2017 Health Fund

About the Health Fund

This medical plan option is available almost everywhere in the U.S. except Hawaii. Additional plans may be available depending on where you live. See your 2017 medical plans by state.

Depending on the state you live in, the Health Fund is administered by either Aetna or UnitedHealthcare, but the plan works the same:

  • Medical coverage includes prescription drug benefits, mental health and substance abuse benefits, access to Teladoc and Expert Medical Opinion.
  • The Health Fund medical plan option comes with access to a Health Savings Account (HSA) that you can use to help meet your deductible, pay for other out-of-pocket expenses, or save for future needs.
  • You can choose to see any doctor or other provider you like, but you will pay less when you see an in-network provider, because they have agreed to charge lower, negotiated rates.
  • If you have any questions about your mental health and substance abuse coverage, or if pre-certification/notification is required, contact the Behavioral Health Claims Administrator, Beacon Health Options, at 1-877-888-6440 or visit achievesolutions.net/Dell.
  • The plan pays 100 percent for covered in-network preventive care, such as annual physicals, age-based screenings and specialized services for children and women. Preventive care guidelines are updated by the government on a regular basis. If you have questions about what is considered preventive care services, contact the health plan number on the back of your ID card.
  • Certain preventive prescription drugs are also available at no cost, or only require you to pay coinsurance with no deductible. These medications are shown on the Express Scripts’ preventive drug list.
  • For all other covered medical services and prescription drugs, you must pay an annual deductible before the plan begins to pay benefits. Use Castlight to know your cost in advance.
  • Once you reach your annual deductible, the plan pays 80 percent of most in-network eligible expenses and you pay 20 percent (called “coinsurance”) until you reach your out-of-pocket maximum. Note: The coinsurance is 80 percent for outpatient diagnostic lab and high-tech radiology (MRI and CT scans) at in-network freestanding facilities and 60 percent at a hospital or hospital affiliated facility. See Coverage for high-tech radiology and lab services for more details.
  • Once you reach the out-of-pocket maximum for the year, the plan pays 100 percent of eligible in-network expenses for the rest of the year.
Keep in mind Under the Health Fund medical plan, you pay the full cost of all medical and prescription drug* services (excluding eligible preventive care) until you reach the $1,500 deductible ($3,000 if you cover dependents). Note: The full cost of in-network providers is equal to the negotiated rates.

For more information on the Health Fund, see the Summary Plan Descriptions on Your Benefits Resources website (@ Work  | Log in ). From Your Benefits Resources home page, go to the Knowledge Center.

Remember: If you have questions about your benefits, contact the Dell Benefits Center at 1-888-335-5663, option 1, option 1.

Key features of the Health Fund

This table highlights the key benefit features of the Health Fund (benefits are shown for in-network services):

 

Dell contribution to your HSA to help cover your expenses
Note: For new hires, Dell’s contributions will be prorated based date of hire.

You only: $500
You + dependent(s): $1,000

HSA bonus for 2017:
You only: $250
You + dependent(s): $500

Can you enroll in the Health Care FSA?

Yes, but the IRS limits eligible expenses. Learn more.

Annual deductible

Note: You must meet the annual deductible before prescription drugs other than those on the preventive drug list will be covered. 

You only:     $1,500
Family:        $3,000

Primary care physician
office visit

You pay the entire amount until you meet the deductible. After the deductible is met, the plan pays 80% and you pay 20% coinsurance for eligible expenses. Note: The full cost of in-network providers is equal to the negotiated rates.

At Well at Dell Health Centers, you pay a flat fee of $65 per visit until you meet your deductible. Then coinsurance applies.

Specialist visits

After you meet the deductible, the plan pays 80% and you pay 20% coinsurance for eligible expenses.

Teladoc

You pay $40 per visit until you meet your deductible. After you meet your deductible, you pay 20% coinsurance ($8).

