Before we run through the plans, let’s make sure you understand all the terminology. In a perfect world, these names would be helpful, or even self-explanatory. But as far as anyone can tell, these terms were created by an evil warlock, whose sole goal was to confuse everyone who read or heard them. (If you’re wondering, the winner of the most-misleading-name-ever award goes to “coinsurance.”)

Here is what we’ll be covering…

General Health Coverage:

• Overview of Health Terms
• Network
• Premium
• Deductible
• Coinsurance
• Copay
• Out-of-Pocket Maximum
• Preventive Care

Pharmacy Specific Coverage:

• Formulary
• Generic Drugs
• Specialty Drugs
• Preventive Drug
• Mail-order Prescription Service

Let’s dive in.

Health-Coverage-to-English Translation Guide

Overview of Health Terms

Network

What is the difference between In-Network and Out-of-Network?

This is the group (or groups) of doctors, treatment centers, and pharmacies who have reached an agreement with your plan to provide you health care at a reduced cost, which saves you money.

Not only do in-network services have a lower price tag, but your plan will usually cover a higher percentage of that cost.

On the other hand, going out-of-network can also mean more limited coverage – or even no coverage at all. So you’ll always want to make sure to try and go to in-network providers. You can always search for in-network providers using your health plan’s website or app, or just call them to request assistance.

You should know though, in an emergency, you’ll be covered no matter where you go. In a life threatening situation, there’s no such thing as “out-of-network.”

Premium

What is a Premium?

This is what you pay each paycheck for your plan.

For many plans, the premium is automatically taken out of your paycheck before taxes (aka pre-tax). So you don’t pay taxes on that money. (Though some plans have post-tax premiums. If and when that’s the case, I’ll point it out.)

Deductible

What is a Deductible?

This is the amount you pay for health care services on your own, before your plan starts to pay.

If your plan has a deductible, here’s how it works:

At first, you’ll pay the full cost for most services you receive. But once you’ve paid a certain amount on your own (the deductible), your coverage kicks in and the plan starts sharing the costs of services with you.

The deductible can be tricky. Some services are covered before you reach the deductible. Some after. We’ll lay out the specifics as we walk through your plan details.

Coinsurance

What is Coinsurance?

While some costs are covered 100% by your plan, some are covered only partially: maybe at 90%, 85%, or so on. And you are then responsible for the remaining portion of the charges. When your plan splits the check with you like this, it’s called coinsurance.

Different services in a plan may have different levels of coinsurance.

Coinsurance usually kicks in after you’ve paid your deductible. But I’ll point out any exceptions below.

Be careful when reading coinsurance amounts; they can be shown in a number of ways. Sometimes they’re written as a fraction, like 90%/10%. Other times it’s just as a single percentage.

Usually, when shown as just a percentage, that number refers to the share of costs your plan pays for the services you receive. But plan descriptions out in the world can vary, and sometimes the number you see is the percentage of the bill YOU would be responsible for.

Always be careful when reading coinsurance values, and make sure you know which side of the split the number represents.

Copay

What is a Copay?

Some services always cost a fixed amount. This fixed price is a copay.

The amount of your copay depends on the type of service you receive.

Most copays go into effect the moment your plan coverage begins, even before you meet your deductible. And they may even apply to your deductible (though not always). Just check your plan details to see when they kick in, and at what amount.

Out-of-Pocket Maximum

What are Out-of-Pocket maximum expenses?

This is the limit to what you’d have to pay out of pocket in a worst-case scenario. While this number DOES include the deductible any copays, and coinsurance payments, it does NOT include your premiums. (For a true sense of your annual expenses in a worst-case scenario, you need to add your out-of-pocket max to your yearly, total premium costs.)

Past this number, your medical plan covers all your in-network costs at 100% for the remainder of the calendar year. (There are rare exceptions, but your plan details will call those out if they exist.)

The out-of-pocket maximum is sometimes confused with the deductible, but they are often very different numbers. Always, always, always check the out-of-pocket maximum before choosing a plan.

Preventive Care

This is routine health care that includes services like check-ups and preventive screenings.

Pharmacy-to-English Translation Guide

All the standard insurance-speak applies to prescriptions. But there are a few special terms that get brought up when talking about medications.

