Overview

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

2019 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
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).
PPO Plans
Administered by: Horizon Blue Cross Blue Shield
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:
  • High Option PPO
  • Low Option PPO
Compare the plans

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.

Plan Comparison

  High Option PPO Low Option PPO CDHP
HSA eligible No No Yes
Company Contribution to HSA None None $250 for coverage for yourself only
$500 if you cover yourself and your spouse/DP
$750 if you cover yourself and child or yourself and two or more dependents
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: $1,500/$3,000/$4,500
Out-of-network: $3,000/$6,000/$9,000
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: $4,500/$9,000/$12,700 Out-of-network: $9,000/$18,000/$25,400
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.

Preventive Care

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 55 or older and have smoked for more than 30 years)

For more information, including age and frequency limits, see the detailed list of covered preventive care services

Important Medical Plan Information

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.

Global Core

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.

CDHP

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 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.

PPO

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 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 $500 of unused money in your FSA to the next year; you will forfeit amounts above $500. So be sure to plan carefully.

Make the most of your coverage

Take advantage of these resources to manage your care and your costs.

Tools & Resources

Take advantage of these valuable resources to better manage your health.

Medical plan tools

Find a doctor, compare costs, manage claims and more.

Prescription tools

Order or refill prescriptions, sign up for mail order, and more.

icon Horizon CareOnline

Seek medical advice from board-certified physicians who are available 24/7, 365 days a year to consult with you over the phone or through live video right from your mobile device or computer. Horizon CareOnline physicians can provide fast, convenient diagnosis and treatment for many common conditions. If you are in a PPO plan, you pay a $5 copayment for medical and behavioral health visits. If you are in the CDHP, you pay no more than $39 for medical health visits, and what you pay for behavioral health visits varies based on the service/provider. Deductible and coinsurance apply if you are in the CDHP. Visit Horizon CareOnline or call 1-877-716-5657 to enroll or learn more.