We offer three major coverage plans:

• HDHP
• Base PPO
• Buy Up PPO

And two basic coverage plans:

• Minimum Essential Coverage (MEC)
• Minimum Value Plan (MVP)

Each plan differs in deductible amounts, out-of-pocket maximums, and coinsurance. Office visits, specialist visits, and prescription drug costs vary by plan. For more details and to see how the plans differ, see your Benefits Guide on the Resources page.

Our medical plans work with a network of doctors, hospitals, and other providers to help keep your care accessible and costs lower. In order to receive the highest level of benefits and pay the least amount out of your pocket, you need to access care from the providers who have elected to be a part of the network.

Where you receive care — and what you pay for it — varies based on your plan’s tier:

• Major Coverage Medical Plans: BCBS IL
  You can access the BCBS IL provider directory online at bcbsil.com. It’s important to check that your providers are in-network to avoid costly out-of-network charges later.
• Basic Coverage Medical Plans: Apex/TRES Health
  If you are enrolled in a basic coverage medical plan, your medical provider network is PHCS. You can find participating providers by visiting member.tres.health.

We know not everyone understands the lingo, so here are some important terms to know as you decide which medical plan to choose, as well as how to use it during the year:

• Copay: A copay is the fixed amount you pay for a covered health care service (e.g., primary care physician office visit or emergency room visit).
• Annual Deductible: Your annual deductible is the amount you pay for office visits, prescription drugs and other covered services before your plan begins sharing the cost.
• Coinsurance: Coinsurance is the percentage you and your plan each pay when you’re sharing costs. Coinsurance kicks in after you meet your annual deductible.
• Out-of-Pocket Maximum: The most you pay in a year for health care services is called the out-of-pocket maximum. After you reach the out-of-pocket maximum, the plan covers 100% of eligible services for the remainder of the plan year.
• In-Network: A health care provider or facility — such as a doctor, hospital, urgent care center, or lab — that has a contract with your health insurance carrier and agrees to provide services at negotiated, discounted rates. You will generally pay less when you receive care from in-network providers or facilities.
• Out-of-Network: A health care provider or facility that does not have a contract with your health insurance carrier. If your plan covers out-of-network services, you’ll usually pay more for care received outside the network. Your policy will explain how these costs are calculated. Out-of-network providers may also be referred to as non-preferred or nonparticipating providers.

Lowest Cost Share. Always consider tier one medications if you and your doctor decide they are right for your treatment.

Mid-Level Cost Share. Consider tier two medications if you and your doctor decide there are no tier one options appropriate to treat your condition.

Ask your doctor if there are tier one alternatives or over-the-counter brands that are equivalent to tier two medications. They may be used to treat the same condition but are less expensive.

Highest Cost Share. If you are currently taking a medication in tier three, ask your doctor whether there are tier one or two alternatives appropriate for your condition. Refer to the formulary on the BCBS website for more details. You can view the formulary at myprime.com by clicking Sign in > Continue without sign in > BCBS Illinois > Other BCBSIL Plans. Our formulary is called the Performance Full Drug List.

Compounded medications containing one or more ingredients that are prepared on-site by a pharmacist are classified at the tier three level, provided that the individual ingredients used in compounding are covered under the pharmacy benefit.

Supplements major medical coverage by helping you pay the direct and indirect costs associated with a critical illness or event. Conditions covered include cancer, heart attack, stroke, Alzheimer’s, kidney failure, and paralysis. Benefits are paid tax-free in a lump sum up to $30,000 to be used at your discretion. Child coverage is included with your employee election, and you can choose to enroll for spouse coverage.

Designed to supplement major medical coverage by paying specific benefit amounts for expenses resulting from injuries or accidents. Hospitalization, physical therapy, intensive care, transportation, childcare, and lodging are some of the out-of-pocket costs that this policy could cover.

Designed to pay for the costs of a hospital admission that may not be covered by other insurance. The plan covers insureds who are admitted to a hospital or ICU for a covered sickness or injury. The plan gives you cash payments to help you pay for the added expenses that may come up while you recover. Even if your medical insurance covers most of your hospitalization, you can still receive payments from your plan for extra expenses while recovering.

Make contributions. In 2026, the limits on total contributions to your account are:

• Up to $4,400 for single coverage.
• Up to $8,750 for all other coverage levels.
• If you are age 55 or over, you may contribute an additional $1,000 (also known as catch-up contributions).

Never pay taxes. Contributions are made from your paycheck on a pretax basis, and the money will never be taxed when used for eligible expenses.

It’s your money. Unused money can be carried over each year and invested for the future — with the potential to gain interest or earnings tax-free. You can even take it with you if you leave Opensity Solutions or retire.

Note: HSA contribution limits are subject to change annually as determined by the IRS.

You are eligible to open and contribute to an HSA if you:

• You are covered by an HSA-eligible high deductible health plan (HDHP).
• You are not covered by other health insurance.
• Your covered spouse is not enrolled in a non-tax-qualified medical plan, Flexible Spending Account (FSA), or Health Reimbursement Account (HRA).
• Your non-covered spouse is not enrolled in an FSA.
• You are not enrolled in Medicare.
• You are not receiving Social Security benefits.
• You have not received Veterans Administration benefits.
• You are not claimed as a dependent on someone else’s tax return

You don’t need an ID card when you visit the dentist. If you still want an ID card, log in to guardianlife.com/dental-insurance to print a physical copy.

Although an ID Card is available to you, you do not need an ID Card to receive services. To view your ID card, visit vsp.com.

• You are ineligible to participate in the Health Care FSA if you are enrolled in a high deductible health plan (HDHP).
• Use this account to pay for qualified medical, dental, and vision expenses like copays, prescription drugs, dental work, eyeglasses, and other eligible items with pre-tax dollars.
• You have access to your full annual election amount on the first day of the plan year.
• The maximum amount you can contribute in 2026 is $3,400.
• “Use it or lose it” account. Up to $680 of unused funds can be carried over to the next plan year. These carryover dollars can be used for expenses you have at any time during the new plan year. Any unused amount over $680 will be forfeited.
• You will have until March 31 of the following year to submit claims for reimbursement.

• Use pre‑tax income to pay for eligible dependent care expenses.
• Eligible expenses include daycare and at‑home elder care services. Ineligible expenses include kindergarten or private school tuition, sports camps, and overnight camps.
• Eligible dependents include your child up to age 13, disabled spouse, elderly parent, or other dependent who is incapable of self-care due to mental or physical handicap, so you can work (or if you’re married, so your spouse can work), look for work, or attend school full time.
• The maximum amount you can contribute in 2026 is $7,500.
• You will have until March 31 of the following year to submit claims for reimbursement
• “Use it or lose it” account; you forfeit any funds remaining in your account after the grace period ends on March 31.

Use pre-tax dollars to pay for eligible commuter expenses you incur to and from work:

Transportation Account

• Qualifying transportation expenses include transit passes and cards, token fare cards, vouchers, or similar items for buses, subways, streetcars, trains, ferries, and van/carpools.

Parking Account

• Pay for eligible parking costs at or near your place of work (vendor parking, including lots and garages), as well as the location where you commute to work, either by mass transit, qualifying commercial or non-commercial highway vehicle, or carpool.

The maximum amount you can contribute to each of these accounts in 2026 is $340.