One fact of life that’s hard to avoid: There’s a good chance you’ll need medical care at some point. Whether you’ve twisted your wrist, your child has a fever, or you just need an annual checkup, you’ll be glad to have medical coverage you can count on through CSL.
Your Medical Plan Choices
CSL offers a range of medical plans to meet your diverse needs. You have three coverage options to choose from:
- Basic Plan: A preferred provider organization (PPO) option with prescription drug copays
- High Deductible Health Plan (HDHP) with Health Savings Account (HSA): A high-deductible option with an HSA and prescription drug coinsurance
- Premium Plan: A PPO option with prescription drug copays
For each of the three options, you can choose between two comprehensive national provider networks:
- UMR by UnitedHealthcare: UnitedHealthcare provider network: Choice Plus
- Meritain Health, an Aetna company: Aetna provider network: Aetna Choice POS II
The best coverage option and network for you depend on your preferences and needs. Both the Meritain Health and UMR networks include prescription drug coverage through CVS Caremark.
With all the plans, you can choose any doctor or facility, but you’ll pay less when you use in-network providers. The plans all pay 100% of in-network preventive care services, with no copay or deductible.
If you live in California, Colorado, Georgia, Maryland, Oregon, Virginia, Washington or Washington, D.C., you may also have access to Kaiser Permanente medical plans, which also offer four plan coverage options.
Need help deciding?
Connect with your Accolade Health Assistant for personal guidance on finding the best options for your family’s specific needs. You can also use the Provider Tool on Benefits In-Site to research which doctors and hospitals participate in each of the networks.
Basic Plan
- Preventive care is covered 100%.
- The in-network deductible is $2,250 for individual coverage and $4,500 for family coverage.
- You pay $30 for in-network primary care physician visits and $50 for in-network specialist visits (with no deductible) until you’ve met your in-network out-of-pocket maximum of $6,000 for individual coverage or $12,000 for family coverage.
- For most other services, you’ll pay 30% coinsurance after you meet the deductible.
- For more information, refer to the summary of benefits for this plan.
HDHP with HSA
- Preventive care is covered 100%.
- The in-network deductible is $1,800 for individual coverage and $3,600 for family coverage. The entire family deductible must be met before your insurance will pay benefits for any covered family member. There is no “individual deductible” in this coverage option when you have family coverage.
- For in-network doctor visits, you pay 20% after you’ve met the deductible, until you’ve met your in-network out-of-pocket maximum of $4,500 for individual coverage or $9,000 for family coverage.
- When you enroll in this plan, you’re eligible for a Health Savings Account (HSA) that lets you set aside pretax dollars to pay for eligible medical expenses.
- For more information, refer to the summary of benefits for this plan.
Premium Plan
- Preventive care is covered 100%.
- The in-network deductible $600 for individual coverage and $1,200 for family coverage.
- You pay $20 for in-network primary care physician visits and $35 for in-network specialist visits (with no deductible) until you’ve met your in-network (with no deductible) until you’ve met your in-network out-of-pocket maximum of $3,000 for individual coverage or $6,000 for family coverage.
- For most other services, you’ll pay 10% coinsurance after you meet the deductible.
- For more information, refer to the summary of benefits for this plan.
Kaiser Permanente
- This plan is only available to employees in California, Colorado, Georgia, Maryland, Oregon, Virginia, Washington and Washington, D.C.
- You can select from four coverage options.
- You can only use in-network providers (except for emergencies), including Kaiser pharmacies and facilities.
- For more information, refer to the summary of benefits on Benefits In-Site.
Transparency in Coverage
In response to the federal Transparency in Coverage Rule, UMR and Meritain Health have created machine readable files that include negotiated service rates and out-of-network allowed amounts between the health plans and healthcare providers.
More About the Annual Deductible
The deductible is what you pay out of pocket before your insurance starts paying its share of your costs. It doesn’t include amounts taken out of your paycheck for health coverage. Here’s how the deductible works if you have family coverage:
The HDHP with HSA coverage option
This option has a "true family deductible." This means that the entire family deductible must be met before your insurance will pay benefits for any covered family member. There is no “individual deductible” in this coverage option when you have family coverage.
The Basic and Premium Plan coverage options
These options have a traditional deductible. This means that once a covered family member meets the individual deductible, your insurance will begin paying benefits for that family member. Charges for all covered family members will continue to count toward the family deductible. Once the family deductible is met, your insurance will pay benefits for all covered family members.
