Medical Coverage

• 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

• Paycheck deductions for premiums are higher.
• The deductible is lower.
• It’s paired with an HRA to help cover your healthcare expenses.
• Your costs for medical and prescriptions accumulate separately toward meeting the annual out-of-pocket limit.
• The care you receive through our onsite Employee Health Services clinic is provided at no cost to you.
• You can contribute to Sandia’s healthcare flexible spending account (HCFSA).
• Kaiser Permanente is an option with the Total Health PPO Plan for employees residing in northern California.

For non-preventive medical services, you need to meet the annual deductible before the plan shares costs with you. (As a reminder, there is no annual deductible for prescription drugs).

Here’s what that looks like:

Note: Your family members’ expenses accumulate together as you meet the deductibles noted above. But, if one person in the family meets the individual deductible, the plan begins to share costs for that person.

Once you meet your annual deductible, the plan will share the cost of your care. You’ll pay:

• 10% coinsurance for Tier 1 providers
• 20% coinsurance for Tier 2 providers
• 40% coinsurance for Tier 3 (out-of-network) providers

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.

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 limits reset at the start of each calendar year.)

Here’s what that looks like:

Note: Your family members’ expenses accumulate together as you meet the out-of-pocket limits noted above. But, if one person in the family meets the individual out-of-pocket limit, the plan pays 100% of eligible expenses for that person for the rest of the year.