Dupont

2020 Benefits Enrollment Kit

Compare 2020 Medical Plan Options

This information in this section does not apply to employees in Puerto Rico or to expatriates on international assignment.

For 2020, you’ll have three medical plan options to choose from:

  • New! Traditional Copay PPO option,
  • Core option, and
  • Premium Saver option.

All three options provide you with:

  • Comprehensive medical coverage, including prescription drug and mental health/chemical dependency coverage, and
  • The opportunity to contribute to tax-advantaged flexible spending accounts you can use to pay for eligible out-of-pocket health care expenses.

The table below shows a summary of your coverage under each option. For a more comprehensive description of each option, see your 2020 Enrollment Guide and the Health Plan Comparison Charts and Medical Expense Estimator on DuPont Connection. Use the Medical Expense Estimator to estimate your total expenses under each medical option—including both the out-of-pocket costs you pay when you receive care and your monthly premiums.

Core Option Premium Saver Option Traditional Copay PPO Option
Medical Carrier Aetna or Highmark Blue Cross Blue Shield (BCBS), depending on your home address
Annual Deductible1,2
(individual/other coverage levels)
  • In-network: $1,400/$2,800
  • Out-of-network3: $2,500/$4,000
  • In-network : $2,800/$5,600
  • Out-of-network3: $3,500/$6,000
  • In-network: $700/$1,400
  • Out-of-network3: $1,800/$2,600
Annual Out-of-Pocket Maximum4,5
(individual/other coverage levels)
  • In-network : $5,000/$10,000
  • Out-of-network3: No limit
  • In-network : $6,000/$12,000
  • Out-of-network3: No limit
Covered Preventive Care6
  • In-network : 100% paid, no deductible        
  • Out-of-network4: 100% paid; no deductible
Office and Facility Visits
(primary care provider [PCP] office visits [including outpatient mental health/chemical dependency visits administered by ComPsych], specialist office visits7, urgent care visits, retail clinic visits, and emergency room [ER] visits)
  • In-network : You pay 20% after deductible
  • Out-of-network3: You pay 40% after deductible
  • In-network: Amounts not subject to the deductible. You pay:
    • PCP office visit: $30 copay
    • Specialist office visit: $45 copay
    • Urgent care visit: $45 copay
    • Retail clinic visit: $30 copay
    • ER visit: $250 copay, not waived if admitted
  • Out-of-network3: You pay 40% after deductible
Other Medically Necessary Care (Labs, X-Rays, hospitalization, surgery, etc.)
  • In-network : You pay 20% after deductible        
  • Out-of-network3: You pay 40% after deductible
Prescription Drugs — Through CVS Caremark (applies to retail [up to two fills] and mail order)9
Generic No charge after deductible
Brand Formulary8 You pay 25% after deductible; $125 maximum8
Brand Non-Formulary8 You pay 45% after deductible; $250 maximum8
Maintenance medications filled more than two times at a retail pharmacy other than CVS You pay 45% after deductible; no maximum9
Associated Tax-Advantaged Accounts — Through Bank of America
Health Savings Account (HSA)10 Yes
Use it to pay for eligible out-of-pocket medical, prescription drugs, dental, and vision expenses.
Use it or keep it. Any money left over in your account at year-end rolls over and is yours to keep.
Not applicable
DuPont HSA Contribution10 $600 individual/
$1,200 other coverage levels
Not applicable
Your Optional Tax-Free Contributions11 Up to $2,950 individual/
$5,90011 other coverage levels
Not applicable
Healthcare Flexible Spending Account (FSA) Optional Limited Purpose Healthcare FSA: You may contribute up to $2,700 per year on a before-tax basis to pay for eligible out-of-pocket dental and vision expenses only.
Use it or lose it: You’ll forfeit any money left over in your account as of December 31, but have until April 15 to file all claims from the prior year.
Optional Traditional Healthcare FSA: You may contribute up to $2,700 per year on a before-tax basis to pay for eligible out-of-pocket medical, prescription drug, dental, and vision expenses.
Use it or lose it: You’ll forfeit any money left over in your account as of December 31, but have until April 15 to file all claims from the prior year.

1. Applies to medical, mental health/chemical dependency, and prescription drug expenses combined.

2. All options have an “aggregate” deductible. This means that for all coverage levels except “individual,” the full family deductible must be met before coinsurance applies for any one covered individual. The full family deductible can be satisfied by one or a combination of eligible family members.

3. Eligible expenses are limited to the amount of the charge that is the reasonable and customary (R&C) as determined by the carrier.

4. All options have an “embedded” or “individual” out-of-pocket maximum. This means that for all coverage levels, eligible expenses are paid at 100% for a covered individual as soon as that individual meets his/her individual out-of-pocket maximum.

5. The out-of-pocket maximum does not apply to fertility services. There is an infertility lifetime maximum benefit per family (including males and females) of $15,000 for medical and $10,000 for prescription drugs.

6. Coverage follows the standard preventive care guidelines of the Patient Protection and Affordable Care Act; includes prescription drugs classified by the guidelines as preventive.

7. Includes allergy testing, physical therapy, and chiropractic care in addition to other specialties. Chiropractic care has a $1,000 annual limit.

8. Applies before and after deductible is met when a generic equivalent is not available (e.g., contains same active ingredients in the same strength). If a generic equivalent is available, you will pay the difference between the generic and brand cost; coinsurance will not apply.

9. Coinsurance for maintenance medications filled more than two times at a retail pharmacy other than CVS applies pre-and post-deductible; however, you will never pay more than 100% of the cost of the medication. The coinsurance amount applies toward your deductible or out-of-pocket maximum.

10. Subject to eligibility; you must certify on DuPont Connection during Annual Enrollment that you meet the HSA eligibility requirements.

11. Includes any contributions made by your spouse/domestic partner, assuming your domestic partner qualifies as a tax dependent.

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