Medical

To support you in living your best life, Transamerica provides valuable benefits that help you and your family stay healthy and pay for care in the event of illness or injury.

2023 medical plans

Transamerica offers you a choice of medical plans¹ with a range of coverage levels and costs, so you have the flexibility to select the option that’s best for you.

The following information provides an overview of your medical plan options. For complete details on coverage and for more information on how to enroll, visit the Mercer Marketplace 365+ website. Learn how to access the site.

Please note: Deductibles in the medical plan names reflect Self Only coverage; deductible amounts are double for all other coverage tiers.

¹Number of medical plan options varies by location and eligibility. If you live in Hawaii, you are only eligible for the Platinum Be Fit Plan offered by Kaiser-Hawaii.
²The $4,500 Deductible Plan with HSA is not offered by Kaiser.

The chart below provides a comparison of the medical plans’ key features. For more information, including out-of-network coverage details, visit the Mercer Marketplace 365+ website.

¹With the $900, $3,000 and $4,500 Deductible Plans, coinsurance will begin for a covered family member if that family member’s individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met.
²With the $1,850 Deductible Plan (excluding the Kaiser California $1,850 Deductible Plan), the family deductible must be met before the plan will begin to pay coinsurance for any covered family member.
The Kaiser California $1,850 Deductible Plan has, as required by state law, a three tier deductible consisting of a $1,850 individual deductible for Self Only coverage, a $2,800 individual-within-family deductible for employees electing dependent coverage and a $3,700 overall family deductible
³With the $900, $3,000 and $4,500 Deductible Plans, the plan will begin to pay 100% of the cost of a covered family member’s covered expenses if that family member's individual out-of-pocket maximum is met; the plan begins to pay 100% of covered expenses for all covered family members once the family out-of-pocket maximum has been met.
⁴With the $1,850 Deductible Plan (excluding the Kaiser California $1,850 Deductible Plan), the family out-of-pocket maximum must be met before the plan will begin to pay 100% of the cost of covered services for any covered family member. With the Kaiser California $1,850 Deductible Plan, the plan will begin to pay 100% of the cost of a covered family member’s covered expenses if that family member’s individual out-of-pocket maximum is met; the plan begins to pay 100% of covered expenses for all covered family members once the family out-of-pocket maximum has been met.
⁵Deductible does not apply.
⁶If you take a long-term or “maintenance” medication to manage a health condition like high blood pressure, diabetes or high cholesterol, the Smart90 program gives you the option to pick up a three-month supply of your medication at a CVS or Walgreens, or have your medication shipped to your home using Express Scripts mail-order pharmacy.

The $4,500 Deductible Plan is a high deductible health plan, or HDHP. It offers the lowest premiums and highest deductibles, along with the option to elect a tax-advantaged Health Savings Account (HSA) that helps you save pre-tax money to cover eligible medical expenses. When participating in the wellness program, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of reaching certain point levels. Employees can earn up to $500, and a covered spouse has the opportunity to earn an additional $300. Employees covering themselves and child(ren) only can earn up to $800 (only the employee is required to complete the activities).

You have until November 30 of each year to earn Reward Dollars. Money in your HSA can be carried forward from year to year and is always yours to keep.

How it works

• Your in-network preventive care is covered in full – the deductible does not apply.
• You pay for your initial medical and prescription costs until you meet your annual deductible. Your pre-tax HSA contributions and any earned Reward Dollars from Transamerica can help you pay your out-of-pocket costs.
• Once you meet the deductible, you’ll pay 30% of your covered medical expenses; this amount is called your coinsurance.
• If you choose a coverage tier other than Self Only, there is an embedded individual deductible, which means that coinsurance will begin for a covered family member if that person’s individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met.
• If your share of medical expenses reaches $6,550/$13,100 (individual/family), the plan’s out-of-pocket (OOP) maximum, the plan pays 100% of your eligible expenses for the rest of the year. An individual OOP maximum applies for each covered family member; once the family OOP maximum is met, 100% payment begins for all covered family members.

The $3,000 Deductible Plan is a high deductible health plan, or HDHP. It pairs lower-premium, higher-deductible coverage with the option to elect a tax-advantaged Health Savings Account (HSA) that helps you save pre-tax money to cover eligible medical expenses. When participating in the wellness program, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of reaching certain point levels. Employees can earn up to $500, and a covered spouse has the opportunity to earn an additional $300. Employees covering themselves and child(ren) only can earn up to $800 (only the employee is required to complete the activities).

