How to Choose a Medical Plan Review the medical plan design and out-of-pocket costs. Check the provider network. Compare the medical plan premiums. Decide which medical plan is best for you. Consider making contributions to a Health Care Spending Account. If you enroll in the UHC High Deductible + HSA Plan, you may be eligible for a Health Savings Account. 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 – Surest, Blue Cross Blue Shield (BCBS), UnitedHealthcare (UHC) Choice Plus 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. Step 3:Compare the costs of the medical plan premiums. Step 4:Decide which option is best for you. Step 5:Consider making contributions to a Health Care Spending Account. Step 6:If you enroll in the UHC High Deductible + HSA Plan, you may be eligible for a Health Savings Account. |
Step 1. Review the medical plan design and out-of-pocket costs. Step 2. Check the provider network. Step 3. Compare the medical plan premiums. Step 4. Decide which medical plan is best for you. Step 5. Consider making contributions to a Health Care Spending Account. Step 6. If you enroll in the UHC High Deductible + HSA Plan, you may be eligible for a Health Savings Account. | ||
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Step 1: Compare the medical plans available to you – Surest, 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.
Health Plan | Plan Highlights |
Surest, BCBS & UHC | In-network benefits are available with the Surest plan, national BCBS BlueCard plan, BCBS Select Network plans in designated locations and the UHC Choice Plus plan. Out-of-network benefits are also 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. |
UHC 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. NOTE: Fertility and Infertility Medications and Services are not covered under the High Deductible + HSA Plan |
Surest Plan | BCBS and UHC Choice Plus Plans | UHC High Deductible + HSA Plan | |||
In-Network | Out-of-Network | In-Network | Out-of-Network | UHC High Deductible + HSA Plan | |
Deductible | N/A | N/A | $900 per person, $1,800 per family | $1,800 per person, $3,600 per family | $1,800 for single coverage, $3,600 for family coverage* |
Out-of-Pocket Maximum | $3,800 per person, $7,600 per family | $7,600 per person, $15,200 per family | $4,200 per person, $8,400 per family | $8,400 per person, $16,800 per family | $5,000 for single coverage, $10,000 for family coverage** (combined medical and prescription drug out-of-pocket maximum) |
Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited |
Retail Medical Clinic | $15 copay | No coverage | $15 copay | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Medical Virtual Visit (using preferred virtual provider network) | Covered at 100% | No coverage | $10 copay | No Coverage | 20% coinsurance |
Primary Care Office Visit | $20-$105 copay | $220 copay | $50 copay | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Specialist Office Visit | $20-$105 copay | $220 copay | $60 copay | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Maternity Office Visits (prenatal and postnatal) | Covered at 100% | Not Covered | $60 copay for initial visit, $0 copay thereafter | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Childbirth / Delivery | $500-$1,500 copay per stay | $4,500 copay per stay | 10% coinsurance after the deductible | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Urgent Care Facility | $100 copay | $180 copay | $60 copay | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Emergency Room | $250 copay | $250 copay | $275 per visit; waived if admitted to a hospital | $275 per visit; waived if admitted to a hospital | 20% coinsurance after the deductible |
MRI/CT Scans | $100-$1,400 copay | Up to $4,200 copay | 10% coinsurance after the deductible | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Home Health Care | $60 copay | $180 copay | 10% coinsurance after the deductible | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Durable Medical Equipment (DME) | $0-$1,000 copay | Up to $2,000 copay | 10% coinsurance after the deductible | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Inpatient Hospital and Physician Services | $200-$3,000 copay per stay | Up to $6,600 copay per stay | 10% coinsurance after the deductible | 30% coinsurance after the deductible | 20% coinsurance after the deductible |
Outpatient Surgical Services | $150-$3,000 copay | Up to $6,600 copay | 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% | No coverage | Covered at 100% |
Physical Examinations and Immunizations | Covered at 100% | No coverage | Covered at 100% | No coverage | Covered at 100% |
Mammography | Covered at 100% | No coverage | Covered at 100% | No coverage | Covered at 100% |
Colonoscopy | Covered at 100% | No coverage | Covered at 100% | No coverage | Covered at 100% |
Vision screening (routine exam) | Covered at 100% | No coverage | Covered at 100% | No coverage | Covered at 100% |
Hearing screening (routine exam) | Covered at 100% | No coverage | Covered at 100% | No coverage | Covered at 100% |
When you enroll in a Travelers medical plan you automatically receive prescription drug coverage through CarelonRx. Review the out-of-pocket costs associated with the prescription drug coverage using the chart below.
