HSP medical coverage overview
How the HSP Options Work
The plan pays 100% (before deductible) for:
in-network preventive care such as regular checkups
generic prescriptions and insulin on the HSP Preventive Therapy Drug List
oral and injectable diabetes drugs (brand drugs without generic alternatives) and supplies (including insulin pumps and test strips)
You'll pay 50% and CVS Health pays 50% after the deductible for out-of-network preventive care.
You’ll pay the full discounted cost for non-preventive health care services out of your pocket — including doctor visits and prescriptions — until you reach your deductible. Then, you and CVS Health share the cost of services — you pay 20% and CVS Health pays 80% — until you reach your out-of-pocket maximum.
Learn more about Health Savings Plan (HSP)
| HSP 1 | HSP 2 | HSP 3 |
|---|---|---|
| Annual Deductible
For family coverage, the entire family deductible must be met before coinsurance applies for non-preventive medical and prescriptions for anyone in the family.1 |
||
| In-network | ||
| Aetna: $1,600 individual / $3,200 family Kaiser Permanente (Non-Aetna, California Only):Individual coverage: $1,600 |
$2,100 individual / $4,200 family |
$3,375 individual / $6,750 family |
| Out-of-network2 | ||
$3,200 individual / $6,400 family |
$4,200 individual / $8,400 family |
$6,750 individual / $13,500 family |
| Coinsurance3 Once you meet your plan’s deductible, CVS Health begins to share the cost of your care. You pay a percentage of the cost of your care, and CVS Health pays the rest. | ||
| In-network | ||
Plan pays 80% / You pay 20% after the deductible | ||
| Out-of-network2 | ||
CVS Health pays 50% / You pay 50% after the deductible | ||
| Preventive Medical Care4 | ||
| In-network | ||
CVS Health pays 100%, no deductible | ||
| Out-of-network2 | ||
CVS Health pays 50% / You pay 50% after the deductible | ||
| Prescription Drugs (Value Formulary through CVS Caremark) | ||
| ||
| Mental Health Counseling | ||
| ||
Annual Out-of-Pocket Maximum
| ||
| In-network | ||
$3,200 per individual / $6,400 family maximum |
Individual coverage: $4,200 |
Individual coverage: $6,750 |
| Out-of-network | ||
$6,400 per individual / $12,000 family maximum |
$8,400 per individual / $16,800 family maximum |
$13,500 per individual / $27,000 family maximum |
1 Colleagues who are eligible for Kaiser Permanente: If you’re enrolled in HSP 1 Kaiser Permanente (applies only to certain ZIP codes in California, for colleagues not in the Aetna Business Unit), your family deductible works differently: Once one person in the family meets the individual deductible, coinsurance applies for that person’s non-preventive medical and prescriptions.
2 Out-of-network benefits are payable based on the recognized charge for each service. The recognized charge is based on a formula for determining typical charges for services in your area. Your costs above the recognized charge don’t count toward your deductible or out-of-pocket maximum. The out-of-network deductible is separate from the in-network deductible and claims do not cross apply.
3 Applies to non-preventive services, including office visits, lab tests, hospitalization, surgery and prescriptions. See the Medical Option Summaries on the enrollment website for details.
4 Colleagues who are eligible for Kaiser Permanente: If you’re enrolled in HSP 1 Kaiser Permanente (applies only to certain ZIP codes in California, for colleagues not in the Aetna Business Unit), your family out-of-pocket maximum works differently:
Once one person in the family meets the individual out-of-pocket maximum, all covered medical and prescriptions for that person will be covered at 100% for the rest of the plan year.
Once the family out-of-pocket maximum is met, CVS Health pays 100% of the cost of covered expenses for all family members for the rest of the plan year.
Keep in mind: Using Centers of Excellence (specialized surgical facilities that meet rigorous program requirements) for certain medical services, such as IVF, transplants and bariatric surgery, is required for all options. If you don’t use one of these facilities, your medical plan will not cover your treatment. You’ll pay the full cost out of your own pocket.
Your paycheck costs for coverage will depend on your annual benefits base rate (ABBR)* , the option you choose and who you cover.
You can see your personalized rates, ABBR** and summaries of the plans available to you on the enrollment website during the enrollment period.
*ABBR is not used for determining paycheck costs for HSP 1 Kaiser Permanente in California. See below for information about this option.
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Prescription Coverage
HSP Prescription Coverage
All HSP options cover prescriptions on the Value Formulary through CVS Caremark.
About the Value Formulary
The Value Formulary promotes use of generics and select preferred brands and specialty medications.
Brand medications that have a generic alternative are not typically covered. For example, Crestor®, a brand name medication used to treat high cholesterol, is not covered. The generic Atorvastatin is covered at 100%.
Selected lifestyle medications (e.g., weight loss, smoking cessation and erectile dysfunction) are covered.
The percentage of the cost you pay is the same for all non-preventive drugs (except for specialty drugs; see “Non-Preventive Generic and Brand Drugs Covered by the Value Formulary” below). However, the dollar amount you pay for a prescription will depend on the specific drug.