You have until November 30 of each year to earn Reward Dollars. Money in your HSA can be carried forward from year to year and is always yours to keep.

How it works

• Your in-network preventive care is covered in full – the deductible does not apply.
• You pay for your initial medical and prescription costs until you meet your annual deductible. Your pre-tax HSA contributions and any earned Reward Dollars from Transamerica can help you pay your out-of-pocket costs.
• Once you meet the deductible, you’ll pay 30% of your covered medical expenses; this amount is called your coinsurance.
• If you choose a coverage tier other than Self Only, there is an embedded individual deductible, which means that coinsurance will begin for a covered family member if that person’s individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met.
• If your share of medical expenses reaches $5,500/$11,000 (individual/family), the plan’s out-of-pocket (OOP) maximum, the plan pays 100% of your eligible expenses for the rest of the year. An individual OOP maximum applies for each covered family member; once the family OOP maximum is met, 100% payment begins for all covered family members.

The $1,850 Deductible Plan is a high deductible health plan, or HDHP. It pairs lower-premium, high-deductible coverage with the option to elect a tax-advantaged Health Savings Account (HSA) that helps you save pre-tax money to cover eligible medical expenses. When participating in the wellness program, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of reaching certain point levels. Employees can earn up to $500, and a covered spouse has the opportunity to earn an additional $300. Employees covering themselves and child(ren) only can earn up to $800 (only the employee is required to complete the activities).

You have until November 30 of each year to earn Reward Dollars. Money in your HSA can be carried forward from year to year and is always yours to keep.

How it works

• Your in-network preventive care is covered in full – the deductible does not apply.
• You pay for your initial medical and prescription costs until you meet your annual deductible. Your pre-tax HSA contributions and any earned Reward Dollars from Transamerica can help you pay your out-of-pocket costs.
• Once you meet the deductible, you’ll pay 20% of your covered medical expenses; this amount is called your coinsurance.
• Important note: With this plan, there is a true family deductible, which means that if you choose a coverage tier other than Self Only, the family deductible must be met before the plan will begin to pay coinsurance for any covered family member.
• If your share of medical expenses reaches $3,500/$6,500 (individual/family), the plan’s out-of-pocket (OOP) maximum, the plan pays 100% of your eligible expenses for the rest of the year. For coverage tiers other than Self Only, the entire family OOP maximum must be met before the plan begins paying for covered expenses at 100%.

The $900 Deductible Plan offers the lowest out-of-pocket costs when you need care, but has the highest premiums of all your plan options. With this plan, your costs are more predictable, but you’ll likely still have out-of-pocket expenses.

How it works

• Your in-network preventive care is covered in full — the deductible does not apply.
• You pay your medical costs in full until you meet the plan’s annual deductible.
• Once you meet the deductible, you’ll pay 20% of your covered medical expenses; this amount is called your coinsurance.
• If you choose a coverage tier other than Self Only, there is an embedded individual deductible, which means that coinsurance will begin for a covered family member if that person’s individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met.
• The deductible does not apply to prescription drugs with this plan ― you pay a coinsurance amount with a minimum and maximum out-of-pocket cost for prescriptions.
• If your share of medical expenses reaches $3,000/$6,000 (individual/family), the plan's out-of-pocket (OOP) maximum, the plan pays 100% of your eligible expenses for the rest of the year. An individual OOP maximum applies for each covered family member; once the family OOP maximum is met, 100% payment begins for all covered family members.

Use the $900 Deductible Plan wisely

Here are ways to make the most of your plan all year long.

• Track your stats. Log in to your carrier’s website to see how much of your deductible you’ve met, review claims and more.
• Pair it with a Health Care FSA. If you enroll in the Health Care FSA, you can set aside pre-tax dollars to help pay for your out-of-pocket costs. Keep in mind, you can only carry over up to $610 of unused money in your FSA to the next year; you will forfeit amounts above $610.
• Be cost-conscious. Visit your carrier’s website to search for in-network providers and use the tools to compare costs for medical services.

Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.

Additional Network Option for Iowa Residents

If you live in Iowa, you have an additional option for medical coverage: the Narrow Network (Iowa only). This plan offers the same range of deductibles as the National Network – $900, $1,850, $3,000 or $4,500 – but the premiums are much lower because the network is Iowa-only. The online Doctor On Demand and many of the same providers are part of the Narrow Network (about 98%); the biggest differences are you can't receive care out of state (except for emergencies, pre-approved referrals, and dependents that live out of state); you must designate a Primary Care Physician; and the number of chiropractic care providers is substantially less.

