Medical

Many employees don’t understand what their medical insurance covers.

We’re here to help you understand your benefits and make the best choices for you and your family.

Lincoln is pleased to continue to offer the Premier Consumer Driven Health Plan (CDHP) .

Click the icons below to see a brief summary of each plan.

The plan is a Consumer Driven Health Plan (CDHP) designed to coordinate with the Health Savings Account (HSA). It provides you with traditional medical coverage and a tax-free way to build savings for future medical expenses. It also gives you great flexibility and direction over how to use your health care benefits.

The CDHP Premier plan provides you with options to save health care dollars, such as mail order prescription drugs, wellness programs and a discounted vision program. An important feature is the preventive care services are covered at 100% in-network. In other words, when using in-network providers, benefits for preventive care services are provided at no cost. This makes it easier to maintain your family’s health by taking advantage of preventive care services such as immunizations, check-ups and screenings. Please see the plan certificate for the complete list of preventive services.

The Plan offers two levels of benefits: in-network and out-of-network. When you seek care in-network, simply select a provider who is on the Anthem network list—you do not have to go through a primary care physician first. When you use network providers, you receive higher benefit coverage (less out-of-pocket). Plus, network doctors have agreed to charge lower rates—this saves you and the plan money. Simply show your medical I.D. card when receiving in-network benefits so you don’t have to file any claim forms. The Anthem network offers a broad network of providers, giving you access to most major hospitals in the country.

If you select a provider not in the network, services will be covered by the plan but at a lower level of benefits, which may mean higher out-of-pocket expenses for you. While you get the flexibility of seeing the provider of your choice, the provider will likely charge more for services and you must complete a claim form for reimbursement. Both in-network and out-of-network benefits are subject to out-of-pocket limitations.

For anyone enrolling a spouse in our medical plan, there is a monthly surcharge for a working spouse who is eligible for coverage through their employer.

Medical Overview

CDHP Premier Medical (Benefits you pay after deductible)
	In-Network	Out-of-Network**
Your out-of-pocket costs
Calendar Year Deductible	$3,300 individual / $6,600 family	$3,300 individual / $6,000 family
Calendar Year Deductible	Embedded Deductible
Annual Out-of-Pocket Max	$6,000 individual / $12,000 family	$8,000 individual / $16,000 family
Lifetime Benefit Max	Unlimited
Hospital
Room and Board	20%	50%*
Diagnostic	20%	50%*
Surgical	20%	50%*
Home Health	20%	50%* up to 120 visits per year
Emergency Room	20%	20%
Urgent Care	0% coinsurance	0% coinsurance
Retail Clinics	20%	50%*
LiveHealth Online	20%	Not Covered
Physician Services
Surgical	20%	50%*
Inpatient Visit	20%	50%*
Diagnostic	20%	50%*
Maternity	20%	50%*
Office Visits (Primary & Specialist)	20%	50%*
Allergy Testing	20%	50%*
Spinal Manipulation	20%	50%*
Spinal Manipulation	up to 12 visits per year
Speech & Physical Therapy	20%	50%*
Preventive Care
Physical Exam	Covered in full	50%*
Well Child Care	Covered in full	50%*
Mammograms	Covered in full	50%*
Pap Tests	Covered in full	50%*
Other Services
Skilled Nursing	20%*	50%*
Ambulance	20%*	100%*
Organ Transplant	20%*	50%*
Prescription Drug Retail (30-day supply)
Generic	$15	50% (Diabetic and Asthmatic not covered)
Preferred Brand	30% ($30 min – $75 max)	50% (Diabetic and Asthmatic not covered)
Non-Preferred Brand	40% ($50 min – $125 max)	50% (Diabetic and Asthmatic not covered)
Prescription Drug Mail Order (90-day supply)
Generic	$37.50	Not Available
Preferred Brand	30% ($75 min – $187.50 max)	Not Available
Non-Preferred Brand	40% ($125 min – $312.50 max)	Not Available
Durable Medical Equipment	20%*	50%*
Mental Health Inpatient	20%*	50%*
Mental Health Outpatient	20%*	50%*
Substance Abuse Inpatient	20%*	50%*
Substance Abuse Outpatient	20%*	50%*

ALL “PER YEAR” LIMITS ARE BASED ON A CALENDAR YEAR.
Benefits for occupational, physical and speech therapy are limited to 80 combined visits per calendar year.
** Out-of-Network benefits are paid up to usual, reasonable and customary limits.
*Under the CDHP Premier Plan, all benefits except for in-network preventive care and preventive drugs are subject to the deductible. Specialty medication must be filled at the CVS Caremark specialty pharmacy. No out-of-network coverage.

Preventative medications are not subject to the deductible

Important Terms to Know

Coinsurance refers to money that an individual is required to pay for services after a deductible has been paid.

Copayment is a predetermined (flat) dollar amount that an individual pays for health care services in addition to what the insurance covers. Copayments are not usually specified by percentages.

Deductible is the amount that you pay during a calendar year before the health plan “kicks in” to reimburse for medical expenses.

Embedded deductible – If any family member reaches the individual deductible, then the deductible is satisfied for that family member. If any combination of family members reach the family deductible, then the deductible is satisfied for the entire family

Prescription Drug Overview

CDHP Premier Medical Plan provides a prescription drug benefit. If you are enrolled in the plan, you and your dependent(s) will automatically be enrolled. Caremark is your pharmacy benefit manager. You’ll receive a separate prescription drug card in addition to your medical card. You and your dependent(s) should present the card at the pharmacy when purchasing prescription medication.

Preventative medications are not subject to the deductible.