Non-emergency, non-preventive diagnostic lab work and radiology services (such as MRIs and CAT scans)

  • In-network preferred facility (like a Quest Diagnostics® lab for Aetna or a LabCorp  lab for UnitedHealthcare) covered at 80% of cost after deductible
  • In-network, non-preferred facility (like a hospital lab) covered at 60% of cost after deductible

How you meet the deductible

 

All covered medical and prescription drug* expenses count toward the deductible, including mental health and substance abuse.

There are no individual deductibles under family coverage. All covered family members pay toward the family deductible. The family must be met before the plan begins to pay coinsurance.

Out-of-pocket maximums (includes deductibles and expenses at Well at Dell Health Centers)

Medical:
You only: $5,000
Family $10,000 (no one individual will pay more than $6,850)

Prescription drug*:
Included in medical out-of-pocket maximum
For more information about prescription drugs, see the Paying for prescription drugs in the Health Fund section.

How you reach the out-of-pocket maximum

Expenses for each covered person count toward the family out-of-pocket maximum (no one individual will pay more than $6,850) before the plan begins to pay 100% of eligible expenses for the rest of the year for that individual.

  • If you cover only yourself, that amount is $5,000.
  • If you cover dependents, once any one family member reaches the $6,850 individual limit, the plan pays 100% of that individual’s medical and prescription costs for the remainder of the year. Once the combined expenses for all covered individuals reach the family limit of $10,000, the plan pays 100% of eligible medical and prescription expenses for all covered family members (including those who haven’t yet met their individual limit).

*No requirement to meet deductible for prescriptions on Express Scripts’ preventive drug list.

Paying for services under the Health Fund

In the Health Fund, how much you pay depends on whether or not you’ve met your deductible.

You choose how to pay your share. You can use the money in your HSA, or you can pay out of your own pocket and save your HSA funds for future expenses. If you pay with your HSA, the easiest way is to use the HSA debit card you receive after you elect your account. It works just like your checking account debit card and makes it easy to pay without the hassle of submitting paperwork.

Before you meet your deductible

You pay 100% of your medical and prescription expenses, except preventive care (such as your annual physical or health screenings), which is covered at 100% — meaning it’s free to you if it’s in-network. Note: The full cost of in-network providers is equal to the negotiated rates. Certain preventive medications are covered before the deductible or are free to you. See Express Scripts’ preventive drug list.

After you meet your deductible

You pay a percentage of the cost of medical services, called “coinsurance,” while the plan pays the majority. For prescriptions, you pay either a set copay amount or coinsurance, based on the type of medication. In 2017:

  • You pay 20% coinsurance for in-network medical care.1
  • For prescriptions, you’ll pay:
 

Retail generics (up to a 34 day supply)

$8

Home delivery generics (61 to 90 day supply)

$16

Formulary brand names ($40 minimum, $90 maximum) (up to a 34 day supply)

30% coinsurance

Brand names not on the formulary

Full price, even after deductible, unless your doctor has the brand name version approved as an exception

1 If you need radiology or lab work, such as an MRI or CAT scan, use and independent, freestanding in-network provider, otherwise you will pay more. Contact your carrier to search for providers.

When going to the doctor

Find quality in-network care. Make sure your doctor, hospital or other health care provider is in-network — you’ll pay a lot more when you go outside the network! Use Castlight to search for nearby in-network providers and compare cost and patient ratings.

Talk to your doctor. Ask about your options. Can a generic drug replace your brand-name prescription? Are alternative treatments available? Is this service considered “preventive care”?

Don’t make a payment at your appointment. Instead, present your medical plan ID card. Your provider submits the claim, and you’ll get a bill later for the negotiated rate as a Dell team member. (Some doctors may require payment at your appointment, so find out their policy when you schedule it. You can also ask for an estimate of the cost beforehand, so you’re prepared when you go.)

Check your provider’s bill against your carrier’s Explanation of Benefits (EOB). Make sure the amount you were billed matches the patient responsibility amount on your EOB, and contact your carrier if you find errors.

At the pharmacy

Make sure your medication is on the Express Scripts formulary (the list of drugs covered under the plan) at express-scripts.com.

Find affordable pharmacies. Even in network, costs can vary from pharmacy to pharmacy. Castlight can help you find the cheapest pharmacy near you, or you can search on express-scripts.com to find a nearby in-network pharmacy.

