Blue Shield $aver/HSA plan
Blue Shield Super $aver/HSA plan
Take charge of your spending through lower rates, higher deductibles, and a tax-free Health Savings Account (HSA) (with contributions from Mercury) that you own for life.
Our benefits program includes medical plan options with a range of coverage levels and costs, so you can choose the one that’s best for you. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event. Review your rates and enroll at UKG.
2023 medical plans
Kaiser Permanente HMO
Kaiser Permanente Deductible HMO
Blue Shield HMO
Blue Shield HMO Trio
Receive coverage for in-network care only, coordinated by your primary care provider (PCP).
Blue Shield EPO
A deductible applies to some services, except for most commonly used services and goods, such as PCP office visits and prescription medications.
Key features at a glance
All our medical plans provide:
Comprehensive, affordable coverage
for a wide range of health care services. Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in supplemental medical coverage.
Free in-network preventive care,
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
Prescription drug coverage
included with each medical plan. Prescription benefits are provided by Blue Shield.
Financial protection
through annual out-of-pocket maximums that limit the amount you’ll pay each year.
Access health resources
1 Available in California only
2 Available outside California only
$aver/HSA Plans
| Blue Shield $aver/HSA plan | Blue Shield Super $aver/HSA plan | |||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Mercury Insurance HSA contribution | ||||
| Team Member Only | $600 | $600 | ||
| Team Member + Spouse/Registered Domestic Partner |
$950 | $950 | ||
| Team Member + Child(ren) |
$950 | $950 | ||
| Family | $1,200 | $1,200 | ||
| Calendar year deductible | ||||
| Team Member Only | $1,500 | $3,000 | ||
| Team Member + Spouse/Registered Domestic Partner | $3,000 (or $3,000 for an individual enrolled in team member + SP/RDP coverage) | $6,000 (or $3,000 for an individual enrolled in team member + SP/RDP coverage) | ||
| Team Member + Child(ren) | $3,000 (or $3,000 for an individual enrolled in team member + child(ren) coverage) | $6,000 (or $3,000 for an individual enrolled in team member + child(ren) coverage) | ||
| Family | $3,000 (or $3,000 for an individual enrolled in family coverage) | $6,000 (or $3,000 for an individual enrolled in family coverage) | ||
| Annual out-of-pocket maximum | ||||
| Team Member Only | $4,5001 | $5,0001 | $10,0001 | |
| Team Member + Spouse/Registered Domestic Partner | $6,8501,2 | $10,0001,2 | $20,0001,2 | |
| Team Member + Child(ren) | $6,8501,2 | $10,0001,2 | $20,0001,2 | |
| Family | $6,8501,2 | $10,0001,2 | $20,0001,2 | |
| Coinsurance and other services | ||||
| Preventive care3 | No charge; deductible waived | 40% after deductible | No charge; deductible waived | 50% after deductible |
| Office visits | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Specialist office visits | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Hospital room and board | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Outpatient facility | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| X-ray/lab | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Chiropractic | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Emergency Room | 20% after deductible | 30% after deductible | ||
| Urgent care | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Maternity care | 20% after deductible | 40% after deductible | 30% after deductible | 50% after deductible |
| Prescription drugs – retail (30-day supply)4 | ||||
| Generic formulary | $10 after deductible | Not covered | $10 after deductible | Not covered |
| Brand formulary | $30 after deductible | Not covered | $30 after deductible | Not covered |
| Brand non-formulary | $50 after deductible | Not covered | $50 after deductible | Not covered |
| Prescription drugs – home delivery (90-day supply)4,5 | ||||
| Generic formulary | $20 after deductible | Not covered | $20 after deductible | Not covered |
| Brand formulary | $60 after deductible | Not covered | $60 after deductible | Not covered |
| Brand non-formulary | $100 after deductible | Not covered | $100 after deductible | Not covered |
1 Includes the calendar year deductible.
2 If you’re enrolled in team member + spouse/registered domestic partner, team member + child(ren), or family coverage and you or one of your enrolled dependents meets the individual out-of-pocket maximum amount, the plan will pay 100% of eligible benefit costs for that individual.
3 Coverage for preventive health care also includes women’s preventive care (e.g., coverage for specified contraceptive methods and counseling; breast-feeding support and equipment; prenatal care; gestational diabetes screening; annual well-woman exam; and annual mammogram).
4 Blue Shield $aver/HSA and the Blue Shield Super $aver/HSA are the only Mercury medical plans that offers 100% coverage for eligible prescription drugs that treat asthma, diabetes, high cholesterol, and hypertension. This means that for eligible prescription drugs, team members and their families will receive free preventive prescriptions — with no deductibles or copays to meet.
