High Deductible Health Plan with HSA

Anthem/Blue Cross Blue Shield.

Benefits eligible employees (50% or more FTE) may participate in AUI's High Deductible Plan with Health Savings Account (HSA) or Health Reimbursement Account (HRA) through Anthem.The High Deductible Plan has two levels of deductible: Single ($2,000) and Family (2 or more) ($4,000) for in-network services. All preventative services are covered at 100% under the plan. Deductibles are on an annual, calendar year basis and reset each January.

Enrollment in the Medical plan is allowed as a new hire, through qualifying events (marriage/divorce, change in employment status, etc. Need to notify HR within 30 days), or annual open enrollment. Additional details of the plan are available below.

If you or your spouse attain age 65 while you are still employed and you are participating in the AUI Medical Plan, please contact your local HR representative as it may impact your HSA contribution eligibility.

If you have questions regarding your Medical Benefits, please contact your HR representative or Sarah Arnold.

What's Covered?	How to use Anthem	HSA vs HRA	Anthem Value Adds
Medical Plan Documents Summary Plan Description (SPD) Summary of Benefits (SOB) Summary of Coverage and Benefits (SBC) These documents were produced by Anthem and follow specific federal guidelines. Please note that some are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description as posted above. How much does it cost? Current Year Medical Premiums Preventive Services covered at 100% Preventive Services List Preventive drugs covered outside of the deductible, at coinsurance level Preventive Drug List Essential Drug List CarelonRx Specialty Drug List Enrolling in Medical There are two steps to enroll in the High Deductible Health Plan: 1. Complete the Medical/Dental/Vision enrollment form through Dayforce - Health Savings Account (HSA), or - Health Reimbursement Account (HRA) if you have other insurance coverage, including Medicare, Medicaid, spouse plan, flexible spending, etc. 2. Complete the HSA Salary Reduction Agreement in Dayforce (optional) - if you intend to contribute your own pre-tax money to your HSA. - HRA participants cannot contribute their own money. For married couples who both work at the Observatory, medical coverage is carried by the higher earner. Legal Plan Document AUI Comprehensive Medical Plan Document. Legal document outlining who can be covered and how the plan works. Anthem Transparency in Coverage link https://www.anthem.com/machine-readable-file/search Please use Employer Identification Number (EIN) to access.	Anthem Member Services: Call Anthem if you have any issues regarding your coverage at: 833-820-8990 Register online at Anthem.com. For more information, view the Anthem Portal Guide. Download Explanations of Benefits, Manage your HSA, Download ID cards, Find a doctor, etc. Download Anthem's Sydney App - virtual primary care, chat with a doctor, & more right from your phone/tablet. Click here for demo. CareIon - Anthem's Rx provider. More information below: Mail Order Mail Service Order Form Find a Doctor Go Green! Anthem offers electronic statements for you to save on fees. A $1.50 charge will appear on your HSA if you continue with paper HSA statements. To "go green", Log into your Anthem.com account Click on “My Plan” on the top left and choose Spending Accounts Click on the “Manage your account” link, which will open a new window or tab Click on the settings icon in the top right; look for the option to “Go Green” Claim and Pre-Authorization Forms Medical Claim Form Medical Claim Form for out-of network claims, not for use with prescriptions. Rx Drug Claim Form Use this form to file claims. Rx Pre-Authorization Form Use this form to receive pre-authorization drugs.	The Health Savings Account (HSA) and Health Reimbursement Account (HRA) are tied to being enrolled in the High Deductible Health Plan (HDHP). If you have other insurance but still want to enroll in dual coverage into AUI's HDHP plan, you are only eligible for the HRA: Health Savings Account (HSA) Tax-exempt contributions to an HSA remain exempt if you use them (and their earnings) to pay for qualifying Medical expenses. Certain restrictions exist for participation in an HSA: Must be enrolled in a high deductible health plan. Must not have any other insurance coverage. Dependents with other coverage may impact the amount you can save. Employer contributions are not guaranteed and are determined on a plan year basis. We are pleased to be able to offer an employer contribution for plan year 2026 (pro-rated based on date of hire): HSA Single: $375 HSA Family: $750 If you have a balance over $1,000, you can invest your HSA dollars in mutual funds.Please note there will be a monthly $2.25 investment fee. More information below: HSA Investment Guide Eligible HSA Expenses HSA Routing Number: 075072157* Sample Anthem HSA/HRA Card Health Reimbursement Account (HRA) If you enroll in the HDHP plan, but also have other coverage, you can participate in the HRA. Individuals who are not eligible for an HSA due to other medical coverage (Medicare, Medicaid, spouse insurance, flexible spending accounts, etc.). Must be enrolled in a high deductible health plan. HRAs only have balances if an employer contribution is made to employee HSA accounts. The HRA is a "use it or lose it" at the end of each calendar year.	Anthem Health Guide Personal healthcare navigator/concierge to support you as you need assistance to find providers or understand benefits Total Health Total You Anthem's total health-support program, including Health Guide, plus additional clinical programs and wellness resources Created to help you take care of your health, work on lifestyle changes, & connect with specialized health professionals 24/7 NurseLine, Case Management, Behavioral Health, and more Online Virtual Primary Care Virtual Primary Care visits with Anthem's Sydney Health Mobile App Provides easy to schedule primary care appointments Easy prescription refills, lower healthcare costs, efficient & fast care VPC Access to Care Options LiveHealth Online - Telehealth Services Anthem BlueCard Global Core -If you are traveling abroad and need services: Anthem will cover your claim as in-network if it is considered a "true emergency" (heart attack, bone break, seizure, etc.). You will have to pay at the time of service and submit the claim later. Claim forms are available on this page, or from Anthem.com Non-emergency services can be handled through LiveHealth Online. Anthem Special Offers! Did you know Anthem offers special discounts on things like vision and hearing products, or health and fitness services? To view the discounts offered, log into your Anthem.com portal. Click on Care, Discounts.

