Health Reimbursement Copay Advantage Plan

The Health Reimbursement Copay Advantage Plan is administered through Anthem Blue Cross Blue Shield (BCBS) or UnitedHealthcare (UHC). With Anthem BCBS and UHC national provider networks, in-network care is available almost anywhere in the USA. Please note: In 2027, the Health Reimbursement Copay Advantage Plan will only be offered through Anthem Blue Cross Blue Shield.

In addition, the Copay Advantage plan automatically comes with a Health Reimbursement Account (HRA) to help with costs. Siemens Healthineers gives you money to fund this account: $500 for individual coverage or $1,000 if you cover dependents. You can earn more by completing wellness activities. If you join after January 1, the amount is adjusted based on when you enroll.

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How the plan works

You’ll pay fixed costs for things like doctor visits, specialist appointments, and urgent care, which can help you budget your healthcare expenses. Copays are for in-network providers and are not applied to your deductible.

Primary care visit: $30
Specialist visit: $45
Urgent care: $60

For more complex care, like hospital stays or surgeries, you cover the full cost of care until you reach your deductible—$1,500 for individuals or $3,000 for families if you stay in-network.
Then we share costs: After the deductible, you pay 10% coinsurance and Siemens Healthineers pays 90% until you hit your out-of-pocket max—$3,700 for individuals or $7,400 for families.
After that, it’s covered: Once you reach the out-of-pocket max, the plan pays 100% of eligible costs for the rest of the year.
Out-of-network costs are higher: You pay more out of pocket, and the deductible is $2,250 for individuals or $5,550 for families. After that, you pay 35% and Siemens Healthineers pays 65%, up to a higher out-of-pocket max.
Annual checkups and recommended screenings are covered at no cost when you stay in-network.

Tip! You can use your HRA to help pay these medical costs for you and your covered family members.

Health Reimbursement Copay Advantage Plan at-a-glance

You can see any doctor—no referral or primary care physician needed. In-network providers usually cost less, offer better coverage, and fully cover most preventive care. Here’s a look at coverage if you receive care in-network or out-of-network:

Plan provision	In-network	Out-of-network
Annual deductible	$1,500 per individual; limited to $3,000 per family	$2,250 per individual; limited to $5,550 per family
Automatic company HRA contribution	$500 employee $1,000 employee + dependent(s) You can earn additional company contributions called Healthy Rewards
Preventive care	100% covered for most services	You pay 35%, not subject to the deductible
Copays	Primary care visit: $30 Specialist visit: $45 Urgent Care: $60	N/A (Coinsurance applies for office visits)
Coinsurance	You pay 15% after the deductible is met	You pay 35% after the deductible is met
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

Extra protection—at no cost to you

You automatically receive company-paid* Critical Illness coverage through Voya—no action needed.

$5,000 benefit for you and your covered spouse
50% benefit for covered children
Coverage for serious conditions like heart attack, stroke, cancer, organ transplant, and more
$50 wellness reward each year when you or your dependents complete a qualified health screening

* 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.
For more information about this program, watch this Voya’s website.

Other Coverage Highlights

Pharmacy Maximums

Siemens Healthineers understands that prescription drugs are vital but can be costly. To help reduce the burden of out-of-pocket costs for prescriptions, we have implemented flat copays for prescription drugs under the Health Reimbursement Copay Advantage Plan.

Retail (30-day supply): $10 for generics*; $50 for preferred brands; $100 for non-preferred brands.
Mail Order (90-day supply): $20 for generics*; $100 for preferred brands; $200 for non-preferred brands.

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

Fertility Services

The Health Reimbursement Copay Advantage Plan will pay benefits for fertility services when provided by or under the direction of a physician, with or without a diagnosis of infertility. Fertility services are covered subject to the Health Reimbursement Copay Advantage Plan’s deductible, coinsurance, copays and out-of-pocket maximum. In addition, these services will be limited to a lifetime maximum of $25,000 (in and out of network combined) for medical and prescription drug benefits. Services for the diagnosis and treatment of an underlying cause of infertility are covered as described in the Summary Plan Description and are not subject to the fertility lifetime maximum benefit.

Gender Dysphoria

Siemens Healthineers medical and prescription drug benefit plans cover certain services for the treatment of gender dysphoria. Go here to learn more.

HRA information and tips

The HRA is paired with the Health Reimbursement Copay Advantage Plan and is a reimbursement account that you can use to pay for eligible medical expenses. Only Siemens Healthineers contributes to this account—$500 for individual coverage or $1,000 if you enroll one or more dependents.

Tip #1: How the HRA works.

Tip #2: Know when to use the Healthcare FSA vs. your HRA.

Access your HRA through your medical plan administrator (Anthem Blue Cross Blue Shield or UnitedHealthcare).
The company contribution is available on January 1, if you enrolled during the previous Annual Enrollment period. If you join after January 1, the amount is adjusted based on when you enroll.
You can use your HRA to help pay medical costs for you and your covered family members.
You can submit HRA claims through March 31 of the following year (e.g., 2026 HRA claims can be submitted through March 31, 2027). Don’t forget that you must request reimbursement from your HRA unless you elect to have your claims automatically paid from your HRA.
You can carry over balances up to $4,000 from year to year.
If you change your medical plan option, leave or retire from Siemens Healthineers, or drop coverage under the medical plan, you will lose any unused amounts in your HRA.

Medical expenses that are eligible for reimbursement under both the HRA and the Healthcare FSA must be submitted to your HRA first. This includes out-of-pocket medical expenses, such as your deductible, copays and coinsurance. After your HRA balance has been exhausted, future medical expenses for the year may be submitted directly to your Healthcare FSA.
Certain expenses that are not eligible for reimbursement under the HRA (for example, prescription drug, eligible over-the-counter medication, vision and dental expenses) may be paid from your Healthcare FSA.
You are responsible for requesting reimbursement from your HRA, unless you elect to have your claims automatically paid from your HRA. This election can be made on the HRA website of your claims administrator (Anthem BCBS or UHC).

For our company couples

If you change who pays for coverage, for example, in 2026 you drop family coverage but your spouse, also a Siemens Healthineers benefits-eligible employee enrolls the family—your unused HRA balance will not transfer. Any unused funds from the previous year will be forfeited.

Eligible healthcare expenses

Please refer to the Siemens Medical Solutions USA, Inc. Group Insurance and Flexible Benefits Summary Plan Description (SPD)

Expenses not eligible under your medical plan option; amounts above the Reasonable and Customary charges or Maximum Allowed Amount; prescription drug, dental and vision expenses; as well as payroll contributions are not eligible for reimbursement under the HRA.

Earn additional company contributions with Healthy Rewards.

It’s as easy as 1, 2, 3! Participate in certain wellness activities and receive additional company contributions deposited into your HRA.