Formulary

This is the list of prescription drugs covered by your health plan – though the exact amount of coverage can vary. Health insurance companies often will update their formulary annually (although they can change their formulary whenever they want).

On a formulary, drugs are divided into tiers. And these tiers identify how the drug is covered by the plan. Tier-1 drugs have the highest coverage, while Tier-2 drugs have somewhat less. Then come Tier-3 drugs, and sometimes even Tier-4 or Tier-5 drugs, depending on how the formulary is designed. (Sometimes the tiers have names, and sometimes they only have the numbers I just showed you.)

Drugs not on the formulary may be more expensive than those on the tiers, or simply not covered at all.

Generic Drugs

These are medications with the same active ingredients as their brand-name counterparts, though potentially different inactive ingredients. A generic version of a drug becomes available once the patent for the brand-name drug ends.

The fact that generics are called “generic,” and that they cost less, sometimes raises suspicion when they’re prescribed. But generic drugs are strictly monitored by the FDA to make sure that the dosage and quality of the active ingredients is on par with the brand-name version.

Specialty Drugs

These are prescription drugs that require special handling, administration, or monitoring. They are typically used to treat rare and/or chronic diseases, and can often cost more than non-specialty drugs (sometimes, a lot more).

Preventive Drugs

Medications which help you manage a condition, to keep it from becoming more serious.

Mail-order Prescription Service

This is an authorized alternative to a retail pharmacy. Instead of going out every month and standing in line for your prescription, you can have a 90-day supply delivered to your home every three months. (It’s usually less cost to you than going to a local pharmacy, too.)

Medical Health Insurance

It’s important to recognize that not everyone needs the same amount of care. So, Waters provides you with some options for different situations. You’ll have a choice of three Aetna health plans:

• The Deductible $2,500/$6,250 Plan with an HSA or HRA
• The Deductible $1,550/$3,700 Plan with an HSA or HRA
• The Copay and Deductible Plan

With Aetna’s commitment to the health and wellbeing of the Waters family, you’ll have access to:

• Aetna’s concierge health advocates
• industry-leading technology that can help you navigate the complex world of health care
• and help managing the best care for you and your family.

Additionally, both the Deductible $1,550/$3,700 plan and the Deductible $2,500/$6,250 plan come with the option for you to contribute to a special pre-tax account, called a Health Savings Account, or HSA, to help pay for out-of-pocket medical costs.

The Deductible $1,550/$3,700 medical plan is designed to pay more up front, from each paycheck, but with lower out-of-pocket costs over the year, if you have non-preventive medical and/or Rx services.

The Deductible $2,500/$6,250 medical plan costs less up front in premiums, saving you money on each paycheck (this is a good opportunity for you to put the pay check savings into your pre-tax HSA Account). The deductible is higher, your share of the coinsurance and the maximum potential out-of-pocket costs are more than the other medical plan, the Deductible $1,550/$3,700 plan.

Note: if you do not qualify for an HSA, per IRS regulations, you can select a Health Reimbursement Account, or HRA, instead.

The Copay and Deductible plan is designed to have a higher premium cost, but a lower out-of-pocket cost at the point of service. This plan may be a good choice if you expect to have high health care needs. Most employees don’t have health care utilization claims high enough to make this plan be the best choice. Most employees are likely to still be better off in one of the other two plan choices. This is because throughout the whole year, total cost, premium costs and out of pocket expenses during the year, this plan will be the most expensive. Most employees don’t have health care utilization claims high enough to make this plan be the best choice. Most employees are likely to still be better off in one of the other two plan choices. This is because throughout the whole year, total cost, premium costs and out of pocket expenses during the year, this plan will be the most expensive.

Also, the Copay and Deductible plan does not qualify for an HSA or an HRA.

When going through enrollment, you don’t want to pick a more expensive plan than you need. But you also don’t want the reverse to happen, and pick too inexpensive a plan, just to end up paying too much out-of-pocket during the year. We’ll go over the key considerations you should make in the Choosing the Right Medical Plan section. But first, we should go over the details of each plan, so you know what you’re choosing between.

