To support your health and financial wellness, DSM provides valuable benefits that help you and your family stay healthy and pay for care in the event of illness or injury.
Medical Plans:
Our benefits program includes medical plan options with a range of coverage levels and costs designed to meet the diverse needs of our employees.
| Plan | Description |
|---|---|
| PPO Plans | Two Preferred Provider Organization (PPO) plans with copayments (with no deductible) for in-network office visits, most prescription drugs and some other services; the deductible and coinsurance apply to most other services:
|
| CDHP Administered by: Horizon Blue Cross Blue Shield |
A consumer-directed health plan (CDHP) that puts you in charge of your spending through lower premiums, higher deductibles, and a tax-free Health Savings Account (HSA). |
| Compare the plans | |
Monthly Webinars through Horizon
Horizon provides monthly topics webinars to help educate you on your health and wellness. See below for a list of webinars available in 2024. You will receive a link each month inviting you to reserve a spot in that month’s webinar.
| Webinar Title | Date |
|---|---|
| Why Does My ______ Hurt? | January 16 |
| At the Heart of Health | February 14 |
| Stress Reduction Made Easy: Western and Eastern Perspectives | March 12 |
| Mastering Your Metabolism | April 10 |
| Body Positivity | May 8 |
| Plant-Based Diet | June 12 |
| Migraine Awareness and Management | July 10 |
| Gut Health | August 14 |
| Breaking the Diet Cycle | September 11 |
| Colon Cancer Awareness, Prevention and Detection | October 9 |
| Diabetes | November 13 |
| Meditation | December 11 |
The Transparency in Coverage Final Rules (and related sub-regulatory guidance (see Q&A-1 and 2)) require non-grandfathered group health plans to disclose on a public website information regarding: (1) the in-network provider rates for covered items and services (see “in-network-rates” in filename); and (2) the historical out-of-network allowed amounts and billed charges for covered items and services (see “allowed-amounts” in filename) in two separate machine-readable files (MRFs). The files must, in part, also include plan option/coverage identifier information; billing codes to identify items and services for claims processing; and all applicable rates. The MRFs for the non-grandfathered group health plan(s) in The DSM Consolidated Welfare Benefit Plan are linked here. DSM’s EIN is 58-1858661.
Support for the LGBTQ+ Community
DSM is committed to building an inclusive culture where all employees feel welcomed, respected and appreciated for being exactly who they are. Below are the benefits and resources that can provide help and support to those in the LGBTQ+ community:
- Expenses related to gender dysphoria, such as hormone therapy and gender-affirming surgery, are covered under your DSM medical plan.
- As well, treatment related to gender affirmation could be considered eligible expenses and could be paid for from your Health Savings Account (HSA) or Healthcare Flexible Spending Account (FSA).
- Preventive care can help support members of the LGBTQ+ community that may be predisposed to certain health conditions.
- Virtual visits are an easy way to make sure you receive the care you need, from a safe place.
Key features at a glance
All our medical plans provide:
Comprehensive, affordable coverage
that fulfills the requirements of the health care reform law.
Free in-network preventive care
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
Prescription drug coverage
included with each medical plan.
Financial protection
through annual out-of-pocket maximums that limit the amount you’ll pay each year.
Inclusive benefits
for people from all walks of life, including our LGBTQ+ community.
