Making health care work better
The Health Connect Plan, offered through Premera, provides personalized, coordinated care and cost predictability to help simplify managing your health.
The Health Connect network
The Health Connect Plan is built around a select group of providers on the Eastside, primarily located in Redmond/Bellevue/Kirkland and other areas on the east side of Lake Washington. Health Connect Plan providers share Microsoft’s goal of delivering
a more personalized health care experience in an effort to help you achieve improved health outcomes over time. Since Health Connect network providers are primarily concentrated on the Eastside, the Plan is only offered to employees
who live in King and Snohomish counties.
A personalized and coordinated approach to your health care
In the Health Connect Plan, you are encouraged to work closely with a Health Connect network primary care provider (PCP) of your choice. Your PCP gets to know your health care needs and goals and helps coordinate your care. Learn more about PCPs
Predictable out-of-pocket costs when you see Health Connect network providers
You pay a convenient copay for many basic services, such as office visits and prescription medications, making your out-of-pocket costs predictable. When you see a provider
in the Health Connect network, your out-of-pocket costs for other services, like lab work and inpatient care, are also lower. Plus, you do not have to pay an annual deductible.
The flexibility of no referrals
Even though you have a PCP, and one benefit of this plan is to coordinate care through your PCP, you still have the freedom to see any provider, including specialists, in the Health Connect network without a referral. You can also see any provider
in the Extended network, but your out-of-pocket costs will be higher.
Less administrative work to save you time
When you see Health Connect network providers, there may be fewer claims to review or bills to reconcile because you pay copays for many services. Copays are typically due at the time of service, so there is no need to send you another bill after
your service.
Maternity Bundle
We’ve simplified the paperwork for maternity care with the Maternity Bundle. You will pay a single $500 copay for your routine maternity care, including professional prenatal and delivery care. This benefit is available to employees, their enrolled
spouses/domestic partners, and eligible dependent children. In addition, the Health Connect Plan offers a $1,000 allowance, per pregnancy, for doula services. More information is on the FAQ.
A dedicated service center for all your questions
Call 800-676-1411 and select Health Connect Navigator for personalized service, such as help with finding providers, answering plan questions, making appointments, and much more.
How you pay for care
Your out-of-pocket costs depend on the type of provider you use and whether that provider is in the Health Connect network. Your out-of-pocket costs are lower and more predictable when you see a Health Connect network provider. If you see providers
in the Extended network, you are still covered by the Plan, but your out-of-pocket costs may be higher.
There are certain types of services, such as chiropractic and acupuncture, where your costs are the same whether you see a provider in the Health Connect or Extended network. This gives you access to a wide range of these providers.
Access the Provider Finder tool for a complete list of providers. For more information about plan benefits, see Health Connect Plan at a glance below.
Costs based on network
You pay nothing for these services:
- Preventive care
- Preventive prescription medications (generic)
You only pay a copay for many common services, including:
- Office visits for PCPs and specialists, including chiropractors, acupuncturists, and massage therapists
- Non-preventive prescription medications
- Urgent care visits
- Emergency room visits
- Mental health and chemical dependency outpatient visits
- Physical, occupational, and speech therapy
- Telehealth
- Maternity
- Nutrition therapy
- Hearing exams
- Vision therapy
For most other services you pay 10% coinsurance and Premera covers the rest:
- Hospital inpatient care
- Hospital outpatient care/ASC (surgery)
- Diagnostic testing such as lab tests and X-rays
Remember: If you use Health Connect network providers, you don't have to pay an annual deductible.
You pay nothing for these services:
- Preventive care
- Preventive prescription medications (generic)
40% coinsurance after you meet your annual deductible for most services such as:
- Office visits for PCPs and specialists
- Hospital stays
Copays for certain services, including:
- Emergency room visits
- Mental health and chemical dependency outpatient visits
Note: Certain services are covered at the Health Connect network level even when you visit an Extended network provider, which means lower out-of-pocket costs for you. Examples include:
- Applied Behavior Analysis (ABA)
- Audiology
- Chiropractic, acupuncture, and massage therapy
- Diagnostic services such as lab tests and X-rays
- Durable medical equipment
- Hearing aids
- Mental health and chemical dependency treatment
- Naturopathic care
- Optometry
- Physical, occupational, and speech therapy
- Nutritional therapy
You pay the annual deductible and then 50% of the allowable charges for most out-of-network services. Out-of-network providers may not accept the allowable charge as payment in full. You are responsible for paying the difference
between the allowable charge and the amount your out-of-network provider charges.
Health Connect Plan at a glance
The table below provides an overview of the Health Connect Plan benefits. For more information, check the Summary Plan Description.
| Feature |
Health Connect network |
Extended network |
Out-of-network |
Annual deductible
When you see providers in the Extended network, each dependent only needs to meet the individual deductible before the Plan starts paying coinsurance for that family member. And, once you meet
the family deductible, the Plan pays coinsurance for the whole family, even those who haven't met their individual deductible, up to the out-of-pocket maximum.
Your out-of-pocket maximum works in the same way: each family member can reach their individual out-of-pocket max, and you can reach the family out-of-pocket max without reaching each individual's
out-of-pocket max.
