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HSA Plan

Network

100% coverage for FDA-approved contraceptive methods available only through a physician's office

100% coverage for sterilization procedures for women

20% coinsurance after deductible for sterilization procedures for men

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

100% coverage for FDA-approved contraceptive methods available only through a physician's office

100% coverage for sterilization procedures for women

20% coinsurance after deductible for sterilization procedures for men

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

100% coverage for FDA-approved contraceptive methods available only through a physician's office

100% coverage for sterilization procedures for women

20% coinsurance after deductible for sterilization procedures for men

Non-Network

40% coinsurance after deductible

Available under the prescription drug plan only: preferred* oral and preferred* patch covered 100% when accompanied by a prescription and filled at a network pharmacy (non-preferred may be covered in limited situations).

Available under the medical plan only: tubal ligation.

Available under the prescription and/or medical plan:

  • Cervical cap
  • Diaphragm
  • Implants, such as an intrauterine device (IUD)
  • Injection
  • Vaginal ring

Members have the option to select a Non-Contraception Benefit Option if they have a religious or moral objection to these items.

*Preferred drug as determined by ESI


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