, after deductible
Specialists 100%, after deductible 70%, after deductible 50%, after deductible
Physician Office Services
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Lab Tests and X-rays 100%, after deductible 70%, after deductible 50%, after deductible
Reading of Labs Preventive 100%, no deductible 100%, no deductible 50%, after deductible
Reading of Labs Sick and X-rays 90%, after deductible 70%, after deductible 50%, after deductible
Other Physician Office Services 90%, after deductible 70%, after deductible 50%, after deductible
Outpatient Hospital Charges
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Surgery – Facility Charge 90% after deductible 70% after deductible 50% after deductible
Surgery – Physician/Anesthesiologist 90% after deductible 70% after deductible 50% after deductible
Labs – Test 90% after deductible 70% after deductible 50% after deductible
Labs – Reading of Labs 90% after deductible 70% after deductible 50% after deductible
X-rays – Facility 90% after deductible 70% after deductible 50% after deductible
X-rays – Physician 90% after deductible 70% after deductible 50% after deductible
MRI/CAT/PET/Nuc Scans – Facility 90% after deductible 70% after deductible 50% after deductible
MRI/CAT/PET/Nuc Scans – Physician 90% after deductible 70% after deductible 50% after deductible
Occupational, Physical and Speech Therapy and Cardiac Rehab 90% after deductible 70% after deductible 50% after deductible
Inpatient Hospital Charges
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Facility 90% after deductible 70% after deductible 50% after deductible
Physician/Anesthesiologist 90% after deductible 70% after deductible 50% after deductible
Emergency Dept
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Visit 90% after deductible 90% after deductible 90% after deductible
Urgent Care
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Visit 100% after deductible 70% after deductible 50% after deductible
Mental Health
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Office Visit 100% after deductible 70% after deductible 50% after deductible
ED Visit 90% after deductible 90% after deductible 90% after deductible
Other Ancillary Services
  Primary (BEH/UMG/MyHealthFirst) Tier Secondary (BCBS) Tier Out-of-Network
Home Health 100% after deductible 70% after deductible 50% after deductible
DME 90% after deductible 70% after deductible 50% after deductible
Hospice 100% after deductible 70% after deductible 50% after deductible

*For Employee + Spouse, Employee + Child(ren) and Family coverage, the family deductible is satisfied once your total family expenses reach the family deductible. One member cannot meet the family deductible. Only a combination of two or more individuals can meet the family deductible. Individual deductible applies to Employee coverage. In addition, there is an individual deductible within Employee + Spouse, Employee + Child(ren) or Family coverage.  When only two individuals are on the medical plan, each member must meet their individual deductible.  For plans including three or more members, one member can meet their individual deductible, with the combination of all other members adding up to meet the remainder of the deductible. Or, the combined claims of all members can meet the deductible.

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QUESTIONS?

Contact the Total Rewards

Benefits Service Center at (800) 963-3456

or email TotalRewards@PalmettoHealth.org

Plan Year: January 1 through December 31, 2018

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