Medical

Our benefits program includes medical plan options with a range of coverage levels and costs, so you can choose the one that’s best for you. These plans are administered by Blue Cross Blue Shield of North Carolina. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event. Otherwise, your next opportunity to change your benefits will be the next Open Enrollment period.

Qualifying life events include but are not limited to:

• Marriage
• Divorce or legal separation
• Birth or adoption of an eligible child
• Death of your spouse or covered child
• Loss or addition of other group coverage
• Change in your spouse’s work status (part time to full time or vice versa; taking or returning from an unpaid leave of absence)
• Change in your work status that affects your benefits
• Change in residence that affects your eligibility for coverage
• You or your covered dependent becomes eligible for Medicare

What to do if you experience a life event

If you need to make changes to your 2024 benefit elections as a result of a life event, visit the Mercer Marketplace 365+ website or call a benefits counselor at 1-866-385-8032. Changes must be made within 30 days of your qualifying life event. Changes are effective as of the date of the event.

2024 medical plans

Key features at a glance

There’s a lot included with whichever medical plan you select! Take a look.

All Calyx’s medical plans include:

Free in-network preventive care.

Annual physicals, recommended immunizations, and other routine services are fully covered at 100%. See more covered preventive services.

Annual deductible.

Each year, you pay for certain non-preventive medical and prescription drug costs until your annual deductible is met.

Cost sharing.

Cost sharing applies to non-preventive medical and prescription drug costs. Depending on your plan, this cost sharing may be coinsurance (a percentage of the cost) or a copayment (a flat dollar amount).

• For the $900 Deductible Plan, copayments apply for many services, and the annual deductible does not apply. However, for other services you must first meet the annual deductible, and then coinsurance applies.
• For $1,850 Deductible Plan and $3,200 Deductible Plan, you must first meet the annual deductible for all services, and then coinsurance applies.

Out-of-pocket maximum.

Each plan protects you by capping the total amount paid each year for medical care. Once met, the plan pays 100% of your eligible expenses for the rest of the year.

Get to know your plan

• $900 Deductible Plan
• $1,850 Deductible Plan
• $3,200 Deductible Plan

Find a doctor

Seeing in-network providers saves you money.

Access 365 HUB

One-on-one health care advocacy support is available online or by phone.

Here’s an overview of your medical plan options, showing coverage highlights for in-network care. Find complete cost and coverage details on the Mercer Marketplace 365+ website.

*True family: If a plan has a “true family" deductible, it means that for employee + spouse/domestic partner, employee + child(ren), and family coverage levels, coinsurance begins when the family deductible is met — even if only one person has all the claims. Once the family out-of-pocket maximum is met, the plan will pay 100% for any and all family members. If a plan does not have a “true family" deductible, coinsurance begins for an individual once that person meets the individual deductible, even if a dependent has already reached his or her deductible. Once that person meets the individual out-of-pocket maximum, the plan will pay 100% for that person's covered expenses. Each covered person must satisfy the individual out-of-pocket maximum until the family out-of-pocket maximum is satisfied. Once the family out-of-pocket maximum is met, the plan will pay for 100% of covered expenses for any and all family members.
**Does not apply toward the deductible but does apply toward the out-of-pocket maximum.

Out-of-network costs

Here’s an overview of your medical plan options, showing coverage highlights for out-of-network care.

*True family: If a plan is “true family,” the employee + spouse, employee + child(ren), and family coverage levels begin to cost-share after the family deductible is met — even if only one person has all the claims. Once the family out-of-pocket maximum is met, the plan will pay 100%. If a plan is not “true family,” it begins to pay once an individual meets the individual deductible, even though you cover dependents. Once that person meets the individual out-of-pocket maximum, the plan will pay 100% for that person’s covered expenses. Your dependents will need to satisfy their individual out-of-pocket maximums until the family out-of-pocket maximum is satisfied. Once the family out-of-pocket maximum is met, the plan will pay for 100% of covered expenses.
**Does not apply toward the deductible but does apply toward the out-of-pocket maximum.

In the $900 Deductible Plan, you pay slightly higher out-of-pocket costs in exchange for lower premium contributions. Once you meet the deductible, you pay a percentage of the cost of care (coinsurance)—up to the out-of-pocket maximum. Coinsurance for prescriptions are subject to minimum and maximum amounts: you won’t pay less than the minimum, but won’t pay more than the maximum. With this plan, you can see any provider you wish, but you will pay less when you stay in network.

How the $900 Deductible Plan works

You pay the plan premium from your paycheck to have coverage.

 

Prescriptions

You pay the coinsurance amount for prescriptions* (with a minimum and maximum cost per prescription type) without having to meet the annual deductible.

 

Deductible

For doctor’s office visits and hospital services, you pay 100% of the costs until you meet the annual deductible.

 

Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.

 

Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Use your $900 Deductible Plan wisely

Here are ways to make the most of your plan all year long.

