Medical

Overview

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

2020 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.

Medical Plan	Description
$4,500 Deductible Plan2 Administered by: Aetna or United Healthcare, based on the state you live in.	A high deductible health plan (HDHP) that offers the lowest premiums and highest deductibles, along with a tax-advantaged Health Savings Account (HSA) to put you in charge of your spending. You have the opportunity to earn Reward Dollars as a reward for completing wellness activities if you elect an HSA.
$2,850 Deductible Plan Administered by: Aetna or United Healthcare, based on the state you live in. Kaiser may be available as a carrier option for participants living in California, Colorado, the District of Columbia, Georgia, Maryland and Virginia. You will only be offered Kaiser as a medical option if it is available for your home ZIP code. Click here for a list of ZIP codes where Kaiser is available.	A high deductible health plan (HDHP) that offers lower premiums and higher deductibles, along with a tax-advantaged Health Savings Account (HSA) to put you in charge of your spending. You have the opportunity to earn Reward Dollars as a reward for completing wellness activities if you elect an HSA.
$1,850 Deductible Plan Administered by: Aetna or United Healthcare, based on the state you live in. Kaiser may be available as a carrier option for participants living in California, Colorado, the District of Columbia, Georgia, Maryland and Virginia. You will only be offered Kaiser as a medical option if it is available for your home ZIP code. Click here for a list of ZIP codes where Kaiser is available.	A high deductible health plan (HDHP) that offers lower premiums and high deductibles, along with a tax-advantaged Health Savings Account (HSA) to put you in charge of your spending. You have the opportunity to earn Reward Dollars as a reward for completing wellness activities if you elect an HSA.
$900 Deductible Plan Administered by: Aetna or United Healthcare, based on the state you live in. Kaiser may be available as a carrier option for participants living in California, Colorado, the District of Columbia, Georgia, Maryland and Virginia. You will only be offered Kaiser as a medical option if it is available for your home ZIP code. Click here for a list of ZIP codes where Kaiser is available.	A low deductible plan that offers the highest premiums and lowest deductibles to reduce your out-of-pocket responsibility when you need care. This plan is not HSA-eligible, but you can contribute to a Health Care Flexible Spending Account (FSA).
Compare the plans in the Plan Comparison section below

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.

Key features

All of Transamerica’s medical plans offer:

• Comprehensive, affordable coverage that also fulfills the requirements of the federal health care law. Tip: If you want extra protection from large or unexpected medical expenses, you may also choose to enroll in one of the supplemental health insurance plans.
• In-network preventive care, with services such as annual physicals, recommended immunizations and routine cancer screenings covered at 100%. View a complete list of covered preventive services at healthcare.gov/coverage/preventive-care-benefits.
• Prescription drug coverage included with each medical plan. Prescription benefits are provided by Express Scripts if you enroll in an Aetna or United Healthcare plan, and by Kaiser Pharmacy if you enroll in a Kaiser plan.
• Financial protection through annual out-of-pocket maximums that limit the amount you’ll pay each year.

Once you’ve enrolled for coverage, you will receive a medical plan ID card from Aetna, United Healthcare or Kaiser within 30 days of enrollment.

Plan Comparison

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.