To get the best value, use generics whenever possible. Note that some brand or other drugs may not be covered if other, more clinically effective medications are available.
Preventive Drugs
Our HSP options help you stay on the path to better health with lower costs for certain preventive drugs that control cholesterol, high blood pressure and other health risks. The Internal Revenue Service (IRS) determines the medications considered to be preventive and included on the HSP Preventive Therapy Drug List.
You pay nothing for generic preventive drugs or brand insulin on the list.
You also pay nothing for oral and injectable diabetes drugs (brand drugs without generic alternatives) and supplies (including insulin pumps and test strips).
You pay a $100 copay for specialty brand preventive drugs on the list.*
You pay 20% of the discounted cost of all other brand preventive drugs on the list; no deductible applies.
*If your brand preventive drug is a specialty drug and its actual cost is less than $100, you’ll pay the actual cost. If the actual cost of the specialty brand preventive drug is $100 or more and the 20% coinsurance amount is less than $100, the $100 copay will still apply.
Non-Preventive Generic and Brand Drugs Covered by the Value Formulary
For drugs that aren’t on the HSP Preventive Therapy Drug List, you’ll pay the full discounted cost until you meet the combined medical/prescription deductible.*
For non-preventive drugs (such as antibiotics and pain relievers): After you meet the deductible, you pay 20% of the cost and CVS Health pays 80%.
For specialty drugs: After you meet the deductible, you pay a $100 copay.
* Not applicable to oral and injectable diabetes drugs (brand drugs without generic alternatives) and supplies (including insulin pumps and test strips) covered at 100%.
Specialty Drugs
After you meet your deductible, if the drug is included in the PrudentRx program:
If enrolled: You pay a $0 copay.
If not enrolled: You pay 30% of the discounted cost until you meet the annual out-of-pocket maximum.
If your drug is not on the Prudent Rx list: You pay 100% of the discounted cost until you reach the deductible, then you pay $100 until you meet the out-of-pocket maximum.
Maintenance Drugs
If you take a generic maintenance drug, you may receive two fills with a 30-day supply; after that, you’re required to fill your maintenance drugs every 90 days.
A CVS pharmacist will contact your prescribing doctor to update your maintenance drug prescription to a 90-day supply. You can pick up your maintenance drugs at a CVS Pharmacy or through mail order.
Note: If you take a brand maintenance drug, you are required to fill your prescriptions with a 30-day supply. You can pick up your maintenance drugs at a CVS Pharmacy or through mail order.
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HSP - Out-of-Pocket-Maximums
HSP out-of-pocket maximums
How the HSP Out-of-Pocket Maximum Works
The out-of-pocket maximum is the most you will pay from your own pocket during the plan year for covered medical care and prescriptions. The out-of-pocket maximum includes your deductible and any money you pay toward your coinsurance. Each HSP option has a separate out-of-pocket maximum for in-network and out-of-network services and claims do not cross-apply.
If you cover someone besides yourself, the out-of-pocket maximum works differently for family coverage for HSP 2 and HSP 3. Individuals have a separate out-of-pocket maximum, or “Limit,” within family coverage. This means that one individual with large medical expenses within the family can have expenses capped without having to meet the full family out-of-pocket maximum.
Example
Note: HSP 3 would work the same way, using the in-network $6,750 family deductible, $6,750 individual out-of-pocket maximum and $13,500 family out-of-pocket maximum.
In HSP 1, you must meet the entire family out-of-pocket maximum before CVS Health pays 100% of eligible expenses for any family member for the rest of the plan year.*
In HSP 2 and HSP 3, once one person meets the individual out-of-pocket maximum within their family coverage ($6,750 for in-network care for both HSP 2 and HSP 3), CVS Health pays 100% of eligible expenses for that person for the rest of the plan year. Then, once you meet the family out-of-pocket maximum, CVS Health pays 100% of eligible expenses for all family members for the rest of the plan year.
* If you’re enrolled in HSP 1 Kaiser Permanente, your family out-of-pocket maximum works differently. Refer to the "HSP Provider Networks" or view the Medical Option Summaries on the enrollment website for more information.
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HSP - Health Savings Account (HSA)
HSP Health Savings Account (HSA)
The HSA is a special savings account that’s set up in your name for your eligible health care expenses when you enroll in an HSP option:
CVS Health adds tax-free money to your HSA in equal amounts each pay cycle: $500 per year if you elect individual coverage and $1,000 per year if you elect family coverage.
If you become eligible for an HSA after June 1, the CVS Health contribution will be pro-rated.
You can spend the money in your HSA on eligible health care expenses — which is especially helpful before you meet your deductible — or save it for future expenses.
You can also save your own tax-free money in your HSA by making contributions through payroll. The IRS places an annual calendar year limit on HSA contributions based on the coverage you elect. This limit will be reflected in the enrollment system.
Any HSA money you don’t use by the end of the plan year rolls over into the next plan year and earns interest.
When your HSA balance reaches $1,000, you can invest it to potentially earn more.
The money in your HSA is yours to keep, even if you leave the company or change your health plan.
