Sandia Total Health Program
The Sandia Total Health PPO features comprehensive medical and prescription drug coverage — plus it comes with a Sandia-funded Health Reimbursement Account (HRA) that you can use to help cover out-of-pocket healthcare expenses.
Although you’ll pay higher monthly premiums for this plan than for the Sandia HDHP, your annual deductible is lower, which means the plan starts sharing costs with you sooner.
Unlike the Sandia HDHP, with this plan, your costs for medical services and prescription drugs accumulate separately to meet separate medical and prescription drug annual out-of-pocket limits. The Total Health PPO has a separate prescription drug out-of-pocket limit of $1,500 per covered individual, up to a total of $5,950 for all family members combined.
Prescription drugs purchased from an out-of-network provider are covered at 50% up to the prescription drug annual out-of-pocket limit.
Health Reimbursement Account
You can use your tax-free HRA to help offset eligible out-of-pocket medical, prescription, dental, hearing, vision and other IRS-eligible expenses. Sandia automatically funds your HRA each year, based on your coverage level.
HRA Funds Rollover
Your HRA rollover is subject to a maximum amount each year.
Note: If you enroll in the HDHP, you are no longer eligible for an HRA. You must use your HRA funds before switching to the HDHP or they will be forfeited.
HRA Funds and Medicare
If you have HRA funds remaining when you become Medicare eligible at age 65, these funds will transfer to your pre-Medicare spouse or dependent(s) enrolled in the Total Health PPO. If you don’t have a pre-Medicare spouse or dependent enrolled in the Total Health PPO, those funds will be forfeited.
The Sandia Total Health Program has two main components – comprehensive medical and prescription drug coverage and a Sandia-funded health reimbursement account (HRA).
You can choose the medical plan administrator you want to use, depending on your location. The plan benefits are generally the same, regardless of which administrator you choose:
- Blue Cross Blue Shield of New Mexico (BCBSNM), with prescription drugs through Express Scripts
- UnitedHealthcare (UHC), with prescription drugs through Express Scripts
- Kaiser Permanente, including Kaiser-administered prescription drugs (offered to California retirees only)
How Coverage Works
When you need care, you can go in-network or out-of-network; however, you will pay less when you use an in-network provider. You can save even more when you use high-quality, lower-cost providers in the Tier 1 network, offered through BCBSNM and UHC:
- BCBSNM replaces the Sandia Health Provider Network (SHPN) in New Mexico effective Jan. 1, 2021, with the Blue Preferred Plus Provider Network. This network features an expanded number of providers who offer high-quality services at the lowest cost.
- UHC also offers a lower-cost Tier 1 network called UnitedHealthcare Choice Plus Premier Provider Network, effective Jan. 1, 2021. (California residents are not yet eligible for this network due to current state regulations). Learn more about the Tier 1 network at whyuhc.com/snl.
- Note that if you have access to a Tier 1 network through your benefit administrator, the payments you make for care under Tier 1 and Tier 2 accumulate and count toward the deductible and out-of-pocket maximum requirements of both tiers. In other words, they “cross-apply.”
Preventive care through an in-network provider is generally covered at 100%, including annual physical exams and certain cancer screenings.
For more detailed information about how the plan works, refer to the 2024 Sandia Retiree Health Benefits Enrollment Guide.