Medical

Last updated date: 7/23/2026

Shields Health provides valuable benefits to help you and your family stay well and access quality health care when you need it.

Overview

Shields Health offers three comprehensive medical plan options that offer a range of coverage levels and costs, so you can choose the one that’s best for you and your family. These plans are administered by HPI. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event.

Our medical plans provide:

Comprehensive, affordable coverage

for a wide range of health care services.

Free in-network preventive care

with annual physicals, recommended immunizations, and routine preventive screenings all 100% covered.

Prescription drug coverage

automatically included with your medical plan enrollment.

Financial protection

through out-of-pocket maximums that limit your annual costs.

Plan Comparison

Use this side-by-side plan comparison to understand key differences between medical plans. You can select which plans to compare using the left button below. Click on a row to expand that section or click on the “Expand All” button to see everything at once.

TIP: Review the Glossary of Terms and check out our educational video library to better understand how the medical plans work and determine which one might be best for you.

	PPO $2,500 / $5,000	HDHP $2,500 / $5,000 (HSA eligible)	HDHP $4,000 / $8,000 (HSA eligible)
Health Savings Account (HSA) or Health Care Flexible Spending Account (FSA) features
HSA-eligible	No (Consider a Health Care FSA instead.)	Yes (Learn about the HSA.)	Yes (Learn about the HSA.)
Company contribution to HSA	None	If working 40+ hours per week, $625 for employee-only coverage or $1,250 if you cover dependents. If working 24-39 hours per week, $312.50 for employee-only coverage or $625 if you cover dependents.	If working 40+ hours per week, $1,500 for employee-only coverage or $3,000 if you cover dependents. If working 24-39 hours per week, $1,500 for employee-only coverage or $3,000 if you cover dependents.
Annual deductible (individual/family)
In-network	$2,500 / $5,000	$2,500 / $5,000	$4,000 / $8,000
Out-of-network	$5,000 / $10,000	$5,000 / $10,000	$8,000 / $16,000
Coinsurance
In-network	You pay 0%, plan pays 100%	You pay 0%, plan pays 100%	You pay 10%, plan pays 90%
Out-of-network*	You pay 20%, plan pays 80%	You pay 20%, plan pays 80%	You pay 30%, plan pays 70%
Annual out-of-pocket maximum (individual/family)
In-network	$7,500 / $15,000	$7,500 / $15,000	$8,000 / $16,000
Out-of-network	$15,000 / $30,000	$15,000 / $30,000	$16,000 / $32,000
Health care services: Your costs
Preventive care	You pay nothing in-network, covered 100%	You pay nothing in-network, covered 100%	You pay nothing in-network, covered 100%
Primary care (in-network)	You pay $30 copay	You pay 0% after deductible, plan pays 100%	You pay 10% after deductible, plan pays 90%
Primary care (out-of-network)	You pay 20% after deductible	You pay 20% after deductible	You pay 30% after deductible
Specialist (in-network)	You pay $50 copay	You pay 0% after deductible	You pay 10% after deductible
Specialist (out-of-network)	You pay 20% after deductible	You pay 20% after deductible	You pay 30% after deductible
Behavioral health (in-network)	You pay $30 copay	You pay 0% after deductible	You pay 10% after deductible
Behavioral health (out-of-network)	You pay 20% after deductible	You pay 20% after deductible	You pay 30% after deductible
Telehealth	You pay $30 copay	You pay 0% after deductible	You pay 10% after deductible
Urgent care (in-network)	You pay $50 copay	You pay 0%, plan pays 100%	You pay 10%, plan pays 90%
Urgent care (out-of-network)	You pay 20% after deductible	You pay 20% after deductible	You pay 30% after deductible
Emergency room (in- and out-of-network)	You pay 0%, plan pays 100%	You pay 0%, plan pays 100%	You pay 10%, plan pays 90%
Inpatient/outpatient hospital care (in-network)	You pay 0%, plan pays 100%	You pay 0%, plan pays 100%	You pay 10%, plan pays 90%
Inpatient/outpatient hospital care (out-of-network)	You pay 20% after deductible	You pay 20% after deductible	You pay 30% after deductible
Prescriptions – 30-day supply at retail pharmacy: Your costs
Generic	You pay $10 copay	You pay $10 copay after deductible	You pay $10 copay after deductible
Preferred brand	You pay $25 copay	You pay $25 copay after deductible	You pay $25 copay after deductible
Non-preferred brand	You pay $45 copay	You pay $45 copay after deductible	You pay $45 copay after deductible
Specialty	You pay 30% coinsurance	You pay 30% coinsurance after deductible	You pay 30% coinsurance after deductible
Prescriptions – 90-day supply (mail order or retail pharmacy): Your costs
Generic	You pay $20 copay	You pay $20 copay after deductible	You pay $20 copay after deductible
Preferred brand	You pay $50 copay	You pay $50 copay after deductible	You pay $50 copay after deductible
Non-preferred brand	You pay $90 copay	You pay $90 copay after deductible	You pay $90 copay after deductible

*Out-of-network benefits are based on reasonable and customary charges.

Combining low-premium, high-deductible coverage with a tax-free Health Savings Account (HSA) helps you save money and plan ahead for future medical expenses. This type of medical plan is often known as a consumer-directed health plan — by taking more responsibility for your actual medical and prescription costs, you’re rewarded for making healthy, cost-conscious choices. In addition, Shields Health will contribute to your HSA to help cover your out-of-pocket costs — the company's contribution is based on your scheduled hours, medical plan, and coverage tier.

For employees scheduled to work 40 hours per week, the contribution is $625 for employee-only coverage or $1,250 if covering dependents under the $2,500 HDHP, and $1,500 for employee-only coverage or $3,000 if covering dependents under the $4,000 HDHP.
For employees scheduled to work 24–39 hours per week, the contribution is $312.50 for employee-only coverage or $625 if covering dependents under the $2,500 HDHP, and $1,500 for employee-only coverage or $3,000 if covering dependents under the $4,000 HDHP.

Prescription Drugs

When you enroll in Shields Health's HPI medical coverage, you automatically receive prescription drug benefits through Express Scripts. Use the Express Scripts website or mobile app to manage your prescriptions, order refills, sign up for home delivery, and more.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred brand, or non-preferred brand. All prescription plans have a formulary, or list of drugs based on effectiveness and cost. This list will determine how your prescriptions are covered. Keep in mind that the formulary may change as a result of regular reviews and updates. You can find the current formulary on your prescription plan's website.

Learn about the drug tiers

Generic drugs

Preferred brand drugs

Non-preferred brand drugs

You pay: $

Generic drugs have the same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

You pay: $$

Preferred brand drugs are brand-name medications favored by your prescription plan and included on the plan’s formulary.

You pay: $$$

Non-preferred brand drugs are brand-name medications not preferred by your prescription plan. They may still be covered, but may require prior authorization and cost more.

Prescription programs

Your prescription drug benefits include several programs aimed at ensuring the most clinically appropriate and cost-effective medication use.

Specialty medication – All prescriptions for specialty medication used to treat certain conditions (such as rheumatoid arthritis, multiple sclerosis, or psoriasis) must be filled through the Express Scripts Specialty Pharmacy.
Prior authorization – Some medications may require prior authorization from your doctor before receiving approval for coverage. This is done to ensure the medication is the best option for you.
Step therapy – Step therapy requires that you try the most cost-effective medications appropriate for your condition before more expensive medications can be approved for coverage.