• Use multiple words
• Use correctly spelled words

• Vacation policy
• Health spending account
• Saving money

Learn More About 

Your Benefits Non-California Associates

Learn More About 

Your Benefits

Non-California

Associates

WHAT’S NEW?

PLAN COMPARISON

Blue Shield PPO

Plan Provision 2024/2025 Plan Year 2025/2026 Plan Year
Annual Deductible:
In-network / Out-of-network
$250 / individual & $500/family $500 / individual & $1,000 / family
Annual Out-of-pocket Maximum:
In-network / Out-of-network
$2,250 / individual & $4,500 / family INN: $2,500 / individual & $5,000 / family
OON: $5,750 / individual & $11,500 / family
PCP/Specialist Copay:
In-network
PCP: $10 per visit
Specialist: $10 per visit
PCP: $20 per visit
Specialist: $30 per visit
Urgent Care:
In-network
$10 per visit $40 per visit
Emergency Room Visit:
In-network / Out-of-network
$100 copay (waived if admitted) + 10% $150 copay (waived if admitted) + 10%
Prescription Drugs Retail Copays:
In-Network (Tiers 1, 2, 3 and 4)
$10 / $15 / $30 / $30 $10 / $20 / $40 / $60
Prescription Drugs Mail Order Copays:
In-Network (Tiers 1, 2, 3 and 4)
$20 / $30 / $60 / $60 $20 / $40 / $80 / $120
Level of Coverage (You, You + Spouse, You + Child(ren) and You + Family) $80 / $160 / $150 / $320 $100 / $200 / $190 / $400

Blue Shield EPO

Plan Provision Blue Shield EPO
In-Network Only
HSA Eligible No
Calendar Year Deductible Individual: $750
Family: $1,500
Coinsurance 20% Deductible applies
Calendar Year Out-of-Pocket Max Individual: $3,250
Family: $6,500
Doctor Visit PCP: $20/visit
Specialist: $40/visit
(deductible does not apply)
Preventive Care No charge
Hospitalization 20% Deductible applies
Emergency Room Visit $200 (copay waived if admitted)
Emergency Room Physicians 20% Deductible applies
Urgent Care $50/visit (deductible does not apply)
Ambulance 20% Deductible applies
Prescription Drugs Retail Copays:
In-Network (Tiers 1, 2, 3 and 4)
$10 / $20 / $40 / $80
Prescription Drugs Mail Order Copays:
In-Network (Tiers 1, 2, 3 and 4)
$20 / $40 / $80 / $160
Level of Coverage (You, You + Spouse, You + Child(ren) and You + Family) $60 / $120 / $110 / $240

EyeMed Vision

Plan Provision EyeMed Vision (PPO Plan) EyeMed Vision (Buy – Up PPO Plan)
In-Network Out-of-Network Reimbursement In-Network Out-of-Network Reimbursement
Routine Eye Exam $10 copay
PLUS Providers: $0 copay
Up to $50 $10 copay
PLUS Providers: $0 copay
Up to $50
Eyeglass Frames $130 allowance; 20% off balance over $130 allowance
PLUS Providers: $180 allowance; 20% off balance over $180 allowance
Up to $98 $160 allowance; 20% off balance over $160 allowance
PLUS Providers: $210 allowance; 20% off balance over $210 allowance
Up to $112
Contact Lenses Up to $105 allowance; 15% off balance over $105 allowance
PLUS Providers: Up to $155 allowance; 15% off balance over $155 allowance
Up to $105 Up to $130 allowance; 15% off balance over $130 allowance
PLUS Providers: $180 allowance; 20% off balance over $180 allowance
Up to $105
Medically Necessary Contact Lenses No Charge Up to $210 allowance No Charge Up to $210
Standard Contact Fitting Up to $40 Not available Up to $40 Not available
Premium Contact Fitting 10% off retail price Not available 10% off retail price Not available
Eyeglass Lenses
Single Vision $25 copay Up to $50 $25 copay Up to $50
Bifocal $25 copay Up to $70 $25 copay Up to $70
Trifocal $25 copay Up to $90 $25 copay Up to $90
Frequency
Exams Every 12 months Every 12 months
Lenses Every 12 months Every 12 months
Frames Every 24 months Every 12 months

LIMITED PURPOSE FSA

HSA Annual Contribution Regulations

2025 Annual Limit EWB HSA Contribution Maximum Associate HSA Contribution
Individual Coverage $4,300 Up to $360 $3,940
Family Coverage $8,550 Up to $720 $7,830
Catch-Up Plan (must be 55-65 years old) $1,000 N/A Extra $1,000

Remember!

Investments options are available if your HSA balance is over $1,000

Increased Health Care Flexible Spending Account (HCFSA) and Health Savings Account (HSA) contribution limits: The IRS has increased the annual amount that you can contribute to your HCFSA to $3,300. Remember, the Health Care Flexible Spending Account (HCFSA), Dependent Care Flexible Spending Account (DCFSA), and Health Savings Account (HSA) require you to actively re-enroll each plan year.

What You Need to Do:

1. Enroll via UKG between April 14 – 25, 2025! Go to UKG > Menu (three lines at top left) > Person Icon > Myself > Benefits > Manage My Benefits to complete the process.
2. For instructions on how to enroll, visit this page