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.
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 |
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$4,500 Deductible Plan2 Administered by:
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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:
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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:
|
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:
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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.
All of Transamerica’s medical plans offer:
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.
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$4,500 Deductible Plan | $2,850 Deductible Plan | $1,850 Deductible Plan | $900 Deductible Plan |
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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 |
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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.
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. 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.
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.
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.
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.
Here are ways to make the most of your plan all year long.
Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.
You will have either Wellmark Blue Cross Blue Shield or United Healthcare as your medical plan carrier, based on the state where you live. 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 | |
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Wellmark Blue Cross Blue Shield Alabama Arizona California* Colorado* Connecticut District of Columbia* Delaware Idaho Indiana Iowa Kentucky Louisiana Maine Massachusetts Michigan Mississippi Montana Nevada New York North Dakota Ohio Pennsylvania Rhode Island South Carolina South Dakota Utah Virginia* Vermont West Virginia Wyoming |
UnitedHealthcare Alaska Arkansas Florida Georgia* Illinois Kansas Maryland* Minnesota Missouri Nebraska New Hampshire New Jersey New Mexico North Carolina Oklahoma Oregon Tennessee Texas Washington Wisconsin |
*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). |
Wellmark Blue Cross Blue Shield
United Healthcare
Kaiser
Keep in mind: If you choose a Kaiser plan in California, Colorado, the District of Columbia, Georgia, Maryland or Virginia, you are required to select a Primary Care Provider (PCP), who will manage your care.
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.
The cost of your prescription drugs under each medical plan depends on the “tier” of the medication:
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:
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.
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 Wellmark Blue Cross Blue Shield medical plan. (Note: These programs do not apply to Kaiser plans.)
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.
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.
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.
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:
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.
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:
TouchCare also offers a 30-minute consultation during open enrollment. To get started, visit www.touchcare.com or call 866-486-8242.
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.
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:
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. There is no cost for Kaiser members, and it is available 8 a.m. – 10 p.m., seven days a week.
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:
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:
Order or refill prescriptions, sign up for mail order and more on your prescription websites:
Manage your Health Savings Account and Health Care Flexible Spending Account online with Transamerica at Transamerica.com/portal. Make sure to submit any 2021 FSA expenses to TRI-AD at yourflexbenefits.mercermarketplace365.com.