You also have the option of waiving coverage by choosing “I don’t want this benefit. (Waive).” (Be aware though that you will have to pay an IRS tax penalty if you aren’t covered by health insurance for at least 9 months of the year, so you should only waive Waters medical coverage if you’ll be getting it somewhere else.)

To help you decide, I’ve highlighted some of the features and costs for each.

The costs of your plan will depend on two factors:

• Which plan you pick
• Who you cover

To compare the costs of the three plans, just click on whichever group describes you best, and I’ll jump you down to that table:

• Employee Only (aka Individual)
• Employee + Child(ren)
• Employee + Spouse/Partner
• Employee + Spouse/Partner + Any Children (aka Family)

Employee-Only

The below premiums show in-network pricing only, and do not reflect the potential Working Spouse/Partner surcharge if applicable to you. The full plan summary, including out-of-network coverage, is located in the Library of WatersBenefitsNow.com.

	Deductible $2,500/$6,250 Plan	Deductible $1,500/$3,700 Plan	Copay and Deductible Plan
Premium	$23.40/paycheck (bi-weekly rate) ($608.40/yr) OR $25.35/paycheck (semi-monthly rate) ($608.40/yr)	$52.26/paycheck (bi-weekly rate) ($1358.76/yr) OR $56.62/paycheck (semi-monthly rate) ($1358.76/yr)	$76.44/paycheck (bi-weekly rate) ($1,987.44/yr) OR $82.81/paycheck (semi-monthly rate) ($1,987.44/yr)
Preventive Care	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)
Deductible	$2,500.00	$1,550.00	$750
Coinsurance	85%/15% (after deductible)**	90%/10% (after deductible)**	90%/10% (after deductible)**
Prescriptions To see what your specific prescription drugs cost, visit www.aetna.com	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 85%/15% coinsurance after deductible. 100% covered after out-of-pocket max	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 100% covered after deductible.	Eligible Preventive Tier 1 and Tier 2 Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Subject to a set copay amount per tier Tier 1 Generic $10 copay Tier 2 Brand Name Preferred $30 Tier 3 Brand Name Non-Preferred $50
Out-of-Pocket Max	$6,750.00	$4,450.00	$3,000

* Eligible Preventive Prescriptions – you can find preventive drugs that are eligible in the Preventive Drug Lists, under the Quick Links or Library Sections of WatersBenefitsNow.com

**For the two High Deductible Health Plans (HDHPs): Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office will be covered at 100% after your deductible is met. The plan will cover all eligible costs after you have met your annual deductible.
For the Copay and Deductible Plan: Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office are covered at 100%. The plan will cover all eligible costs. Your annual deductible does not apply for these services.

Employee + Children

The below premiums show in-network pricing only, and do not reflect the potential Working Spouse/Partner surcharge if applicable to you. The full plan summary, including out-of-network coverage, is located in the Library of WatersBenefitsNow.com.

	Deductible $2,500/$6,250 Plan	Deductible $1,500/$3,700 Plan	Copay and Deductible Plan
Premium	$46.02/paycheck (bi-weekly rate) OR $49.86 (semi-monthly rate) ($1196.52/yr)	$100.62/paycheck (bi-weekly rate) OR $109.01 (semi-monthly rate) ($2616.12/yr)	$152.88/paycheck (bi-weekly rate) OR $165.62 (semi-monthly rate) ($3,974.88/yr)
Preventive Care	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)
Deductible	$6,250.00	$3,700.00	$1,500.00
Coinsurance	85%/15% (after deductible)**	90%/10% (after deductible)**	90%/10% (after deductible)**
Prescriptions To see what your specific prescription drugs cost, visit www.aetna.com	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 85%/15% coinsurance after deductible. 100% covered after out-of-pocket max	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 100% covered after deductible.	Eligible Preventive Tier 1 and Tier 2 Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Subject to a set copay amount per tier Tier 1 Generic $10 copay Tier 2 Brand Name Preferred $30 Tier 3 Brand Name Non-Preferred $50
Out-of-Pocket Max	$13,500.00 ($6,750 for any one person)	$10,500.00 ($6,550 for any one person)	$6,000.00 ($3,000 for any one person)

* Eligible Preventive Prescriptions – you can find preventive drugs that are eligible in the Preventive Drug Lists, under the Quick Links or Library Sections of WatersBenefitsNow.com

**For the two High Deductible Health Plans (HDHPs): Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office will be covered at 100% after your deductible is met. The plan will cover all eligible costs after you have met your annual deductible.
For the Copay and Deductible Plan: Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office are covered at 100%. The plan will cover all eligible costs. Your annual deductible does not apply for these services.

