Medical Plans & Pharmacy
The Meissner Mfg. Co., Inc. health plans are built on choice, offering you the opportunity to make decisions about what will best meet you and your family’s health and financial needs.
The cost of benefits is a partnership between the Company and employees. Meissner Mfg. Co., Inc. bears the majority of the cost by paying, on average, the monthly employee premium of Gold TRIO HMO plan minus $65.00 per month. You pay a portion of the cost through your payroll contributions, co-payments, and co-insurance.
The Meissner Mfg. Co., Inc. medical plan options, administered by Blue Shield are designed to help you maintain your health through preventive care services, access to an extensive network of providers, and affordable prescription medication.
You can choose from five flexible plan options:
- Blue Shield Gold Trio HMO 1000/35 OffEx (narrow network)
- Blue Shield Platinum Trio HMO 0/30 OffEx (narrow network)
- Blue Shield Gold Access+ HMO 500/35 OffEx (full network)
- Blue Shield Platinum Access+ HMO 0/30 OffEx (full network)
- Blue Shield Gold PPO 0/25 OffEx (full network)
| ACCESS + (FULL) TRIO (NARROW) | Platinum HMO 0/30 OffEx (full network/narrow network) | Gold HMO 1000/35 OffEx (narrow network) | Gold Access+ HMO 500/35 OffEx (full network) |
|---|---|---|---|
| DEDUCTIBLE PER PLAN YEAR (You Pay) | |||
| Calendar Year Deductible | None | $1,000 / $2,000 (embedded $1,000) | $500 / $1,000 (embedded $500) |
| ANNUAL OUT-OF-POCKET MAXIMUMS | |||
| Individual | $2,700 | $7,500 | $7,500 |
| Family | $5,400 ($2,700 Individual) | $15,000 ($7,500 Individual) | $15,000 ($7,500 Individual) |
| PHYSICIAN BENEFITS | |||
| Primary Care (PCP) office Visits | $30 copay | $35 copay | $35 copay |
| Specialists Office Visit | $50 copay | $65 copay | $65 copay |
| Teladoc/Virtual Visits & Behavioral Health | No charge | No charge | No charge |
| Diagnostic Lab & X-Ray | $30 / $50 copay | $40 / $60 copay (deductible waived) | $35 / $65 copay (deductible waived) |
| Complex Imaging | Freestanding: $50 copay OP Hospital: $250 copay | Freestanding: $50 copay OP Hospital: $250 copay (deductible waived) | Freestanding: $50 copay OP Hospital: $250 copay (deductible waived) |
| PREVENTIVE CARE | |||
| Preventive Services | Plan pays 100% | Plan pays 100% | Plan pays 100% |
| MEDICAL CARE | |||
| Inpatient Hospital Stays | $500 copay per day, max 4 days | 20% after deductible | 20% after deductible |
| Outpatient Surgery | $150 copay | $300 copay | $300 copay |
| Emergency Room Services (waived if admitted) | $250 copay per visit | $300 copay after deductible | $300 copay after deductible |
| Urgent Care | $30 copay | $35 copay | $35 copay |
| Chiropractic Care & Acupuncture 20 visits per member | $15 copay | $15 copay | $15 |
| Prescription Drugs (Retail Pharmacy) | 30 Day Supply | 30 Day Supply | 30 Day Supply |
| Tier 1 | $5 | $15 | $15 |
| Tier 2 | $15 | $35 | $50 |
| Tier 3 | $25 | $55 | $70 |
| Tier 4 | 20% up to $250 | 20% up to $250 | 20% up to $250 |
| (Mail Order) | 90 Day Supply | 90 Day Supply | 90 Day Supply |
| Tier 1 | $10 | $45 | $30 |
| Tier 2 | $30 | $105 | $70 |
| Tier 3 | $50 | $165 | $110 |
| Tier 4 | 20% up to $500 | 20% up to $750 | 20% up to $500 |
GOLD FULL PPO 0/25 OFFEX PLAN |
||
|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK | |
| DEDUCTIBLE PER PLAN YEAR (You Pay) | ||
| Calendar Year Deductible | None | $1,000 Ind $2,000 fam (embedded )$1,000 |
| OUT-OF-POCKET MAXIMUMS Includes co-insurance, deductible, and co-pays. After you reach the calendar year out-of-pocket maximum, plan pays 100% of covered expenses for the remainder of the calendar year. |
||
| Employee Only | $8,500 | $17,000 |
| Employee + 1 or More | $17,000 ($8,500 embedded) | $34,000 ($17,000 embedded) |
| PHYSICIAN BENEFITS | ||
| Office Visits | $35 copay | 40% coinsurance after deductible |
| Specialists Visit | $50 copay | 40% coinsurance after deductible |
| Teladoc virtual visits | No charge | Not covered |
| Diagnostic Lab & X-Ray | $35 copay lab $50 copay x-ray | 40% coinsurance after deductible |
| Complex Imaging | 30% coinsurance | 40% coinsurance after deductible |
| PREVENTIVE CARE | ||
