Employee Benefits Guide
January 1 - December 31, 2025
Your Health, Your Family,
Your Life, Your Choice
RXINSIDER 2025
At RXinsider, we are committed to your health and well-being. We are proud to provide
you and your family with valuable and signi�cant bene�ts. This guide is a summary of
the bene�ts available to you.
Healthcare/Medical Bene�ts .................................................................................. 3
• Blue Cross Blue Shield (BCBS) Medical Bene�ts .............. 3
• Harvard Pilgrim Health Care Medical Bene�ts .................. 5
• Blue Cross Blue Shield (BCBS) Dental Bene�ts ................. 7
• Blue Cross Blue Shield (BCBS) Vision Bene�ts ................. 8
• Eligibility & Enrollment/Rates ......................................... 9-11
Paid Time Off............................................................................................................12
Retirement/401k & Life Insurance ......................................................................13
RXinsider Perks ........................................................................................................14
Contact Information ...............................................................................................15
Table of Contents
RXINSIDER 2025
PPO Plan
The PPO plan gives you the freedom to seek care from the provider of your choice.
However, you will maximize your bene�ts and reduce your out-of-pocket costs if you
choose a provider participating in the (carrier name/network name) network.
The calendar year deductible must be met before certain services are covered.
Blue Cross Blue Shield (BCBS) – Side-by-Side Medical Bene�t Summary
Medical Plan
PPO 500
In-Network
PPO 1500
In-Network
Deductible
• Employee Only
• Family
$500
$1,000
$1,500
$3,000
Out-of-Pocket Limit
• Employee Only
• Family
$1,800
$3,600
$6,000
$12,000
Preventive Care
Primary Care Visit (PCMH)
Primary Care Visit (Non PCMH)
Specialist Visit
Emergency Room
Urgent Care
No Charge
$10/Copay
$20/Copay
$30/Copay
$100/Copay
$50/Copay
No Charge
$20/Copay
$30/Copay
$40/Copay
$200/Copay
$100/Copay
Prescription Drugs
Retail
• Tier 1 Lowest Cost Generic Drugs
• Tier 2 Low-Cost Generic Drugs
• Tier 3 Higher Cost Generic and Preferred Brand Name Drugs
$10/Copay
$25/Copay
$35/Copay
$10/Copay
$40/Copay
$70/Copay
Mail Order
• Tier 1 Lowest Cost Generic Drugs
• Tier 2 Low-Cost Generic Drugs
• Tier 3 Higher Cost Generic and Preferred Brand Name Drugs
$25/Copay
$62.50/Copay
$87.50/Copay
$25/Copay
$100/Copay
$175/Copay
BCBS Medical Bene�ts
RXINSIDER 2025
A Few of the Many Benefits You’ll Receive With Blue Cross Blue Shield
Making Fitness Fun
Our wellness program, powered by the Virgin Pulse® app, makes �tness contagious.
Earn points and get motivated with healthy team challenges, customized nutrition tools,
and trackers for activity, weight, sleep, and mood.
Doctors Online
Doctors Online is perfect for when your personal doctor is unavailable or when going
into the of�ce is not an option. See a doctor—365 days a year, seven days a week—on
your phone. Doctors are board-certi�ed professionals, and the online experience—via
mobile, tablet, or desktop—is designed to be private and secure. You also can schedule
appointments with licensed therapists.
BCBS Medical Bene�ts
RXINSIDER 2025
PPO Plan
The PPO plan gives you the freedom to seek care from the provider of your choice.
However, you will maximize your bene�ts and reduce your out-of-pocket costs if you
choose a provider participating in the (carrier name/network name) network. The
calendar year deductible must be met before certain services are covered.
Harvard Pilgrim HealthCare – Medical Bene�t Summary
Deductible
• Employee Only
• Family
$1,500
$3,000
Out-of-Pocket Limit
• Employee Only
• Family
$8,500
$17,000
Preventive Care
Primary Care Visit to Treat an Illness or Injury
Specialist Visit
Emergency Room
Urgent Care
No Charge
$30/Copay
$50/Copay
$250/Copay
$50/Copay
Prescription Drugs
Retail
• Tier 1 Generic Drugs
• Tier 2 Preferred Brand and Some Generic
• Tier 3 Non-Preferred Brand drugs
$5/Copay
$30/Copay
$60/Copay
Mail Order
• Tier 1 Lowest Cost Generic Drugs
• Tier 2 Low-Cost Generic Drugs
• Tier 3 Higher Cost Generic and Preferred Brand Name Drugs
$10/Copay
$60/Copay
$180/Copay
Harvard Pilgrim Health Care
RXINSIDER 2025
A Few of the Many Bene�ts You’ll Receive With Harvard Pilgrim Health Care
Get Con�dential Therapy Your Way
Talk to a Doctor On Demand Provider, and establish an ongoing relationship. From talk
therapy to medication management, Doctor On Demand licensed providers are here
to support you and your dependents through video or phone visits. Appointments are
con�rmed in less than 72 hours.
