What you need to know
Sandia offers two medical plan options: The Health Savings Plan and the Total Health PPO Plan.
The Health Savings Plan comes with comprehensive medical and prescription drug coverage — plus a health savings account (HSA) to help you save and pay for current and future healthcare expenses.
With the plan’s lower healthcare premiums, you can save for the future by contributing to your HSA. Sandia also contributes. The money in your HSA is yours to keep forever, even if you change medical plans, leave Sandia, or retire.
View a comparison of the Health Savings Plan and the Total Health PPO Plan (pdf)
View the Sandia 2024 Benefits Guide (pdf)
View the 2024 medical plan premiums (pdf)
To access the Medical Plan Comparison Tool, go to ebi.sandia.gov, then choose Human Resources > Benefits > Medical Plan Comparison Tool.
Plan Features
The Health Savings Plan shares many features with the Total Health PPO Plan. Other features are unique to the Health Savings Plan — and they’re the ones that can help you spend less for healthcare coverage and save for the future.
- Covered services
- Coinsurance rates for medical services and some prescription drugs
- Same tiered provider network choices: Blue Cross Blue Shield of New Mexico and UnitedHealthcare
- In-network doctors and hospitals
- Incentives for completing healthy activities
- It comes with lower paycheck deductions for premiums.
- It’s paired with a tax-advantaged HSA to help cover your healthcare expenses.
- The plan has a higher deductible but many trade-offs, including enhanced prescription drug coverage. You’ll benefit from an expanded preventive drug list and pay $0 for certain preventive medications (pdf).
- Your costs for both medical and prescriptions accumulate together toward your annual deductible — which must be met before cost sharing begins — and also toward your annual out-of-pocket limit.
- You can get many services free through our onsite Employee Health & Wellbeing clinic, but you will pay the fair market cost for personal healthcare services until you meet your annual deductible. You can use your HSA funds (including contributions from Sandia) to pay these and other eligible out-of-pocket expenses.
- You can contribute to Sandia’s dependent care flexible spending account, but you cannot contribute to the healthcare flexible spending account.
- Kaiser Permanente isn’t an option with this plan.
- You’ll pay a $10 copay for virtual visits with designated providers after you’ve met the combined medical and prescription drug deductible.
How the Plan Works
You pay nothing for eligible preventive care and certain preventive medications. For all other care and prescriptions, you pay the full cost until you meet the annual deductible.
Your out-of-pocket costs are determined by your doctor’s or provider’s network:
- Tier 1 (select in-network providers; Tier 1 providers for UHC are not currently available in California; Tier 1 providers for BCBSNM are only available in New Mexico)
- Tier 2 (contracted local, regional, and nationwide in-network providers), or
- Tier 3 (out-of-network providers)
Refer to the Networks Tiers and Plan Providers page for more details.
Here’s how cost-sharing works.
| Annual Deductible | ||
|---|---|---|
| Employee-only coverage | $1,600 for Tiers 1 and 2 combined (in-network) Separate $3,250 deductible for Tier 3 services (out-of-network) |
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| Coverage for yourself and other family members | $3,200 for Tiers 1 and 2 combined (in-network) Separate $6,500 deductible for Tier 3 (out-of-network)Your family members’ expenses accumulate together to meet the overall family deductible ($3,200 for Tier 1 and Tier 2 services, or $6,500 for out-of-network services). You’ll pay this full amount before plan cost sharing begins for any one family member. |
|
Once you meet your annual deductible, the plan will share the cost of your care. You’ll pay:
- 10% coinsurance for Tier 1 providers (if available)
- 20% coinsurance for Tier 2 providers
- 40% coinsurance for Tier 3 (out-of-network) care
You’ll pay coinsurance until you meet your annual out-of-pocket limit.
Note: If you receive out-of-network care (Tier 3 providers), the plan bases its 60% share of the cost on the allowed charge for a given service. At times, the cost billed by the provider is more than the allowed charge. If this happens, you’ll be responsible for your 40% share of the allowed charge plus any balance due, except for services covered by the No Surprises Act described in the medical plan benefits summary. (Tip: You can generally use the money in your HSA to pay your deductible and coinsurance, or you can pay out of pocket and save your HSA money for later.)
After you meet your annual out-of-pocket limit, the plan will pay 100% for eligible expenses for the rest of the calendar year. (The deductible and out-of-pocket limit reset at the start of each calendar year.)
| Annual Out-of-Pocket Limit | ||
|---|---|---|
| Employee-only coverage | $3,200 for Tiers 1 and 2 combined (in-network) Separate $6,500 limit for Tier 3 (out-of-network) |
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| Coverage for yourself and other family members | $9,450 for Tiers 1 and 2 combined (in-network) Separate $19,500 limit for Tier 3 (out-of-network)Your family members’ expenses accumulate together to meet the overall family out-of-pocket limit ($9,450 for Tier 1 and Tier 2 services or $19,500 for out-of-network services). Once you reach the limit, the plan pays 100% of the covered services for all family members. |
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Using Sandia Employee Health & Wellbeing Clinics
Sandia’s Employee Health & Wellbeing clinics provide Sandians with quality care regardless of which medical plan you choose. The clinics in New Mexico and California provide a full range of services, including preventive care, treating acute illnesses, emergency care, treating work-related injuries, supporting emotional health, and management of health conditions like diabetes and asthma.
Most services are provided at no cost to Sandians. However, if you select the Health Savings Plan, you’ll pay the fair-market value for personal healthcare services until you meet the deductible ─ then you’ll have no additional cost when using the clinics for the rest of the year.
(Personal healthcare services are acute or episodic in nature — they may result from a flare-up or complication from a chronic condition or from an unforeseen health condition that is not covered under our umbrella of occupational- and work-related services. A few examples include coming to the clinic for a sore throat or flu symptoms, or for physical therapy following elective shoulder surgery.)
To ensure a seamless experience, Health Savings Plan participants will not be charged for a personal healthcare visit when receiving treatment at a clinic. Your insurer will first process the claim for your visit, then you’ll receive a bill for the services received.
(Remember, you can use your HSA funds to pay for eligible expenses applied to your deductible.)
Plan Premiums
Sandia sets employee premiums based on salary levels. Salaries are tiered to ensure employee premiums are competitive when compared to organizations like Sandia. Employees making less money pay a lower premium.
The salary used to determine your monthly premium is based on your pretax annual salary as of Jan. 1, 2024.
The premiums for the Health Savings Plan are about 25% lower than the Total Health PPO Plan’s premiums.
You’ll find the medical/prescription drug, dental, and vision premiums in our 2024 premium charts (pdf).
Contacts and Resources
Go to the Get to Know Our Benefit Providers page for details.
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