We offer you a choice of 3 medical plan options—the ElevateHealth HSA Plan, the ElevateHealth HRA Plan, and the Choice Health Plan. Deciding which plan to choose is a personal and financial decision. To help you choose, we have outlined some similarities and differences between the plans.
- ElevateHealth Plans: ElevateHealth is an insurance partnership of Dartmouth Hitchcock Medical Center and Clinics, Elliot Health System, and Harvard Pilgrim Health Care. Employees who enroll in one of the two ElevateHealth plans can expect care from a network of providers and facilities primarily located in New Hampshire and Vermont, where most of our employees and their families are seeking care today; however, coverage is not provided for service outside the ElevateHealth network. The only exception to this provision is in the event of an emergency situation or a service that is not provided at the facilities in the ElevateHealth network which is medically necessary.
- Choice Health Plan: Our Health Choice Health Plan, administered by Health Plans, Inc., offers a national network of providers. In the Choice Health Plan, you have access to the Harvard Pilgrim network of providers. If you choose to see a provider that is out-of-network, you will be responsible for the out-of-network deductible, coinsurance, and plan provisions.
The following sections describe the benefits available for each plan.
- Employee contributions
- Medical plans
- Pharmacy benefits
- Vision coverage
- Dental plans
- Reimbursement accounts
Medical, prescription drug, and dental plan employee contributions
Bi-weekly premiums shown here are for non-tobacco users with the ElevateHealth Plan with HSA and HRA Choice Health Plans. Additional premiums or premium adjustments may apply.
Medical and prescription drug plan employee contributions
FTE 0.75 or greater
| Salary range | Covered | Cost |
|---|---|---|
| Base salary $0 to $49,999 | Employee | $42.45 |
| Employee and children | $63.65 | |
| Employee and spouse | $89.10 | |
| Family | $117.50 | |
| Base salary $50,000 to $99,999 | Employee | $59.40 |
| Employee and children | $89.10 | |
| Employee and spouse | $124.75 | |
| Family | $164.50 | |
| Base salary $100,000 to $149,999 | Employee | $63.15 |
| Employee and children | $94.75 | |
| Employee and spouse | $132.70 | |
| Family | $175.00 | |
| Base salary $150,000 or greater | Employee | $94.55 |
| Employee and children | $141.80 | |
| Employee and spouse | $198.55 | |
| Family | $261.85 |
FTE 0.5 to 0.74
| Covered | Cost |
|---|---|
| Employee | $137.40 |
| Employee and children | $210.30 |
| Employee and spouse | $291.50 |
| Family | $383.20 |
Dental plan employee contributions
Premiums shown are for FTE 0.5 to 1.0.
| Covered | Basic | Enhanced |
|---|---|---|
| Employee | $2.62 | $5.77 |
| Employee and children | $11.01 | $21.99 |
| Employee and spouse | $11.01 | $21.99 |
| Family | $20.96 | $41.39 |
Additional premiums
- Tobacco use premium: The employee contributions shown are for non-tobacco users only. If you or a covered dependent use tobacco, a $15 tobacco user premium will be added to your contribution each pay period.
- Spouse premium: If you choose to cover your spouse under a Dartmouth Hitchcock Medical Center and Clinics health care plan, your 2023 health care contributions will be twice the standard premium if your spouse has access to group-sponsored health insurance coverage through their own employer. This does not apply if your spouse is employed and benefits eligible at Dartmouth Hitchcock Medical Center and Clinics, Alice Peck Day, Cheshire Medical Center, New London Hospital or Visiting Nurse and Hospice for Vermont and New Hampshire.
- Salary level premium: All salary-based insurance premiums, such as medical insurance, life and disability buy-up insurance, may increase or decrease based on salary adjustments throughout the calendar year. For example, medical insurance premiums are based on salary levels. If an employee has an adjustment in salary, the premium and/or benefit level change will take effect within two pay periods of the date in which Human Resources receives the change.
