Medical

My Health

Medical

Ulta Beauty provides medical coverage for you and your family. With different plan options available, you can choose the coverage that is right for you.

• Medical Plans – Non-Hawaii Associates

  Eligibility: Full-time associates (non-Hawaii)

  Provider: Blue Cross and Blue Shield of Illinois (BCBSIL)

  Enroll: https://ultabenefits.bswift.com/

  Post-Enrollment:

  • Physical ID cards will be mailed to your home within 14 business days.

  • Register for Blue Access for Members to download your virtual card, find an in-network provider through the BCBS Physician Finder, review claims, and utilize additional programs and resources offered to you.

  BCBSIL All plans have the same network of doctors but vary in service coverage costs and payroll deductions.	PPO Plus Plan In Network	PPO Plan In Network	HSA Plan In Network
  Deductible (annual) • Per Person • Per Family	• $450 • $1,350	• $1,250 • $3,750	Non-Embedded* • $2,000 • $5,000
  Coinsurance (associate %)	10% after deductible	30% after deductible	20% after deductible
  Out-of-Pocket Max • Per Person Per Year • Per Family Per Year	• $2,000 • $6,000	• $3,500 • $10,500	• $5,000 • $12,500
  Primary Care Visit	$25 copay	$30 copay	20% coinsurance after deductible
  Specialist Visit	$40 copay	$50 copay	20% coinsurance after deductible
  Preventive Care	$0	$0	$0
  Inpatient Hospital	Additional $300 deductible; then 10% coinsurance	Additional $300 deductible; then 30% coinsurance	20% coinsurance after deductible
  Outpatient Hospital	Additional $150 deductible; then 10% coinsurance	Additional $150 deductible; then 30% coinsurance	20% coinsurance after deductible
  Emergency Room	$200 co-pay	$200 co-pay	20% coinsurance after deductible
  Urgent Care	$75 co-pay	$75 co-pay	20% coinsurance after deductible
  Telemedicine	$0	$0	$0
  Lifetime Maximum	Unlimited	Unlimited	Unlimited
  Health Savings Account Employer Contribution (annual/per plan year)	N/A	N/A	$500 - associate only $1,000 - all other coverages
  Pharmacy	Click here.

  *With a non-embedded deductible, there is only one deductible for the entire family. This means that all medical expenses paid by any family member count toward the same family deductible. Once the total family deductible is met, the health plan begins to cover costs for everyone in the family, using the plan’s usual coinsurance.

  **In addition to the telemed services included in your medical plan, you have access to separate telemedicine services through First Stop Health. These are two different options you can use for virutal care. Click here for more information on virtual health options.

• Medical Plans – Hawaii Associates

  You have two options through Hawaii Medical Service Association (HMSA): PPO or HMO. Each of the plans includes a pharmacy benefit and virtual care.

  Eligibility: Full-time Hawaii associates

  Provider: Hawaii Medical Service Association (HMSA)

  Enroll: https://ultabenefits.bswift.com/

  Hawaii Medical Service Association (HMSA)	PPO	HMO
  Deductible (Single/Family)	N/A	N/A
  Out-of-Pocket Max (Single/Family)	$2,500/$7,500	$2,500/$7,500
  Preventive Care	$0	$0
  Coinsurance	10% inpatient 20% outpatient	10% inpatient 20% outpatient
  Office Visit Copay (PCP/SP)	$12/$12	$20/$20
  Physical Therapy Copay	20% coinsurance	$20
  Radiology (X-Ray)	20% coinsurance	$10
  Radiology (MRI, CT Scan, etc.)	20% coinsurance	20% coinsurance
  Urgent Care Copay	$12	$20
  Emergency Room Copay	20% coinsurance	$100
  Hospital Room & Board	10% coinsurance	10% coinsurance
  Surgery	10% coinsurance (cutting) 20% coinsurance (non-cutting)	10% coinsurance (cutting) 20% coinsurance (non-cutting)
  Telemedicine**	Click here.
  Pharmacy	Click here.

  Rates and information can be found at ultabenefits.bswift.com.