Your and your family’s health and well-being are important and, H&R Block provides valuable medical and prescription drug benefits that help you stay well and pay for care if you get sick or injured.

 

Overview

You have options to choose the right medical plan to take care of your health based on your needs.

  • HD Value Plan
  • HD Standard Plan
  • PPO Plan (new for 2022 and replaces the HD Plus Plan)
  • Kaiser HMO (only for Hawaii associates)
Your Medical Plan Features
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Broad Network of Providers

You have access to the Anthem BCBS extensive network of providers. These providers contract with Anthem to provide discounted rates to our associates. The HD Value Plan, HD Standard Plan and PPO Plan all utilize this network.

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Pre-Tax Savings Accounts

If you enroll in the HD Value Plan, HD Standard Plan or the PPO Plan, you may contribute to a Health Savings Account or Flexible Spending Account.

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Prescription Drug Coverage

When you enroll in a medical plan, you automatically receive prescription drug benefits. Preventive medications are covered according to the plan you elect and are not subject to the deductible.

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Additional Anthem Programs Available

When you enroll in the HD Value, HD Standard or PPO Plan, you have access to many Anthem programs to help you and your family through your life journeys. Check out the programs.

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Summary of Benefits and Coverage

Use the Summary of Benefits and Coverage (SBC) for each medical plan which provide detailed information about coverage and costs to help you compare plans and make informed decisions.

 

Anthem Medical Plans

The HD Value Plan, HD Standard Plan and PPO Plan provide:

  • Comprehensive medical coverage administered by Anthem BCBS and prescription drug coverage administered by Express Scripts.
  • In-network preventive care covered at 100%.
  • Access to Anthem BCBS 360° Health® programs.

When choosing the plan right for you and your needs, consider the following differences:

  • Per paycheck premiums: What you pay bi-weekly to have medical and prescription drug coverage differs by plan. The PPO Plan has the highest premiums and the HD Value Plan has the lowest premiums.
  • Deductible: The amount you pay for medical and prescription drug expenses during the year before the plan begins paying a portion of the coverage. The PPO Plan has the lowest deductible and the HD Value Plan has the highest deductible. For all medical plan options, the deductible does not apply to in-network preventive care; that’s covered at 100%!
  • Coinsurance: The percentage you and the company pay for expenses after you meet your deductible. For instance, under the HD Standard Plan or the PPO Plan, after you meet the deductible, the company pays 80% of expenses, and you would pay 20% of expenses.
  • Copay: The fixed, flat-dollar amount you pay upfront for a doctor’s visit or prescription drug purchase. Copays only apply to the PPO Plan.
  • Out-of-pocket maximum: The most you and your family are responsible for paying in one plan year. The PPO Plan has the lowest out-of-pocket maximum and the HD Value Plan has the highest out-of-pocket maximum.
What plan should I choose?

You may consider the...

  • HD Value Plan if you are generally healthy and expect to have low medical plan usage except for annual checkups and occasional illnesses. You will pay lower premiums than the other two plans but will pay more out-of-pocket when you use the plan benefits.
  • HD Standard Plan if you expect to have moderate medical expenses. With the Standard Plan, you will pay higher premiums than the HD Value Plan, but your out-of-pocket costs will be lower when you use the plan benefits. You will also have a lower deductible and out-of-pocket maximum.
  • PPO Plan if you expect to have high medical plan usage, and want to rely on a lower out-of-pocket maximum. The PPO Plan has the highest monthly premiums in exchange for paying lower out-of-pocket costs. It also has the lowest deductible of all three plans.

Compare here! Use the Medical Plan Cost Estimator to see your health costs under each medical plan option.

 

Your Medical Plans Side-By-Side

Compare and contrast your medical plan options using the chart below.

