Medical Benefits | Discount Tire Family

UnitedHealthcare (all employees except MI)

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Selecting the right medical plan takes careful consideration. For most full-time employees, the Company offers medical plan options through United Healthcare (UHC); these plans include pharmacy benefits through OptumRx.

You have 24/7 access to your UHC account information at www.myuhc.com. You can also use the site to find medical and pharmacy providers, place orders with the Mail Service Pharmacy, request new cards and print temporary cards. If you haven’t signed up already, create your account today.

Recently hire or promoted to full-time? Learn more about your coverage choices through the Company’s plans through UHC below and via our Pre-Member Website.

Preventive Care at No Cost

With either plan option, in-network preventive care is usually covered with no cost sharing, including well child, routine physicals, OB/GYN exams, mammograms and prostate exams. Costs will only be incurred if additional non-preventive lab work is requested. Also, many prescription medications are considered preventive and also covered with no cost sharing. Call the member number on your Medical Plan ID card to find out which preventive medications and services are covered at no cost.

UHC Overview Video:

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Choice Plus Plan / Options Plan

Coverage through the Choice Plus Plan (Options Plan in Wisconsin) is a more traditional health care option with a deductible, set co-pays and coinsurance amounts.
With the Choice Plus Plan, you have the option to elect the Flexible Spending Account (FSA).
Prescription costs are not counted towards the annual deductible; co-pays apply.

Health Savings Plan

The Health Savings Plan is a medical plan with a Health Savings Account (HSA).
The Company contributes to your HSA once your medical benefits go into effect: $500 for individual / $1,000 for family. Plus, you can contribute to your HSA tax free.
Use your HSA money to pay your out of pocket health care expenses. All medical and prescription costs are applied to your deductible; after you meet the deductible, the plan covers 80% with 20% employee coinsurance.
With the Health Savings Plan, you have the option to elect the Flexible Spending Account (FSA), but you may only use FSA funds to pay for dental and vision expenses. You cannot use FSA funds to pay for medical expenses when enrolled in the Health Savings Account.
Your HSA goes where you go! Even if you change jobs, switch health plans, or retire, your HSA is yours—you own it, and the money carries over from year to year.

Medical Plan Choice	UHC Choice Plus/Options Plan		UHC Health Savings Plan
Company Contribution to Your HSA
Individual/Family	(Does not apply)		$500/$1,000 ∑
Annual Deductible	In-Network	Out-of-Network ∆	In-Network	Out-of-Network ∆
Individual/Family	$600/$1,800	$2,000/$5,000	$2,000/$4,000 Ω	$4,000/$8,000 Ω
Maximums
Out-of-Pocket: Individual/Family	$3,000/$7,000	$7,000/$16,000	$3,500/$6,850	$7,000/$14,000
Lifetime Maximum	Unlimited	Unlimited	Unlimited	Unlimited
Co-pays:
Preventive Care
Routine physicals, immunizations, and more!	100%	60%*	100%	60%*
Get rewarded for your Annual Physical! See the Physician Affidavit form
Physician’s Services: Sickness and Injury
Virtual Visit – Medical – via myuhc.com	FREE	N/A	Less than $50	N/A
Physician Office Visit	$20/visit	60%*	80%*	60%*
Specialist Office Visit	$40/visit	60%*	80%*	60%*
Mental Health / Substance / Addiction
Virtual Visit – Telemental Health – via myuhc.com	$20/visit	60%*	80%*	60%*
Inpatient	80%*	60%*	80%*	60%*
Outpatient	$20/visit	60%*	80%*	60%*
Emergency Care
Urgent Care	$40/visit	60%*	80%*	60%*
Emergency Room	$200	$200	80%*	80%*
Tests
Lab, X-Ray and Major Diagnostics (CT, PET, MRI, MRA and Nuclear Medicine) – Outpatient	80%*	60%*	80%*	60%*
Hospital Care
Inpatient / Outpatient Care and Surgery	80%*	60%*	80%*	60%*
Maternity Care
Prenatal Visit	$40 first visit; $0 after	60%*	80%*	60%*
Postnatal Visits/Surgery	80%*	60%*	80%*	60%*
Specialty Care
Acupuncture (max 10 visits per year)	$40/visit	60%*	80%*	60%*

* = After deductible
∑ = The Company funds your HSA on the day Medical Benefits go into effect.
Ω = The Health Savings Plan requires the FULL family deductible (e.g. $4,000 for in network) be met if you have enrolled any dependents.
∆ = When you receive out-of-network care, the plan covers its percentage up to the Reasonable and Customary (R&C) limit after you satisfy the Annual Deductible. You pay the remaining percentage up to the R&C limit plus any amount above the R&C limit.