1. First, determine the medical carrier in your area.

You will have either Wellmark Blue Cross Blue Shield or United Healthcare as your medical plan carrier, based on the state where you live. If you live in Hawaii, you are only eligible for the Platinum Be Fit Plan offered by Kaiser-Hawaii. Aligning a medical carrier to each state gives you access to the best service, most competitive discounts and an extensive network of providers and facilities available.

2. Second, go to your carrier’s website to find in-network providers.

Wellmark Blue Cross Blue Shield

• Visit Wellmark at wellmark.com.
• Under the Menu, click on “Find a provider or facility" under “Quick Links."
• Click on the “Find a provider or facility" option at the top of the page, then click on “Continue to New Site" when the “You are now leaving Wellmark.com" box appears.
• Click on “Choose a location and plan" when the “Hi there, let's get started!" box appears.
• Enter your ZIP code. The city, state and zip code will appear, then if correct, click “Yes, this is correct."
• When the “Find your plan by prefix" box appears, click on “Browse a list of plans" at the bottom of the box. 
  • For the “National network" plans: Select “Wellmark Blue PPO," and then click “Confirm selection." 
  • For the “Narrow network (Iowa only)" plans: Select “Wellmark Blue HMO," and then click “Confirm selection." 
• You can click on “Search all" then enter a name or phrase, or click on one of the categories to search by a doctor's name, specialty, facility name or type of facility.

United Healthcare

• Visit United Healthcare at myuhc.com.
• Select “Find a Provider.”
• Select either "Medical Directory” or “Behavioral Health Directory” as appropriate.
• Select “Employer and Individual Plans,” followed by “Choice Plus.”
• Enter your ZIP code to continue your search. You can provide a Doctor Name or Specialty, Facility Name, Clinic Name or Medical Group Name. Or, under “Find Health Care by Category,” you can click on People, Places, Services and Treatments, or Care by Condition.

Kaiser

• Visit Kaiser at kp.org
• Click on “Doctors & Locations” along the top menu.
• Choose your region.
• Use the fields under “What can we help you find?” to select your search criteria.
• You can search by Doctors or Locations, Region or Specific Location, and can search by Hospitals, Specialties, Doctors' Names or Keywords.

Coming in 2023: If you are enrolled in a Wellmark or United Healthcare plan, you will have access to Rx Savings Solutions, which can help you save on prescription drugs. Watch for more information in 2023.

When you enroll in a Transamerica medical plan, you will automatically receive prescription drug coverage. Benefits are provided by Express Scripts for Wellmark Blue Cross Blue Shield and United Healthcare plans, and by Kaiser Pharmacy for Kaiser plans.

Once you enroll for medical coverage, you will receive a prescription drug ID card from Express Scripts or Kaiser Pharmacy within 30 days of enrollment.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the “tier” of the medication:

 

Tier 1 drugs

include most generics; these drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.

 

Tier 2, or formulary drugs

are brand-name medications that are preferred by a prescription plan based on drug effectiveness and cost.

 

Tier 3, or non-formulary drugs

are brand-name medications that are not on a prescription plan's preferred list (or formulary) based on drug effectiveness and cost. They may still be covered, but may require prior authorization and cost more.

Filling your prescription

The cost of prescription drugs is rising faster than many other health care services and supplies. But there are ways for you to save money when you’re filling prescriptions:

• Retail or mail order? For short-term medication needs, such as antibiotics, a retail pharmacy is your best and most convenient option. 
  
  Long-term medications are prescriptions you take for an ongoing condition such as high blood pressure. After three retail prescription fills for long-term medications, you need to either use Express Scripts mail-order pharmacy or the Smart90 program and pick up a three-month supply of your medication at CVS or Walgreens. If you don’t use one of these options, you’ll pay 100% of the prescription cost at a retail pharmacy.


• Generic or brand name? Generic medications are generally just as effective as brand-name medications, yet the cost of generics is substantially lower ― they typically cost between 30% and 75% less than brand-name drugs.
  
  If you choose a brand-name drug when a generic is available, you will pay the cost of the generic drug plus the difference in cost between the generic and the brand name. Although you may use any available HSA or FSA funds to pay for the brand-name prescription, the difference in cost is not a covered expense under the plan, and will not apply to your deductible or out-of-pocket maximum.