Medical plans
These tables summarize the costs associated with each medical plan. "Single" = Employee only coverage. "Family" = all other coverage levels.
ElevateHealth HSA Plan
| Plan features | Preferred providers | ElevateHealth network |
|---|---|---|
| Deductible | Single: $1,500 Family: $3,000 |
Single: $1,500 Family: $3,000 |
| Co-insurance | 10% after deductible | 30% after deductible |
| Preventive care | Covered 100% | Covered 100% |
| Out-of-pocket maximum | Single: $2,400 Family: $4,800 (Includes RX drugs) |
|
| Employer annual HSA or HRA contribution | Employees earning less than $150,000 that are enrolled in, and eligible for, the HSA or HRA will receive an employer contribution. The contribution amount is based on your salary tier and HSA or HRA effective date. | |
ElevateHealth HRA Plan
| Plan features | Preferred providers | ElevateHealth network |
|---|---|---|
| Deductible | Single: $1,500 Family: $3,000 |
Single: $1,500 Family: $3,000 |
| Co-insurance | 10% after deductible | 30% after deductible |
| Preventive care | Covered 100% | Covered 100% |
| Out-of-pocket maximum | Single: $2,400 Family: $4,800 (Includes RX drugs) |
|
| Employer annual HSA or HRA contribution | Employees earning less than $150,000 that are enrolled in, and eligible for, the HSA or HRA will receive an employer contribution. The contribution amount is based on your salary tier and HSA or HRA effective date. | |
Choice Health Plan
| Plan features | In-network | Out-of-network |
|---|---|---|
| Deductible | Single: $2,000 Family: $4,000 |
Single: $4,000 Family: $8,000 |
| Co-insurance | 30% after deductible | 50% after deductible |
| Preventive care | Covered 100% | 50% after deductible |
| Out-of-pocket maximum | Single: $3,400 Family: $6,800 (Includes RX drugs) |
Single: $5,600 Family: $11,200 (Includes RX drugs) |
| Employer annual HSA or HRA contribution | Employees earning less than $150,000 that are enrolled in, and eligible for, the HSA or HRA will receive an employer contribution. The contribution amount is based on your salary tier and HSA or HRA effective date. | |
Pharmacy benefits
These tables show the costs, deductibles and relevant pharmacy location information for pharmacy benefits. "Single" = Employee-only coverage. "Family" = all other coverage levels.
ElevateHealth HSA Plan
| Days supply | Locations | Benefits |
|---|---|---|
| 30 days |
|
Subject to deductible and 10% co-insurance |
| 30 days | All other retail pharmacies | Subject to deductible and 30% co-insurance |
| 90 days |
|
Subject to deductible and 10% co-insurance |
| 90 days |
|
Subject to deductible and 30% co-insurance |
| 90 days | All other retail pharmacies | Not available |
ElevateHealth HRA Plan
| Days supply | Locations | Benefits |
|---|---|---|
| 30 days |
|
|
| 30 days | All other retail pharmacies |
|
| 90 days |
|
|
| 90 days |
|
|
| 90 days | All other retail pharmacies | Not available |
Choice Health Plan
| Days supply | Locations | Benefits |
|---|---|---|
| 30 days |
|
Subject to deductible and 10% co-insurance |
| 30 days | All other retail pharmacies | Subject to deductible and 30% co-insurance |
| 90 days |
|
Subject to deductible and 10% co-insurance |
| 90 days |
|
Subject to deductible and 30% co-insurance |
| 90 days | All other retail pharmacies | Not available |
Vision coverage
We offer vision coverage for eyewear through DeltaVision. DeltaVision is supported by the EyeMed Vision Care network, with over 88,000 providers at over 27,000 locations nationwide, including private practitioners and the most popular optical retail outlets. You can search for providers at EyeMed. (On the Find an eye doctor page, choose Access Network in the Network box.)
