2023 Medical Plan Option Chart
Imaging / Other
Outpatient Surgeon fee (for procedure)
Outpatient Facility fee (for procedure)
1 Deductible applies; if you’re covering dependents in HSA Copay option, 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.
(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.
Telehealth Services
Telehealth services will be offered through your medical plan administrator.
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.
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 services is determined by your medical plan administrator. It’s generally defined as 250% of the Medicare reimbursement rate. For certain other supplies and services, including those for which Medicare doesn’t provide a reimbursement rate, the Allowed Amount will be determined based on the method utilized by your medical plan administrator. Contact your medical plan administrator for details before receiving out-of-network services.
Pfizer Contributions to the HSA
(As of September 1, 2022 or hire date if later)
(individual/family)