Health Choice 1 | Health Choice 2 | |
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Feature | In-Network* | In-Network* |
Annual Deductible** |
If you cover yourself only: $1,350 |
If you cover yourself only: $2,500 |
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% |
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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% |
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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. 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. | |
Well-being Centers (Pittsburgh and Miamisburg) | Available to you and your covered family members age 2 and up for primary care, preventive and urgent health 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. |
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Emergency Room (ER) Non-emergency treatment is not covered in the ER. | After you meet the deductible, plan pays 80% and you pay 20% | |
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*** |
Preventive Drugs: Deductible does not apply; you pay 20% No-cost Preventive List: Deductible does not apply; you pay nothing (plan pays 100%) All other covered drugs: After you meet the deductible, you pay 20% (includes Specialty Drugs, Preventive Drugs, Advanced Control Specialty Formulary and Preferred Drugs)
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*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 qualified 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.