Save money
Link to Horizon Blue Cross Blue Shield
| High Option PPO | Low Option PPO | CDHP | |
|---|---|---|---|
| HSA eligible | No | No | Yes |
| Company Contribution to HSA | None | None | Employee only $500 Employee + Spouse $750 Employee + Family $1,000 Up to an additional $1,200 if you and/or your spouse/DP earned the wellness incentive |
| Preventive Doctor’s Visit | No cost to you when you see in-network providers — covered at 100% in-network | No cost to you when you see in-network providers — covered at 100% in-network | No cost to you when you see in-network providers — covered at 100% in-network |
| Employee/Employee + 1 dependent/family deductible | In-network: $350/$700/$1,050 Out-of-network: $700/$1,400/$2,100 |
In-network: $1,050/$2,100/$3,150 Out-of-network: $2,100/$4,200/$6,300 |
In-network: $1,600/$3,200/$4,800 Out-of-network: $3,200/$6,400/$9,600 |
| Employee/Employee + 1 dependent/family out-of-pocket maximum | In-network: $1,850/$3,700/$5,550 Out-of-network: $3,700/$7,400/$11,100 |
In-network: $2,850/$5,700/$8,550 Out-of-network: $5,700/$11,400/$17,100 |
In-network: $4,800/$9,600/$14,400 Out-of-network: $9,600/$19,200/$28,800 |
| Coinsurance | In-network: 90% after deductible
Out-of-network: 70% after deductible*
|
In-network: 80% after deductible
Out-of-network: 60% after deductible*
|
In-network: 80% after deductible
Out-of-network: 60% after deductible*
|
| Primary Physician Office Visit | In-network: 100% after $20 copay
Out-of-network: 70% after deductible*
|
In-network: 100% after $20 copay
Out-of-network: 60% after deductible*
|
In-network: 80% after deductible
Out-of-network: 60% after deductible*
|
| Specialist Physician Office Visit | In-network: 100% after $40 copay
Out-of-network: 70% after deductible*
|
In-network: 100% after $40 copay
Out-of-network: 60% after deductible*
|
In-network: 80% after deductible
Out-of-network: 60% after deductible*
|
| Urgent Care Office Visit | In-network: 100% after $20 primary physician/$40 specialist copay
Out-of-network: 70% after deductible*
|
In-network: 100% after $20 primary physician/$40 specialist copay
Out-of-network: 60% after deductible*
|
In-network: 80% after deductible
Out-of-network: 60% after deductible*
|
*Out-of-network benefits are based on reasonable and customary charges.
Fertility Benefits Under Your DSM Medical Plan
All DSM medical plans cover infertility benefits (such as in vitro fertilization or gamete intrafallopian transfer) with a $15,000 maximum. The DSM prescription drug plan also covers infertility drugs with a separate $10,000 maximum.
The PPO offers lower out-of-pocket costs in exchange for higher paycheck contributions. With this plan, your costs are more predictable, but you’ll likely still have out-of-pocket expenses.
You can choose any in-network or out-of-network provider each time you receive care. But keep in mind: You will generally receive higher benefits when you use in-network providers.
How it works
You pay nothing for in-network preventive care — it’s covered in full.
Copay
You pay a small fee at the time of service for doctor visits and prescriptions. Copays do not count toward your deductible.
Deductible
For care that doesn’t charge a copay, such as hospital services, you pay 100% of costs until you meet the annual deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of certain services.
Out-of-Pocket Maximum
You're protected by an annual limit on costs — the plan pays 100% of reasonable and customary costs of any further covered expenses for the rest of the year.
Money-saving Tip
If you have a Health Care Flexible Spending Account (FSA), take advantage of the tax-free savings when paying for care. You can only carry over up to $610 of unused money in your FSA to the next year; you will forfeit amounts above $610. So be sure to plan carefully.
Make the most of your coverage
Take advantage of these resources to manage your care and your costs.
The CDHP pairs low-premium, high-deductible medical coverage with a tax-free Health Savings Account (HSA) that helps you save up for future expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.
With the plan, you can choose any in-network or out-of-network provider each time you receive care. But keep in mind: You will generally receive higher benefits when you use in-network providers.
CDHP at a glance
How it works
You pay nothing for in-network preventive care — it’s covered in full.
Plan ahead with your HSA
You can set aside tax-free money from your paycheck and receive company contributions to help cover your costs — now, or in the future.
Deductible
You pay 100% of costs until you meet the annual deductible.
Coinsurance
You and the plan share the cost of covered services after meeting the deductible.