5 You have access to 90-day supplies through a Blue Shield network pharmacy or any retail pharmacy.
HMO Plans – California only
| Kaiser Permanente HMO | Kaiser Permanente Deductible HMO | Blue Shield HMO | Blue Shield HMO Trio | |
|---|---|---|---|---|
| In-Network Only | In-Network Only | In-Network Only | In-Network Only | |
| Calendar year deductible | ||||
| Team Member Only | None | $750 | None | None |
| Team Member + Spouse/Registered Domestic Partner | None | $1,500 (or $750 for an individual enrolled in team member + SP/DP coverage) | None | None |
| Team Member + Child(ren) | None | $1,500 (or $750 for an individual enrolled in team member + SP/DP coverage) | None | None |
| Family | None | $1,500 (or $750 for an individual enrolled in family coverage) | None | None |
| Annual out-of-pocket maximum | ||||
| Team Member Only | $1,500 | $3,000 | $1,500 | $1,500 |
| Team Member + Spouse/Registered Domestic Partner | $3,0001 | $6,0001 | $4,5001 | $4,5001 |
| Team Member + Child(ren) | $3,0001 | $6,0001 | $4,5001 | $4,5001 |
| Family | $3,0001 | $6,0001 | $4,5001 | $4,5001 |
| Coinsurance and other services | ||||
| Preventive care2 | No charge | No charge | No charge | No charge |
| Office Visits | $20 copay | $25 copay; deductible waived | $25 copay | $25 copay |
| Specialist office visit | $35 copay | $25 copay; deductible waived | $35 copay | $35 copay |
| Hospital room and board | $250 copay per admission | 20% after deductible | $250 copay per admission | $250 copay per admission |
| Outpatient facility | $150 per surgical procedure | 20% after deductible | $150 copay | $150 copay |
| X-ray/lab | No charge | $10 per encounter; deductible waived | No charge | No charge |
| Chiropractic | Not covered | Not covered | $25 copay PCP/$35 copay specialist | $25 copay PCP/$25 copy specialist |
| Emergency care | $125 copay per visit; waived if admitted | 20% after deductible | $150 copay per visit; waived if admitted | $150 copay per visit; waived if admitted |
| Urgent care | $20 copay per visit | $25 copay; deductible waived | $25 copay per visit | $25 copay per visit |
| Maternity Care | No charge | No charge | $25 copay PCP/$35 copay specialist | $25 copay PCP/$25 copay specialist |
| Prescription drugs – retail (30-day supply) | ||||
| Generic Formulary | $10 copay | $10 copay; deductible waived | $10 copay | $10 copay |
| Brand Formulary | $30 copay | $30 copay; deductible waived | $40 copay | $40 copay |
| Brand Non-formulary | $30 copay | $30 copay; deductible waived | $70 copay | $70 copay |
| Prescription drugs – home delivery (90-day supply) 3 | ||||
| Generic Formulary | $20 copay (up to 100-day supply) | $20 copay ; deductible waived (up to 100-day supply) | $20 copay (90-day supply) | $20 copay (90-day supply) |
| Brand Formulary | $60 copay (up to 100-day supply) | $20 copay ; deductible waived (up to 100-day supply) | $80 copay (90-day supply) | $80 copay (90-day supply) |
| Brand Non-formulary | $60 copay (up to 100-day supply) | $20 copay ; deductible waived (up to 100-day supply) | $140 copay (90-day supply) | $140 copay (90-day supply) |
1 If you’re enrolled in family coverage and you or one of your enrolled dependents meets the individual out-of-pocket maximum amount, the plan will pay 100% of eligible benefit costs for that individual.
2 Coverage for preventive health care also includes women’s preventive care (e.g., coverage for specified contraceptive methods and counseling; breast-feeding support and equipment; prenatal care; gestational diabetes screening; annual well-woman exam; and annual mammogram).
3 You have access to 90-day supplies through a Blue Shield network pharmacy or any retail pharmacy.
Blue Shield EPO
(Outside California only)
| Blue Shield EPO | |
|---|---|
| In-Network Only | |
| Calendar year deductible | Applies to certain services |
| Team Member Only | $500 |
| Team Member + Spouse/Registered Domestic Partner | $1,0001 |
| Team Member + Child(ren) | $1,0001 |
| Family | $1,0001 |
| Coinsurance and other services | |
| Preventive care1 | No charge |
| Office Visits | $25 copay |
| Specialist office visit | $35 copay |
| Hospital room and board | $250 copay per admission |
| Outpatient facility | $150 copay per facility visit |
| X-ray/lab | No charge |
| Chiropractic | PCP: $25 copay after deductible Specialist: $35 copay after deductible |
| Emergency Room | $150 copay per visit after deductible; waived if admitted |
| Urgent Care | $25 copay per visit |
| Maternity | PCP: $25 copay; Specialist: $35 copay; Hospital: $250 copay per admission after deductible |
| Prescription drugs – retail (30-day supply) | |
| Generic Formulary | $10 copay |
| Brand Formulary | $40 copay |
| Brand Non-formulary | $70 copay |
| Prescription drugs - home delivery order (90-day supply)2 | |
| Generic Formulary | $20 copay |
| Brand Formulary | $80 copay |
| Brand Non-formulary | $140 copay |
1 Coverage for preventive health care also includes women’s preventive care (e.g., coverage for specified contraceptive methods and counseling; breast-feeding support and equipment; prenatal care; gestational diabetes screening; annual well-woman exam; and annual mammogram).