Our medical plan continues to cover your routine eye exams under preventive services, and the DeltaVision plan can be used to cover your frames and lenses, as well as eye exams if you are not enrolled in the medical plan. The plan provides the following in-network benefits:
- Exams: You pay a $10 co-pay if you are not covered by the medical plan.
- Frames: You have a $150 allowance every 24 months, then 20% off the balance.
- Lenses: You pay only a $10 co-pay for standard plastic lenses, including bifocal and trifocal; the plan pays the balance. Available once every 12 months. Additional co-pays apply to other lens options, like UV coating, tinting, and scratch resistance.
- Contacts: You have a $150 allowance every 12 months (in lieu of spectacle lenses). In addition to the allowance, you also receive 15% off any balance payable for non-disposable contacts.
- Laser Vision Correction - Lasik or PRK: You get 15% off the retail price or 5% off the promotional price.
| Members | Cost |
|---|---|
| Employee only | $2.39 |
| Employee and children | $4.52 |
| Employee and spouse | $4.66 |
| Family | $7.05 |
Dental plans
We offer 2 dental options for you and your eligible dependents through Northeast Delta Dental.
| Plan features | Basic | Enhanced |
|---|---|---|
| Deductible | Single: $50 Family: $150 |
Single: $25 Family: $75 |
| Preventive care | 100%, no deductible (2 annual cleanings) | 100%, no deductible (2 annual cleanings) |
| Basic restorative care: Fillings, extractions, root canals |
Plan pays 50%, after deductible | Plan pays 80%, after deductible |
| Major restorative care: crowns, dentures, bridges |
Plan pays 50%, after deductible | Plan pays 50%, after deductible |
| Orthodontia | Plan pays 50%, no deductible, lifetime maximum benefit of $2,000 per covered member | Plan pays 50%, no deductible, lifetime maximum benefit of $2,000 per covered member |
| Annual maximum benefit | $1,000 per covered member | $1,500 per covered member |
Reimbursement accounts
We offer reimbursement accounts to help employees cover health care costs.
Health Care Reimbursement Account (HCRA)
The HCRA is a pre-tax savings account available to employees who waive health care coverage or enroll in the ElevateHealth HRA plan. The HCRA can be used to pay for eligible health care, dental, or vision care expenses that are not covered by insurance, for you and your eligible dependents. The maximum amount you may contribute to your HCRA is $2,850 each calendar year. Once you sign up for the HCRA, you will receive a personalized debit card from HealthEquity to use when paying for your eligible health care expenses.
Note: You may not use your HSA, HRA, or HCRA to pay for, or be reimbursed for, over-the-counter medications unless prescribed by a provider.
Dependent Care Reimbursement Account (DCRA)
The DCRA is a pre-tax savings account that may be used to pay for eligible elder and child care expenses. You may only use this account if you utilize day care or elder care services so that you and your spouse can work, obtain gainful employment, or attend school full time. It is important to note that your day care or elder care provider must furnish you with his/her Social Security Number (SSN) or Tax Identification Number (TIN) in order to receive reimbursement for your expenses. IRS regulations limit the amount you may contribute to any DCRA to $5,000 for your family (or $2,500 if married and filing separate tax returns) per calendar year.
In order to qualify for reimbursement, expenses must be incurred for the care of “eligible dependents,” who the IRS defines as:
- A child under the age of 13, or a child of any age who is physically or mentally incapable of self-care
- Your spouse, if physically or mentally incapable of self-care and living in your home for more than 50% of the year
- Any other dependent who is physically or mentally incapable of self-care who meets specific criteria. For more details about who qualifies as eligible dependents under the DCRA, refer to IRS Publication 503, titled Child and Dependent Care Expenses, which is available by calling the IRS at 800-829-1040 or at the IRS website.
Note: You can only participate in the DCRA if you earn less than the highly compensated limits. For the 2023 plan year, an employee who earns more than $135,000 is considered a highly compensated employee.