• Track your stats. Log in to the Blue Cross Blue Shield of North Carolina website to see how much of your deductible you’ve met, review claims, and more.
• Pair it with a Health Care Flexible Spending Account (FSA). If you enroll in the Health Care FSA, you can set aside before-tax dollars to help pay for your out-of-pocket costs. You will have a grace period that extends into the following year, allowing you extra time to use up your FSA funds. Eligible expenses incurred through March 15, 2024, may be submitted by March 31, 2024. After that, any unused money will be forfeited.
• Be cost-conscious. Visit the Blue Cross Blue Shield of North Carolina website to search for in-network providers and use the tools to compare costs for medical services.

The $1,850 Deductible Plan and $3,200 Deductible Plan pair low premium contribution rate, high-deductible coverage with a tax-free Health Savings Account (HSA) that helps you save up for future medical expenses. As an added bonus, Calyx will contribute to your HSA — $500 for employee-only coverage and $1,000 for all other coverage levels. Money in your HSA can be carried forward from year to year and is always yours to keep. You can see any provider you wish, but you will pay less when you stay in network.

How $1,850 Deductible Plan and $3,200 Deductible Plan Work

You pay the plan premium from your paycheck to have coverage.

 

Deductible

You pay 100% of the costs until you meet the annual deductible.

 

Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.

Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Use your $1,850 Deductible Plan or $3,200 Deductible Plan wisely

Here are ways to make the most of your plan all year long.

• Track your stats. Log in to the Blue Cross Blue Shield of North Carolina website to see how much of your deductible you’ve met, review claims, use helpful tools, and more. Likewise, keep tabs on your HSA by logging in to the WEX website to view your balance, submit claims, and more.
• Think about your costs. You pay lower contribution rates in exchange for assuming more financial responsibility when you receive care, so it’s smart to plan ahead. Visit the Blue Cross Blue Shield of North Carolina website to search for in-network providers and use the tools to compare costs for medical services. Try to contribute enough to your HSA to cover your expected out-of-pocket costs, such as your annual deductible and coinsurance.
• Change your HSA contributions anytime. Adjust your contributions as necessary during the year to keep your savings on track with your anticipated expenses. Note: You can only spend HSA contributions that have actually been deposited into your account.
• Look long term. You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses — or if you want to save for your health care costs in retirement — set aside a little extra each paycheck so your balance can grow over time.

When you enroll in a Calyx medical plan, you automatically receive prescription drug benefits through Blue Cross Blue Shield of North Carolina.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the tier of the medication — Tier 1 & Tier 2 (most generics), Tier 3 (formulary), or Tier 4 and Tier 5 (non-formulary).

• Tier 1 & 2 (most generics) The prescription drug tier which consists of the lowest cost tier of prescription drugs (most are generic) and some medium-cost prescription drugs (some brand name).
• Tier 3 (formulary) consists of high-cost prescription drugs, most are brand-name prescription drugs.
• Tier 4 & 5 (non-formulary) consists of the higher-cost prescription drugs (mostly brand-name prescription drugs and some specialty drugs) and the highest-cost prescription drugs (most are specialty drugs).

Mail Order

If you regularly take medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — you can take advantage of the convenience and cost savings of using the mail order program to receive a three month supply.

Why use mail order?

• No more waiting in line at the pharmacy – prescriptions are shipped to you for free!
• You save money with a reduced cost for a three-month supply.
• You can set up automatic refills.

Seeing in-network providers saves you money. These doctors and health care professionals have agreed to discounted pricing for their services, and you’ll receive a higher level of benefits when using your in-network coverage. Here’s how to find doctors in your medical plan network.

• Go to the Blue Cross Blue Shield of North Carolina.
• Use the Find a Doctor / Drug / Facility link in the menu bar.
• Follow the prompts to look for providers, drugs, and facilities in the network.

Look up providers on the Mercer Marketplace 365+ website

You can also use the Provider Lookup tool on the Mercer Marketplace 365+ website to easily find in-network doctors.

• Click “Provider Lookup” above the medical plan options
• This link will open up a secondary window containing the Provider Search tool. You can search by zip code, provider’s name, type of procedures, facility, etc.

Teladoc is a convenient, low-cost telehealth service where you can see a therapist or board-certified doctor through a phone or video call or using the app. All of the medical plans include this valuable coverage. The full cost per visit is:

• Medical: $55
• Dermatology: $85
• Counseling: $85
• Psychologist: $180

You pay the full cost per visit until you meet your annual deductible. Once you meet the deductible, the amount you pay depends on the plan you enroll in:

• For $900 Deductible Plan and $1,850 Deductible Plan, you pay 20% of the cost.
• For the $3,200 Deductible Plan, you pay 30% of the cost.

If you enroll in a Calyx medical plan for 2024, you may also choose to enroll in the Mercer Marketplace 365+ HUB — a voluntary benefit that provides one-on-one health care advocacy support — online and by phone — to help you improve the quality and cost of your care.

Mercer Marketplace 365 HUB supports you as you take on a more active role as an involved, informed health care consumer. Calyx will offer a subsidy toward the cost of this benefit. This benefit provides you with year-round access to personal health advocacy services, price comparison tools, physician performance ratings, expert medical opinions, and more.

Click the features below to learn more about 365+ HUB services.