Employee + Spouse/Partner

The below premiums show in-network pricing only, and do not reflect the potential Working Spouse/Partner surcharge if applicable to you. The full plan summary, including out-of-network coverage, is located in the Library of WatersBenefitsNow.com.

	Deductible $2,500/$6,250 Plan	Deductible $1,500/$3,700 Plan	Copay and Deductible Plan
Premium	$51.48/paycheck (bi-weekly rate) OR $55.77 (semi-monthly rate) ($1338.48/yr)	$116.22/paycheck (bi-weekly rate) OR $125.91 (semi-monthly rate) ($3021.72/yr)	$159.12/paycheck (bi-weekly rate) OR $172.38 (semi-monthly rate) ($4,137.12/yr)
Preventive Care	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)
Deductible	$6,250.00	$3,700.00	$1,500.00
Coinsurance	85%/15% (after deductible)**	90%/10% (after deductible)**	90%/10% (after deductible)**
Prescriptions To see what your specific prescription drugs cost, visit www.aetna.com	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 85%/15% coinsurance after deductible. 100% covered after out-of-pocket max	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 100% covered after deductible.	Eligible Preventive Tier 1 and Tier 2 Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Subject to a set copay amount per tier Tier 1 Generic $10 copay Tier 2 Brand Name Preferred $30 Tier 3 Brand Name Non-Preferred $50
Out-of-Pocket Max	$13,500.00 ($6,750 for any one person)	$10,500.00 ($6,550 for any one person)	$6,000.00 ($3,000 for any one person)

* Eligible Preventive Prescriptions – you can find preventive drugs that are eligible in the Preventive Drug Lists, under the Quick Links or Library Sections of WatersBenefitsNow.com

**For the two High Deductible Health Plans (HDHPs): Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office will be covered at 100% after your deductible is met. The plan will cover all eligible costs after you have met your annual deductible.
For the Copay and Deductible Plan: Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office are covered at 100%. The plan will cover all eligible costs. Your annual deductible does not apply for these services.

Employee + Spouse/Partner + Any Children (Family)

The below premiums show in-network pricing only, and do not reflect the potential Working Spouse/Partner surcharge if applicable to you. The full plan summary, including out-of-network coverage, is located in the Library of WatersBenefitsNow.com.

	Deductible $2,500/$6,250 Plan	Deductible $1,500/$3,700 Plan	Copay and Deductible Plan
Premium	$74.88/paycheck (bi-weekly rate) OR $81.12 (semi-monthly rate) ($1946.88/yr)	$162.24/paycheck (bi-weekly rate) OR $175.76 (semi-monthly rate) ($4218.24/yr)	$243.36/paycheck (bi-weekly rate) OR $263.64 (semi-monthly rate) $6,327.36
Preventive Care	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)	100% covered (even before hitting deductible)
Deductible	$6,250.00	$3,700.00	$1,500.00
Coinsurance	85%/15% (after deductible)**	90%/10% (after deductible)**	90%/10% (after deductible)**
Prescriptions To see what your specific prescription drugs cost, visit www.aetna.com	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 85%/15% coinsurance after deductible. 100% covered after out-of-pocket max	Eligible Preventive Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Full, network-discount price, until you meet deductible 100% covered after deductible.	Eligible Preventive Tier 1 and Tier 2 Prescriptions* covered 100% (from day 1 of plan year) All other eligible prescriptions... Subject to a set copay amount per tier Tier 1 Generic $10 copay Tier 2 Brand Name Preferred $30 Tier 3 Brand Name Non-Preferred $50
Out-of-Pocket Max	$13,500.00 ($6,750 for any one person)	$10,500.00 ($6,550 for any one person)	$6,000.00 ($3,000 for any one person)

* Eligible Preventive Prescriptions – you can find preventive drugs that are eligible in the Preventive Drug Lists, under the Quick Links or Library Sections of WatersBenefitsNow.com

**For the two High Deductible Health Plans (HDHPs): Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office will be covered at 100% after your deductible is met. The plan will cover all eligible costs after you have met your annual deductible.
For the Copay and Deductible Plan: Services received at CVS Minute Clinics, CVS Health Hubs, and Waters’ own on-site walk-in MedExpress clinic in the Milford office are covered at 100%. The plan will cover all eligible costs. Your annual deductible does not apply for these services.

