WoodmenLife Career Central

	HSA		HRA
Benefit Summary	In-Network	Out-of-Network	In-Network	Out-of-Network
Deductible/Coinsurance	Aggregate		Aggregate
Associate	$1,500	$3,000	$2,000	$4,000
Associate Plus	$3,000	$6,000	$4,000	$8,000
Coinsurance	25%	40%	30%	50%
Out-of-Pocket Maximum (includes Deductible, Coinsurance and Copays)
Associate	$3,000	$6,000	$4,500	$9,000
Associate Plus	$6,000	$12,000	$9,000	$18,000
WoodmenLife HSA or HRA Contributions
Associate	$500		$1,000
Associate Plus	$1,000		$2,000
Office Visit
Primary Care	D/C	D/C	$30 Copay	D/C
Specialist	D/C	D/C	D/C	D/C
Other Office Visit Services	D/C	D/C	Included in Copay	D/C
Preventive Care	100%	D/C	100%	D/C
Virtual Doctor	D/C	D/C	$15 Fee	D/C
Urgent and Emergency Care
Physician	D/C	D/C	$55 Copay	D/C
Other Urgent Care Services	D/C	D/C	Included in Copay	D/C
Emergency Care	D/C	Same as In-Network	$175 Copay + D/C	Same as In-Network
Prescription Drug Retail 30-day supply
Generic	D/C	In-Network + 25%	$15 Copay	In-Network + 25%
Formulary	D/C	In-Network + 25%	30%, $37.50 min to $150 max	In-Network + 25%
Non-Formulary	D/C	In-Network + 25%	30%, $62.50 min to $250 max	In-Network + 25%
Specialty	D/C	Not covered	30%, $75 min to $300 max	Not covered
Prescription Drug Retail 90-day supply
Generic	D/C	Not covered	$37.50 Copay	Not covered
Formulary	D/C	Not covered	30%, $93.75 min to $375 max	Not covered
Non-Formulary	D/C	Not covered	30%, $156.25 min to $625 max	Not covered

Health Insurance