• Certain compound medications are not covered under the prescription drug plan. To be covered under the drug plan, a medication must be approved by the Food and Drug Administration (FDA). While certain ingredients in the compound may be FDA approved, the resulting medication after compounding may not be. The FDA does not verify the quality, safety or effectiveness of compound medications.


• Specialty medications are drugs used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis and rheumatoid arthritis. If you take a specialty medication, you should purchase it through the specialty pharmacy offered by your medical plan.
  • Accredo is the specialty pharmacy for United Healthcare and Wellmark Blue Cross Blue Shield plans.
  • Kaiser’s specialty pharmacy will vary by location. Please contact Kaiser for more information.

Please note: If you receive manufacturer coupons, discount cards or copay assistance for specialty medication, the amount applied to your annual deductible and out-of-pocket maximum will equal the amount you pay for your prescription drug after the coupon or discount is applied.

Prescription management programs

We have partnered with Express Scripts to offer prescription drug management programs to help you use your prescription drugs safely and effectively, as well as save money. These programs automatically apply to all participants who choose either a Wellmark Blue Cross Blue Shield or United Healthcare medical plan. (Note: These programs do not apply to Kaiser plans.)

Specialty Deductible/Out-of-Pocket Protection Program

Provides copay assistance toward the purchase of certain specialty medications. However, only the amount you pay towards your specialty prescriptions will be applied to your deductible and out-of-pocket maximum.

Safeguard Rx: Diabetes Care Value Program

If you have diabetes, this program helps you monitor and control your glucose levels. With Diabetes Remote Monitoring, you will receive a free smart glucose meter that synchronizes with your smartphone and securely sends data to specialist pharmacists who are available to support you. You can also access Mango Health, which offers a mobile app with games and rewards for healthy habits, such as taking medication on time.

Advanced Opioid Management Program

Opioids are a highly effective treatment for pain when taken correctly, but they can also be addictive. If you take prescription opioids for pain, Express Scripts will send you a letter and a short guide with important guidelines and tips to help you stay safe, as well as a number you can call with any questions or concerns.

Maintenance Medications

If you take a long-term or “maintenance” medication to manage a health condition like high blood pressure, diabetes or high cholesterol, the Smart90 program gives you the option to pick up a three-month supply of your medication at a CVS or Walgreens, or have your medication shipped to your home using Express Scripts mail-order pharmacy.

With a three-month supply of your medicine on hand, you're less likely to miss a dose, which can keep you healthier and save money.

With Express Scripts, you can:

• Get prescriptions delivered to your door with free standard shipping, or with Smart90 pick up a three month supply at a CVS or Walgreens near you
• Transfer prescriptions easily online, by phone or via Express Scripts® mobile app
• Set up auto-refills and refill reminders
• Talk with a pharmacist by phone 24/7

To get started, log in to esrx.com review your 90-day options. If this is your first time visiting the site, take a minute to register (be sure you have your member ID number handy). You can also use the Express Scripts mobile app on your digital device to locate a participating pharmacy or call Express Scripts at the number listed on the back of your member ID card.

If you choose to use Express Scripts home delivery for your 90-day supply of your maintenance medication, you can either have your doctor send the prescription directly to Express Scripts or use the Express Scripts website to initiate the transfer to home delivery. If you’d prefer to get a 90-day supply at a CVS or Walgreens, you can have your doctor provide CVS or Walgreens with a 90-day prescription, ask the pharmacist to contact your doctor if you already have a prescription on file at the pharmacy, or to transfer your current 90-day prescriptions from another pharmacy.

You have access to a wealth of resources and helpful tools through your medical plan provider. From tracking claims to improving your health, information that puts you in charge of your spending and your well-being is just a click away. Each medical plan provider provides a wide variety of tools and resources, in addition to those listed below. Visit your provider’s website for more information.

TouchCare

You have access to TouchCare. As a member, you have a personal health assistant to help answer all of your healthcare and benefit questions.

TouchCare can help you and your family:

• Resolve claims issues with your insurance company
• Find the right doctor and/or get an appointment scheduled
• Make the right decisions while keeping costs down
• Understand your benefits and cost share

TouchCare also offers a 30-minute consultation during open enrollment. To get started, visit www.touchcare.com or call 866-486-8242.

Wellmark Blue Cross Blue Shield

The following programs are available to those enrolled in a Wellmark BlueCross Blue Shield medical plan:

2nd.MD Expert Second Opinions

The 2nd.MD program gives you access to board-certified doctors across the country for an expert second opinion, enabling you to connect with a top specialist by video or by phone at a time that’s convenient for you.

