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Benefits

Medical Plan Summary

Below is a summary of our core medical benefits, including the specifics of the two available plans.  The plans were designed so that utilization plays more of a role in how we, as a group, pay for our insurance. The more you use the plan, the more you will pay. If you go for your preventive care and stay healthy, you will pay less.

Here are the three ways you pay for your medical insurance

  1. Payroll Contribution: Your premium will be deducted from your paycheck every pay period.
  2. Deductible: The amount you pay out of pocket for services before benefits begin. 
  3. Coinsurance: A form of cost sharing between you and Standard Motor Products.

     

Anthem BlueCross BlueShield PPO

  In-Network Out-of-Network
Annual Member Responsibility    
Single Deductible $900 $1,800
Family Deductible $1,800 $3,600
Single Co-Insurance 10% of the next $9,000 ($900) 30% of the next $9,000 ($2,700)
Family Co-Insurance 10% of the next $18,000 ($1,800) 30% of the next $18,000 ($5,400)
Single Out of Pocket Max (incl. Deductible) $1,800 $4,500
Family Out of Pocket Max (incl. Deductible) $3,600 $9,000
Copays & Co-Insurance    
Preventative Care No Charge Not Covered
Sickness Office Visit Deductible + Co-Insurance Deductible + Co-Insurance
Specialist Office Visit Deductible + Co-Insurance Deductible + Co-Insurance
Lab & X-Ray Fees Deductible + Co-Insurance Deductible + Co-Insurance
Mental Health Office Visit Deductible + Co-Insurance Deductible + Co-Insurance
Mental Health Maximum Visits Per Plan Year Unlimited Unlimited
ER Visit Deductible + Co-Insurance Deductible + Co-Insurance
Inpatient Hospital Admission Deductible + Co-Insurance Deductible + Co-Insurance
Outpatient Hospital Visit Deductible + Co-Insurance Deductible + Co-Insurance
Retail Rx Drugs (30-Day Supply)    
Generic $0 $5
Preferred Brand $25 $30
Non-Preferred $45 $75
Mail Order Rx Drugs (90-Day Supply)    
Generic $0 N/A
Preferred Brand $37.50 N/A
Non-Preferred $90 N/A

Employees that elect the PPO plan have the option to enroll in the Health Care FSA, but not the Health Savings Account (HSA).

Anthem BlueCross BlueShield High Deductible Health Plan (HDHP)

  In-Network Out-of-Network
Annual Member Responsibility    
Single Deductible $1,500 $3,000
Family Deductible (Combd. Deductible*) $3,000 $6,000
Single Coinsurance 10% of the next $15,000 ($1,500) 30% of the next $10,000 ($3,000)
Family Coinsurance 10% of the next $30,000 ($3,000) 30% of the next $20,000 ($6,000)
Single Out of Pocket Max (incl. Deductible) $3,000 $6,000
Family Out of Pocket Max (incl. Deductible) $6,000 $12,000
Copays & Co-Insurance    
Preventative Care No Charge Not Covered
Sickness Office Visit Deductible + Co-Insurance Deductible + Co-Insurance
Specialist Office Visit Deductible + Co-Insurance Deductible + Co-Insurance
Lab & X-Ray Fees Deductible + Co-Insurance Deductible + Co-Insurance
Mental Health Office Visit Deductible + Co-Insurance Deductible + Co-Insurance
Mental Health Maximum Visits Per Plan Year Unlimited Unlimited
ER Visit Deductible + Co-Insurance Deductible + Co-Insurance
Inpatient Hospital Admission Deductible + Co-Insurance Deductible + Co-Insurance
Outpatient Hospital Visit Deductible + Co-Insurance Deductible + Co-Insurance
Rx Plan All non-preventive prescriptions are subject to deductible and co-insurance. There are several prescription preventive drugs available for free that fall under the following categories: birth control, blood clots, bowel prep, breast cancer, diabetes, heart health, high blood pressure, high cholesterol, malaria, nausea, osteoporosis, RSV, stopping smoking, stroke, vaccines, vitamins, weight loss, etc. Find a complete list of covered drugs under the document library of SMPbenefits.com.

Employees that elect the High Deductable Health Plan have the option to enroll in the Health Savings Account, if you meet the IRC’s eligibility guidelines. Please note, enrollment in the HSA will make you ineligible for enrollment in the HCFSA.

*Combined Deductible: If you have Employee +1 or Family coverage under the HDHP plan, all collective member claims under the plan must meet the full $3,000 deductible before the plan goes into the 10% co-insurance. Once the total member responsibility exceeds $3,000, the entire family (or employee +1) goes into co-insurance.