Medical
Our medical plans are designed to offer affordability and access to quality care, with broad coverage for medical services, prescriptions, and routine care. The primary medical benefit is access to a traditional health insurance network, with multiple plan designs to choose your desired level of coverage. Together with no-cost care available through local health centers and telehealth from MDLive, you have several options for receiving care.
Coverage
Each medical plan option includes coverage for:
- Office visits and access to urgent care facilities
- Inpatient hospital stays and outpatient procedures
- Prescription coverage
- Mental health support and treatment
- Medical imaging
- Telehealth from MDLive
- No-cost care from Marathon Health and Scripps Health (CA only)
Insurance is great for in-the-moment medical needs, but what about protection from future expenses and improving health? We have you covered!
Health Insurance Network:
Blue Cross Blue Shield (BCBS) PPO
BCBS is the largest health care network in the US, and you have access to more than a million providers with their PPO network. You can use PPO hospitals and doctors without a referral, and BCBS rates for services are among the lowest in the market.
Prescription Network:
CVS Caremark
CVS provides the most network pharmacies in the US, and includes many national chains like Walmart, Target, Walgreens, and Rite Aid. Specialty medicine is dispensed directly from CVS and mail order options are available.
Health Insurance Partner: Marathon Health Clinic
We have partnered with Marathon Health to support the health and wellness of tkAT employees and their families. Marathon provides no-cost care for a wide range of services, including annual exams, preventive screenings, sick care, minor injury treatment, and basic lab work. For more information, contact Marathon Health or your local HR representative.
Note: California employees may access low and no-cost care from Scripps Health.
Medical Insurance Options at a glance
We have three different medical plan options: The Standard Plan with a Health Care Account (HCA), the Plus Plan, and the Select HSA Plan with a Health Savings Account (HSA). Here’s a high level summary of how the plans compare:
| Standard Plan | Plus Plan | Select HSA Plan | |
|---|---|---|---|
| Account funding by tkAT | Health Care Account (HCA) seed: Individual/$750 Family/$1,500 |
$0 | Health Savings Account (HSA) match: Individual/$500 Family/$1,000 |
| Pre-Deductible Member Costs | |||
| Routine physical | $0 | $0 | $0 |
| Office visit at Marathon Health | $0 | $0 | $25 |
| Telehealth from MDLive | $0 | $0 | $0* |
| Office visit with BCBS Provider | As billed | PCP-$35 / Specialist-$50 | As billed |
| Emergency / Urgent care | As billed | Emergency-$250 / Urgent-$75 | As billed |
| Rx copay (GEN/FORM/BRAND) | $10/$35/$60 | $10/$35/$60 | Drug cost |
| Rx specialty | $0 w/Prudent Enroll | $0 w/Prudent Enroll | Drug cost |
| Rx weight loss | Not covered | $200 w/30+ BMI | Not covered |
| Deductible | Per Person: $3,500 2+ People: Not to Exceed $7,000 |
Per Person: $1,500 2+ People: Not to Exceed $3,000 |
Per Person: $1,500 2+ People: Not to Exceed $3,000 |
| Post-Deductible Member Costs | |||
| Routine physical | $0 | $0 | $0 |
| Office visit at Marathon Health | $0 | $0 | $0 |
| Telehealth from MDLive | $0 | $0 | $0 |
| Office visit with BCBS Provider | 20% | PCP-$35 / Specialist-$50 | 20% |
| Emergency / Urgent care | 20% | Emergency-$250 / Urgent-$75 | 20% |
| Rx copay (GEN/FORM/BRAND) | $10/$35/$60 | $10/$35/$60 | 20% |
| Rx specialty | $0 w/Prudent Enroll | $0 w/Prudent Enroll | $0 w/Prudent Enroll |
| Rx weight loss | Not covered | $200 w/30+ BMI | Not covered |
| Out-of-pocket maximum | Per Person: $5,500 2+ People: Not to Exceed $10,500 |
Per Person: $4,000 2+ People: Not to Exceed $9,000 |
Per Person: $4,500 2+ People: Not to Exceed $8,000 |
Medical Options Overview
Profile: The Standard Plan might be a fit for you if you value the company-funded Health Care Account (HCA), are comfortable with out-of-pocket spend after the HCA is used, want the lowest premiums, and have moderate healthcare needs.