	$4,500 Deductible Plan	$2,850 Deductible Plan	$1,850 Deductible Plan	$900 Deductible Plan
HSA-eligible	Yes	Yes	Yes	No
Reward Dollars (if wellness activities completed)	Up to $500 for Self Only coverage; up to $800 if you cover your spouse and/or child(ren)	Up to $500 for Self Only coverage; up to $800 if you cover your spouse and/or child(ren)	Up to $500 for Self Only coverage; up to $800 if you cover your spouse and/or child(ren)	N/A
In-network care: Your costs
Preventive care	Covered at 100% in-network
Annual deductible (individual/ family)	$4,500/$9,0001	$2,850/$5,7001	$1,850/$3,7002	$900/$1,8001
Annual out-of-pocket maximum (individual/ family)	$6,550/$13,1003	$5,500/$11,0003	$3,500/$6,5004	$3,000/$6,0003
Coinsurance (after meeting deductible)	You pay 30%, plan pays 70%	You pay 30%, plan pays 70%	You pay 20%, plan pays 80%	You pay 20%, plan pays 80%
Retail prescriptions (30-day supply)
Tier 1 (most generics)	You pay 30% after meeting deductible	You pay 30% after meeting deductible	You pay 20% after meeting deductible	You pay 30% (min. $10/max. $20)5
Tier 2 (formulary)	You pay 30% after meeting deductible	You pay 30% after meeting deductible	You pay 20% after meeting deductible	You pay 30% (min. $25/max. $50)5
Tier 3 (non-formulary)	You pay 30% after meeting deductible	You pay 30% after meeting deductible	You pay 20% after meeting deductible	You pay 45% (min. $40/max. $80)5
Mail-order prescriptions (up to a 90-day supply6)
Tier 1 (most generics)	You pay 30% after meeting deductible	You pay 30% after meeting deductible	You pay 20% after meeting deductible	You pay 30% (min. $25/max. $50)5
Tier 2 (formulary)	You pay 30% after meeting deductible	You pay 30% after meeting deductible	You pay 20% after meeting deductible	You pay 30% (min. $62.50/max. $125)5
Tier 3 (non-formulary)	You pay 30% after meeting deductible	You pay 30% after meeting deductible	You pay 20% after meeting deductible	You pay 45% (min. $100/max. $200)5

¹With the $900, $2,850 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, $2,850 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.
⁶Beginning in 2020, 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.

$4,500 Deductible Plan ($9,000 family deductible)

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. As a reward for completing certain wellness activities, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of completing certain wellness activities. 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.

$2,850 Deductible Plan ($5,700 family deductible)

The $2,850 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. As a reward for completing certain wellness activities, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of completing certain wellness activities. 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.

$1,850 Deductible Plan ($3,700 family deductible)

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. As a reward for completing certain wellness activities, you and your covered spouse (if applicable) can earn Reward Dollars that will be deposited automatically into your HSA within six weeks of completing certain wellness activities. 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%.

Use the HDHPs wisely

With lower premiums, the $4,500, $2,850 and $1,850 Deductible Plans give you more opportunity to take control of your health care spending. Here’s how you can 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, use helpful tools and more. Likewise, keep tabs on your HSA by logging in to Optum Bank's website to view your balance, manage claims, etc.
• Be cost-conscious. Visit your carrier’s website to search for in-network providers and use the tools to compare costs for medical services.
• Plan for your expenses. You pay lower premiums in exchange for assuming more financial responsibility when you receive care, so it’s smart to plan ahead. Try to contribute enough to your HSA to cover your expected out-of-pocket costs, such as your annual deductible and coinsurance.
• Change your HSA contributions anytime. Adjust your contributions as necessary during the year to make sure you have money available when you need it. Keep in mind: With an HSA, you can only spend up to the amount that’s actually been deposited into your account.
• Look long term. You will never forfeit any money left in your HSA, it rolls over year after year. If you know about future expenses, or if you want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time. Once your account reaches a certain balance, there are investment options to help your money grow.

$900 Deductible Plan ($1,800 family deductible)

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 $500 of unused money in your FSA to the next year; you will forfeit amounts above $500.
• Be cost-conscious. Visit your carrier’s website to search for in-network providers and use the tools to compare costs for medical services.

365+ HUB

Imagine you’ve been told you need a medical procedure to treat a recently diagnosed condition. It’s hard to know where to start. How will you find the best doctor, and what will it cost? Where can you get a second opinion? What if you need help resolving a complicated bill or claim issues?

If you enroll in a Transamerica medical plan, you may also choose to enroll in the Mercer Marketplace 365+ HUB^SM, a voluntary benefit that provides one-on-one support — online and by phone — to help you improve the quality and cost of your care. For a small monthly cost, you will have year-round access to personal health advocacy services, price comparison tools, physician performance ratings, expert medical opinions and more.

