Medical & prescription plan for 2021

Medical plans


Temporary benefit updates for Northwell employee medical plan participants (Value, Buy-Up or High Deductible Health Plans) due to COVID-19

  • Copays, deductibles, and coinsurance for testing and test-related physician office, urgent care, emergency room and telehealth visits for COVID-19 related care are waived

Northwell offers three medicals plans.

The High Deductible Health Plan is administered by MagnaCare and the value and buy-up plans are administered by UnitedHealthcare (UHC).

1. Northwell Health High Deductible Health Plan (HDHP) and Health Savings Account (HSA) is designed for those who use Northwell Direct Network and in-MagnaCare network providers and facilities and are looking to save for future medical expenses. This plan has lower premiums but higher deductibles than a traditional health plan. When covered by an HDHP, it is a requirement to have an HSA, which allows you to put aside up to $3,100 in pre-tax money if you elect single coverage and $6,200 in pre-tax money if you elect family coverage. These are per paycheck deductions and you can change your contributions monthly. To help offset your deductible, Northwell will also fund your account, $500 for single and $1,000 for family coverage (pro-rated per paycheck). The total maximum employee and employer contributions into the HSA are $3,600 for single coverage and $7,200 for family coverage.

Health Saving Account Highlights

View HDHP Chart


2. Northwell Health Value Plan is designed for those who utilize in-system providers and Northwell facilities, but would like access to out-of-system care. When utilizing in-system providers/facilities, team members will be subject to a small copay only for physician visits, with many additional services covered at 100%. Deductible and coinsurance apply for in- and out-of-network services/facilities.

View Value Plan chart
3. Northwell Health Buy-Up Plan is designed for those who do not exclusively use in-system providers and facilities. If you frequently seek care outside of the in-system network you will pay a lower deductible and coinsurance compared to the Value Plan but you will pay more via paycheck deductions. It is designed for those who do not exclusively use in-system providers and facilities. When utilizing in-system providers/facilities, team members will be subject to a small copay only for physician visits, with many additional services covered at 100%. However, if you frequently seek care outside of the in-system network you will pay a lower deductible and coinsurance compared to the Value Plan, but you will pay more via paycheck deductions.

View Buy-Up Plan chart
Out-of-Area Plans

Northwell assigns team members who live outside of our primary service area, which is determined by zip code, into Out-of-Area (OOA) plans. If you are considered OOA, you can choose either the Value or Buy-Up plans, and will be subject to lower out of pocket costs for certain in-network services provided. The two primary differences are:

  1. If you are undergoing an elective hospitalization, you can use an in-UHC network hospital, rather than in-system, for a $0 copay.

  2. Primary Care / Specialist copays will be ($20/$40) rather than the deductible and coinsurance. Additional testing and procedures will continue to be subject to deductible and coinsurance.

Virtual Visits

Northwell Health-GoHealth Urgent Care is offering Virtual Visits as an alternative to center-based urgent care. This great new resource has the capability to Save a Spot with a healthcare provider via your electronic device of choice within a 24 hour pocket of time. Virtual Visits are available weekdays, 8:00 a.m. to 8:00 p.m. and weekends, 9:00 a.m. to 5:00 p.m. to Northwell employee medical plan participants and their covered dependents with a $10 copay. Click here to schedule your virtual visit.


Health Programs for medical plan participants

Northwell Health offers hypertension, nutrition and diabetes management programs to medical plan participants at no cost. For more information, click here.


Hospital Pre-Certification applies to Northwell Value and Buy-Up Plans

The medical plans require pre-certification before you are admitted to an out-of-network hospital. To receive the maximum hospital benefits under your medical plan, you or your physician must call the carrier’s pre-certification phone number to pre-certify your hospital admission or emergency visit. You may have to pay a penalty if you do not receive authorization from your medical plan. For pre-certification, call 888-254-3698.

Note: By enrolling in a Northwell employee medical plan you and your enrolled dependents may be contacted by a service provider (which may be a Northwell team member) offering information, support or assistance, related to the usage of plan benefits. Any participation in, or cooperation with, such services or providers is completely voluntary and without extra charge. Any personal health information that is voluntarily provided will not be used for purposes other than the services offered.


Please be aware before you visit your provider:

  • Some providers may practice at multiple locations. Click here to ensure that the provider and location that you are visiting are in-system for those with value and buy-up plans.

  • Make sure your provider sends your lab work to Northwell labs, which are covered at 100%.

