Benefits – Medical

Overview

We know that our employees have different needs. That’s why we offer three medical plan options –  the PPO Plan, HSA Plan and HSA Plus Plan – so you have the flexibility to choose the coverage that best fits your needs. All three medical plans are administered by Anthem and cover a broad range of medical services and include prescription drugs and vision coverage. The plans differ in the amounts that Anthem will pay and what you will pay:

How Our Plans Differ

The PPO Plan has lower out-of-pocket costs due to a lower deductible and coinsurance. While your costs are more predictable when you visit a provider, your payroll contribution is greater.

The HSA Plan and the HSA Plus Plan are consumer-driven medical plans that give you more flexibility to manage your coverage with employee contributions that are less than the PPO Plan. The HSA medical plans work differently because they combine a high deductible health plan with a special tax-advantaged Health Savings Account (HSA). You can use the funds in your HSA to pay for current or future qualified healthcare expenses for yourself, your spouse and your tax eligible dependents.

OCU 2025 Benefit Plan – Embedded vs. Aggregate

What are the coverage levels?

You have four different coverage levels to choose from:

• Employee only
• Employee + spouse/domestic partner
• Employee + child(ren)
• Employee + family*

*Family includes employee, spouse/domestic partner and child(ren)/domestic partner’s child(ren).

You have the flexibility to elect medical coverage and waive dental coverage or vice versa. This allows you to choose only the coverage you want and need. So consider your situation and anticipated healthcare needs carefully and choose the options that are right for you.

Medical employee contributions based on annual pay!!

Your 2025 employee contributions will depend on your annual pay. This makes what you pay for medical more in line with your income. It is a more equitable and fair approach because it considers the different financial circumstances faced by employees at various pay levels.

What this means for you

Your specific employee contributions will depend on your pay (if you make less, you’ll pay less), the plan you choose and who you cover. With the redesigned medical plans providing more flexibility to choose what best fits your budget, many could see a decrease compared to what they pay today depending on their coverage choices.

2025 Medical Contributions

Find Your Fit!

Life changes and so can your benefit needs. Before you make your decision, be familiar with what’s offered, ask yourself key questions and consider your choices. That way you’ll know you have the right fit, with the right combination of benefits and coverage for you and your family in the coming year.

Understand What’s Available

You have choices and annual Open Enrollment is your opportunity to consider the benefits that best fit your needs.

• Medical ― Choose from the HSA, HSA Plus and PPO Plans.
• Dental ― Coverage provided by Delta Dental.
• Supplemental medical benefits ― Optional coverage in case of an accident, hospital stay or diagnosis of a critical illness.
• Health Savings Account (HSA) ― Offers an opportunity to save tax-free for your qualified health care expenses if you enroll in the HSA Plan or HSA Plus Plan.
• Flexible Spending Accounts (FSAs) including the new Limited Purpose Health Care FSA ― Provides opportunities to save on taxes by paying yourself back for eligible health care and/or dependent day care expenses with tax-free dollars.
• Optional life and AD&D Insurance ― Additional Life and AD&D benefits in addition to your employer-provided base level coverage.
• Supplemental Coverage ― Supplemental benefits, offered through Voya, provide financial support and some peace of mind if you or a family member experience a covered accident, illness or hospitalization.

Consider Your Choices

Keep in mind:

• The way you pay for medical: If you prefer to have lower employee contribution amounts for medical coverage deducted from your paycheck but have higher cost-sharing amounts apply (i.e., deductible and coinsurance) in the event you need medical care, consider a coverage option that’s paired with an HSA. If you’d rather pay more in employee contributions out of your paycheck to keep your potential cost-sharing amounts lower if/when you need medical care, consider the PPO Plan.
• Opportunities to maximize your health care savings. If you choose HSA or HSA Plus medical coverage, consider taking full advantage of the Health Savings Account’s (HSA’s) triple-tax advantage*. In addition to Cummins’ contribution to your HSA, you can contribute to the HSA and use the money to pay for eligible health care expenses now or in the future. The money you contribute is tax free, earns interest/investment returns that are also tax free and is withdrawn tax free if used for eligible health care expenses.
• Tax savings when you use the Flexible Spending Accounts (FSAs). You can use FSAs to pay yourself back with tax-free dollars for your eligible health care and/or dependent day care expenses. However, plan carefully if you decide to participate in the FSAs. By law, you’ll forfeit any money you don’t use during the year. Note: If you enroll in the HSA or HSA Plus Plan, you are not eligible to participate in the Health Care FSA. However, you can participate in the Dependent Care or Limited Purpose FSAs.
• Additional life and accident financial protection. Understand the coverage you automatically receive from Cummins and the options you have to purchase additional protection. This includes added coverage for yourself, as well as optional coverage for your spouse/domestic partner and children (if applicable).
• Added benefits and resources included with medical coverage. When you enroll in medical coverage, you and your covered dependents automatically receive vision coverage. You also have access to a number of programs to help you get the care you need. This includes 24/7 medical advice through the Anthem NurseLine, LiveHealth Online Virtual Care, Anthem’s Inclusive Care program and Carrum Health to help you plan for a surgery.

* If you elect the HSA Plus Plan, Cummins will contribute $600 for Employee only coverage and $1,200 for all other coverage levels. If you are not eligible to contribute to an HSA, Cummins will contribute to a Health Reimbursement Arrangement (HRA) instead.