Virtual Doctor’s Visits

All United Health Care medical plans offer virtual visits. Please review the virtual visits section below for more information.

OptumRx Pharmacy Benefits

Visit our UHC Pharmacy Copay page for cost comparisons.

Consider home delivery for your 90-day prescriptions; it’s easy to get started! Request a prescription from your doctor for a three-month supply, with refills for up to one year (if appropriate), then contact OptumRx to fill your prescription.

Cost savings: With free standard shipping, the average savings is 50% or more when compared to retail pharmacy pricing.
24/7 access to pharmacists
By fax / ePrescribe: Ask your doctor to call 1-800-791-7658 for instructions on how to fax your 90-day prescription directly to OptumRx Mail Service Pharmacy. Or your doctor can send an electronic prescription to OptumRx Mail Service Pharmacy.
Online: Log in or register at www.myuhc.comand select Manage My Prescriptions.
By phone: Call the Advocate4Me phone number on the back of your plan ID card to talk with a customer service representative. It’s helpful to have your plan ID card and medication bottle available. The representative can also contact your doctor directly if you need a new prescription.
Maximum convenience and peace of mind

Additional United Healthcare Information

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Blue Cross Blue Shield (MI only)

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BLUE CROSS BLUE SHIELD COVERAGE IS OFFERED TO MICHIGAN EMPLOYEES ONLY

Selecting the right medical plan takes careful consideration. For full-time Michigan employees, the Company offers medical plan options through Blue Cross Blue Shield (BCBS) of Arizona; these plans include pharmacy benefits through Medco.

You have 24/7 access to your BCBS account information at: www.mybenefitshome.com. You can also use the site to find medical and pharmacy providers, place mail orders for prescriptions, request new cards and print temporary cards. If you haven’t signed up already, create your account today.

Preventive Care at No Cost

With either plan option, in-network preventive care is usually covered with no cost sharing, including well child, routine physicals, OB/GYN exams, mammograms and prostate exams. Costs will only be incurred if additional non-preventive lab work is requested. Also, many prescription medications are considered preventive and also covered with no cost sharing. Call the member number on your Medical Plan ID card to find out which preventive medications and services are covered at no cost.

PPO Blue Plan

Coverage through the PPO Blue Plan is a more traditional health care option with a deductible, set co-pays and coinsurance amounts.
With the PPO Blue Plan, you have the option to elect the Flexible Spending Account (FSA).
Prescription costs are not counted towards the annual deductible; co-pays apply.

Health Savings Plan

The Health Savings Plan is a medical plan with a Health Savings Account (HSA).
The Company contributes to your HSA at the beginning of the plan year: $500 for individual / $1,000 for family. Plus, you can contribute to your HSA tax free.
Use your HSA money to pay your out of pocket health care expenses. All medical and prescription costs are applied to your deductible; after you meet the deductible, the plan covers 80% with 20% employee coinsurance.
With the Health Savings Plan, you have the option to elect the Flexible Spending Account (FSA), but you may only use FSA funds to pay for dental and vision expenses. You cannot use FSA funds to pay for medical expenses when enrolled in the Health Savings Account.
Your HSA goes where you go! Even if you change jobs, switch health plans, or retire, your HSA is yours—you own it, and the money carries over from year to year.