Doctor on Demand

With Doctor On Demand, you and your family members can connect face-to-face with a board-certified doctor on your schedule. You can get treatment for conditions including cold and flu, allergies, fever and other conditions, such as mental health. To get started, download the Doctor On Demand® app or visit www.DoctorOnDemand.com.

Blue365

Just by being a Wellmark member, you have access to Blue365. When you sign up, you get exclusive discounts for wellness products and services you use every day, such as fitness trackers, eyeglasses and athletic shoes. Visit Wellmark.com/Blue365 for a full list of deals and discounts available to you.

IDX Identity

Your Wellmark health insurance coverage keeps you safe, secure and protected from more than the cost of health care. Just by being a member, you and your dependents have exclusive, free access to identity protection services called IDX Identity. With IDX Identity, you can monitor your credit record, keep track of your online activity 24/7, and have access to complete identity recovery if fraudulent activity is found. Register or sign in to myWellmark® at myWellmark.com to get started.

BeWell 24/7

BeWell 24/7 is here for you, when you need it — connecting you with a real person who can help with a variety of health-related concerns. Whether you need help discussing care options, determining if a fever warrants a trip to the doctor or even finding elder care, you can call 24 hours a day, 7 days a week at 844-84-BeWell.

Blue

Each issue of Blue features health and wellness articles, consumer tips and health plan news. It provides resources on living a fulfilling and healthy life. Find it online at Wellmark.com/Blue.

Health support programs

Wellmark has three different programs — case management, pregnancy support and rare condition management — that can help improve outcomes when there is a significant health need.

UnitedHealthcare

The following programs are available to those enrolled in a UnitedHealthcare medical plan:

2nd.MD Expert Second Opinions

The 2nd.MD program gives you access to board-certified doctors across the country for an expert second opinion, enabling you to connect with a top specialist by video or by phone at a time that's convenient for you.

Virtual Visits

When you are sick and need care quickly, a Virtual Visit is a convenient way to start feeling better faster. With Virtual Visits, you have access to United Healthcare’s network of virtual doctors who can provide care using live audio and video technology. Visits typically take less than 20 minutes and will typically cost you $50 or less. To get started, go to www.uhc.com/virtualvisits and register today.

Mercer Health Advantage

If you have a complex or chronic condition, Mercer Health Advantage provides a special support team with your own “nurse in the family” approach, along with various health services at your fingertips. In the event that you or a covered family member are diagnosed with a health condition that requires complex care, or requires follow-up care after a recent hospital stay, you and your family will receive support from a dedicated team of nurses, clinicians and other specialized professionals to help you improve your health.

Mercer Health Advantage provides specialized support for things such as:

• Managing a chronic condition, such as diabetes, coronary artery disease, asthma, COPD or heart failure;
• Dealing with a complex condition such as cancer or chronic kidney disease;
• Treating back pain and musculoskeletal conditions; and
• Maternity support.

Kaiser Permanente

The following programs are available to those enrolled in a Kaiser Permanente medical plan:

Video Visits & Chat with a Doctor

Kaiser offers two ways to get care that are secure, convenient and personalized. If your Kaiser provider determines the care you need can be provided in a video visit, this is a great alternative to making a trip for an in-person visit. Kaiser also offers an online chat feature. “Chat with a Doctor” is on demand, real-time messaging with a doctor to receive medical advice and triage. These services are available 8 a.m. - 10 p.m., seven days a week.

Wellness Coaching

Health Solutions offers an invitation-only coaching program which provides tools and guidance to empower you to effectively manage your health and to ultimately achieve a better quality of life. If you qualify, you will receive an invitation via email to this free, confidential program, and your health coach will help you develop and implement a personal wellness plan to address any high-risk areas, with help from a licensed Health Solutions clinical pharmacist.

You will work with your Health Solutions Care Team to:

• Review health screening results and understand areas of risks;
• Receive education specific to your conditions and risks;
• Develop goals and action plans to reduce risk;
• Coordinate care with your doctor; and
• Get support in overcoming obstacles, tracking progress and celebrating success.

Prescription Tools

Order or refill prescriptions, sign up for mail order and more on your prescription websites:

• Express Scripts
• Kaiser Pharmacy

HSA/FSA Tools 

Manage your Health Savings Account and Health Care Flexible Spending Account online with Transamerica at Transamerica.com/portal.