Prescription Drug Overview
Surest Plan | BCBS and UHC Choice Plus Plans | UHC High Deductible + HSA Plan | ||||
Network Pharmacy | Non-network Pharmacy | Network Pharmacy | Non-network Pharmacy | Network Pharmacy | Network Pharmacy | |
Prescriptions | Preventive Medications*** | Non-Preventive & Specialty Medications |
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Tier 1 | 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: | 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: | You pay 20% coinsurance after meeting the deductible |
- 30-day supply at retail | $15 copay | $15 copay | $15 copay | |||
- 90-day supply at eligible retail 90 pharmacies or through CarelonRx mail order | $30 copay | $30 copay | $30 copay | |||
Tier 2 | You pay 20% coinsurance: | You pay 20% coinsurance: | You pay 20% coinsurance: | |||
- 30-day supply at retail | $65 minimum, $210 maximum | $65 minimum, $210 maximum | $65 minimum, $210 maximum | |||
- 90-day supply at eligible retail 90 pharmacies or through CarelonRx mail order | $130 minimum, $420 maximum | $130 minimum, $420 maximum | $130 minimum, $420 maximum | |||
Tier 3 | You pay 40% coinsurance: | You pay 40% coinsurance: | You pay 40% coinsurance: | |||
- 30-day supply at retail | $65 minimum, $210 maximum | $65 minimum, $210 maximum | $65 minimum, $210 maximum | |||
- 90-day supply at eligible retail 90 pharmacies or through CarelonRx mail order | $130 minimum, $420 maximum | $130 minimum, $420 maximum | $130 minimum, $420 maximum | |||
GLP-1 Medications prescribed for Weight Loss (limited to a 30-day supply) |
N/A | |||||
Tier 2 | 30% coinsurance, when prescribed by a Form Health provider | 30% coinsurance, when prescribed by a Form Health provider | 30% coinsurance after the deductible, when prescribed by a Form Health provider | |||
Tier 3 | 50% coinsurance, when prescribed by a Form Health Provider | 50% coinsurance, when prescribed by a Form Health Provider | 50% coinsurance after the deductible, when prescribed by a Form Health Provider | |||
Infertility Medications | Covered at Tier 1-3 benefit levels shown above, as applicable | Covered at Tier 1-3 benefit levels shown above, as applicable | Infertility medications are not covered by this plan. | Infertility medications are not covered by this plan. | ||
Specialty Drugs - available exclusively through BioPlus Specialty Pharmacy (limited to a 30-day supply) | $0 copay if participating in Cost Relief program; 30% coinsurance if not participating in Cost Relief Program | Specialty medications not sourced though BioPlus Specialty Pharmacy are not covered. | $0 copay if participating in Cost Relief program; 30% coinsurance if not participating in Cost Relief Program | Specialty medications not sourced though BioPlus Specialty Pharmacy are not covered. | Preventive Specialty medications are covered at the generic/formulary/non-formulary benefit levels shown above, as applicable | You pay 20% coinsurance after meeting the deductible |
Annual Prescription Out-of-Pocket Maximum | $3,100 per person / $6,200 per family | $3,100 per person / $6,200 per family | There is no separate OOPM for prescriptions. Prescription drug cost sharing accumulates to the OOPM listed in the general section. |
*For family coverage in the High Deductible + HSA Plan, the plan does not begin to cost share until the full family deductible is met.
**There is a $8,000 out-of-pocket maximum per individual with family coverage in the High Deductible + HSA Plan.
***Copays and coinsurance for preventive medications in the High Deductible + HSA Plan do not count towards the plan deductible, but do count towards the out-of-pocket maximum.
Step 2: Check to see which doctors, hospitals and specialists are available in each plan.
Included Health is a free service for Travelers medical plan members that matches you with doctors based on their quality and expertise. Included Health can help you find a high-quality doctor in your area and a second opinion from a leading specialist. Go to https://includedhealth.com/microsite/travelers/.
Health Plan | Instructions | Referrals Required |
Surest | Surest uses the UnitedHealthcare Choice Plus Network. Visit surest.care/Travelers to search for providers. Click “Search Coverage” on the top navigation. | Enrollees do not have to select a primary care physician and referrals are not required to see a specialist. |
BCBS | Use the BCBS provider directory. Click “Find Care” in the top navigation. | |
UHC | Use the UHC provider directory. Click "Health Plans" then “Search for network providers” from the top navigation. | |
UHC High Deductible + HSA Plan | UHC 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.
Use the UHC provider directory. Click "Health Plans" then “Search for network providers” from the top navigation. |
Step 3: Compare 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 pretax dollars from your salary.
You can use the Rate Calculator to estimate your premiums.
Step 4: Decide which medical plan is best for you.
After you've compared the plan benefits, network and medical plan premiums 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: Consider making contributions to a Health Care Spending Account.
Through pretax payroll deductions, the Health Care Spending Account provides an opportunity to fund qualifying health care expenses not covered by insurance, including deductibles, copays and coinsurance. Additional information can be found on the Health Care Spending Account page.*
Participants who elect to enroll in the UHC High Deductible + HSA Plan are not eligible to participate in a Health Care Spending Account (HCSA).
*This link is accessible only to employees logged into Travelers secure network.
Step 6. If you enroll in the UHC High Deductible + HSA Plan, you may be eligible for a Health Savings Account (HSA).
If you enroll in the UHC High Deductible + HSA Plan, you may be eligible to make pretax contributions into a Health Savings Account (HSA). For additional information on the HSA, visit the High Deductible + HSA overview page.*
*This link is accessible only to employees logged into Travelers secure network.