Medical Plan Choice	BCBS PPO Blue Plan		BCBS Health Savings Plan
Company Contribution to Your HSA
Individual/Family	(Does not apply)		$500/$1,000 ∑
Annual Deductible	In-Network	Out-of-Network ∆	In-Network	Out-of-Network ∆
Individual/Family	$600/$1,800	$2,000/$5,000	$2,000/$4,000 Ω	$4,000/$8,000 Ω
Maximums
Out-of-Pocket: Individual/Family	$3,000/$7,000	$7,000/$16,000	$3,500/$6,850	$7,000/$14,000
Lifetime Maximum	Unlimited	Unlimited	Unlimited	Unlimited
Co-pays:
Preventive Care
Routine physicals, immunizations, and more!	100%	60%*	100%	60%*
Get rewarded for your Annual Physical! See the Physician Affidavit form
Physician’s Services: Sickness and Injury
Virtual Visit – Medical – via mybenefitshome.com	FREE	N/A	Less than $60	N/A
Physician Office Visit	$20/visit	60%*	80%*	60%*
Specialist Office Visit	$40/visit	60%*	80%*	60%*
Mental Health / Substance / Addiction
Virtual Visit – Telemental Health – via mybenefitshome.com	$20/visit	60%*	80%*	60%*
Inpatient	80%*	60%*	80%*	60%*
Outpatient	$20/visit	60%*	80%*	60%*
Emergency Care
Urgent Care	$40/visit	60%*	80%*	60%*
Emergency Room	$200	$200	80%*	80%*
Tests
Lab, X-Ray and Major Diagnostics (CT, PET, MRI, MRA and Nuclear Medicine) – Outpatient	80%*	60%*	80%*	60%*
Hospital Care
Inpatient / Outpatient Care and Surgery	80%*	60%*	80%*	60%*
Maternity Care
Prenatal Visit	$40 first visit; $0 after	60%*	80%*	60%*
Postnatal Visits/Surgery	80%*	60%*	80%*	60%*
Specialty Care
Acupuncture (max 10 visits per year)	$40/visit	60%*	80%*	60%*

* = After deductible
∑ = The Company funds your HSA on the day Medical Benefits go into effect.
Ω = The Health Savings Plan requires the FULL family deductible (e.g. $4,000 for in network) be met if you have enrolled any dependents.
∆ = When you receive out-of-network care, the plan covers its percentage up to the Reasonable and Customary (R&C) limit after you satisfy the Annual Deductible. You pay the remaining percentage up to the R&C limit plus any amount above the R&C limit.

Virtual Doctor’s Visits

All United Health Care medical plans offer virtual visits. Please review the virtual visits section below for more information.

Express Scripts Pharmacy Benefits

Visit our BCBS Pharmacy Copay page for cost comparisons.

Consider mail order through Express Scripts for your 90-day prescriptions
Express Scripts manages the home delivery pharmacy benefit for BCBS. Home delivery is a great option for maintenance medications – those you need on a long-term basis – for which your doctor can provide a 90-day prescription. (You should still use a retail pharmacy for medications you take on a short-term basis, such as antibiotics.)

Cost savings: With free standard shipping, the average savings is 50% or more when compared to retail pharmacy pricing.
Health and safety support: Pharmacists are available 24/7 to help answer medication questions.
Coordination: Express Scripts can help coordinate with your doctor; let them know and they will contact your doctor to get a new 90-day prescription and follow up as necessary.
Register and order online: Log in or register at mybenefitshome.com and select Prescriptions Services to get started.
Or order by phone: Call 1-800-652-9451 to talk with a customer service representative. It’s helpful to have your plan ID card and medication bottle available.

Additional Blue Cross Blue Shield Information

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Virtual Doctor's Visits (aka eHealth or Telemedicine)

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A virtual visit – Medical or Telemental Health – lets you see and talk to a doctor from your mobile device or computer. UnitedHealthcare and Blue Cross Blue Shield offer virtual visits as a provider choice for Discount Tire employees enrolled in medical benefits.

You have a choice of different provider groups depending on your plan’s virtual visit network. The cost of your visit will vary depending on your plan and whether the visit is Medical or Telemental Health. Check your plan documents (above) for more information about you plan’s specific costs.

Virtual Visits – Medical – for sickness or injury

Available to all members of any of the UHC/BCBS plans above for certain non-emergency medical conditions like the flu, colds, pink eye, rashes and fevers.
See and talk to a doctor from your mobile device or computer from a network of virtual provider groups, including Amwell and Doctor on Demand.
Providers are expected to deliver care within 30 minutes or less from the time you put in a request for a visit.
Visit the Virtual Visits – Medical page for more information

Virtual Visits – Telemental Health – for behavioral health

Convenient appointments that may fit your lifestyle.
The care you need sooner.
Secure technology meets or exceeds HIPPA security standards.
See and talk to a doctor from your mobile device or computer from a network of virtual provider groups.
UHC participants visit the UHC – Telemental Health page for more information
BCBS participants visit the BCBS – Telemental Health page for more information

Don’t wait until you throw your back out or have a 102° fever to sign up for Virtual Visits! Sign up now via your healthcare plan website to easily access virtual visits when you need them.

Additional Documents:

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