  • If you use out-of-network providers you may end up with high out-of-pocket costs. Click here to find an in-system provider for the value and buy-up plans.

Prescription/Rx

Prescription Drug Plan for Value or Buy-Up Plan with Vivo Health

Your prescriptions will automatically be covered by Vivo Health if you enroll in a medical plan. Vivo Health offers convenient services such as the mail order plan, specialty pharmacy and a mobile app for your on-the-go pharmacy needs.

Vivo Health has a large pharmacy network, which includes more than 64,000 participating pharmacies, including ten Vivo Health Pharmacy locations.

Visit northwell.edu/myMeds for information about Vivo Health and its participating pharmacies.

Benefit for Value or Buy Up Cost Mail Order Cost
Generic Drug $10 Copay $20 Copay (90-day supply)
Brand Formulary 30% or $40 minimum/$80 maximum 30% or $80 minimum/ $160 maximum
(90-day supply)
Brand Non-Formulary 50% or $80 minimum/$160 maximum 50% or $160 minimum/ $320 maximumn
(90-day supply)
Specialty Drug (must submit through Vivo) Variable copay not to exceed 20% up to $300 maximum Variable copay not to exceed 20% up to $300 maximum
(30-day supply)
Out-of-Pocket Max $1,600 Individual/ $3,200 Family
Notes:
  • After three refills of a maintenance medication at retail, your copay will be 100% at retail unless you refill through mail order.
  • If you are using specialty medication, check with Vivo and your manufacturer on their copay assistance program to see if you can apply.
  • Northwell currently has in place the Member Pay the Difference. This means that when there is a brand dispensed per your request when generic is available, you will be charged the generic copay plus the difference in cost between the brand and generic.
  • Northwell team members are encouraged to take advantage of the convenience and value that our in-system pharmacy, Vivo Health offers. Vivo provides reduced pricing on specific medications for all employees, as well as a full line of Over-The-Counter medications, convenient delivery services and more.
    • Specialty medications delivery to your home or office for FREE
    • Access to a dedicated and knowledgeable team who can collaborate with your providers to provide you with the highest level of care
    • Medication Therapy Management
    • Patient education and drug counseling services


Click here to watch the 2021 Health and welfare video


FAQ's - medical

The out-of-pocket max refers to the largest amount of money you are responsible for paying towards the cost of your healthcare each year (this includes copays, deductibles, coinsurance, and prescriptions). Once you have reached your out-of-pocket max, the carrier will begin to pay the allowed amount for the remainder of the year.

In-system providers means the healthcare provider is a member of

Northwell’s Clinical Integration Independent Physician Association (CIIPA, or IPA for short). The association consists of approximately 9,000+ community-based physicians throughout New York who have agreed to take the Northwell employee benefit plan and to deliver quality care to employees at set rates. The plan provision for both United Healthcare medical plans encourages employees to use physicians and non-physician providers (such a psychologists and dietitians) who are in Northwell’s Clinical Integration IPA. In doing so, the employee and their dependents will be covered at 100% for their medical care (including office visits and tests/care performed in-office), and will only pay the usual office visit copays. You can find in-system providers and services at northwell.edu/insystem.

An in-network physician/healthcare provider means they are within United Healthcare's national network. This is a very large network and can be found on the United Healthcare website uhc.com.

Out-of-network means the physician doesn't participate in our IPA or United Healthcare's national network. If you choose to use physicians that are out-of-network you will pay significantly more.

It also applies to your physicians. Meaning, if your physician sends you to non-system facilities (such as competitors like Winthrop hospital, or Quest for lab work or Zwanger-Pesiri for x-rays) then you will be responsible for paying a deductible and coinsurance. Be sure to have a conversation with your physician(s) so they understand how your medical plan works regarding using in-system services.

In-system physicians and facilities are part of the Northwell CIIPA, whereas in- UHC network providers are outside of the CIIPA network, but still covered by the United Healthcare network. Although all deductible and coinsurance fees are waived in-system, you will be responsible for paying deductible and coinsurance on many services in-UHC network.

The Buy-Up Plan costs more than the Value Plan because it covers a higher percentage of your medical costs if you choose to use out-of-network physicians and facilities instead of Northwell in-system providers/facilities, and in-UHC network United Healthcare providers/facilities.



Quick links

Important documents Video library Frequently asked questions Benefit rates


Provider finder

Value and buy-up plans

In-system

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In-network UHC

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HDHP

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Patient access services

888-321-3627