2 You have access to 90-day supplies through a Blue Shield network pharmacy or any retail pharmacy.
The Blue Shield $aver/HSA plan and Blue Shield Super $aver/HSA plan offer low rates and high-deductible coverage. With these plans, you’ll save money when you choose in-network providers (check out the network provider infographic for details), though you also have the option to use out-of-network providers.
Both plans allow you to participate in a tax-advantaged Health Savings Account (HSA) that helps you save money and plan ahead for future medical expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices. As an added bonus, Mercury will contribute to your HSA — $600 for team member-only coverage, $950 for team member + 1 coverage, or $1,200 for family coverage.
How the Blue Shield $aver/HSA plan and Blue Shield Super $aver/HSA plan work
You pay the plan rates from your paycheck to have coverage.
HSA
You can set aside tax-advantaged money from your paycheck and receive company contributions to help cover your costs — now, or in the future.
Deductible
You pay 100% of your medical and prescription costs until you meet the annual deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of eligible expenses for the rest of the year.
Use your HSA to save money and plan ahead!
Contributing to your HSA is a great way to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free!*
Keep in mind:
- The Blue Shield $aver/HSA plan and the Blue Shield Super $aver/HSA plan costs you less from your paycheck, so you may have extra money available to put in your HSA.
- You can only spend HSA money that’s actually been deposited into your account. If you don’t have enough money in your HSA when you need it, you can pay another way and reimburse yourself later so you take full advantage of your HSA’s tax savings.
- You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses or want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time.
- You can change your HSA contribution amount throughout the year as needed to keep up with any changes in your situation.
*Contributions are not subject to federal tax. Exceptions include California and New Jersey, where you’ll pay state tax on HSA contributions, and New Hampshire and Tennessee where state taxes apply to tax dividend and interest earnings after a certain dollar amount. Consult with your tax advisor to understand the potential tax consequences of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you will pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.
The Kaiser Permanente HMO, Kaiser Permanente Deductible HMO, Blue Shield HMO, and Blue Shield HMO Trio plans provide coverage only when you receive care from providers within the HMO network. Your primary care provider (PCP) will coordinate your care to help manage costs.
How the HMO works
Copay
You pay a set fee at the time of service for doctor visits and prescriptions.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
The Blue Shield EPO offers lower copays, no deductibles and lower out-of-pocket maximums in exchange for higher rates and staying within a specified network. With this plan, your costs are more predictable, but you’ll likely still have out-of-pocket expenses.
How the Blue Shield EPO works
Deductible
For certain services, you pay 100% of your medical costs until you meet the annual deductible. For most commonly used services and goods, such as PCP office visits and prescription medications, you pay no deductible.
Coinsurance
For services that require an annual deductible, once you meet the deductible, you and the plan share the cost of those services, with the plan paying the majority.
Copay
For most commonly used services, such as doctor visits and prescriptions, you pay a set fee at the time of service.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Save money with an FSA!
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully: the money in your FSA does not carry over to the next plan year; you must “use it or lose it.”
Do you have a PCP?
When you enroll in the Blue Shield EPO, you (and each enrolled family member) have the option to select a primary care physician (PCP) from the network. A PCP isn’t required, though if you choose to select one, a PCP can help you manage all aspects of your health care. You have the right to designate any primary care provider who participates in the plan’s network and who is available to accept you or your family members. See how to find a doctor.
When you enroll in a Mercury medical plan, you automatically receive prescription benefits through either Blue Shield or Kaiser Permanente depending on your choice of medical plan.
Drug tiers
The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred, or non-preferred. All prescription carriers have a formulary, or list of preferred drugs based on effectiveness and cost.
Generic formulary drugs
Same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.
You pay: $
Brand formulary drugs
Brand-name medications included on the formulary and favored by your prescription carrier.
You pay: $$
Brand non-formulary drugs
Brand-name medications not preferred by your carrier. They may still be covered, but may require prior authorization and cost more.
You pay: $$$
Specialty drugs
Complex drugs that are used to treat complex or rare chronic conditions and are often injectable or infused.
You pay: $$$$
Save money on your prescriptions!
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.
- Ask your doctor about generic formulary medications. Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
- Use the home delivery program. If you take maintenance medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — the convenience and cost savings of the home delivery prescription programs through a Blue Shield network pharmacy will save you time and money. You can get 90-day fills of prescription drugs through a Blue Shield network pharmacy, or at a retail pharmacy.
Generic vs. Brand Name
Prescription management programs
Your pharmacy benefits include several programs aimed at ensuring your safety and making sure you receive the most clinically appropriate and cost-effective medication.
Formulary
Your pharmacy plan has an extensive listing of generic and brand-name prescription medications that offer the greatest overall value. This list will determine how your prescription will be covered. Keep in mind that the medications on the formulary may change as the result of regular reviews and updates.
Mail service pharmacy
Blue Shield plan members have can save money and stay on track when refilling maintenance medications. When you fill your prescription at a Blue Shield network pharmacy, you pay less for a 90-day supply of medication than you would purchasing three 30-day supplies of medication at full price.