Find an advocate

The 365+ HUB has a team of registered nurses, medical directors and benefits and claims specialists who work right alongside each other to help you. This is available to you and your covered family members. A personal health advocate with expert knowledge about your benefits will help you:

• Find the right doctor
• Schedule appointments
• Resolve health care billing and insurance claims disputes
• Secure elder care with confidence, including answering Medicare questions
• Work seamlessly with insurance providers
• Transfer medical records promptly and securely

Compare prices

The cost of health care services can vary significantly, even within the same geographic area and health plan. Here are just a few examples:

• Knee replacement surgery: $18,887–$57,194
• MRI: $450–$2,450
• Colonoscopy: $1,314–$3,007

Health Cost Estimator+ is an easy-to-use online tool offered through the 365+ HUB. You’ll see what you can expect to pay for a medical procedure at different locations — based on the medical plan you’re enrolled in — and can easily compare prices so you can make the right choice for your needs and budget.

Compare quality

With the Mercer Marketplace 365+ HUB, you can review the quality scores of doctors in your area based on your condition and need. Scorecards include:

• Physician performance scores
• Quality analysis
• Experience and outcomes ranking
• Evaluations based on billions of doctor-patient interactions

Get expert medical opinions

Don’t hesitate to get another opinion, especially if it’s a serious condition. The 365+ HUB gives you and your covered family members access to specialists who will review your case and give you an expert opinion on your diagnosis and treatment plan. It’s peace of mind at a time when you may need it most. The 365+ HUB accepts all cases and sticks with you every step of the way.

Find a Doctor

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

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

You will have either Aetna or UnitedHealthcare as your medical plan carrier, based on the state you live in. 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.

Medical plan carrier by state
Aetna Arizona California* District of Columbia* Delaware Georgia* Kansas Maine New Jersey Nevada New York Oklahoma Oregon Pennsylvania Utah Washington West Virginia	UnitedHealthcare Alabama Alaska Arkansas Colorado* Connecticut Florida Idaho Illinois Indiana Iowa Kentucky Louisiana Massachusetts Maryland* Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Mexico Ohio Rhode Island South Dakota Tennessee Texas Virginia* Vermont Wisconsin Wyoming
*If you live in California, Colorado, the District of Columbia, Georgia, Maryland or Virginia, Kaiser may be an additional medical carrier option that provides in-network coverage only (availability depends on your home ZIP code). Kaiser is an HMO, and all your care must be coordinated by your Primary Care Provider (PCP).

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

Aetna

• Visit Aetna at aetna.com.
• Click on “Find a Doctor” along the top of the page.
• Under “Guests” click on “Plan from an employer.”
• Under “Continue as a guest,” enter home zip code and click “Search.”
• Under “Select a Plan,” select “Aetna Choice POS II (Open Access)” network under “Aetna Open Access Plans” and click “Continue.”
• You can either enter a provider name, specialty, procedure or condition in the search field, or click on a category.

United Healthcare

• Visit United Healthcare at myuhc.com.
• Select “Find a Provider.”
• Select either "Medical Directory” or “Mental Health Directory” as appropriate.
• Select “All United Healthcare plans,” followed by “Shopping Around” and “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.

Prescription Drugs

When you enroll in a Transamerica medical plan, you will automatically receive prescription drug coverage. Benefits are provided by Express Scripts for Aetna 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 Aetna 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 UHC or Aetna 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 express-scripts.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.

Tools & Resources

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 a variety of tools and resources, in addition to those listed below. Visit your provider’s website for more information.

Telemedicine Services

Teladoc® (for Aetna members only)

For less than you’d typically pay for the cost of an urgent care or ER visit ($40 or less for general health issues, $75 or less for dermatology), you can talk to a U.S. board-certified physician, licensed in your state, to diagnose, treat and prescribe medications for your non-emergency conditions. Whenever you need care, a doctor is available within minutes, by phone or video. Visit Teladoc.com/Aetna or call 1-855-Teladoc to set up your account today. You can also download the Teladoc app to your mobile device by going to Teladoc.com/mobile or visiting your app store.

Virtual Visits (for UHC members only)

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/virtualvists and register today.

Video Visits & Chat with a Doctor (for Kaiser members only)

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. There is no cost for Kaiser members, and it is available 8 a.m. – 10 p.m., seven days a week.

Mercer Health Advantage (for Aetna and United Healthcare plans)

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.

Health Solutions

The Health Solutions coaching program uses data analytics to identify members who may benefit from access to a health coach. 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 online:

• Optum Bank

Manage your Health Care Flexible Spending Account online:

• Discovery Benefits