Special Feature: The HCA comes pre-loaded and ready to offset the first $750* ($1,500 with family coverage) of medical expenses. The best part is that – if you don’t use it all and stay in the plan – it rolls into next year! Here’s what’s also important to know: For prescription drugs, you always pay a copay — the deductible does not apply.
If you get sick: Your first expenses will be paid for by the HCA. The deductible and total out-of-pocket expense of this plan is the highest of your medical plan choices, but this is offset by the lowest paycheck premiums deducted. Note: This plan has an “embedded deductible.” That means that if one family member meets the individual deductible, the plan begins paying benefits for that person, even if the family deductible has not been met. For common medical issues, you can get convenient and no or low-cost care through Marathon Health centers (Scripps Health centers in CA only) and telehealth from MDLive.
Remember: The company HCA contribution isn’t going to cover your full
deductible in the first year, so make sure you’re stocking away some of those premium savings in case you have an unexpected expense. All routine and preventative care is covered at 100% so you don’t have to worry about that.
Conclusion: If you want a plan that offers overall value at the lowest premiums and more predictable costs, you should give the Standard Plan a close look.
* Prorated for mid-year coverage start dates
Profile: The Plus Plan might be a fit for you if you use healthcare frequently, prefer lower out-of-pocket costs, are comfortable paying higher premiums, and value predictable costs.
Special Feature: For medical services, the deductible is lower than the other options, so copays and coinsurance kick in sooner. For prescription drugs, you always pay a copay — the deductible does not apply.
If you get sick: For common medical issues, you can get convenient and no or low-cost care through Marathon Health centers (Scripps Health centers in CA only) and telehealth from MDLive.
Remember: This plan has an “embedded deductible.” That means that if one family member meets the individual deductible, the plan begins paying benefits for that person, even if the family deductible has not been met. For common medical issues, you can get convenient and no or low-cost care through Marathon Health centers (Scripps Health centers in CA only) and telehealth from MDLive.
Conclusion: If your budget can afford the paycheck deductions, this plan can work for you. The other options offer lower premiums while offering the same level of care, but on this plan – while you’ll likely pay more by the end of the year – there will be more consistency in your doctor bills.
Profile: The Select HSA Plan might be a fit for you if you want lower premiums, plan to contribute to an HSA, and are comfortable with variable pricing for your prescription and medical needs.
Special Feature: Health Savings Accounts (HSA) are the modern approach to traditional healthcare. You make additional contributions pre-tax like you would with a 401(k) Plan, and tkAT matches your contributions, up to a certain amount. When you use the money, it’s tax free, too. This becomes your private account; you won’t lose the balance if you ever change plans or leave tkAT. Note: Unlike the Standard and Plus Plans, you must first meet your deductible before the plan begins paying for prescription drugs.
If you get sick: You can go to any doctor you want, but you do have a higher deductible. After you reach the deductible, you pay copays and coinsurance when you access care. Note: With the Select HSA Plan, even if one family member meets their individual deductible, the plan does not begin paying benefits until the full family deductible has been met. For common medical issues, you can get convenient and no or low-cost care through Marathon Health centers (Scripps Health centers in CA only) and telehealth from MDLive.
Remember: The idea behind the HSA part of this plan is that you’re savingfor medical expenses, either now or in the future. It’s a good idea to increase your balance up to the deductible first, and then to the out-of-pocket maximum. It’s okay if you have to spend the money in the account; that’s why it’s there. And you’re automatically saving money when you do because you avoid paying any taxes, even if you don’t build the balance very high.
Conclusion: It’s a health insurance plan that isn’t just about the insurance. The HSA is a legitimate tool that people use to reduce their taxable income and save for future expenses in a way that they get to control. And, when you need it, you’re still getting excellent medical coverage.
Who is eligible and how much does this cost?
Medical benefits are available for full-time employees and their families. The company pays the majority of costs for health care benefits and you share in the cost through premiums deducted from your paycheck.
Prescription Drug Coverage
If you have coverage under one of the tkAT medical plans, you also receive prescription drug benefits provided by CVS/Caremark. Coverage amounts differ based on the medical plan you choose. For specific coverage comparisons, visit the Resources page to view the benefits guide.
Prescription drug benefits include:
- Over 68,000 network pharmacies (including CVS, Walgreens, Target, and Walmart)
- Mail service option for convenient delivery
- Generic drug options to reduce your cost
Contact CVS Caremark at caremark.com and (888) 886-8520.
Resources
tkAT Benefit Guide
BCBSIL App
Manage your claims and medical benefits directly from your phone.