Wellness Reimbursement Program
Fitness Reimbursement
Health Coaching
Support for a Healthy Mind
Dedicated Nurse Care Managers to Guide You
Harvard Pilgrim Medical Bene�ts
RXINSIDER 2025
BCBS Dental FlexChoice Certi�ed 873C Plan Summary
Dental Care Services
Deductibles
Employee
Family
Annual Maximum Per Member
$50
$150
$1,500
Diagnostic and Preventative
Plan Pays
Up to Age 19
Age 19 and Over
• Oral Evaluations
• Cleanings
• Fluoride Treatment
• X-rays
• Sealants
100%
100%
100%
100%
100%
100%
100%
Not Covered
100%
Not Covered
Basic Dental
• Fillings
• Simple Extractions
• Root Canal Therapy
• Braces (Medically Necessary)
• Braces (Elective)
100% After Deductible
100% After Deductible
100% After Deductible
50% After Deductible
Not Covered
100% After Deductible
100% After Deductible
100% After Deductible
Not Covered
Not Covered
BCBS Dental Care Bene�ts
RXINSIDER 2025
Blue Cross Vision – Optics Vision 130-24 Eye Med
BCBS Vision Care Bene�ts
Vision Care Services
In-Network Cost
Out-of-Network Cost
Exam (With Dilation as Necessary)
$10/Copay
Up to $35
Contact lens �t and follow-up visits are
available once a comprehensive eye exam
has been completed.
Standard Contact Lens Fit and Follow-Up
Up to $40/Copay
10% Off Retail Price
N/A
Standard Plastic Lenses
Single Vision
Bifocal
Standard Progressive
$25/Copay
$25/Copay
$90/Copay
Up to $25
Up to $40
Up to $40
Frames
$0 Copay; 20% Off Balance
Over $130 Allowance
Up to $65
Frequency
Examination
Lenses or Contact Lenses
Frames
Once Every 12 Months
Once Every 12 Months
Once Every 24 Months
Once Every 12 Months
Once Every 12 Months
Once Every 24 Months
RXINSIDER 2025
RXinsider is committed to providing the best
possible coverage. We are proud to offer you
a choice between three different medical
plans. Coverage under all plans includes
comprehensive medical care and prescription
drug coverage. The plans also offer many
resources and tools to help you maintain a
healthy lifestyle. RXinsider will be absorbing a
signi�cant amount of the cost. Your share of
the contributions for medical, dental, and vision
bene�ts will be deducted on a pre-tax basis.
Medical, Dental, and Vision Eligibility
You are eligible for bene�ts if you are a regular, full-time employee, work at least
30 hours weekly, and have met the required initial waiting period. Bene�ts will begin the
�rst of the month following the 30 days of employment.
Eligible Dependents
Eligible dependents are de�ned as spouses and/or dependent children up to
age 26. Employee coverage must be elected for dependent coverage to be valid.
Eligibility & Enrollment
RXINSIDER 2025
10
When Coverage Begins
You must complete the enrollment process within 30 days of your hire date. Coverage is
effective the month following 30 days of employment.
Making Changes
Once you elect your bene�t options, your elections will remain in effect until the next
Open Enrollment. The only exception is if you need to make a change due to an IRS
approved qualifying life event.
Qualifying Events
• A Change to Your Legal Marital Status
• Birth or Adoption of a Child
• If a Child is No Longer an Eligible Dependant (26 Years Old)
• Death of a Spouse or Child
• Change in Your Employment Status From Full-Time to Part-Time or Part-Time to
Full-Time (Resulting in a Loss or Gain of Coverage)
• Change in Coverage Election Made by Your Spouse During Their Open
Enrollment Period
• You Lose Coverage Under Your Spouse’s Plan
• Entitlement to Medicare or Medicaid
To make changes to your bene�t
elections, you must contact human
resources within 30 days of the
qualifying event. You will need to
show documentation of the event,
such as a marriage license, birth
certi�cate, or divorce decree. If
changes are not submitted on time,
you must wait until the next open
enrollment period to make changes.
Eligibility & Enrollment