*When you enroll in an HSP option, an HSA is set up in your name automatically, unless you indicate you aren’t eligible. For example, you aren’t eligible to contribute to an HSA if you are enrolled in Medicare, have other coverage that is not also a qualifying high deductible plan or can be claimed as a dependent on someone else’s tax return. If you aren’t eligible for an HSA and you indicate the reason when you enroll, a Health Reimbursement Account (HRA) will be set up for you to receive your company contribution. You’ll receive a new PayFlex HRA debit card in the mail to use to pay for eligible health care expenses. Please note: Any HRA balance that remains at the end of the plan year will roll over to the following plan year as long as you continue to be enrolled in a CVS Health HSP option.
Contribute to your HSA
For extra tax savings, add your own money to your account during the plan year to build on the CVS Health contribution as well as any Well-being Rewards you (and your enrolled spouse/partner, if applicable) earn by participating in certain My Well-being programs. (Earned rewards are deposited into your HSA). You can start, stop or change your contributions anytime. Contributing even a small amount from each paycheck could offer extra peace of mind, potentially lower your taxable income and build your HSA over time.
Learn about when to pay for care by viewing the Understanding your Health Savings Plan (HSP) PDF.
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HSP - Find Provider
Find an HSP in-network provider
To find doctors and other providers in an Aetna network, use the Aetna online provider directory or call 1-800-558-0860.
Your network for medical coverage is based on your home ZIP code
For most locations, all three HSP options use the Aetna Choice POS II network, the broadest Aetna national network.
The following 12 locations use the APCN Plus network for HSP 1 only and the broad national Aetna Choice POS II network for HSP 2 and HSP 3.
Location APCN Plus ACO/Joint Venture (JV) Network for HSP 1 Phoenix, Arizona Banner | Aetna JV Los Angeles, CA Aetna Whole Health (AWH) Southern California Connecticut Aetna Whole Health (AWH) Value Care Alliance & Trinity Health of New England Jacksonville, FL Aetna Whole Health (AWH) Baptist Health & St. Vincent’s HealthCare Minneapolis, MN Allina Health | Aetna JV New Jersey Aetna Whole Health (AWH) New Jersey Raleigh, NC Aetna Whole Health (AWH) Duke Health, WakeMed & THN-Cone Health Memphis, Nashville, Upper Cumberland, TN Aetna Whole Health (AWH) Tennessee Vanderbilt Health Affiliated Network (VHAN) Dallas, Texas Texas Health Aetna JV Houston, TX Aetna Whole Health (AWH) Memorial Hermann San Antonio, Texas Aetna Whole Health (AWH) Baptist Health System & Health Texas Medical Group – Quality Partners in Care (QPIC) Cleveland,OH Aetna Whole Health (AWH) Cleveland Clinic If you’re eligible for an APCN Plus network and choose HSP 1, your paycheck contributions for coverage will be the same as those for HSP 2 through Aetna Choice POS II.
California Colleagues: Kaiser Permanente May Be an Additional Network Option for HSP 1
If you reside in California, and are not in the Aetna Business Unit, HSP1 Kaiser Permanente may be an additional network option depending on your zip code. Kaiser Permanente believes “together is better.” Your doctors and caregivers work together directly, coordinating your care so you get the right care, right when you need it.
If you enroll in HSP 1 Kaiser Permanente: Your medical option will cover in-network care only.
What's different?
Family deductible:
Once one person in the family meets the individual deductible, coinsurance applies for that person's non-preventive medical and prescriptions.
Out-of-pocket maximum:
Once one person in the family meets the individual out-of-pocket maximum, all covered medical and prescriptions for that person will be covered at 100% for the rest of the plan year.
Once the family out-of-pocket maximum is met, CVS Health pays 100% of the cost of covered expenses for all family members for the rest of the plan year.
Find Kaiser Permanente Doctors and Other Providers
Go to my.kp.org/cvs and choose Your Region from the drop-down and then click Select.
From the Support tab, scroll down to Find doctors and locations and choose Find the right doctor or locate a facility.
Follow the prompts on the page to select Doctor or Location to find network providers for your medical coverage in HSP 1.
You will use providers in this network once your medical plan coverage begins.
**Annual Base Benefits Rate (ABBR)
For the 2024−2025 plan year (June 1, 2024 − May 31, 2025), your ABBR is defined as follows:
If you have completed two or more years of service as of Feb. 29, 2024, ABBR is your annual salary, as of Feb. 29, 2024, plus your total averaged annual performance-related bonuses and commissions paid during the two-year period before Feb. 28, 2024.
If you have not completed two years of service as of Feb. 29, 2024, ABBR is your annual salary, as of Feb. 29, 2024, plus your total performance-related bonuses and commissions paid during the one-year period before Feb. 29, 2024.
If you were hired or were rehired after 13 weeks on or after Feb. 29, 2024, your ABBR is your annual salary as of your date of hire/rehire. If you terminate your employment and then are rehired within 13 weeks, your prior ABBR is restored.
ABBR is updated effective on June 1 each year if you are actively at work. If you are on paid or unpaid leave, your ABBR will not be updated until you return to work for one full day. Generally, your ABBR will not change throughout the plan year.