What is the coverage for HSA Plan?

Plan Feature	In-Network	Out-of-Network
Preventive Care	100%	Not available
Annual Deductible	Individual: $5,000 Family: $10,000 (Embedded/ Individual limit $5,000)	Individual: $10,000 Family: $20,000 (Embedded/ Individual limit $10,000)
Cummins HSA Contribution	$0 from Cummins, but you can contribute your own tax-free dollars up to IRS limits.
Employee HSA Contribution	Maximum allowable contribution per IRS guidelines  Individual coverage: Up to $4,300 for 2025 Family coverage: Up to $8,550 for 2025 Plus, you can contribute an additional $1,000 “catch-up” contribution if you’ll be age 55 or older in 2025.
Coinsurance (plan pays)	100% after deductible	50% of reasonable and customary fee
Annual Out-of-Pocket Maximum (includes annual deductible and coinsurance) Individual / Family* [Individual Limit]	Individual: $5,000 Family: $10,000($5,000 individual limit)	Individual: $10,000 Family: $20,000 ($10,000 individual limit)

* With the HSA Plan, the deductible and out-of-pocket maximum amounts are calculated under an embedded approach. Once one person meets the individual deductible (or out-of-pocket maximum amount), the plan begins to pay its share for that person. When another family member, or combination of family members, reach the second half of the deductible (meeting the full family deductible), the plan begins paying coinsurance for all covered family members.

2025 Summary of Benefits and Coverage (SBC) – HSA Plan

What is the coverage for HSA Plus Plan?

Plan Feature	In-Network	Out-of-Network
Preventive Care	100%	Not available
Annual Deductible	Individual: $2,250 Family: $4,500 (Aggregate/No individual limit)	Individual: $4,500 Family: $9,000 (Aggregate/No individual limit)
Cummins HSA Contribution	Cummins annual contribution amount is $600 Employee only or $1,200 for other coverage levels New hires will receive a prorated funding based on hire date and coverage level.
Employee HSA Contribution	Maximum allowable contribution per IRS guidelines  Individual coverage: Up to $4,300 for 2025 Family coverage: Up to $8,550 for 2025 Plus, you can contribute an additional $1,000 “catch-up” contribution if you’ll be age 55 or older in 2025.
Coinsurance (plan pays)	80% after annual deductible	50% of reasonable and customary fee
Annual Out-of-Pocket Maximum (includes annual deductible and coinsurance) Individual / Family*	Individual: $4,500 Family: $9,000 (Embedded/$7,500 individual limit)	Individual: $9,000 Family: $18,000 ($15,000 individual limit)

* Aggregate deductible and out-of-pocket maximum.

2025 Summary of Benefits and Coverage (SBC) – HSA Plus Plan

What is the coverage for PPO Plan?

Plan Feature	In-Network	Out-of-Network
Preventive Care	100%	Not available
Annual Deductible	Individual: $750 Family: $1,500*	Individual: $1,500 Family: $3,000*
Cummins HSA Contribution	Not available
Employee HSA Contribution	Not available
Coinsurance (amount plan pays after annual deductible)	80% after annual deductible	50% of reasonable and customary fee
Annual Out-of-Pocket Maximum** (includes annual deductible, copays, and coinsurance) Individual / Family*	Individual: $3,250 Family: $6,500 (Embedded/$3,250 individual limit)	Individual: $6,500 Family: $13,000 ($6,500 individual limit)

*The deductible and out-of-pocket maximum amounts are calculated under an embedded approach. Once one person meets the individual deductible (or out-of-pocket maximum amount), the plan begins to pay its share for that person. When another family member, or combination of family members, reach the second half of the deductible (meeting the full family deductible), the plan begins paying coinsurance for all covered family members.

**Prescription drug expenses are not counted toward the calendar-year deductible but are counted toward the calendar-year out-of-pocket maximum.

2025 Summary of Benefits and Coverage (SBC) – PPO Plan

Transparency in Coverage

Transparency in Coverage (TIC) regulations require health insurers and group health plans to make Machine Readable Files (MRFs) publicly available that contain the negotiated rates for in-network providers and allowed amounts for out-of-network providers. The MRFs are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. Anthem is responsible for publishing and maintaining the MRFs for our Cummins plans. These files will be published on anthem.com and will be updated monthly.

Users can view the Anthem machine readable files at: https://www.anthem.com/machine-readable-file/search/. These files are identified by the Cummins Employer Identification Number (EIN): 35-0257090.

What are the preventive care benefits?

Regardless of the medical plan you select, eligible preventive care services are covered at 100% with no deductible when you use in-network providers. Preventive care benefits include:

• Physical exams
• Well-child care
• Immunizations
• Mammograms
• Pap smears
• Colonoscopy
• Women’s contraceptives
• Breast pumps
• Other preventive care tests connected to the physical exam

For additional information, please refer to the Preventive Services List or contact the Anthem 866-251-1779 or visit the website.

Downloads

2024-2025 Flu Voucher

Anthem Medical Claim Form

Cummins Active Exchange Model Notice

IRS Publication 502 Medical and Dental Expenses

Medical FAQ

US Health Benefits Outside US Coverage FAQ
Blue Cross Blue Shield Global Core – Coverage While Traveling Outside the U.S.
Blue Cross Blue Shield Global Core – International Claim Form