2022 Per Paycheck Premiums

Coverage Level HD Value Plan HD Standard Plan NEW for 2022! PPO Plan
Associate only $50.50 $78.50 $115.00
Associate + spouse/domestic partner $105.50 $158.00 $230.50
Associate + child(ren) $93.50 $142.50 $206.50
Family $145.00 $219.00 $319.50

2022 Medical and Prescription Drug Coverage

HD Value Plan HD Standard Plan NEW for 2022! PPO Plan
Health Savings Account ​(HSA) company contribution $400 single
$500 family
$400 single
$500 family
N/A
Deductible $3,500 single
$7,000 family
$2,500 single
$5,000 family
$600 single
$1,200 family
Coinsurance Plan pays 70%
You pay 30%
Plan pays 80%
You pay 20%
Plan pays 80%
You pay 20%
Out-of-pocket Maximum $6,750 single
$13,500 family
$5,000 single
$10,000 family
$3,000 single
$6,000 family
PCP/Specialist Visit After you meet your deductible:
Plan pays 70%
You pay 30%
After you meet your deductible:
Plan pays 80%
You pay 20%
$25 copay for PCP
$50 copay for specialist
(does not apply to deductible)
Prescription Drug Deductible Included in medical deductible Included in medical deductible Included in medical deductible
Prescription Drug Out-of-pocket Maximum Included in medical out-of-pocket maximum Included in medical out-of-pocket maximum Included in medical out-of-pocket maximum
Retail (30-day supply) Plan pays 70%
You pay 30%
Plan pays 80%
You pay 20%
Generic: $10 copay
Preferred: $30 copay
Non-preferred: $60 copay
Specialty: $100 copay
Mail order (90-day supply) Plan pays 70%
You pay 30%
Plan pays 80%
You pay 20%
Generic: $20 copay
Preferred: $60 copay
Non-preferred: $120 copay
Specialty: $200 copay
Eligible for an FSA You can elect and contribute to the Limited Purpose FSA and use it to pay for eligible dental and vision care You can elect and contribute to the Limited Purpose FSA and use it to pay for eligible dental and vision care You can elect and contribute to the Health Care FSA and use it to pay for eligible medical, dental and vision care
Important Details to Know About the HD Plans

True family deductible: The HD Value Plan and HD Standard Plan both have a true family deductible. This means that the combined total of your covered family members’ eligible expenses is used to reach the family deductible, before coinsurance begins.

Embedded out-of-pocket maximum: The HD Value Plan and HD Standard Plan both have an embedded out-of-pocket maximum. This means that if one covered family member reaches the single out-of-pocket maximum, eligible claims for the rest of the year for that individual will be paid by the plan in full. The feature works for every covered family member until the family out-of-pocket maximum is met. Then the plan pays 100% of eligible expenses for the entire family.

Coverage for preventive prescriptions: Certain preventive prescriptions are covered at the levels below with no deductible requirement. These drugs are on the CDH Preventive Medicine List and the formulary drug list.

  • HD Value Plan: Plan pays 70%; you pay 30%.
  • HD Standard Plan: Plan pays 80%; you pay 20%.

Certain prescription contraceptives for women are covered at 100% with no deductible as well.

Express Scripts uses a preferred drug list, called a formulary, which includes both generic and preferred brand-name drugs. Your cost for a specific prescription drug is based on which type of medicine you and your doctor choose. We recommend that you check the formulary list before you fill any prescriptions. Keep in mind, prescription drug prices and categories can change throughout the year and will be reflected when a change occurs.

These plans comply with Affordable Care Act (ACA) requirements to cover certain preventive items and services at a zero dollar cost share to their members.

Important Details to Know About the PPO Plan

Embedded deductible and out-of-pocket maximum: The PPO Plan has an embedded deductible and out-of-pocket maximum. This means that if one covered family member reaches the single deductible, coinsurance will begin for that individual. This feature works for every covered family member until the family deductible is met. The out-of-pocket maximum works the same way – when one of your covered family members reaches the single out-of-pocket maximum, eligible claims for the rest of the year for that individual will be paid by the plan in full. The feature works for every covered family member until the family out-of-pocket maximum is met. Then the plan pays 100% of eligible expenses for the entire family.

More About Prescription Drug Coverage Under the Anthem Medical Plans

Formulary: A formulary is a preferred drug list that includes generic and preferred brand-name drugs. If you enroll in the HD Value Plan, HD Standard Plan or PPO Plan and receive your prescription coverage through Express Scripts, your cost for a specific prescription drug is based on the type of medicine you and your doctor choose. It’s important that you discuss your medication needs and options with your doctor to ensure you’re getting what you need at the lowest cost.

