FMP-PPO Benefits

In 2015

In 2016

Health Savings Account Company Contribution	You only: $375 You + family: $750	You only: $500 You + family: $1,000 The increased HSA Company contribution will help to offset even more of your out-of-pocket costs in 2016!
Diabetic Self-Management Training and Counseling	Diabetic self-management training and counseling are not covered.	Diabetic self-management training and counseling will be covered. Your plan’s annual deductible, coinsurance, and out-of-pocket maximum will apply.
Needles and Syringes	Needles and syringes are covered at 100% only on the day you purchase your injectable prescription medication.	The plan will cover needles and syringes at 100% within 120 days after the date your injectable prescription medication is dispensed.
Specialty Drugs Medications that are used to manage certain chronic conditions. For more information, contact Express Scripts at 1-800-778-0735.	You can use a retail pharmacy for your first, second and third specialty drug Medications that are used to manage certain chronic conditions. For more information, contact Express Scripts at 1-800-778-0735. fills, but you must use Accredo, Express Scripts’ specialty pharmacy, beginning with your fourth fill.	You’ll need to fill certain prescriptions for specialty drugs through Accredo, Express Scripts’ specialty pharmacy. For details, see the 2016 Specialty Drugs list on benefits.com.
Out-of-Pocket Maximum Rules and Limits for Individuals and Families	All members of a family enrolled in the FMP-PPO collectively contribute toward the plan’s annual deductible and out-of-pocket maximum. The most you are responsible to pay during a year for medical care and prescription drugs before your health plan starts paying 100% for eligible in-network expenses. Your annual out-of-pocket maximum includes: In-network medical deductible and coinsurance, PLUS In-network pharmacy deductible and coinsurance This means that an individual family member’s out-of-pocket costs for medical and/or pharmacy treatment can satisfy the entire family out-of-pocket maximum.	Most of the FMP-PPO plan’s rules and limits will remain the same for 2016. What’s new is that, according to IRS regulations, an individual family member’s out-of- pocket costs for medical and/ or pharmacy treatment can no longer satisfy the entire family out-of-pocket maximum. The most any individual’s costs can count toward the annual family out-of-pocket maximum will be $6,550.