Annual Deductible
| Basic Plan | HDHP with HSA | Premium Plan | |
|---|---|---|---|
| In-network (individual/ family) | $2,250/ $4,500 | $1,800/ $3,600 | $600/ $1,200 |
| Out-of-network (individual/ family) | $4,500/ $9,000 | $1,800/ $3,600 | $1,200/ $2,400 |
More About the Out-of-Pocket Maximum
The out-of-pocket maximum is the most you and your covered family members would have to pay in a year for health care costs.
All options have a traditional out-of-pocket maximum.
Once a covered family member meets the individual out-of-pocket maximum, your insurance will pay the full cost of covered charges for that family member. Charges for all covered family members will continue to count toward the family out-of-pocket maximum. Once the family out-of-pocket maximum is met, your insurance will pay the full cost of covered charges for all covered family members.
Out-of-Pocket Maximum
| Basic Plan | HDHP with HSA | Premium Plan | |
|---|---|---|---|
| In-network (individual/ family) | $6,000/ $12,000 | $4,500/ $9,000 | $3,000/ $6,000 |
| Out-of-network (individual/ family) | $12,000/ $24,000 | $9,000/ $18,000 | $6,000/ $12,000 |
It Pays to Stay In-Network
If you choose an out-of-network provider, you pay more in three ways:
- You must meet the higher out-of-network deductible before the plan pays benefits.
- You pay a higher out-of-network coinsurance amount.
- You pay 100% of the out-of-network provider’s charges that exceed the insurer’s maximum allowed amount.
Medical Plans at a Glance (In-Network)
Here’s a high-level listing of commonly covered medical benefits. For more information, refer to the summary of benefits for these plans.
| Basic Plan | HDHP with HSA | Premium Plan | |
|---|---|---|---|
| Flexible Spending Account or Health Savings Account? | Flexible Spending Account (FSA) | Health Savings Account (HSA) | Flexible Spending Account (FSA) |
| 2024 FSA/HSA Contribution Limits | You can contribute up to $3,200 | Employee only: $4,150 Family: $8,300 55 or older: an additional $1,000 CSL will contribute: Employee only: $500 Family: $1,000 | You can contribute up to $3,200 |
| Annual Deductible | Employee only: $2,250 Family: $4,500 | Employee only: $1,800 Family: $3,600 | Employee only: $600 Family: $1,200 |
| Annual Out-of-Pocket Maximum | Employee only: $6,000 Family: $12,000 | Employee only: $4,500 Family: $9,000 | Employee only: $3,000 Family: $6,000 |
| Preventive Care | Covered 100%, no deductible | Covered 100%, no deductible | Covered 100%, no deductible |
| Doctor’s Office Visit | You pay $30 for primary care physician (PCP) visit; no deductible You pay $50 for specialist visit; no deductible | You pay 20% after deductible | You pay $20 for PCP visit; no deductible You pay $35 for specialist visit; no deductible |
| Emergency Room | You pay $150, then 30% after deductible | You pay 20% after deductible | You pay 10% after deductible |
| Urgent Care | $50 copay | You pay 20% after deductible | $40 copay |
| Inpatient Care | You pay 30% after deductible | You pay 20% after deductible | You pay 10% after deductible |
| Diagnostic Care (X-rays, labs, etc.) | You pay 30% after deductible | You pay 20% after deductible | You pay 10% after deductible |
| Outpatient Care (physical therapy, behavioral health, etc.) | If not an office visit, you pay 30% after deductible | You pay 20% after deductible | If not an office visit, you pay 10% after deductible |
Menopause Support
If you or your dependents are enrolled in a Meritain Health or UMR medical plan, you have access to virtual menopause support through Gennev. You can connect with Board-certified OB/GYNs and Registered Dietitian Nutritionists who can:
- Prescribe medications such as hormone replacement therapy (HRT) or FDA-approved non-hormonal medications to help you manage your symptoms.
- Advise you on lifestyle changes related to diet and nutrition, fitness and movement, and sleep and mindfulness to help you manage weight changes, mood swings, brain fog and joint pain.
- Provide mental health support to help you deal with anxiety, mood swings and depression.
Visit Gennev to create your account and book your appointment. You can also call 206-895-4292 to learn more and book an appointment.
Tobacco Surcharge
If you’ve used tobacco or tobacco products, including cigarettes, pipes, cigars, chewing tobacco, snuff and e-cigarettes, or any type of smoking or smokeless tobacco in the previous three months, you’ll pay a $50 monthly surcharge in addition to your medical plan premium.
You can qualify to have the surcharge removed by completing a tobacco-cessation program. Please call the CSL Behring Benefit Center at 844-888-BNFT for details about available programs to help you quit tobacco usage.
Get Rewarded for Good Health
With the Virgin Pulse Wellbeing Program, you can earn up to $400 per year to pursue your wellbeing goals in ways that are most meaningful to you.