Medical Insurance

This is the policy for the US offices.

Questions

If you have questions regarding your health insurance, please email benefits@thoughtbot.com.

Eligibility

All employees 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.

2020 Medical Benefits

thoughtbots pays at least 90% of the medical insurance premiums for individuals and 80% for their families for all medical plans. Family plans cover spouses and/or children. thoughtbot offers two Blue Cross Blue Shield Preferred Blue PPO plans to all full-time US team members, allowing you to pick the best plan for you and your family. In California, we also offer Kaiser Permanente Platinum 90 HMO 0/15. Our plan years run on a calendar year cycle: January 1st to December 31st.

Blue Cross Blue Shield (BCBS)

The two BCBS PPO 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 BCBS 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. Services requiring pre approval are noted under Limitations & Exceptions in the Summary of Benefits & Coverage for each plan.

Create a log-in at MyBlue Member to see if your doctor is in-network, view claims, review benefits, request an ID card, etc, etc. To find in-network doctors search the “Preferred Blue PPO Options v5” network.

BCBS gives members the opportunity to be reimbursed for up to $150 for weight-loss program fees and up to $150 for a gym membership or instructor-led group fitness classes. Members can also participate in Healthy Actions where you are able to earn up to $300 for having a physical.

Helpful Links:

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 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 ($20 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.

BCBS Preferred Blue Saver $2000/$4000 + HSA

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.

Kaiser Permanente Platinum 90 HMO 0/15

With an HMO plan you will need to get referral from your Plan Physician before you are able to see a specialist. There is a $0 deductible on this plan, but there are modest co-pays ($15 for primary doctor/Urgent Care, $30 for a specialist, and $150 for ER visit) There is no out-of-network coverage.

Create a login on the Kaiser Permanente website to find a doctor, schedule/cancel appointments, manage prescriptions, etc.

Information on the plan can also be found on the Kaiser Permanente summary of benefits & coverage

Monthly Premiums for Employees

Medical Plans BCBS Preferred Blue PPO $1000/$2500 BCBS Preferred Blue PPO Saver $2000/$4000 + HSA Kaiser (CA only)
Employee only $63.50 $30.00 $30.00
Employee + spouse $190.52 $60.00 $60.00
Employee + child(ren) $164.43 $50.00 $50.00
Employee + family $320.64 $100.00 $100.00

Changing Your Benefits

You have 30 days to make changes after life events (marriage, childbirth, etc). Otherwise changes must be made during the open enrollment period.

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.

Termination

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 benefits@thoughtbot.com.