What's Covered?

How to use Anthem

HSA vs HRA

Anthem Value Adds

Medical Plan Documents

Summary Plan Description (SPD)

Summary of Benefits (SOB)

Summary of Coverage and Benefits (SBC)

These documents were produced by Anthem and follow specific federal guidelines. Please note that some are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description as posted above.

How much does it cost?

Current Year Medical Premiums

Preventive Services covered at 100%

Preventive Services List

Preventive drugs covered outside of the deductible, at coinsurance level

Preventive Drug List

Essential Drug List

CarelonRx Specialty Drug List

Enrolling in Medical

There are two steps to enroll in the High Deductible Health Plan:

1. Complete the Medical/Dental/Vision enrollment form through Dayforce

- Health Savings Account (HSA), or

- Health Reimbursement Account (HRA) if you have other insurance coverage, including Medicare, Medicaid, spouse plan, flexible spending, etc.

2. Complete the HSA Salary Reduction Agreement in Dayforce (optional)
- if you intend to contribute your own pre-tax money to your HSA.

- HRA participants cannot contribute their own money.

For married couples who both work at the Observatory, medical coverage is carried by the higher earner.

Legal Plan Document

AUI Comprehensive Medical Plan Document.

Legal document outlining who can be covered and how the plan works.

Anthem Transparency in Coverage link

https://www.anthem.com/machine-readable-file/search

Please use Employer Identification Number (EIN) to access.

Anthem Member Services: Call Anthem if you have any issues regarding your coverage at: 833-820-8990

Register online at Anthem.com. For more information, view the Anthem Portal Guide.

Download Explanations of Benefits, Manage your HSA, Download ID cards, Find a doctor, etc.

Download Anthem's Sydney App - virtual primary care, chat with a doctor, & more right from your phone/tablet. Click here for demo.

CareIon - Anthem's Rx provider. More information below:

Find a Doctor

Go Green! Anthem offers electronic statements for you to save on fees. A $1.50 charge will appear on your HSA if you continue with paper HSA statements. To "go green",

Log into your Anthem.com account
Click on “My Plan” on the top left and choose Spending Accounts
Click on the “Manage your account” link, which will open a new window or tab
Click on the settings icon in the top right; look for the option to “Go Green”

Claim and Pre-Authorization Forms

Medical Claim Form
Medical Claim Form for out-of network claims, not for use with prescriptions.

Rx Drug Claim Form
Use this form to file claims.

Rx Pre-Authorization Form
Use this form to receive pre-authorization drugs.

The Health Savings Account (HSA) and Health Reimbursement Account (HRA) are tied to being enrolled in the High Deductible Health Plan (HDHP). If you have other insurance but still want to enroll in dual coverage into AUI's HDHP plan, you are only eligible for the HRA:

Health Savings Account (HSA)

Tax-exempt contributions to an HSA remain exempt if you use them (and their earnings) to pay for qualifying Medical expenses.

Certain restrictions exist for participation in an HSA:

Must be enrolled in a high deductible health plan.
Must not have any other insurance coverage.
Dependents with other coverage may impact the amount you can save.

Employer contributions are not guaranteed and are determined on a plan year basis. We are pleased to be able to offer an employer contribution for plan year 2026 (pro-rated based on date of hire):

HSA Single: $375
HSA Family: $750

If you have a balance over $1,000, you can invest your HSA dollars in mutual funds.*Please note there will be a monthly $2.25 investment fee.

More information below:

HSA Investment Guide

Eligible HSA Expenses

HSA Routing Number: 075072157

Sample Anthem HSA/HRA Card

Health Reimbursement Account (HRA)

If you enroll in the HDHP plan, but also have other coverage, you can participate in the HRA. Individuals who are not eligible for an HSA due to other medical coverage (Medicare, Medicaid, spouse insurance, flexible spending accounts, etc.).

Must be enrolled in a high deductible health plan.

HRAs only have balances if an employer contribution is made to employee HSA accounts.

The HRA is a "use it or lose it" at the end of each calendar year.

Anthem Health Guide

Personal healthcare navigator/concierge to support you as you need assistance to find providers or understand benefits

Total Health Total You

Anthem's total health-support program, including Health Guide, plus additional clinical programs and wellness resources
Created to help you take care of your health, work on lifestyle changes, & connect with specialized health professionals
24/7 NurseLine, Case Management, Behavioral Health, and more

Online Virtual Primary Care

Virtual Primary Care visits with Anthem's Sydney Health Mobile App
Provides easy to schedule primary care appointments
Easy prescription refills, lower healthcare costs, efficient & fast care

VPC Access to Care Options

LiveHealth Online - Telehealth Services

Anthem BlueCard Global Core -If you are traveling abroad and need services:

Anthem will cover your claim as in-network if it is considered a "true emergency" (heart attack, bone break, seizure, etc.).
You will have to pay at the time of service and submit the claim later. Claim forms are available on this page, or from Anthem.com
Non-emergency services can be handled through LiveHealth Online.

Anthem Special Offers!

Did you know Anthem offers special discounts on things like vision and hearing products, or health and fitness services? To view the discounts offered, log into your Anthem.com portal. Click on Care, Discounts.

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