Benefits Health Insurance

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Group #101498
Network BLUE Network
1-888-592-8961

PHARMACY NETWORK

Network C

DRUG LIST

PDL 20 (Formerly “BCBSNE Standard Formulary“)

Which One Is Right For You?

One of the most important differences between the two health insurance options is that the employer owns the HRA and you own the HSA. This means you take the HSA when you change jobs. If you have an HRA and change jobs, any remaining amount in an HRA defaults to WoodmenLife.

Additionally, an HSA is a tax-advantaged account that can be used to pay for IRS-defined health care expenses, including long-term care and COBRA premiums.

However, there are many factors to consider. Please consult the chart below to make the best decision for you and your family.

	HSA View Details	HRA View Details
Definition	Health Savings Account	Health Reimbursement Account
Deductibles¹	$1,650 Associate Only $3,300 Associate Plus²	$2,000 Associate Only $4,000 Associate Plus
Coinsurance¹	25% of cost (After Deductible is Met)	30% of cost (After Deductible is Met)
Out-of-pocket Maximum¹	$3,300 Associate Only $6,600 Associate Plus	$4,500 Associate Only $9,000 Associate Plus
Annual Contribution by WoodmenLife³	$500 Associate Only $1,000 Associate Plus	$1,000 Associate Only $2,000 Associate Plus
May I contribute additional funds?	Yes, contributions can be made on a pre-tax basis up to the annual maximum. Contributions can be changed throughout the year.	No
What is the most I can contribute per year?	For 2025: $4,300 Associate Only $8,550 Associate Plus $1,000 additional for age 55+ For 2024: $4,150 Associate Only $8,300 Associate Plus $1,000 additional for age 55 or older	N/A
When are funds available?	Funds are available as they are added to the account	Full fund allocation for the year is available as early as Jan. 1
How do I access funds in my account?	Funds are accessed via debit card, request for reimbursement or request to have payment sent	Request reimbursement from account
What can account funds be used for?	Can be used for medical, dental, vision and federally-approved over-the-counter items.	Can be used for second half of medical deductible expenses
What happens to remaining funds at the end of the year?	100% available the following year	50% rollover available if enrolled in the Select HRA the following year
What am I financially responsible for?	Full out-of-pocket payment on all services and prescriptions until deductible is met, then coinsurance until out-of-pocket maximum is met No payments after reaching annual out-of-pocket maximum	Co-pays for doctors visits, prescriptions, urgent care, and emergency room visits Full out-of-pocket payment on hospital stays, outpatient procedures, labs, X-rays until deductible is met, then coinsurance until out-of-pocket maximum is met No payments after reaching annual out-of-pocket maximum
Can I use this plan with a Health FSA?	Yes, but only for dental and vision expenses View eligible expenses	Yes, for medical, dental, vision, and federally approved over-the-counter items.

HRA vs HSA

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Disclosures

For In-Network Expenses
Associate Plus means Associate + Child(ren), Associate + Spouse or Associate + Family
For Associates not enrolled for the entire year, WoodmenLife's contribution will be prorated based on the coverage start date.