Out-of-Pocket Maximum
You're protected by an annual limit on costs — the plan pays 100% of reasonable and customary costs of any further covered expenses for the rest of the year.
Money-saving Tip
Use your HSA to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free! You can also pair your HSA with a Limited Purpose Flexible Spending Account (FSA).
Make the most of your coverage
Take advantage of these resources to manage your care and your costs.
Budgeting for your costs
With the CDHP, you pay less in premiums and assume more financial responsibility when you receive care. So, it’s important to plan ahead for your out-of-pocket expenses. Here are some ideas to consider:
- Think about your costs. Contribute at least enough to your HSA to cover your expected out-of-pocket costs, such as your annual deductible and coinsurance. Remember — because you’re keeping more of your paycheck by paying lower medical plan premiums, you may have extra money available to put in your HSA.
- Plan ahead. You can only spend HSA money that’s actually been deposited into your account. Adjust your contributions as necessary during the year to make sure you have money available when you need it. And if you don’t, remember to reimburse yourself later so you take full advantage of your HSA’s tax savings.
- Look long term. You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses — or if you want to save for your health care costs in retirement — set aside a little extra each paycheck so your balance can grow over time.
To help you stay healthy and avoid serious illness, preventive care is covered at 100 percent in-network with no deductible. When you enroll in any DSM Medical Plan, you pay nothing when you receive preventive care from an in-network provider.
Covered Preventive Care
The following services are covered as routine screenings, not diagnostic services:
- Cholesterol screening
- Colon cancer screening
- Colonoscopy
- Routine adult physical and well child care
- Immunizations (routine adult and child)
- Mammography
- Pap smear
- Prostate cancer screening (PSA)
- Well woman preventive care (e.g., contraceptives, sterilization, breast pump)
- Skin cancer screening
- Lung cancer screening (if you are age 55 or older and have a 30 "pack-year" smoking history - see more
For more information, including age and frequency limits, see the detailed list of covered preventive care services
Hospital Precertification
All inpatient services except those relating to behavioral health (mental health and substance abuse treatment) must be precertified by calling BCBS at 1-800-664-2583.
All inpatient behavioral health services must be precertified by calling 1-800-626-2212. Horizon Behavioral Health provides this service for BCBS.
Pre-existing Conditions
The DSM medical plan has no pre-existing condition limitations. This means once you enroll, you are eligible for treatment of an existing illness or injury covered under the DSM medical plan.
Surgical Predetermination
Consider obtaining a Predetermination of Medical Benefits, which is a voluntary clinical review, before your surgery. This enables you and your provider to find out up-front if the services meet medical necessity criteria and are covered under your plan. The form can be found on myDSMbenefits.com which you can share with your doctor. It takes several weeks for the review.
If you need medical care when traveling outside the U.S., the DSM Medical Plan provides coverage through Global Core — an affiliate of Blue Cross Blue Shield — where you have global access to medical assistance services, doctors and hospitals. Here’s how it works:
- In most cases, you will be required to pay the provider up front and then submit your eligible claims to Global Core for reimbursement.
- For emergency care: During a medical emergency, always seek care from the nearest medical facility, then call Global Core.
- For non-emergencies: If you contact BCBS before seeking treatment, they can help you find a provider. Or, you can look one up online if that’s an option.
- If you need hospitalization or surgery: You must contact BCBS to precertify coverage.
- To connect with BCBS Global Core, visit the BCBS Global Core service center.
Wellness Resources
Horizon Blue Cross Blue Shield has resources that can help you manage your health and wellness. Blue365 is a program available at no cost to all DSM employees enrolled in a Horizon Medical plan. The program offers discounts from 5% to 20% off gym memberships, fitness gear, healthy eating options and virtual wellness programs. By signing up, you will have access to top retailers offering discounts on fitness apparel, footwear, tracking devices like Fitbit, headphones, water bottles and even race registrations. To learn more and register, visit www.HorizonBlue.com/healthydiscounts and read this flyer.