How to Choose a Medical Plan

Review the medical plan design and out-of-pocket costs.

Check the provider network.

Compare the plan premiums.

Decide which medical plan is best for you.

Review the Health Care Spending Account information.

Additional information if you are considering enrollment in the High Deductible + HSA Plan.

The How to Choose a Medical Plan tool allows you to compare the medical plans offered by Travelers. Use the steps below to determine what differences exist between the plans and which plan may best fit your needs.

Step 1:

Compare the medical plans available to you – Blue Cross Blue Shield (BCBS), UnitedHealthcare Choice Plus (UHC) and High Deductible + HSA. Estimate what your out-of-pocket costs may be with each plan.

Step 2:

Check to see which doctors, hospitals and specialists are available in each plan, and which plans may require a specialist referral.

Grand Rounds is a free service for Travelers medical plan members that matches you with doctors based on their quality and expertise. Whether you need help finding a top-ranked doctor in your area, a second opinion on a medical diagnosis from a leading specialist or information about a new diagnosis or treatment, Grand Rounds can take care of it all. grandrounds.com/travelers

Step 3:

Compare the costs of the medical plan premiums.

Step 4:

Decide which option is best for you.

Step 5:

Factor the Health Care Spending Account into your decision.

Step 6:

Additional information if you are considering enrollment in the High Deductible + HSA Plan.

Step 1. Review the medical plan design and out-of-pocket costs.
Step 2. Check the provider network.
Step 3. Compare the plan premiums.
Step 4. Decide which medical plan is best for you.
Step 5. Review the Health Care Spending Account information.
Step 6. Additional information if you are considering enrollment in the High Deductible + HSA Plan.

Step 1: Compare the medical plans available to you – Blue Cross Blue Shield (BCBS), UnitedHealthcare Choice Plus (UHC) and High Deductible + HSA. Estimate what your out-of-pocket costs may be with each plan.

All three plans cover the same kinds of services, but how you access care and the way each plan pays benefits is different.

Health Plan Plan Highlights
BCBS/UHC In-network benefits are available when using the national BCBS BlueCard or UHC Choice Plus provider networks. Out-of-network benefits are available, but are more expensive since there are no negotiated provider discounts and the out-of-network deductible and out-of-pocket maximum are higher.
High Deductible + HSA There is no difference in benefits if you use an in-network or out-of-network provider. However, when you receive care from in-network providers, your plan costs are typically lower because UHC has negotiated discounts with in-network providers.

Blue Cross Blue Shield Plan and
UnitedHealthcare Choice Plus Plan
High Deductible + HSA Plan
In-Network Out-of-Network High Deductible + HSA Plan
Deductible $750 per person/$1,500 per family maximum $1,500 per person/$3,000 per family maximum $1,400 single/$2,800 per family maximum
Out-of-Pocket Maximum $3,800 per person/$7,600 per family $7,600 per person/$15,200 per family $4,300 single/$8,600 per family* (combined medical and prescription drug out-of-pocket maximum)
Lifetime Maximum Unlimited Unlimited Unlimited
Retail Medical Clinic $10 copay per visit 30% coinsurance after the deductible 20% coinsurance after the deductible
Telemedicine (Online Visit) $10 copay per visit No Coverage 20% coinsurance after the deductible (must use UHC network provider)
Primary Care Office Visit (including allergy shots) $35 copay per visit 30% coinsurance after the deductible 20% coinsurance after the deductible
Specialist Office Visit $45 copay per visit 30% coinsurance after the deductible 20% coinsurance after the deductible
Maternity Office Visits (prenatal and postnatal) $45 copay for initial visit 30% coinsurance after the deductible 20% coinsurance after the deductible
Urgent Care Facility $45 copay per visit 30% coinsurance after the deductible 20% coinsurance after the deductible
Emergency Room $200 per visit; waived if admitted to a hospital $200 per visit; waived if admitted to a hospital 20% coinsurance after the deductible
MRI/CT Scans 10% coinsurance after the deductible 30% coinsurance after the deductible 20% coinsurance after the deductible
Home Health Care 10% coinsurance after the deductible 30% coinsurance after the deductible 20% coinsurance after the deductible
Durable Medical Equipment (DME) 10% coinsurance after the deductible 30% coinsurance after the deductible 20% coinsurance after the deductible
Inpatient Hospital and Physician Services 10% coinsurance after the deductible 30% coinsurance after the deductible 20% coinsurance after the deductible
Outpatient Surgical Services 10% coinsurance after the deductible 30% coinsurance after the deductible 20% coinsurance after the deductible
Well Baby Covered at 100% No coverage Covered at 100%
Physical Examinations and Immunizations Covered at 100% No coverage Covered at 100%
Mammography Covered at 100% No coverage Covered at 100%
Colonoscopy Covered at 100% No coverage Covered at 100%
Vision Care (routine exam) Covered at 100% No coverage Covered at 100%
Hearing Care (routine exam) Covered at 100% No coverage Covered at 100%

When you enroll in any of the medical plans offered by the company, you will automatically receive prescription drug coverage through Express Scripts. Review the out-of-pocket costs associated with the prescription drug coverage using the chart below.


