Medical

Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.

Each plan has different:

• Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
• Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
• Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
• Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.

Reminders:

• Complete your annual Wellness Exam and see a reduction in your monthly contributions ($50 for Employee only coverage and $75 for Employee + One or Family Coverage). To qualify for the contribution credit for 2026, you must have had your wellness exam in the prior year (2025).

• Tobacco Surcharge – $50 charge per month for Tobacco Users (waived if the member joins a smoking cessation program).

• Spousal Surcharge – $100 charge per month if covered spouse has access to coverage at their place of employment.

Tobacco Surcharge:

Stanadyne applies a $50 per month surcharge to anyone enrolled in the medical plan who uses tobacco. A tobacco use affidavit must be completed in ADP during open enrollment for both the covered individual and spouse. Not completing the affidavit results in the surcharge. The surcharge can be waived or removed with proof of completing a tobacco cessation program. Providing inaccurate information can lead to disciplinary action and retroactive premiums. A tobacco user is anyone who has used tobacco in any form within the past six months, excluding limited religious or ceremonial use. A reasonable alternative is available for those who cannot meet the standard. Contact Human Resources for program details and support.