If you go out of network under either the Deductible $1,550/$3,700 Plan or the Deductible $2,500/$6,250 Plan, the deductible is higher, your co-insurance responsibility is higher, and the out-of-network maximum is higher, so you’ll most likely end up paying a lot more for your care. For example, while preventive care is covered 100% in-network in both plans, it’s covered at just 70% out-of-network, in the Deductible $1,550/$3,700 Plan, and 65%, in the Deductible $2,500/$6,250 Plan. And that 70%/60% only applies after you’ve met your deductible. (Up until then, you’ll pay full price of the visit.)

For the Copay and Deductible Plan, you may have some out-of-network coverage, depending on the type of provider you see.

Check your plan details in the Library section of this web site, WatersBenefitsNow.com, for the full list of out-of-pocket costs.

You can make sure your providers are in your plan’s network (“Aetna’s Open Access Choice Point of Service II”) by:

• Calling your doctor’s office directly
• Calling an Aetna Concierge Health Advocate using 1-855-643-6143.
• Going online, at: www.aetna.com, and entering your personal login information.

Spouse/Partner Surcharge for medical insurance

Waters has a working spouse/partner surcharge for medical insurance. This means that you will incur a surcharge ($650 annually) if your spouse or partner has access to subsidized group medical insurance through their own employer, but is enrolled in the Waters medical plan. If your spouse/partner doesn’t have access to subsidized group medical insurance through his/her own employer, you will not be assessed the surcharge.

The spousal/partner surcharge will be deducted from each paycheck. The surcharge is prorated and divided by the number of pay periods left in the year, and will be assessed on a pre-tax basis, for as long as the spouse or partner is covered under a Waters medical plan and is eligible for their own employer’s subsidized group medical insurance. If your partner or spouse happens to also work at Waters, this surcharge does not apply.

New Hire enrollment is your opportunity to evaluate and compare all of the options available from Waters and other sources, including your spouse/partner’s employer plans. You’ll want to compare payroll deductions and benefit levels including provisions such as deductible, copays, coinsurance, and out-of-pocket maximums.

• Some employees may find the Waters’ plans best fit their needs; others may find a more suitable option elsewhere.
• Some employees may keep all family members on one employer plan, while others may choose to split enrollment between the Waters’ plan and another employer plan.
• Many employees may pay less in total payroll deductions if their spouse/partner is covered on the spouse/partner’s employer plan.

Waters hopes employees and their spouse or partners will take the time to thoroughly review all the options they have available and make the best decision for their situation.

Many Waters employees covering a family don’t realize that, if their spouse or partner were to pick up Employee-Only coverage at their employer, the Waters employee would drop down two tiers! And by switching from the Family tier to the Employee + Child(ren) tier, they’d pay a good amount less in premiums.

If you’re covering a family, and the surcharge applies, it makes sense to compare your two options:

• The premium of the Family tier at Waters (with the $25 surcharge)
• The Employee-Plus-Child(ren) tier premium at Waters, plus the employee-only premium at your spouse’s or partner’s employer

Of course, a plan’s premium isn’t the only factor to consider. But it’s one to be aware of.

What you need to do:

1. As explained above, review options available from Waters and your spouse/partner’s employer to determine what works best for you and your family.
2. Make your elections in the WatersBenefitsNow.com platform before the end of your enrollment window.
 
And I can help you do that! I’ll take all the rules for how each of your plan options covers your health care, compare that to the services you’d expect to need this year, and average in the costs of those services based on where you live.
 
3. Review your confirmation statement at the end of your enrollment, and your first pay stub of the new year, to ensure the surcharge was (or was not) processed correctly.