Once you reach your out-of-pocket max, the Plan pays for the full cost of care.
|
None |
$1,000 per person; $3,000 per family, shared with Out-of-network |
$1,000 per person; $3,000 per family, shared with Extended network |
| Copayments |
$20 PCP visit; $40 specialist/other office visit |
Not applicable |
Not applicable |
| Annual out-of-pocket maximum |
$2,000 per person; $6,000 family |
| Amount plan pays for covered services |
| Ambulance |
90% |
90%, deductible does not apply |
90%, deductible does not apply |
| Autism/ABA therapy |
90% |
90%, deductible does not apply |
50% of allowable charges, after deductible |
| Chiropractic, massage, and acupuncture services (when medically necessary) |
100% after $40 copay; deductible does not apply |
50% of allowable charges, after deductible |
| Combined 24-visit limit per year for Health Connect, Extended, and Out-of-network |
| Contraception |
100% |
100%, deductible does not apply |
50% of allowable charges, after deductible |
| Diabetes health education |
100% |
100%, deductible does not apply |
50% of allowable charges, after deductible |
| Emergency room care & professional services |
100% after $250 copay (waived if admitted) |
| Home health care |
90% |
60% after deductible |
50% of allowable charges, after deductible |
| Hospice care |
90% |
60% after deductible |
50% after deductible |
| Hospital inpatient and outpatient |
90% |
60% after deductible |
50% of allowable charges, after deductible |
| Infertility |
90% of covered benefits, within the Progyny provider network |
Not applicable |
Not applicable |
| Lab tests and X-rays |
90% |
90%, deductible does not apply |
50% of allowable charges, after deductible |
| Maternity care |
90% |
60% after deductible |
50% of allowable charges, after deductible |
| Maternity care bundle (Routine pregnancy and delivery care received within the Health Connect network)
|
$500 copay |
Not applicable |
Not applicable |
| Doula services |
Maximum benefit of $1,000 per pregnancy |
| Medical equipment and supplies |
90% |
90%, deductible does not apply |
50% of allowable charges, after deductible |
Mental health, attention deficit disorder, and substance use disorder treatment
*In no event will the outpatient copay exceed 40% of the allowed amount. |
Inpatient: 90%
Outpatient: 100% after $20 copay per visit |
Inpatient: 90%, deductible does not apply
Outpatient: 100% after $20 copay* per visit, deductible does not apply |
Inpatient: 90% of allowable charges, deductible does not apply
Outpatient: 90% of allowable charges, deductible does not apply |
| Office visit |
PCP visit: 100% after $20 copay
Specialist/other office visit: 100% after $40 copay |
Office visit: 60% after deductible
Specialist/other office visit: 60% after deductible |
Office visit: 50% of allowable charges, after deductible
Specialist/other office visit: 50% of allowable charges, after deductible |
| Prescription drugs—Retail |
Generic maintenance: 100% after $10 copay; deductible does not apply
Generic (all other): 100% after $20 copay; deductible does not apply
Brand preferred: 100% after $30 copay, deductible does not apply
Brand non-preferred: 100% after $60 copay, deductible does not apply
Check the Health Connect Plan drug formulary
|
Generic: 50% of allowable charges, deductible does not apply
Brand preferred: 50% of allowable charges, deductible does not apply
Brand non-preferred: 50%
of allowable charges, deductible does not apply |
Prescription drugs—Mail order
(90-day supply) |
Generic: 100% after $20 copay, deductible does not apply
Brand preferred: 100% after $60 copay, deductible does not apply
Brand non-preferred: 100%
after $120 copay, deductible does not apply
Check the Health Connect Plan drug formulary
|
Not covered |
Prescription drugs – Specialty (30-day supply)
through Accredo Specialty Pharmacy or Walgreen’s
Specialty Pharmacy
|
Specialty Brand preferred: 100% after $30 copay, deductible does not apply
|
Specialty Brand non-preferred: 100% after $60 copay, deductible does not apply
|
Not covered
|
| Preventive care |
Preventive services: 100%, deductible does not apply
Preventive generic prescription drugs: 100%, deductible does not apply
Check the preventive care services list
Check the preventive drug list
|
Preventive services: 50% of allowable charges, after deductible
Preventive generic prescription drugs: 50% of allowable charges, deductible does not apply
|
| Routine hearing exam and hardware |
Exam: 100% after $40 copay |
Exam: 100% after $40 copay |
Exam: 50% of allowable charges, after deductible |
| Hardware: 90% up to $10,000 maximum benefit per member in a period of three consecutive calendar years |
| Skilled nursing facility (120-day maximum per calendar year) |
90% |
60% after deductible |
50% of allowable charges, after deductible |
| Urgent care |
100% after $40 copay |
60% after deductible |
50% of allowable charges, after deductible |
| Virtual care |
Mental health and substance use disorder treatment: 100%
Other services: 100% |
Mental health and substance use disorder treatment: 100%
Other services: 60% after deductible |
Mental health and substance use disorder treatment: 100% of allowable charges, deductible does not apply
Other services: 50% of allowable charges, after deductible |
Here are some tools to help you decide if the Health Connect Plan is right for you.
Review your Summary Plan Description (SPD) to compare plan options and to better understand benefit coverage and eligibility requirements. The SPD can be found on aka.ms/benefits.
Select Guide to Benefits and then Summary Plan Description.
Determine if the Health Connect Plan meets your needs
What are your priorities when choosing a medical plan?
- You can continue to see your current providers.
- Your out-of-pocket costs are as predictable as possible, including prescription medications.
- You have a complex health issue and want to make managing it as easy as possible.
- You have covered family members who live outside the Puget Sound area that need access to care.
- Others?
See how the Health Connect Plan might work for you based on your priorities.
Compare plan benefits
In addition to the Health Connect Plan, Microsoft offers multiple health plan options to employees. Although the plans all provide comprehensive coverage, the plans work differently and the amount you pay out-of-pocket for the same covered services may vary. Learn more about the key features and important differences between plans before
deciding which plan is right for you.
Review your Summary Plan Description (SPD) to compare plan options and to better understand benefit coverage and eligibility requirements. The SPD can be found on aka.ms/benefits. Select Guide to Benefits and then Summary Plan Description.