| Preventive Services | Plan pays 100% | Not covered |
| MEDICAL CARE |
||
| Inpatient Hospital Stays | 30% coinsurance | 40% coinsurance after deductible |
| Outpatient Surgery Including | 30% coinsurance + $150 | 40% coinsurance after deductible |
| Emergency Room Services (waived if admitted) | 30% coinsurance + $250 | 30% coinsurance + $250 |
| Urgent Care | $35 copay | $35 copay |
| Chiropractic Care 20 visits | $10 copay | 40% coinsurance after deductible |
| Acupuncture Care 20 visits | $25 copay | 40% coinsurance after deductible |
| Prescription Drugs (Retail Pharmacy) 30 Day Supply | ||
| Tier 1 | $20 | Not covered |
| Tier 2 | $45 | |
| Tier 3 | $60 | |
| Tier 4 | 30% up to $250 | |
| Prescription Drugs (Mail Order) 90 Day Supply | ||
| Tier 1 | $40 | Not covered |
| Tier 2 | $90 | |
| Tier 3 | $120 | |
| Tier 4 | 30% up to $500 | |
Age Band | Gold PPO Full Network | HMO Platinum Full Network | HMO Platinum Narrow Network | HMO Gold Full Network | HMO Gold Narrow Network |
| Gold 0/35 - Full PPO | Platinum 0/30 - Access+ HMO | Platinum 0/30 - Trio HMO | Gold 500/35 - Access+ HMO | Gold 1000/35 - Trio HMO | |
| 0-14 | $440.34 | $392.83 | $332.97 | $365.10 | $303.04 |
| 15 | $479.48 | $427.75 | $362.56 | $397.55 | $329.98 |
| 16 | $494.45 | $441.10 | $373.88 | $409.96 | $340.28 |
| 17 | $509.42 | $454.45 | $385.20 | $422.37 | $350.58 |
| 18 | $525.53 | $468.83 | $397.38 | $435.73 | $361.67 |
| 19 | $541.65 | $483.21 | $409.57 | $449.10 | $372.77 |
| 20 | $558.34 | $498.10 | $422.19 | $462.94 | $384.25 |
| 21 | $575.61 | $513.51 | $435.25 | $477.26 | $396.14 |
| 22 | $575.61 | $513.51 | $435.25 | $477.26 | $396.14 |
| 23 | $575.61 | $513.51 | $435.25 | $477.26 | $396.14 |
| 24 | $575.61 | $513.51 | $435.25 | $477.26 | $396.14 |
| 25 | $577.91 | $515.56 | $436.99 | $479.16 | $397.72 |
| 26 | $589.43 | $525.83 | $445.70 | $488.71 | $405.64 |
| 27 | $603.24 | $538.16 | $456.14 | $500.16 | $415.15 |
| 28 | $625.69 | $558.18 | $473.12 | $518.78 | $430.60 |
| 29 | $644.11 | $574.62 | $487.05 | $534.05 | $443.28 |
| 30 | $653.32 | $582.83 | $494.01 | $541.68 | $449.62 |
| 31 | $667.13 | $595.16 | $504.46 | $553.14 | $459.12 |
| 32 | $680.95 | $607.48 | $514.90 | $564.59 | $468.63 |
| 33 | $689.58 | $615.18 | $521.43 | $571.75 | $474.57 |
| 34 | $698.79 | $623.40 | $528.39 | $579.39 | $480.91 |
| 35 | $703.40 | $627.51 | $531.88 | $583.21 | $484.08 |
| 36 | $708.00 | $631.61 | $535.36 | $587.02 | $487.25 |
| 37 | $712.61 | $635.72 | $538.84 | $590.84 | $490.42 |
| 38 | $717.21 | $639.83 | $542.32 | $594.66 | $493.59 |
| 39 | $726.42 | $648.05 | $549.29 | $602.30 | $499.93 |
| 40 | $735.63 | $656.26 | $556.25 | $609.93 | $506.26 |
| 41 | $749.45 | $668.59 | $566.70 | $621.39 | $515.77 |
| 42 | $762.69 | $680.40 | $576.71 | $632.36 | $524.88 |
| 43 | $781.11 | $696.83 | $590.63 | $647.64 | $537.56 |
| 44 | $804.13 | $717.37 | $608.04 | $666.73 | $553.40 |
| 45 | $831.18 | $741.51 | $628.50 | $689.16 | $572.02 |
| 46 | $863.42 | $770.26 | $652.88 | $715.88 | $594.21 |
| 47 | $899.68 | $802.61 | $680.30 | $745.95 | $619.16 |
| 48 | $941.13 | $839.59 | $711.63 | $780.31 | $647.68 |
| 49 | $981.99 | $876.04 | $742.54 | $814.20 | $675.81 |
| 50 | $1,028.04 | $917.13 | $777.36 | $852.38 | $707.50 |
| 51 | $1,073.52 | $957.69 | $811.74 | $890.08 | $738.80 |
| 52 | $1,123.59 | $1,002.37 | $849.61 | $931.60 | $773.26 |
| 53 | $1,174.25 | $1,047.56 | $887.91 | $973.60 | $808.12 |
| 54 | $1,228.93 | $1,096.34 | $929.26 | $1,018.94 | $845.75 |
| 55 | $1,283.61 | $1,145.12 | $970.61 | $1,064.28 | $883.39 |
| 56 | $1,342.90 | $1,198.01 | $1,015.44 | $1,113.44 | $924.19 |
| 57 | $1,402.77 | $1,251.42 | $1,060.71 | $1,163.07 | $965.39 |
| 58 | $1,466.66 | $1,308.42 | $1,109.02 | $1,216.05 | $1,009.36 |
| 59 | $1,498.32 | $1,336.66 | $1,132.96 | $1,242.30 | $1,031.15 |
| 60 | $1,562.21 | $1,393.66 | $1,181.27 | $1,295.27 | $1,075.12 |
| 61 | $1,617.47 | $1,442.96 | $1,223.05 | $1,341.09 | $1,113.15 |
| 62 | $1,653.73 | $1,475.31 | $1,250.47 | $1,371.15 | $1,138.10 |
| 63 | $1,699.21 | $1,515.88 | $1,284.86 | $1,408.86 | $1,169.40 |
| 64-99 | $1,726.84 | $1,540.52 | $1,305.75 | $1,431.77 | $1,188.41 |
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