MEDICAL

MEDICAL DEDUCTIBLES
Vertex offers medical coverage to all employees and their dependents. The plans are structured as High Deductible Health Plans plus Health Savings Account.
High Deductible Health Plan (HDHP)
HDHPs operate like traditional health plans with a few key differences. HDHPs are structured so the participant pays a low monthly premium, but is responsible for 100% of the costs of healthcare until the deductible is met
(instead of paying a copay or coinsurance amount at each visit to a health care provider). This consumer-driven
plan allows individuals to have more control over how their health care dollars are spent while keeping costs comparatively low and predictable. These BCBS plans allow you to choose both in-network and out-of-network providers. However, you will save money by utilizing in-network providers. The cost of each in-network visit is the discounted rate negotiated by Blue Cross Blue Shield. Once the deductible is met, insurance pays 80% of in-network
costs. Out of pocket expenses are also capped, and once the cap is met, insurance pays 100% of in-network. To
see a current list of BCBSTX network providers online, go to www.bcbstx.com. If you do not have internet access,
please call BCBSTX Customer Care at 800-521-2227 for assistance. For a complete description of benefits see
the Summary of Benefits and Coverage or Summary Plan Document.

Basic High Deductible Health Plan

Enhanced High Deductible Health Plan

In-Network

Out-of-Network

In-Network

Out-of-Network

80%

60%

80%

60%

No Charge

60% after ded.

No Charge

60% after ded.

Coinsurance
Preventive Care

Coinsurance
Preventive Care
Deductible

Deductible
Employee

$1,750

$1,750

Employee

$1,300

$1,300

EE + SP/DP

$3,000

$3,000

EE + SP/DP

$2,600

$2,600

EE + Child(ren)

$3,000

$3,000

EE + Child(ren)

$2,600

$2,600

EE + Family

$3,500

$3,500

EE + Family

$3,000

$3,000

Out of Pocket Maximum

Out of Pocket Maximum

Employee

$5,750

Unlimited

Employee

$4,000

Unlimited

EE + SP/DP

$6,850

Unlimited

EE + SP/DP

$5,000

Unlimited

EE + Child(ren)

$6,850

Unlimited

EE + Child(ren)

$5,000

Unlimited

EE + Family

$6,850

Unlimited

EE + Family

$6,850

Unlimited

80% after ded.

60% after ded.

80% after ded.

60% after ded.

80% after ded.

60% after ded.

Office Visit

Office Visit
80% after ded.

60% after ded.

Urgent Care

Urgent Care
80% after ded.

60% after ded.

Emergency Room

Emergency Room
80% after ded.

60% after ded.

Penalty for Failure to Precertify MRI/CAT Scan

Penalty for Failure to Precertify MRI/CAT Scan

$250

$250

Prescription Drugs

Prescription Drugs

Retail (30-day supply)

Retail (30-day supply)

Preventive
Non-Preventive

80%

80%

80% after ded.

80% after ded.

Preventive
Non-Preventive

Non-Preventive

80%

80% after ded.

80% after ded.

Mail Order (90-day supply)

Mail Order (90-day supply)

Preventive

80%

80%

Not Covered

Preventive

80% after ded.

Not Covered

Non-Preventive
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80%

Not Covered

80% after ded.

Not Covered

The medical premiums will be spread out over 24 pay periods on a bi-monthly basis. Therefore, you will not have
deductions taken out on the 3rd pay period of a month in which there are 3 pay periods.
Basic HDHP Bi-monthly Deduction

Enhanced HDHP Bi-monthly Deduction

Employee

$122.96

Employee

$134.50

EE + SP/DP

$286.94

EE + SP/DP

$305.07

EE + Child(ren)

$171.33

EE + Child(ren)

$189.45

EE + Family

$353.18

EE + Family

$377.85

Wellness Premium Credit

If you and/or your spouse/domestic partner take the wellness screening, you are eligible to receive a wellness
credit of $125 per month ($62.50 per pay period) for you and/or your spouse/domestic partner to help offset the
costs of the bi-monthly premiums. Employees hired as of October 1, 2016 will automatically receive the wellness
credit in 2017 but may have to take the wellness screening at the end of the year to qualify for the credit in 2018.

HEALTH SAVINGS ACCOUNT

HSA online funds transfer through internet banking from your personal checking or savings account
* Your domestic partners claims can be considered
only if they are your tax dependent. If your domestic
partner is not your tax dependent but is covered by
one of the Vertex HDHPs, they may be eligible to
open their own HSA. Please contact Wells Fargo for
more information.

Health Savings Account (HSA)

Enrolling in an HDHP is the only way individuals are permitted to use tax-advantaged Health Savings Accounts..
HSAs are bank accounts that allow individuals to save
money on a pre-tax basis and then use the money taxfree to pay for qualifying expenses. Participants are issued a debit card that can be used to pay for qualifying

Monitoring Your Account

Annual HSA Contribution Limits

(Including Employer Contributions)
Individual

$3,400

Family

$6,750

You can access your account anytime by going to

www.wellsfargo.com/hsa. From this site, you can
view your current account balance and account activity and manage your HSA. Please note, there is a
monthly administration fee that will be deducted out
of your account balance. Please refer to the website
for more information regarding on-going monthly fees
and transactional fees. Please be aware that other
fees may apply for additional services.