When it’s time to pay, present your Express Scripts ID card so the cost of your drug is applied to your deductible.

Health Savings Account (HSA)

The Health Fund comes with access to a Health Savings Account (HSA) that can help you pay your eligible out-of-pocket expenses. Learn about the HSA.

Prescription drugs in the Health Fund

The Health Fund includes prescription drug coverage. Learn how prescription drug coverage works.

What if I'm Medicare eligible?

See how medical coverage is affected when you become eligible for Medicare. Learn more.

More details

About primary care physicians (PCPs)

Your PCP is the physician you work with to manage your routine health care needs and who acts as an advisor in the event you need more specialized care. Don’t have a PCP? Now is a great time to find one and start establishing a relationship with him or her.

To find a network PCP, visit Castlight, go to your carrier’s website or call the NurseLine at 1-866-WELL-DELL or 1-866-935-5335. You can chat with the NurseLine online at the WebMD website (@ Work | Log in ).

Specialist visits

Many team members have access to high-performing specialists through either the Aetna Aexcel® network or the UnitedHealth Premium® program. These specialists (like cardiologists, endocrinologists, etc.) are selected based on the quality of care they provide — measured by treatment outcomes, rates of hospital readmission, and other factors, including cost efficiency. These programs are not yet available to all team members everywhere, but it’s always in your best interest to find a high-quality provider.

If you’re enrolled in the Health Fund, your deductible and coinsurance apply to specialist visits, just as they do to visits to your primary care physician.

Learn More About the Aexcel Network. To find an Aexcel network specialist, look for a star () next to the name.

Learn More About UnitedHealth Premium. To find a UnitedHealth “Premium Care Physician,” look for the two blue hearts (blue_hearts) next to the name.

Coverage levels for high-tech radiology and lab services

The Health Fund pays different levels of benefits for non-emergency, non-preventive diagnostic lab work and radiology services, such as MRIs and CAT scans, depending on the facility chosen. If you need help finding preferred network facilities that offer the highest coverage, contact the health plan number on the back of your ID card.

 

If you use an:

The plan pays:

In-network preferred facility (like a Quest Diagnostics® lab for Aetna or a LabCorp® lab for UnitedHealthcare)

80% of cost after deductible

In-network, non-preferred facility (like a hospital lab)

60% of cost after deductible

Out-of-network facility

50% of eligible cost after deductible

Important: In-network preventive care services are covered at 100 percent. Emergency radiology and lab diagnostics and all tests performed during in-network hospitalization are covered at 80 percent after deductible.

Find an Aetna Preferred Facility.
Find a UnitedHealthcare Preferred Facility.

Mental health and substance abuse benefits

To access these benefits, you and your eligible dependents must be enrolled in a Dell medical plan through Aetna or UnitedHealthcare. The mental health program is administered by Beacon Health Options.*

  • Inpatient and outpatient mental health and substance abuse treatment is covered the same as similar inpatient and outpatient medical services under the medical plans.
  • Any deductibles and coinsurance you pay for mental health and substance abuse treatment apply to your medical plan’s out-of-pocket maximum. There are no annual visit limits or lifetime maximum limits for outpatient office visits.

Applied Behavior Analysis (ABA) therapy is covered for participants with a diagnosis of autism spectrum disorder. “ABA therapy,” when medically appropriate, can help those diagnosed with autism spectrum disorder learn how to communicate better, develop relationships, play, care for themselves, learn in school, succeed at work and participate fully and productively in family and community life. This benefit, administered by Beacon Health Options, includes a network of ABA providers, full care management services and claims payment for authorized ABA services.

ABA therapy is in addition to mental health/ substance abuse and Employee Assistance Program (EAP) benefits.

For information or to find a provider, contact Beacon Health Options at 1-877-888-6440.

*If you’re covered by the Aetna International, Kaiser Permanente POS (Hawaii only), Kaiser Permanente HMO (California only), or Harvard Pilgrim medical plan, mental health and substance abuse benefits are administered by your medical plan. See your 2017 medical plans by state.