H&R Block recommends that you check the formulary list before you fill any prescriptions. Prescription drug prices and categories can change throughout the year and will be reflected as such when a change occurs.

Long-term maintenance medications: You can choose how you want to fill your long-term maintenance medications. You can either have a 90-day supply of your medication sent to your home through mail order, or you can pick up a 30-day supply of your medication at your retail pharmacy.

If you choose home delivery for 90-day refills, you’ll pay the lowest price for your medication through deeper discounts. On average, you save about 25% on costs when you fill long-term prescriptions through mail order versus a retail pharmacy. You will not be able to fill a 90-day prescription at a retail pharmacy; only 30-day supplies can be purchased at a retail pharmacy.

You can fill a 30-day prescription for a long-term maintenance drug twice at a retail pharmacy, covered by the plan with the standard coinsurance or co-pay. After two retail pharmacy fills, if you don’t switch to home delivery, you will pay full price.

Generic medications: You are encouraged to use generic medications as an effective cost-saving step. If a generic equivalent medication is available and you choose a brand-name drug instead, you will pay the cost for the brand-name drug, but only the cost for the generic equivalent will apply toward your deductible. This penalty will not apply if your physician requests a brand-name drug and writes “dispense as written” on your prescription.

Prior authorization: Certain medications may require approval from Express Scripts to be covered by your medical plan. Your doctor will make a recommendation that will have to be approved by Express Scripts. The list of medications subject to prior authorization is reviewed and updated each year. Learn more here.

Step therapy: Step therapy is a process by which a lower-priced medication that is effective to meet your care and financial needs is recommended before stepping up to one that costs more. Here’s an example of step therapy. Let’s say you have allergies. You should first try using an over-the-counter medication. If that doesn’t help you, you’re encouraged to try a tier 1 medication, which is less expensive than tier 2 or tier 3 medication. If that doesn’t work, we’ll review if you met the step therapy requirements before your plan will help pay for a tier 2 or tier 3 medication. Review the list of medications that require step therapy. Learn more here.

 

Kaiser HMO (Hawaii)

If you are an associate living in Hawaii, you may only enroll in the Kaiser Permanente HMO. Learn more about the Kaiser Permanente HMO Plan.

If you select the Kaiser HMO in Hawaii, you and your covered dependents will automatically receive prescription drug coverage administered by Kaiser. Prescription drugs are covered as part of your medical plan when filled at a Kaiser Permanente Pharmacy (located in most Kaiser Permanente clinics), at a pharmacy your plan designates, or through the Kaiser Permanente Mail-Order Pharmacy (for long-term maintenance medication). If you fill a prescription from a non-Kaiser Permanente pharmacy, you will be responsible for 100% of the charges.

This plan complies with the ACA requirements to cover certain preventive items and services at zero dollar cost share to its members.

More information about the Kaiser Permanente prescription drug program is available on the Kaiser website or by calling 808-643-7979.

More About Prescription Drug Coverage Under the Kaiser HMO

Formulary: A formulary is a preferred drug list that includes generic and preferred brand-name drugs. If you enroll in the Kaiser HMO and receive your prescription coverage through Kaiser Permanente, your cost for a specific prescription drug is based on the type of medicine you and your doctor choose.

H&R Block recommends that you check the formulary list before you fill any prescriptions. Even though nonformulary drugs are generally not covered under your prescription drug plan, your Kaiser Permanente physician can sometimes request a nonformulary drug for you, specifically when formulary alternatives have failed or use of nonformulary drug is medically necessary, provided the drug is not excluded by your plan.

H&R Block recommends that you check the formulary list before you fill any prescriptions. Prescription drug prices and categories can change throughout the year and will be reflected as such when a change occurs.

Generic medications: You are encouraged to use generic medications as an effective cost-saving step. If you want a brand-name or specialty drug for which there is a generic equivalent, or if you request a nonformulary drug, you will pay 100% of the charges since they are not covered.

Well Rx Program: The Well Rx Program is a program that provides members who meet specific eligibility criteria with certain chronic disease drugs or diabetes supplies without charge.

Learn More

Find more details about the Kaiser HMO in the Summary of Benefits and Coverage.