Individuals over age 55 are able to contribute an

additional $1,000 annually.
Vertex will contribution the amounts below to your HSA on
a quarterly basis:
Annual Employer HSA Contribution
Employee
Family

Veterans HSA Q&A

$650

Q: If an employee receives VA benefits or moves in

and out of Tricare, is the employer responsible for the
eligibility changes and stopping the pretax payroll
deductions / starting them up again?
A: No. The employee always maintains responsibility
for knowing when they are eligible to contribute or
not.

$1,200

Vertex w i l l contribute an additional match of up to

$200 of employee contributions on a per-payperiod basis.
In order to receive your contributions, you must set up an
HSA account (this is a separate process from completing
online open enrollment through Paycom). If you have not
set up your HSA account before your employment with
Vertex ends, your contribution from Vertex will be
forfeited.

Q: If the services I receive from VA Benefits are entirely preventative, am I still eligible to contribute to an
HSA?
A: Yes, according to IRS Notice 2008-59, Q&A 9.
Q: What is considered preventive benefits for VA
coverage?
A. According to the VA website:
Periodic medical exams (including genderspecific exams)
Health education, including nutrition education
Immunization against infectious disease
Counseling on inheritance of genetically determined disease

Making Withdrawals
You can pay for qualified expenses up to the balance in
your HSA by:

HSA debit card

HSA checkbook (if ordered after account is open)
Withdrawal Form
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MEDICAL

MEDICAL PREMIUMS

PRESCRIPTION, GENERIC DRUGS AND PREVENTIVE SERVICES

Tobacco Surcharge
We will continue to apply a surcharge for tobacco use. Tobacco Use is considered any form of tobacco, including
cigarettes, electronic cigarettes, cigars, snuff, chewing tobacco, pipes, etc., used within the last 3 months,
regardless of the frequency or location.
Tobacco Use Identification:
During initial benefit enrollment and or a qualifying life
event change, employees will self identify as a tobacco
user via the Vertex Benefits online enrollment tool Paycom.
If you or your spouse/domestic partner self identify as a
tobacco user and are enrolled in one of the Vertex Medical Plans, surcharge(s) per employee and per spouse/
domestic partner will be charged as applicable.
Failure to accurately disclose tobacco use can result in
disciplinary action, up to and including termination.
The surcharge is $900 per year for each participant who is
a tobacco user, The surcharge of $37.50 will be deducted
per bimonthly pay period per tobacco-using employee
and/or spouse/domestic partner.

This surcharge is applied to assist with selection of

healthy choices and to help control medical premium
costs. If you make the decision to eliminate tobacco use,
Vertex offers a variety of programs and information to
support this effort.
Tobacco Cessation Tools:
Through Blue Cross Blue Shield, employees have access
to personal coaching, online tools, an audio health library,
and discounts to wellness-related products and services.
Included in these programs is a tobacco cessation program. The surcharge may be removed if you enroll in and
complete the tobacco cessation program and have remained tobacco free for 90 days.
In addition, Vertex covers certain tobacco cessation products under the Medical Plan at no cost to encourage your
success. Please contact BCBSTX for additional information on covered products.

PRESCRIPTION - PRIME THERAPEUTICS

The Vertex Prescription Drug Program is also coordinated through BCBSTX and administered by Prime
Therapeutics. You will have a single ID card for medical and for prescriptions. You may find information on your
benefits coverage and search for network pharmacies by logging on to www.myprime.com or calling the customer
care number on your ID card.
The cost of your prescription is determined by the tier assigned to the prescription drug product. All prescriptions
are assigned as Preventive or Non-Preventive. However, under both categories there are generic and brand drugs.
The most cost effective drugs are generic. See below for more information regarding generic drugs. To find out
which prescriptions are considered Preventive, log on to www.myprime.com and click the prescription tab.

WHAT YOU NEED TO KNOW ABOUT GENERIC DRUGS

Generics Deliver:

Safety Generic drugs are safe. Brand-name and

generic drugs sold in the United States are approved
and regulated by the U.S. Food and Drug Administration (FDA). The standards are the same. Thats safety
you can count on.

Quality Generic drugs work the same way. When

the FDA approves a generic drug, this means the generic drug is the same as its brand- name counterpart
in dosage, performance, safety, strength, quality and
usage.

Savings Generic drugs cost less. When the patent

expires on a brand- name drug, other companies may
begin making and selling the drug as a generic. Generic manufacturers dont have to pay for the costly
research and marketing that was done for the brandname product. Lower prices mean more savings for
you.
Same quality + lower cost = better value

Its a fact generic drugs work in the same way as

brand- name drugs. Dont believe the myths.

PREVENTIVE SERVICES OVERVIEW

Routine Physical Exam

Bone Density Test

Annual Well Women Exam

Annual PSA Test

Annual Mammogram

Well Baby / Well Child Care Exam

Annual Pap smear and other lab

Routine Immunizations

Breast Thermography

Flu and pneumonia shots

The preventive benefits listed above are covered 100% one-time annually. This is only a brief description of the annual
preventive benefits available and is subject to change. To learn more, please visit www.bcbstx.com.
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