Medical
EnerSys provides access to two medical options through Highmark Blue Shield: the PPO Plan and the High Deductible Plan (HDP). Both plans cover the same services and use the same network — the difference is how much you pay per paycheck versus what you pay when you receive care. The HDP is HSA-eligible, meaning you can open a Health Savings Account and receive an EnerSys contribution.
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
PPO Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$750 / $1,500
Out-of-Pocket Max (Individual/Family)
$3,600 / $7,200
Coinsurance
20%
Preventive Care
No charge
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
20%
Emergency Room
20%
Virtual Care (medical)
$0 copay
Diagnostic – Freestanding Facility / Independent Lab
0%; no deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
20% ($25 min / $50 max)
Non-Preferred Brand
40% ($40 min / $80 max)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$75
Non-Preferred Brand
$120
Specialty Rx (Mail Order)
1–30 day supply
5% ($150 min / $250 max)
31–60 day supply
5% ($300 min / $500 max)
61–90 day supply
5% ($475 min / $750 max)
There is no deductible to satisfy for prescription drugs under the PPO Plan. Benefits are effective with the first dollar spent in the new plan year.
Out-of-Network
Deductible (Individual/Family)
$1,500 / $3,000
Out-of-Pocket Max (Individual/Family)
$7,200 / $14,000
Coinsurance
40%
Preventive Care
40%
Primary Care Visit
40%
Specialist Visit
40%
Urgent Care
20%
Emergency Room
20%
Virtual Care (medical)
Not covered
Diagnostic – Freestanding Facility / Independent Lab
40%
Prescription Drugs
Prescription coverage is provided through Express Scripts using participating pharmacies. See the in-network column for applicable copays and coinsurance.
Plan Cost
Coverage Tier
Employee Only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Per Pay Period
$XX
$XX
$XX
$XX
High Deductible Plan (HDP)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,000 / $4,000
Out-of-Pocket Max (Individual/Family)
$5,500 / $9,000
Coinsurance
20%
Preventive Care
No charge
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Virtual Care (medical)
0%
Diagnostic – Freestanding Facility / Independent Lab
You will pay less out of pocket (deductible and coinsurance) at a freestanding location than at a hospital
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
20% ($25 min / $50 max)
Non-Preferred Brand
40% ($40 min / $80 max)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$75
Non-Preferred Brand
$120
Specialty Rx (Mail Order)
1–30 day supply
5% ($150 min / $250 max)
31–60 day supply
5% ($300 min / $500 max)
61–90 day supply
5% ($475 min / $750 max)
Because the HDP deductible is combined with prescription coverage, you pay 100% of drug costs until your deductible is satisfied. After that, the amounts above apply until you reach the out-of-pocket maximum.
Out-of-Network
Deductible (Individual/Family)
$4,000 / $8,000
Out-of-Pocket Max (Individual/Family)
$11,000 / $22,000
Coinsurance
40%
Preventive Care
40%
Primary Care Visit
40%
Specialist Visit
40%
Urgent Care
20%
Emergency Room
20%
Virtual Care (medical)
Not covered
Diagnostic – Freestanding Facility / Independent Lab
40%
Prescription Drugs
Prescription coverage is provided through Express Scripts using participating pharmacies. See the in-network column for applicable copays and coinsurance.
Plan Cost
Coverage Tier
Employee Only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Per Pay Period
$XX
$XX
$XX
$XX
More Than Medical Coverage
Included at No Cost
The EnerSys Medical Plan includes a number of services at no out-of-pocket cost when you are enrolled in the PPO or HDP Plan.
- Preventive Incentive: earn a $300 credit for yourself and $300 for your spouse/domestic partner ($600 total) by completing your annual Preventive Exam. Complete your exam during the 12-month period leading up to October 31 to receive the credit the following calendar year.
- Top Provider Reimbursement by Garner: reimbursement of up to $1,000 for individuals and $2,000 for families when you visit a Garner Top Provider. Providers must be added to your Care Team before your appointment. Sign up at getgarner.com.
- Health Condition Management by Teladoc: diabetes, hypertension, and weight management programs with connected devices and coaching at no cost, including myStrength mental health support.
- Virtual Physical Care by Sword Health: virtual physical therapy with zero out-of-pocket cost, plus Bloom for pelvic health support.
- Well360 Virtual Health: see a doctor anytime from your phone, tablet or computer for urgent care, therapy, psychiatry, nutrition counseling and women’s health, available in the MyHighmark app.
- Member Advocates and Personal Care Management: help finding providers, scheduling appointments, resolving billing issues and more at 833-227-9379.
- 24/7 Nurseline: one-on-one nurse support any time at 888-258-3428.
- Baby Blueprints: maternity education and individualized nurse Health Coach support. Enroll at 866-918-5267.
- Wellness Coaching: tobacco cessation, weight management, sleep and stress programs at 800-650-8442.
- Blue365 Discounts: discounts on hearing aids, fitness memberships, workout apparel and more at blue365deals.com.
Visit the Wellness Program page for full details on these programs.