5 Benefit Coverage Meritain Health (TPA) $1,250 deductible 16569 Meritain Health (TPA) $3,000 Deductible HDHP 16569 In-Network Benefits Out-of-Network Benefits In-Network Benefits Out-of-Network Benefits Retail Pharmacy (30 Day Supply) Generic (Tier 1) 25% Not covered 0% after deductible Not covered Preferred (Tier 2) 25% Not covered 0% after deductible Not covered Non-Preferred (Tier 3) 35% Not covered 0% after deductible Not covered Preferred Specialty (Tier 4) Not covered – contact AroRx Not covered Not covered – contact AroRx Not covered Mail Order Pharmacy (90 Day Supply) Generic (Tier 1) $25 copay Not covered 0% after deductible Not covered Preferred (Tier 2) $25 copay Not covered 0% after deductible Not covered Non-Preferred (Tier 3) $35 copay Not covered 0% after deductible Not covered Preferred Specialty (Tier 4) Not covered Not covered Not covered Not covered Bundled Medical & Vision Monthly Employee Contributions $1,250 Deductible $3,000 HDHP Employee $59.10 $0.00 Employee + Spouse $254.12 $113.20 Employee + Child(ren) $244.88 $109.08 Family $570.30 $369.52 2024 Wellness Incentive The City of Hutchinson will be adding a wellness program through WellWorks. You will have until October 31, 2023, to complete an annual physical with your Primary Care Physician and to complete a Tobacco Attestation form. The incentive will be a medical premium differential for the 2024 plan year. The incentive will be released later in 2023. Stay tuned for more details.
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