Medical/Prescription Drugs

Medical/Prescription Drugs

Medical and prescription benefits help protect your health and finances. Choosing the right plan ensures you and your family have access to quality care when you need it, while also helping you manage health care costs over time. Learn about your medical and prescription plan options below.

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Medical

La-Z-Boy offers two Preferred Provider Organization (PPO) medical plan options through Blue Cross Blue Shield of Michigan (BCBSM): A Standard Plan and the Health Saver Plan (HSA plan). Read below to learn more and check out this Standard vs. Health Saver Plan video to see which plan is best for your situation.

The two plans have many things in common, including:

• Preventive Care

  • Covered at 100% in-network (no copay, deductible, or coinsurance)

• Prescription Coverage

  • Comprehensive prescription drug coverage

• Out-of-Pocket Maximum

  • Yes – Limits how much you’ll pay each year

There are some key differences to consider when choosing which plan is right for you. Read below for a snapshot of differences, plus check out these helpful videos to learn more: What is a Deductible and What is Preventive Care.

Differences in Standard vs. Health Saver Plan

	Standard Plan	Health Saver Plan
Payroll Deductions	Higher	Lower
Deductible	Lower	Higher
Office Visits (Primary/Specialty)	Flat-dollar copays	Full cost until deductible, then 20% coinsurance
Emergency & Teladoc Visits	Flat-dollar copays	20% coinsurance after deductible is fully met
After Deductible	Not applicable – copays continue	Plan pays 80%, you pay 20% (coinsurance)
HSA/FSA Eligibility	Eligible for Health Care FSA	Paired with HSA + $500 (Employee Only) or $1,000 (Employee +1 or More) La-Z-Boy contribution

Visit Blue Cross Blue Shield of Michigan and select “Find a Doctor” to see if your facility or provider is in-network. Your out-of-pocket costs are lower when you visit providers within the BCBSM Network.

Learn more details about each plan below.

• Standard Plan

  • Preventive care is covered at 100% when you use in-network providers. This includes annual checkups, immunizations, and routine screenings.

  • Copays: For some services like doctor visits, you’ll pay a set amount at the time of care. This applies even if you haven’t met your deductible.

  • Deductible: For services like imaging or hospital care, you’ll pay the full cost until your deductible is met. This amount varies based on coverage level and provider network.

  • Coinsurance: After meeting your deductible, you and the plan share costs for eligible services.

  • Out-of-Pocket Maximum: There’s a yearly limit to how much you pay. Once you hit that amount, the plan covers 100% of eligible expenses.

  Tip: You can use a Flexible Spending Account (FSA) to help pay for out-of-pocket costs with pre-tax dollars.

• Health Saver Plan (High-Deductible with HSA)

  This plan works a bit differently than the Standard Plan. It combines a high-deductible PPO medical plan with a special tax-advantaged HSA.

  • Preventive care (annual checkups, immunizations, screenings) is covered at 100% in-network.

  • For non-preventive care, including prescriptions, you must pay the full cost until you meet your plan's deductible.

    • If you cover yourself and one or more dependents, the full Employee +1 or More deductible must be met before the plan pays.

  • La-Z-Boy helps offset these costs with an HSA:

    • $500 for Employee Only

    • $1,000 for Employee +1 or More

  • After meeting your deductible, you’ll pay a share of costs through coinsurance. You can use your HSA to help cover this, too.

  • Coinsurance is the percentage of the cost you pay for a covered service after meeting your deductible. Example: You pay 20%, your plan pays 80%.

  • You’re protected by an out-of-pocket maximum, which limits what you pay in a year. Once you reach it, the plan pays 100% of covered expenses for the rest of the year.

  • If you participate in the Annual Wellness Program, you are eligible for a $520 HSA Reward, the year following participation.

  Tip: You can contribute pre-tax dollars and use HSA funds for eligible medical expenses or save them for the future. Your HSA is yours to keep, no matter where you work.

Prescription Drug

When you enroll in one of the medical plans, you are automatically covered by La-Z-Boy’s prescription drug plan, administered by OptumRx^® through BCBSM. The plan allows you to purchase prescriptions from a network of participating retail pharmacies. Your BCBSM medical card is all you need to present to the pharmacy, there is not a separate pharmacy card.

• How Prescription Coverage Works

  Both medical plans use the same pharmacy network and use the same prescription cost tiers (shown below).

  Standard Plan	Health Saver Plan
  Prescriptions have no deductible requirement. You pay a flat-dollar copay at the time you fill the prescription; amounts vary depending on the drug tier (see next page). The plan pays the rest. There is a Prescription Out-of-Pocket Maximum (OOPM) that is separate from the Medical OOPM. Once you reach it, the plan covers 100% of the cost of prescriptions (with no copay).	You pay 100% of the eligible cost of prescriptions until you reach the medical plan deductible. You may use your HSA to help offset the deductible costs. Once the deductible is met, the plan pays 80% of the cost, and you pay the remaining 20% as your coinsurance.

• Prescription Tiers

  Prescription drugs are categorized into payment tiers, as shown below. The tier your medication falls under determines the copay you will owe at the time you fill the prescription. The plan pays the rest. Generally, the lower the drug tier, the lower your cost.

  Drug Tier	Description	Cost Level
  Tier 1: Generic Drugs	Equivalent to brand-name drugs in quality, active ingredients, and effectiveness — but offered at a much lower cost.	Lowest Cost
  Tier 2: Preferred Brand Drugs	Brand-name drugs on the formulary when no generic alternative is available.	Mid-Level Cost
  Tier 3: Non-Preferred Brand Drugs	Brand-name drugs not on the preferred list — may be new, experimental, or not FDA-approved.	Highest Cost

  Tip: Generic equivalents are available for many of the Preferred and Non-Preferred Brand drugs at a significant cost savings for you. Consult with your provider to see if changing to a generic alternative (with a lower copay) is appropriate for you.

• Filling Your Prescriptions

  Regardless of your medical plan election, you have two convenient ways to fill your prescriptions through Optum Rx^®.

  • Retail Network Pharmacy: Best for one-time or short-term use medication. However, you can get a 90-day prescription filled through any retail in-network pharmacy (Walgreens, CVS, etc.).

  • Mail-Order Delivery or Retail 90 Program: Good option for recurring, long-term prescriptions (i.e., medications for high blood pressure, asthma, or diabetes). Offers a discounted price, receive a three-month’s supply for the cost of a two-month supply.

  IMPORTANT: All prescription drugs must be purchased from a pharmacy within the BCBSM Pharmacy Network, or you will be responsible for paying the full cost of the prescription.