Medical Plan Comparison

See a high-level summary below of how the plans compare. View detailed Medical Plan Comparison Charts at mySHSBenefits.com and prescription plan comparisons here.

Additional Medical Plan Options

Cigna International and Hawaii Medical Service Association (HMSA) are offered in certain areas. You can also elect to waive medical coverage through Siemens Healthineers if you have coverage elsewhere.

Compare Medical Plans

	Health Reimbursement Copay Advantage Plan*	Health Savings Medical Plan	Kaiser HMO Medical Plan
What doctors or providers can I use?	See any doctor or specialist of your choice No PCP or referral required to see a specialist Higher benefit level for in-network care than out-of-network care		PCP required Need PCP referral to see a specialist No coverage for out-of-network care, unless it’s a true emergency
Company Contribution	Includes a Siemens Healthineers-funded HRA; with contributions of: $500 employee $1,000 employee + dependent(s) You cannot make contributions to the HRA	Includes access to a HSA with employee before-tax contributions and Siemens Healthineers contributions of: $400 employee $800 employee + dependent(s) Maximum amount you and Siemens Healthineers can contribute to your HSA: $4,400 individual $8,750 family	None
Annual Deductible	In-network Medical only: $1,500 individual $3,000 family Out-of-network Medical only: $2,250 individual $5,550 family	In-network Medical and Prescription Drug Combined: $2,000 individual $4,000 family Out-of-network Medical and Prescription Drug Combined: $3,000 individual $6,000 family	In-network Medical and Prescription Drug Combined: No deductible Out-of-network: No coverage for out-of-network care, unless it’s a true emergency
Copays	In-network Primary care visit: $30 Specialist visit: $45 Urgent Care: $60	N/A	Primary care visit: $25 Specialist visit: $45 Urgent care: $25 Emergency Room care: $150
Coinsurance	In-network Preventive care: Plan pays 100% for most services; not subject to deductible Other services: You pay 10% Out-of-network: You pay 35%	In-network Preventive care: Plan pays 100% for most services; not subject to deductible Other services: You pay 15% Out-of-network: You pay 35%	In-network Preventive care: Plan pays 100% for most services Out-of-network: No coverage for out-of-network care, unless it’s a true emergency
Out-of-Pocket Maximum	In-network Medical and Prescription Drug Combined: $3,700 individual $7,400 family Out-of-network Medical and Prescription Drug Combined: $4,700 individual $14,000 family	In-network Medical and Prescription Drug Combined: $4,500 individual $9,000 family Out-of-network Medical and Prescription Drug Combined: $7,000 individual $14,000 family	In-network Medical and Prescription Drug Combined: $1,500 individual $3,000 family Out-of-network: No coverage for out-of-network care, unless it’s a true emergency
Lifetime Maximum	None	None	None
Voya Critical Illness	Enrollees in the Health Reimbursement Copay Advantage Plan and Health Savings Medical Plan automatically receive company-paid* Critical Illness coverage through Voya—no action needed. For more information about this program, watch this video. To file a claim, visit Voya’s website. * Siemens Healthineers will pay the full cost of the premiums for this coverage—employees will be taxed on the value of the premiums paid on their behalf via an imputed income charge through payroll.

Compare Prescription Drug Plans

Plan provision	Health Reimbursement Copay Advantage Plan	Health Savings Medical Plan*	Kaiser HMO Medical Plan
Annual deductible	None	You must pay 100% of the cost of prescription drugs until you meet the combined medical and prescription drug deductible. In-network Medical and prescription drug combined $2,000 individual $4,000 family Out-of-network Medical and prescription drug combined $3,000 individual $6,000 family	None
Out-of-pocket maximum	$2,300 per individual; limited to $3,500 per family	Medical and prescription drug combined $4,500 individual $9,000 family*	None
Retail (30-day supply)	Generic: $10 Preferred brand: $50 Non-preferred brand:** $100	Generic: 10% ($5 minimum; $25 maximum) Preferred brand: 30% ($20 minimum; $100 maximum) Non-preferred brand:** 45% ($35 minimum; $150 maximum)	Generic: $15 Preferred brand: $30 Non-preferred brand: $30
Mail order service or CVS pharmacy (90-day supply)	Generic: $20 Preferred brand: $100 Non-preferred brand:** $200	Generic: 10% ($10 minimum; $50 maximum) Preferred brand: 30% ($40 minimum; $200 maximum) Non-preferred brand:** 45% ($70 minimum; $300 maximum)	Generic: $30 Preferred brand: $60 Non-preferred brand: $60
Specialty^† medications (30-day supply)	30%; no minimum copay; $300 maximum (excludes drugs eligible for PrudentRX program)	30% after deductible is met; no minimum copay; $300 maximum (excludes drugs eligible for PrudentRX program)	$30 per prescription (up to a 30-day retail supply and subject to formulary guidelines)

* If an employee covers more than one individual under the Health Savings Medical Plan, and one individual reaches $7,350 in eligible in-network out-of-pocket expenses, all remaining eligible in-network expenses will be paid at 100% for that individual only.

** If the total cost of the drug is less than the flat copay or minimum amount, you’ll pay only the full cost of the drug.

† PrudentRx Copay Program: Siemens Healthineers has contracted with PrudentRx to offer the PrudentRx Copay Program for certain specialty medications. The PrudentRx Copay Program assists members by helping them enroll in manufacturer copay assistance programs. Medications on the plan’s specialty drug list and exclusively dispensed by CVS Specialty are included in the program and will be subject to 30% coinsurance (subject to deductible). However, members enrolled in PrudentRx who get a copay card for their specialty medication (if applicable) or who are taking a specialty medication for which no copay card is available will have a $0 out-of-pocket responsibility after deductible, for their prescriptions covered under the PrudentRx Copay Program.