Benefits corner

Jul 24, 2013 | Intercom

Deductibles on NMC’s medical plans

If you are covered on either the NMC Core Plan or the NMC High Deductible Health Plan, you are responsible for meeting an annual deductible amount on certain services.  This means that you will have to pay out of pocket expenses before any benefits from your health insurance plan can be used.  Some services such as preventive care or ambulance services, are paid at 100% with the deductible waived.  What’s the difference between the deductibles for the two plans?

Core Plan

  • If any individual covered on your plan pays $200 out of pocket for reasonable and customary expenses, the Core Plan will begin paying 80% of costs with the individual paying 20%.
  • If you have 3 or more covered on your plan and you collectively pay $400 out of pocket for reasonable and customary expenses, then the Plan will begin paying 80% of costs for the entire family and the covered members will pay 20%.  This applies to all covered family members, even if they did not contribute toward the family deductible.
  • There is an out-of-pocket maximum of $1,500 per individual or $3,000 per family each calendar year, which includes the deductibles already paid.  If these maximums are reached, the Core Plan pays 100% of covered services for the remainder of the year.
  • You will always pay for pharmacy on the Core Plan, even if you have met the out-of-pocket maximum for services, using the prescription plan costs of $2.50 for generic drugs and 40% of the cost of brand name drugs, with a $20 minimum and a $40 maximum.

High Deductible Health Plan

  • If you are in the individual or single HDHP, you will pay $1,250 out of pocket for reasonable and customary expenses, including the full cost of pharmacy.  Once you reach your deductible, the HDHP will pay 100% for covered medical services.
  • If you are in the family HDHP, you will pay $2,500 out of pocket for reasonable and customary expenses for all covered members, including the full cost of pharmacy.  Once you reach the deductible, the HDHP will pay 100% for covered medical services.  This applies to all covered family members, even if they did not contribute toward the family deductible.
  • Once you meet your deductible in either high deductible plan, you will then use the Core Plan prescription costs of $2.50 for generic drugs and 40% of the cost of brand name drugs, with a $20 minimum and a $40 maximum.
  • If you pay $1,500 on the single HDHP or $3,000 on the family HDHP in prescription costs after you meet your deductible, then even pharmacy is covered at 100%.

For more information on services covered on your NMC medical plan, you can access the applicable Schedule of Medical Benefits and Prescription Coverage summary located on the Intranet Open Enrollment page at https://intranet.nmc.edu/depts/human-resources/open-enrollment/index.html.

If you have any questions about this or other benefits, you can contact Human Resources at 995-1362 or 995-1025.