Medical
Overview
When it comes to medical, ABC Company have you covered. You have several options so you can choose what’s best for you and your family:
- MAP Plus Option 1 – This plan uses a pay up-front approach. You pay higher premiums, but your costs are generally lower when you receive care.
- MAP Plus Option 2 – Think of this plan as a pay as you go option. You pay less in premiums, so more of your money stays with you until you need care. Also, this is the only option that offers access to the Health Savings Account (HSA), allowing you to save tax-free for your current and future needs.
- Health Maintenance Organizations (HMOs) – These plans (where available) offer a coordinated care approach. You choose a primary care provider, who you receive most of your care from, and may need a referral to see others.
MAP = Medical Assistance Program
Did you know? We pay more than $250 million toward medical coverage each year – picking up the majority of the health care tab for our employees.
Things to know.
You have coverage flexibility. Select a coverage tier that works best for you and your family.
For cost and coverage details by state, review the comparisons.
If covering a spouse/domestic partner, you must complete the insurance verification process through the Benefits enrollment website each year. If you do not answer these online questions, you will lose spouse/domestic partner coverage.
See how the MAP Plus Options compare.
In many ways they are alike, but there are also some differences to know about.
How they're alike...
- Same XYZ network of high-quality health care providers and hospitals.
- Same covered services (e.g., doctor office visits, hospital stays).
- Same preventive medical services covered at 100% (e.g., annual physical, annual eye exam, mammograms, well-child care).
- Same XYZ One Advocate high-touch, high-tech premium experience that combines data with the human touch and expertise of highly-trained advocates.
XYZ is ABC Company's largest medical provider in the U.S. and is one of the nation's leading diversified health care insurers. XYZ serves over 23 million medical members and has a network of about 1.2 million health care professionals, more than 690,000 primary care doctors and specialists and over 5,000 hospitals.
How they're different...
- The amount you pay in premiums – MAP Plus Option 1 costs more.
- The amount you pay as you receive care – for example, MAP Plus Option 2 has a higher deductible.
- The way the out-of-pocket maximum works – it’s based on a percentage of your base salary under MAP Plus Option 1 (up to a maximum amount), while it’s a fixed dollar amount under MAP Plus Option 2.
- How preventive medications are covered – under MAP Plus Option 2 you are required to pay only 20% of the costs with no deductible.
- Access to a Health Savings Account (HSA) – only available with MAP Plus Option 2.
Review the scenarios and see how costs compare under three real life situations.
Learn about the ways you pay for health care.
- Premiums – What it costs to buy medical insurance. You pay only part of the total cost through your contributions and ABC Company picks up the rest, covering the majority.
- Tobacco surcharge – An additional $50 per month that you pay if you use tobacco.
- Preventive care – Because good health and prevention are important, you can receive eligible in-network preventive services at no additional cost under ABC Company medical plans.
- Deductible – Comes into play when you receive non-preventive care. It’s the amount you need to spend up front each year for most services before the plan kicks in and starts to pay a portion of the costs.
- Coinsurance – Once you have met your deductible, you pay a percentage of the costs for many of the services you receive and ABC Company pays for the rest (example: you pay 20% for in-network services under MAP Plus Option 2 and ABC Company picks up the other 80%).
- Copayments – Small fixed dollar amounts for certain services under some plans (example: $20 copayment for primary care visits, under MAP Plus Option 1).
- Out-of-pocket maximum – A safety net if you end up needing a lot of care. It is the most you will pay for covered services in a year, protecting you financially. Any care you need after meeting the out-of-pocket maximum is covered by ABC Company.
Considering one of the HMOs? Be sure to understand how they work.
Ready to quit using tobacco products and save on premiums? Learn about support options.
Use your coverage wisely.
How can you help keep health care costs in check? By making good choices.This includes good choices for your health. Good choices when using your benefits. Good choices to manage your health risks. What you do makes a real difference.
Consider this:
Be a savvy shopper.
Find the best care options at the best price using tools available through your health plan.
Get virtual care anytime, anywhere.
Use telemedicine (if available through your health plan) such as Company's Teladoc. It’s a lot like seeing a doctor in-person except without the travel or wait time, since it is through your smartphone or computer. Plus it is typically at a lower cost.
Receive the right care at the right place.
If you are experiencing a true emergency, do not hesitate. Go to the ER. But if it’s not a true emergency, consider receiving care through less expensive options, such as urgent care or your primary care doctor. And remember to use in-network doctors and facilities – it will save you money.
Ask about generics.
Talk to your doctor about generic drugs. They’re often just as effective, but much less expensive than the brand-name counterparts.
Be a champion of your health.
Staying on top of your health, can help you avoid illness and injury. And a healthy lifestyle can help put you at your best.
These are some ideas to get you started – think about all you can do to make a difference for both your physical and financial well-being.
Visit an ABC Company Family Health Center.
ABC Company continues to look for ways to provide access to affordable health care for you and your family. The ABC Company Family Health Centers provide a high quality, low cost option for primary care visits (e.g., consultations and physical exams, preventive screenings, immunizations, etc.), specialist referrals, occupational health and more.
If you and your dependents (excluding individuals who are eligible for Medicare) are enrolled in a ABC Company medical plan and located near Collegeville, PA; Houston, TX; Lake Jackson, TX or Midland, MI – our newest location – consider taking advantage of an ABC Company Family Health Center.
Tools and resources.
Need help making your medical plan decision?
Use the Medical Plan Comparison Tools on the ABC Company Benefits enrollment website. You can also review premiums while you are there.
Looking for more details on medical benefits?
Check out the Benefits & Well-being site for additional information, including Summary Plan Descriptions (SPDs).
Want to know what medical benefit partners offer?
Connect with the resources available from medical benefit partners, including websites, mobile apps and more.