Medical

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High Deductible Health Plan (HDHP)

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In-Network vs Out-of-Network

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Annual Account Contributions by Plan

Key features of both plans:

	Carlisle HSA Plan	Carlisle HRA Plan
Account Ownership	You decide when to use the funds for eligible out-of-pocket expenses. It’s yours when you retire or leave the plan	Funds are held in your name and used to pay claims (by the insurance company) while you are in the plan
Annual Carlisle Contributions*	Individual - $750 You + 1 dependent - $1,500 You + 2 or more Dependents - $2,000	Individual - $500 You + 1 Dependent - $1,000 You + 2 or more Dependents - $1,500
Your Voluntary Annual Contributions	Individual - up to $3,500 less Carlisle contributions You + 1 or more dependents - up to $7,000 less Carlisle contributions	Not Eligible
Your Catch-up Contributions	$1,000 at age 55 or older	Not available
Investment Options	You may invest in mutual funds if you have $2,000 in account; earnings are tax-free	Not Available
	Not Eligible for Health Care FSA	Use It or Lose It
Optional Health Care Flexible Spending Account (FSA)	You cannot contribute to or receive employer contributions in an HSA account if you have a Health Care FSA account balance.	You can contribute up to $2,650 to pay eligible out-of-pocket expenses incurred within the calendar year.

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Medical Plan Comparison

Edit
	$400 Deductible	$1,850 Deductible w/HSA	$2,850 Deductible w/HSA
* Out-of-network expenses are subject to reasonable and customary limits. You pay the full cost of your medical and prescription drug expenses until your deductible has been met. * Out-of-Pocket Maximum includes the deductible. **** Health care reform requires that all medical plans cover a specified list of preventive care services at 100% when received in-network (list subject to change based on recommendations from federal guidelines). Cost sharing may apply for network visits when preventive care services are provided in conjunction with an office visit.
Provider Network	A large network: Cigna Open Access Network	A large network: Cigna Open Access Network	A limited network: Cigna LocalPlus Network
Deductible (Individual / Family)
In-network	$400 / $800	$1,850 / $3,700**	$2,850/$5,700**
Out-of-network*	$2,500 / $5,000	$3,700 / $7,400**	$5,700/$11,400**
Health Savings Account (HSA)
Western Union Contribution (Individual/Family)	Not applicable	$500 / $1,000 per year	$500 / $1,000 per year
Annual Out-of-pocket Maximum (Individual / Family)***
In-network	$2,200 / $4,400	$3,500 / $6,500	$5,500 / $11,000
Out-of-network*	$4,400 / $8,800	$7,000 / $13,000	$11,000 / $22,000
Preventive Care**** (Plan pays…)
In-network	100% no copay	100% no deductible	100% no deductible
Out-of-network*	60% after deductible	60% after deductible	50% after deductible
Coinsurance (Plan pays…)
In-network	80% after deductible	80% after deductible	70% after deductible
Out-of-network*	60% after deductible	60% after deductible	50% after deductible
Office Visit (Plan pays…)
In-network	100% after $20 Primary Care Provider copay / $40 specialist copay	80% after deductible	70% after deductible
Out-of-network*	60% after deductible	60% after deductible	50% after deductible
MDLIVE Consultations	$20 copay	$44 until deductible is met, then coinsurance applies	$42 until deductible is met, then coinsurance applies
Emergency Room (Plan pays…)
In-network	80% after $150 copay	80% after deductible	70% after deductible
Out-of-network*	80% after $150 copay	80% after deductible	70% after deductible
Prescription Drugs
Retail (up to 30-day supply)	$10 copay generic $30 copay brand formulary $60 copay brand non-formulary	80% after deductible	70% after deductible
Mail order (31 to 90-day supply)	$25 copay generic $75 copay brand formulary $150 copay brand non-formulary	80% after deductible	70% after deductible
How Much You Pay Each Month	See your 2018 medical plan rates.