Benefit Stories: Can You Relate?

Learn how people like you make their enrollment decisions.

What’s your story? Each of us has reasons we make the choices we do. That’s true in life and when it comes to the benefits we choose. Click a photo below to see what others may be thinking about when it’s time to enroll.* You may find some new ideas to consider.

This chart focuses primarily on in-network benefits under both the Health Choice 1 and Health Choice 2 plans. For information about out-of-network benefits, please refer to the Medical Benefits SPD.

2019 Health Plan Comparison Chart

Health Choice 1 Health Choice 2
Feature In-Network* In-Network*
Annual Deductible**

If you cover yourself only: $1,350
If you cover any family members: $2,700

If you cover yourself only: $2,500
If you cover any family members: $5,000

Preventive Care Based on federal guidelines

In-network: 100% covered; deductible does not apply

Out-of-network: After you meet the deductible, plan pays 60% and you pay 40%

Coinsurance

In-network: After you meet the deductible, plan pays 80% and you pay 20%

Out-of-network: After you meet the deductible, plan pays 60% and you pay 40%

Teladoc

Telemedicine service that gives you and your covered family members convenient, affordable access to a board-certified doctor by phone or online. Phone consultations are available 24/7. Video consultations are available from 7 a.m. to 9 p.m. ET every day. Note: Limitations apply in some states. You save time and money: regular medical visits are $40, dermatology visits are $75 and behavioral health support is $80 to $160, depending on the service. All fees can be paid from your HSA and are subject to your medical plan deductible, coinsurance and out-of-pocket maximum. That means you’ll pay the full cost of these services until you’ve met your deductible, then only 20% of the regular fee after that until you meet the out-of-pocket maximum.

You can even earn up to $100 in wellness credits when you register for Teladoc or complete a consultation. See the Wellness Incentive Program Checklist for details.

Well-being Centers (Pittsburgh and Miamisburg) Available to you and your covered family members age 2 and up for primary care, preventive and urgent care, physical therapy, chronic condition support, immunizations and more. Services are billed the same way as any other health care provider.
To align with other Living Well offerings, Biometric Screenings and flu shots are available at the Well-being Centers for all employees. This means you can take advantage of these services even if you’re not enrolled in a PNC medical option. Health education events are open to all employees as well. There is no cost to you for these services. Note: Family members must be covered under a PNC medical option to use any Well-being Center services.
Emergency Room (ER) After you meet the deductible, plan pays 80% and you pay 20%.
Non-emergency treatment is not covered in the ER.
Annual Out-of-Pocket Maximum (includes deductible)

If you cover yourself only: $3,000 must be met before you’re covered at 100%

If you cover any family members:

  • any individual who meets $3,000 is covered at 100%
  • all other family members are not covered at 100% until family expenses total $6,000

If you cover yourself only: $5,000 must be met before you’re covered at 100%

If you cover any family members:

  • any individual who meets $6,850 is covered at 100%
  • all other family members are not covered at 100% until family expenses total $10,000
Health Savings Account (HSA) If eligible, the HSA lets you set aside pretax dollars to pay for current eligible health care expenses and/or save for future eligible expenses. You choose how much to contribute (up to IRS limits) and can change your contribution at any time. PNC and Living Well also may contribute to your HSA. Learn more about the eligibility rules, how the HSA works and PNC's and Living Well's contributions.
Prescription Drug Coverage***

Covered Health Care Reform preventive care drugs: No deductible; you pay nothing (plan pays 100%)

Covered preventive care drugs: Deductible does not apply; you pay 20%

All other covered drugs: After you meet the deductible, you pay 20%

  • If you use an out-of-network pharmacy, you must pay the full price and submit a claim to receive reimbursement.
  • To see the lists of covered drugs, requirements for drugs in the CVS Caremark Maintenance Choice and/or Generic Step Therapy programs, or details about drugs that require pre-authorization, visit caremark.com.

*In-network providers agree to accept negotiated rates.

**Deductible and coinsurance apply to eligible medically necessary medical and prescription drug expenses. However, covered in-network preventive care and Health Care Reform preventive-care prescription drugs are covered in full without having to meet the deductible or pay coinsurance. If you cover any family members, the full family deductible must be met before expenses are paid for any individual.

***Subject to the terms of the plan. Please see the Prescription Drug Program section in the Medical SPD for additional information.

ANNUAL WELLNESS CREDITS AVAILABLE FOR COMPLETING WELLNESS INCENTIVE ACTIVITIES THROUGHOUT THE YEAR

For a covered employee* For a covered spouse/domestic partner*
Up to $600 Up to $400
$100 for free online Health Assessment $100 for free online Health Assessment
and and
Up to $500 for additional activities Up to $300 for additional activities
*If you’re enrolled in a PNC medical option, the Wellness Incentive Program offers you and your covered spouse/domestic partner these wellness credits deposited as dollars in your HSA as activities are completed. If you are not enrolled in PNC's medical benefits or not eligible for an HSA, you can earn up to $100 in wellness credits as taxable cash in your regular PNC pay as activities are completed. Learn more

*These stories are fictional and are for illustrative purposes only.