Medical & Prescription Plans

In our continuous effort to ensure the well-being of you and your family, Batesville Tool & Die will continue to provide two medical plans, administered by Imagine360. The table below summarizes the key features of the medical coverage. The deductibles, copays and coinsurance percentages in the following chart indicate the amounts for which you are responsible.

Services

Copay Plan

High Deductible Health Plan

Carrier

Imagine360

Deductible (Individual/Family)	$1,500 Individual/$3,000 Family Wellbridge Surgical: $0	$3,300 Individual/$6,600 Family Wellbridge Surgical: $0 (BTD reimbursing first $1,650 Individual/$3,300 Family
Health Savings Account (HSA) Employer Contributions	N/A	$1 for $1 match for every dollar you contribute up to $125 single/$250 family max per quarter *first time enrollees will receive one-time employer contribution $250 single/$500 family
Out-of-Pocket Maximum (Individual/Family)	$4,000 Individual/$12,000 Family	$6,650 Individual/$13,300 Family
Preventive Care	100% Covered	100% Covered
Physician Visit Primary Care/Specialist	$25 copay/$35 copay	Deductible, then 20% coinsurance
Hospitalization	Deductible, then 30% coinsurance	Deductible, then 20% coinsurance
Emergency Room	$250 Copay, then 30% coinsurance	Deductible, then 20% coinsurance
Urgent Care	$75 copay	Deductible, then 20% coinsurance

Prescription Drugs

Generic	Retail: $10 Copay Mail Order: $20 Copay	Retail: Deductible then, 20% coinsurance Mail Order: Deductible, then 20% coinsurance
Preferred	Retail: 30% Coinsurance Mail Order: 30%	Retail: Deductible, then 20% coinsurance Mail Order: Deductible, then 20% coinsurance
Non-Preferred Brand	Retail: 30% Coinsurance +$15 Mail Order: 30% + $30	Retail: Deductible, then 20% coinsurance Mail Order: Deductible, then 20% coinsurance
Specialty Drugs	Not covered	Not covered

*Aurora Health will be utilized to source specialty medications. See the pharmacy section for more details.

Weekly Deductions

	Employee Only	Employee & Spouse	Employee & Child(ren)	Employee & Family
Copay Plan	$47.85	$85.45	$79.05	$107.66
HSA	$35.62	$68.35	$63.24	$86.13

Manage your benefits on

Paylocity

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