2026 Health Plan FAQ

2026 FAQ What does it mean for a medical plan to have two tiers of coverage? Whether you choose PPO Option 1 or PPO Option 2, you will find that there are two tiers of coverage with different copays, deductibles, and out-of-pocket maximums. Each tier accumulates out of pocket expenses separately, so if you have care with a Tier 2 provider, those expenses you paid out of pocket are not counted toward your Tier 1 deductible. How do I find a provider in network with Anthem HealthSync? It’s very simple to find a network provider as an active Anthem member! When you register for an account on the Anthem member portal or download the Sydney Health app, there’s a simple search function for providers in your area organized by specialty. Are we still using TrueScripts as our pharmacy benefit administrator? No – your prescription drug plan will be administered by Navitus in 2026. You will receive a new health insurance card in the mail prior to 1/1/2026 that will contain updated Rx information. What changes can I expect with our new pharmacy benefit manager, Navitus? You will notice very little change to your pharmacy benefit administration. If you use specialty medications, you will work directly with Navitus’s partners at Lumicera Health Services – please contact their specialists at 855- 847-3553 to learn more. If you would like to save time and money on maintenance medications, consider using the Costco mail order pharmacy! If you are using a brand-name drug, you may be eligible for manufacturer copay assistance; please contact Navitus’s Customer Care at 855-847-1025 to learn more. I am already on a copay assistance program. Do I have to sign up again? No, you do not need to sign up again. However, contact Customer Care at 855-847-1025 to let us know you are already in the program. This will prevent any issues at the pharmacy. The major healthcare providers in Huntington County are Parkview and Lutheran. Where should I go? As a healthcare consumer you should always select a provider that makes you comfortable. You can continue to access care wherever you feel is best. However, the new Lutheran facility that recently opened is considered a Tier 1 facility, which would mean a lower deductible for your family’s care. The Parkview facilities are in the Tier 2 network, which would mean higher deductibles for your family.

2026 FAQ My doctor is in the Parkview hospital system. Do I have to find a new one? Most doctors in the Parkview system are in your Anthem HealthSync network as Tier 2 providers. Remember that both Anthem PPO Plan #1 and PPO Plan #2 offer two tiers of coverage depending on which types of healthcare providers (doctors, hospital systems, etc.) you use. Since Anthem has negotiated the best discounts with their high-performing Tier 1 providers, you will have a lower deductible than if you use a Tier 2 provider. Please reference the 2026 plan summaries and the medical plan design page of your 2026 benefit guide to see how your deductible will be higher with Tier 2 providers than with Tier 1. In summary: most Parkview doctors are in your Anthem network, but you may have a higher deductible to meet for your healthcare services before the Plan’s coinsurance begins to cover the majority of your remaining covered expenses (known as coinsurance). Is the Parkview hospital in network? Yes, the Parkview hospital in Huntington is in-network. However, please keep in mind that Parkview providers will almost always be in Tier 2 for the Anthem HealthSync plans, so your deductible to meet for covered healthcare expenses before the Plan’s coinsurance kicks in will be higher than if you choose a Tier 1 provider. If you would like to search for Tier 1 providers to help manage your healthcare costs, you may start with the Anthem website’s provider search function. Tip: a great place to start is the new Lutheran facility that opened in Huntington in 2024. Their onsite providers are in Tier 1! Do copays count toward my deductible? The flat copay amounts you pay for primary care physician visits, prescription drugs, etc. will not help you reach your deductible, but they are factored into your annual out of pocket maximum. If I have a hospital stay with a Tier 1 provider, will my out of pocket expenses count to my Tier 2 deductible? The tiered system means there are different annual deductibles your family may be subject to during the year. Tier 1 providers offer deeper discounts and will result in lower costs for both you and the insurer, so you will have a lower deductible that will need to be met for non-copay services such as inpatient hospital stays. Tier 2 providers are more expensive, so if you receive care from one you will be subject to a higher deductible for the year. If you incur expenses with a Tier 1 provider and later visit a Tier 2 provider, the out of pocket costs you paid in Tier 1 will be honored to the Tier 2 deductible; however, Tier 2 expenses will not be honored toward your Tier 1 deductible. What does it mean for a deductible to be embedded or non-embedded? Embedded and non-embedded deductibles apply when you have family members as dependents on your medical plan. With a non-embedded deductible, the family has one big deductible that collectively has to be met before the plan’s coinsurance begins. One family member could theoretically meet the whole family’s deductible on their own! With an embedded deductible, each family member has their own smaller share of the deductible. When that family member meets their own deductible, the Plan begins to pay coinsurance for their remaining expenses, even if other family members are still working on their own shares of the deductible.

2026 FAQ How is a PPO different from a HDHP? Prior to 2025, HCCSC only sponsored High Deductible Health Plans (also called HDHPs, Consumer Driven Health Plans, or CDHPs). These plans are designed such that a participant is fully responsible for the full cost of their healthcare and medications until they reach their deductible, after which the plan begins to cover all or a portion of healthcare expenses. In 2025 HCCS switched to a PPO design, which means instead of paying the full cost of healthcare for doctor’s visits and medications, you instead pay a predictable and affordable fixed copay amount. Another major difference between HDHPs and PPOs is that you are not permitted to contribute pre-tax dollars to a Health Savings Account, or HSA. HSAs are designed to help members reach the high deductible amount in an HDHP without the burden of income tax, so if you are enrolled in the PPO, you may not contribute funds to an HSA. I had an HSA prior to 2025 that still has a balance. What happens to those funds? If you have money in an HSA today, don’t worry! The funds already in your account were not forfeited when you began participating in your PPO healthcare plan. You can continue spending available funds from a Health Savings Account even if you are no longer eligible to contribute new funds to the account. You can feel free to spend your unused HSA dollars on your eligible out of pocket medical expenses next year. Please review this list of eligible HSA expenses. Is there an alternative to an HSA I can use to pay for medical expenses on a pre-tax basis? Yes! As a PPO participant, you may be eligible to participate in a traditional Healthcare Flexible Spending Account (FSA). You can sign up with an FSA provider of your choosing, or you can get in contact with American Fidelity before 12/31/2025 to sign up for their FSA product.