Prescription Drug Overview


Blue Cross Blue Shield Plan and
UnitedHealthcare Choice Plus Plan
High Deductible + HSA Plan
Network Pharmacy Non-network Pharmacy Network Pharmacy Network Pharmacy
Prescriptions (excluding fertility drugs)** Preventative Medications*** Non-Preventive & Specialty
Medications
Generic You pay: If you fill a prescription at a non-participating pharmacy but had access to a participating pharmacy, you will be reimbursed for the negotiated pharmacy cost minus the applicable in-network coinsurance. If you did not have access to a participating pharmacy, the in-network coinsurance will apply. You pay: 20% coinsurance after meeting the deductible
- Retail to 30 days $12 copay $12 copay
- Mail to 90 days $24 copay $24 copay
- Retail to 90 days
(CVS & Walgreen's / Duane Reade Pharmacies only)
$36 copay $36 copay
Formulary Brand You pay 20% coinsurance: You pay 20% coinsurance:
- Retail to 30 days $50 minimum, $175 maximum $50 minimum, $175 maximum
- Mail to 90 days $100 minimum, $350 maximum $100 minimum, $350 maximum
- Retail to 90 days
(CVS & Walgreen's / Duane Reade Pharmacies only)
$150 minimum, $525 maximum $150 minimum, $525 maximum
Non-Formulary Brand You pay 40% coinsurance: You pay 40% coinsurance:
- Retail to 30 days $50 minimum, $175 maximum $50 minimum, $175 maximum
- Mail to 90 days $100 minimum, $350 maximum $100 minimum, $350 maximum
- Retail to 90 days
(CVS & Walgreen's / Duane Reade Pharmacies only)
$150 minimum, $525 maximum $150 minimum, $525 maximum
Annual Prescription Out-of-Pocket Maximum $2,800 per person / $5,600 per family There is no separate OOPM for prescriptions. Prescription drug cost sharing accumulates to the OOPM listed in the general section.

*The full deductible must be met before the plan will begin to cost share. For family coverage, if one person meets the single level deductible, the plan does not begin to cost share until the full family deductible is met. There is an individual out-of-pocket maximum of $7,900 for an individual covered under the family tier of the High Deductible + HSA Plan.

**Specialty medicine(s) sourced by CVS Specialty pharmacy is subject to 30% coinsurance or no coinsurance if registered with PrudentRx for the BCBS Plan and UHC Choice Plus Plan. The prescription drug annual out-of-pocket maximum for BCBS Plan and UHC Choice Plus Plan includes both retail and mail order drug expenses. Infertility medications are covered at 50% (in all plans except the High Deductible + HSA Plan) and is separate from the medical plan's annual out-of-pocket expenses. Once you pay $2,800 per individual or $5,600 per family in prescription drug copays and coinsurance, all retail and mail order prescription drugs filled during the remainder of the calendar year will be covered at 100% of eligible expenses.

***Does not apply towards the deductible, does apply to the out-of-pocket maximum.


Step 2: Check to see which doctors, hospitals and specialists are available in each plan.

Health Plan Instructions Referrals Required
BCBS Use the BCBS provider directory. Click “Find a Doctor” in the right navigation. Enrollees do not have to select a primary care physician and referrals are not required to see a specialist.
UHC Use the UHC provider directory. Click “Find a Doctor” from the center navigation.
High Deductible + HSA Plan High Deductible + HSA Plan enrollees have a passive network arrangement. There is no difference in benefits if you use an in-network or out-of-network provider. However, when you receive care from in-network providers, your plan costs are typically lower because UHC has negotiated discounts with in-network providers.

To view participating network providers visit the UHC provider directory. Click “Find a Doctor” from the center navigation.


Step 3: Compare the costs of the medical plan premiums.

You share the cost of your medical coverage with Travelers. Your share of the premium is based on:

You pay for your share of the premium with pre-tax dollars from your salary.

You can use the Rate Calculator to estimate your premiums.

Step 4: Decide which medical plan is best for you.

Take into account what you have considered in steps 1 through 3. When you have completed this process, you may be ready to enroll.

Note: If you have questions regarding your medical plan options or benefits, please contact the Employee Services Unit (ESU) at 4-ESU@travelers.com or 800.441.4378.


Step 5: Factor the Health Care Spending Account into your decision.

Through pre-tax payroll deductions, the Health Care Spending Account provides you with the opportunity to fund a wide range of qualifying health care expenses not covered by an insurance plan, including deductibles, copays and coinsurance. Additional information can be found on the Health Care Spending Account page.*

Participants who elect to enroll in the High Deductible + HSA Plan are not eligible to participate in a Health Care Spending Account (HCSA).

In addition, to be eligible to contribute to your HSA account, you must have a zero balance in your HCSA (as of December 31st of the current plan year), prior to being able to make a contribution for the upcoming plan year.

*This link is accessible only to employees logged into Travelers secure network.

Step 6. Additional information if you are considering enrollment in the High Deductible + HSA Plan.

If you are considering enrollment in the High Deductible + HSA Plan, you are also eligible to enroll in the Health Savings Account (HSA). For additional information on eligibility criteria, FAQ's, information on the medical plan or HSA plan offering visit the High Deductible + HSA overview page.*

*This link is accessible only to employees logged into Travelers secure network.