Choosing medical coverage can be difficult, but Transformco will help you choose the best plan for your personal situation. Regardless of which medical plan you choose, the same types of services – preventive care, office visits, hospital stays, and prescription drugs – are covered.
With each plan, you will pay some of the expenses. The plans vary on the amount of cost-sharing which will be your responsibility. Cost-sharing is influenced directly by whether or not you choose in-network providers, preferred providers, or out-of-network providers each time you need care.
COST OF MEDICAL COVERAGE
Transformco will continue to provide contributions to supplement the cost of medical premiums. This employer contribution will appear on your Confirmation of Benefits as a credit applied to the total cost of benefits.
If your insurance carrier sends out physical ID cards for Annual Enrollment, you will typically receive them by the end of December. Please note not all carriers distribute ID cards, so if you have any questions, please contact your insurance carrier directly. See contacts and Resources on page 23 of this guide. In the case of a new hire, cards will typically be received within 7-14 days after your enrollment has been processed.
2021 MEDICAL OPTIONS BY LOCATION
|Continental U.S. (includes Alaska)||Blue Cross Blue Shield (available nationwide)|
Kaiser Permanente (available in certain areas)
|Hawaii||HMSA HawaiiKaiser Permanente|
|U.S. Virgin Islands||Blue Cross Blue Shield (Triple S)|
|Puerto Rico||Blue Cross Blue Shield (Triple S)|
If you live in these areas and service is available to you, you will also have an option to choose Kaiser Permanente:
- Washington (state)
- Washington, D.C.
COVERAGE LEVELS BY LOCATION
You will have an opportunity to choose from two coverage levels:
BASIC (WITH HEALTH SAVINGS ACCOUNT)
This PPO plan has a high deductible which must be met first before the plan begins to pay. This means that you cover 100% of your medical and prescription drug expenses until you reach the annual deductible.
After you meet the deductible, you and the plan share the cost of healthcare expenses, which is known as co-insurance. If you meet the annual out-of-pocket maximum, the plan will pay 100% of your medical and prescription drug costs for the remainder of the plan year.
With this high-deductible option, you can contribute to a Health Savings Account (HSA). An HSA is a special tax-advantaged account to help cover eligible medical expenses like deductibles, co-pays and co-insurance. Your HSA contributions roll over each year, and the account is yours to keep, even if you no longer work for the Company. To learn more about the advantages of an HSA, go to page 13.
ENHANCED (WITHOUT HEALTH SAVINGS ACCOUNT)
This is a PPO health plan with a lower deductible applying to medical benefits only. The pharmacy benefits don’t have a deductible—only co-pays. Unlike the Basic option, you cannot contribute to a Health Savings Account (HSA), but you may participate in the Healthcare Flexible Spending Account (FSA) to pay for your eligible medical expenses.
The following chart provides a side by side summary of the Basic and Enhanced plan coverage for the continental U.S. only.
Please note: Out-of-network benefits are not available under the Kaiser Permanente medical option.
The chart above is a high-level summary of commonly covered benefits. It is intended to provide you with a snapshot of benefits provided across coverage levels. If you have questions regarding a specific benefit, contact the insurance carrier for additional information.
For additional comparisons you can use:
- Health Plan Comparison Chart (HPCC) tool where you choose to compare both options. Available on the plan enrollment page on MyHR at www.88sears.com.
- Summaries of Benefits and Coverage on Your Benefits Resources™ (YBR)
REMEMBER! All benefits-eligible associates must enrol for medical coverage by November 4 during Annual Enrollment to continue coverage for the Plan Year 2021.
CONSUMERMEDICAL WITH BLUE CROSS BLUE SHIELD (AVAILABLE TO BCBSIL MEMBERS)
ConsumerMedical helps you and your family understand any medical condition and treatment options, recommend the best doctors and hospitals in your area and insurance network, and assist you in getting a second opinion. Participants who engage in surgical decision support services for lower back, knee or hip replacement, weight loss or hysterectomy elective surgeries will be eligible for a $400 incentive. Enrol today in this free benefit by calling 1-888-361-3944 or visiting www.myconsumermedical.com (enter company code: transform).
SUMMARY OF BENEFITS AND COVERAGE AVAILABILITY
The health benefits available to you represent a significant component of your compensation package. Choosing a health coverage option is an important decision. To help you and your dependents make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options available to you:
You can view the SBC on MyHR:
- Log in to Your Benefits Resources (YBR) via MyHR at www.88sears.com.
- Open the Health and Insurance tab.
- From the drop-down menu, select Plan Information.
- Choose the Summary of Benefits and Coverage you’d like to review.
A paper copy of the SBC is also available, free of charge, by calling the Transformco Benefits Center.
Due to Affordable Care Act reporting requirements, Transformco is required to provide you with a 2020 1095-C tax form in early 2021. This form is intended to assist you in filing your taxes for the 2020 tax year, specifically to indicate whether you had a minimum amount of health coverage during the year. To be notified when the form is available to print, visit YBR (via MyHR at www.88sears.com) and choose the electronic method of notification. Otherwise, the form will be mailed to you by late January