Your Medical Benefits
All three of the plans we offer include the following:
- In-network preventive care, such as annual wellness visit, covered at 100%
- Contracted rates for in-network providers
- A limit on out-of-pocket expenses you pay each year
- Coverage for 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 Guide for eligibility and more details on the HSA Copay option.
Learn about your Medical Plan Administrators
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 Facility Fee (for procedure)
1 Deductible applies except for annual preventive care. Additionally, under 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. The deductible will not apply regardless of which medical plan option you are enrolled in. 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 and specialist visits. 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 Pfizer Benefit Extras Program. About two weeks after your hire/eligibility date, you will be able to visit Pfizer 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 whyuhc.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 an annual wellness exam, including related X-rays and lab tests; immunizations and vaccines; preventive screening tests such as colonoscopy and mammography; well-baby care; and well-adult care. Speak with your provider to ensure that services are coded as preventive to ensure your preventive care is paid at 100%.
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). The deductible does not apply for these visits — even if you are enrolled in the HSA Copay option!
For UnitedHealthcare (UHC):
Services will be available through whyuhc.com/pfizer or by downloading the UnitedHealthcare App.
For Horizon BlueCross BlueShield (Horizon):
Services will be available through Horizon CareOnline, which can be found through Horizonblue.com/Pfizer or the Horizon Blue App.
The $15 copay does not apply for telehealth visits you have with regular providers; rather, these are considered office visits under the plan.
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. 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.
1 Flexible Spending Account — Unused funds above the IRS carry over limit will be forfeited under IRS “use it or lose it” rule after the claims submission deadline.
2 Eligible expenses incurred through your Pfizer medical (including prescription drug), dental and/or vision coverage will be submitted automatically for reimbursement.
3 Changes to your contribution rate may be made through November 1 for a given calendar year and are effective prospectively.
4 The deadline for filing claims for eligible expenses you incur during the plan year (January 1st to December 31st) is March 31, 2027.
Visit HealthEquity.com for the HSA (select HealthEquity) and for the GPHCA/LPHCA (select EZ Receipts) to check your account balance, the status of your claims, submit a claim, and more.
Dependent Care Account (DCA)
Use this to pay for eligible child care or adult day care expenses
This account is different from the Health Care Accounts, and you do not need to enroll in a Pfizer medical plan option to participate.1 You contribute money each paycheck in this account to get reimbursed for eligible child care expenses (for children 13 or under) and eligible elder care expenses.
Some important features:
Eligibility
You enroll in the DCA each Annual Enrollment period or when you are newly eligible. You must elect to participate each year.
1 Flexible Spending Account.
2 Qualified life events must be reported within 31 days of the event by calling Fidelity at the Pfizer Benefits Center at 1-877-208-0950.
3 The deadline for filing claims for eligible expenses incurred during the plan year including the grace period (January 1, 2026, to March 15, 2027) is May 31 of the following plan year (e.g., deadline for claims incurred against your 2026 DCA is May 31, 2027). You can be reimbursed up to the amount you have contributed via payroll deductions, less any reimbursement already issued.
Visit HealthEquity.com for the DCA (select EZ Receipts) to check your account balance, the status of your claims, submit a claim, and more.