Your Medical Benefits
All three of the plans we offer include the following:
- In-network preventive care, such as annual well visit, covered at 100%
- Contracted rates for in-network providers
- A limit on out-of-pocket expenses you pay
- Behavioral health and substance use services
- Prescription drug coverage through CVS Caremark®
- Expert Medical Opinion Service through Health Navigator, powered by PinnacleCare and virtual visits services
Only the HSA Copay option includes a Company contribution to a Health Savings Account, ranging from $250 to $2,300 each year if your annual base pay is less than $305,000. View the HSA Copay FAQs for eligibility and more details on the HSA Copay option.
Need Help Choosing the Right Medical Option?
The Pfizer Medical Plan Option Modeler helps you compare the three medical options.
Medical Plan Comparison Chart
Imaging / Other
Outpatient Surgeon fee (for procedure)
Outpatient Facility fee (for procedure)
1 Deductible applies. Note: under the HSA Copay, if you’re covering dependents, you must meet the full family deductible before the plan begins to share the cost of non-preventive benefits.
2 Under Traditional Coinsurance, the deductible and out-of-pocket maximum apply to both in- and out-of-network services.
3 Eligible prescription drug expenses includes both in- and out-of-network pharmacy expenses.
4 Out-of-pocket maximum includes deductible, copays, and coinsurance for eligible expenses.
5 $15 copay for virtual health visits through your medical plan administrator — either through Horizon CareOnline, for Horizon members or myuhc.com/virtualvisits for UHC members. From migraines and sinus infections, flu or COVID-19 concerns, to skin rashes, and more, get care 24/7 from a licensed provider. Excludes behavioral health. The $15 copay does not apply for telehealth visits you have with regular providers; rather, these are considered office visits under the plan.
6 Deductible does not apply.
Remember:
Amounts accumulated toward any lifetime maximums under the plan (e.g., infertility) are carried over from year to year, regardless of whether you change coverage options or plan administrators during Annual Enrollment.
Additional Support
Manage your health with supplemental health and well-being programs including no cost expert medical opinion services and other Medical Support Programs. Save money through Reimbursement Accounts. Get help with expenses not covered under your medical plan through the supplemental health programs.
Note: If you are a new hire/newly eligible colleague, you’re eligible to enroll in supplemental health programs through the Benefit Extras Program. About two weeks after your hire/eligibility date, you will be able to visit Benefit Extras to learn/enroll. If you do not enroll when you are initially eligible, you may enroll during the next Annual Enrollment period.
Estimate costs before you receive care.
Visit your medical plan administrator’s website and use the cost estimator tools to find out how much a service may cost before you receive care.
Horizon Participants: Go to horizonblue.com/pfizer or call 1-888-340-5001
UHC Participants: Go to welcometouhc.com/pfizer or call 1-800-638-8010
Want to compare your potential total annual costs under each medical option? View the Medical Plan Option Modeler.
(As of Sept. 1, 2021 or hire date if later)
Includes One-Time HealthEquity $50 Contribution
(individual/family)
Preventive Care
Services or supplies that aren’t provided for the treatment of an injury or illness. It includes, but is not limited to: routine physical exams, including: related X-rays and lab tests; immunizations and vaccines; screening tests; well-baby care; and well-adult care.
Virtual Visits
$15 Virtual visits will be offered through your medical plan administrator for non-emergency health conditions, such as a rash, the flu, or a sinus infection (excludes mental health and specialist visits).
For UnitedHealthcare (UHC):
Services will be available through myuhc.com/virtualvisits or by downloading the UnitedHealthcare App.
For Horizon BlueCross BlueShield (Horizon):
Services will be available through Horizon CareOnline, which can be found through the Horizonblue.com/Pfizer or the Horizon Blue App.
Deductible
Amount you pay for non-preventive covered services before your plan begins to pay. Review the Understanding the Family Deductible tip sheet for more information.
Out-of-Pocket Maximum
The most you will pay out-of-pocket for eligible expenses in any given calendar year for covered services, including all deductibles, copays, and coinsurance. After you reach the out-of-pocket maximum, all remaining covered services will be paid by the plan at 100% for the remainder of the plan year. Note that different out-of-pocket maximums may apply for in-network and out-of-network care. Additionally, the out-of-pocket maximum for medical expenses is separate from the out-of-pocket maximum for prescription medications dispensed through a pharmacy, except under the HSA Copay, where the out-of-pocket maximum for medical and prescription medication expenses is combined.
Allowed Amount
The Allowed Amount for out-of-network medical (including mental health) services is generally defined as 250% of the Medicare reimbursement rate. For certain other services and supplies where Medicare does not provide a reimbursable rate, the Allowed Amount for these out-of-network services will be determined based on the method utilized by your plan administrator. You may also be responsible for any non-covered services, or the difference between the billed charges and the allowance for out-of-network providers. Please contact your plan administrator if you are billed for amounts in excess of the Allowed Amount to determine if they can provide you with any balance billing support.
Pfizer Contribution to the HSA
(As of September 1, 2024 or hire date if later)
(individual/family)