2023 Medical Insurance
This is the 2023 health insurance policy for team members in the United States.
If you have questions regarding your health insurance, please email firstname.lastname@example.org.
All team members working 30 or more hours per week are eligible to enroll in a health plan immediately upon starting with thoughtbot. Your effective date is your start date.
2023 Medical Benefits
thoughtbot pays at least 90% of the medical insurance premiums for individuals and 80% for their families for all medical plans. Family plans cover spouses, domestic partners, and/or children. thoughtbot offers two Blue Cross Blue Shield (BCBS) plans to all full-time US team members, allowing you to pick the best plan for you and your family. Our plan years run on a calendar year cycle: January 1st to December 31st.
Blue Cross Blue Shield (BCBS)
The two BCBS plans have the same network of doctors and cover all the same services, but the cost for those services vary. This section reviews some of the benefits of both plans.
With a PPO plan, you do not need to get a referral from a primary care doctor before seeing a specialist. But you should make sure all providers you see are in-network. In-network providers will get approval from BCBS before a procedure. It is your responsibility to get approval from BCBS before a procedure if you see an out-of-network provider.
Both in-network and out-of-network expenses count towards your deductible. This is a change from the Cigna plans in previous years, which had separate deductibles for in-netowrk and out-of-network.
In compliance with the Transparency in Coverage rules, BCBS’s machine readable files are made available to everyone. The files include negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
BCBS Preferred Blue PPO $1000/$2500
This plan has a deductible of $1000 for individuals and $2500 for families. The individual member deductible is capped at $1000. So if you enroll in the employee + spouse/domestic partner plan, your family’s total deductible would be $2000.
Many services and prescriptions require that you pay a co-pay instead of an expensive deductible. In network preventative care is fully covered.
In-network coverage is fully covered or requires a modest co-pay ($15 for primary care doctor/specialists/urgent care visits-$150 for the ER) or deductible. Out-of-network coverage requires you to pay 20% co-insurance.
You are not eligible to enroll in the HSA if you select this plan.
For details, please see BCBS Preferred Blue PPO $1000/$2500 Summary of Benefits & Coverage.
BCBS Preferred Blue PPO Saver $2000/$4000 + HSA
This is our high deductible health plan + health savings account (HSA) option. This plan has a deductible of $2000 for individuals and $4000 for families. There is no per member deductible cap on dependent plans. One family member could incur charges equalling the full deductible.
The deductible applies first to everything except preventative care. This includes specialist office visits, sick visits, urgent care, prescriptions, etc.
With an HSA-powered health plan, instead of making copayments at the time of service, you will have a deductible to meet. A deductible is the amount you are required to pay out-of-pocket for services before your health plan benefits kick in. While you may see a higher deductible than you’re used to, the plan has a lower monthly premium. Preventive care is always covered 100%.
If you enroll in an individual plan, thoughtbot will contribute $750 (prorated monthly) to your HSA account. This essentially reduces your deductible to $1250.
If you enroll in a plan with dependents, thoughtbot will contribute $1500 (prorated monthly) to your HSA account. This essentially reduces your deductible to $2500.
You are not eligible to enroll in the FSA if you select this plan.
For details, please see BCBS Preferred Blue PPO Saver $2000/$4000 + HSA Summary of Benefits & Coverage.
Monthly Premiums for Employees
|Medical Plans||BCBS Preferred Blue PPO $1000/$2500||BCBS Preferred Blue PPO Saver $2000/$4000 + HSA|
|Employee + spouse/domestic partner||$246.84||$90.00|
|Employee + child(ren)||$213.04||$75.00|
|Employee + family||$415.43||$150.00|
Changing Your Benefits
You have 30 days to make changes after life events (marriage, childbirth, death, divorce, loss of spousal coverage, etc.). Otherwise changes must be made during the open enrollment period. You may add or drop dependents with a qualifying life event to plans that you are currently enrolled in due to a life event. You may only switch plans during open enrollment.
To change your enrollment following a life event, visit Employee Navigator. We may follow up with you to collect additional information necessary to make the requested change.
Unless otherwise stated, upon termination, your medical benefits will remain in effect until the last day of the month in which you are terminated.
Upon termination you may be entitled to continuation or conversion of the group medical insurance plan in accordance with the terms of the policy and/or applicable state and federal law. For more information, contact email@example.com.