What’s new for 2024? – tables
Changes to your medical and dental paycheck contributions
2025 biweekly cost of dental coverage
Employee only
Employee + spouse or domestic partner*
Employee + children
Family**
DPO Plan
$4.68
$13.58
$13.58
$13.58
2025 Medical – The Big Picture
HSA company contribution
Provider network
Deductible
Out-of-pocket maximum (medical)
Out-of-pocket maximum (prescription)
Prescription drugs
Cost of premium per paycheck
HDHP Saver Plan (HSA eligible)
$1,000 individual
$2,000 family
$2,000 family
National PPO Network
$2,000 individual
$4,000 family**
Family deductible must be met before coinsurance applies
$4,000 family**
Family deductible must be met before coinsurance applies
$6,450 individual
$12,900 family
$12,900 family
Included in medical deductible
After meeting the plan’s deductible, you pay a copay per prescription
$
PPO Plan
N/A – not an HSA-eligible plan
National PPO Network
$500 individual
$1,250 family
$1,250 family
$4,950 individual
$9,650 family
$9,650 family
$1,000 individual
$2,000 family
$2,000 family
The plan deductible does not apply; you pay a copay per prescription
$$$
HMO Plan
N/A – not an HSA-eligible plan
HMO Blue New England
$500 individual
$1,000 family
$1,000 family
$4,950 individual
$9,990 family
$9,990 family
$1,000 individual
$2,000 family
$2,000 family
The plan deductible does not apply; you pay a copay per prescription
$$
2025 Medical – The Details
Preventive care
Office visit (primary and specialist)
Mental health visit
Inpatient mental health treatment
Telehealth
Diagnostic and X-ray, MRI, CAT scan
Urgent care
Emergency room
Physical and occupational therapy (limit 60 visits)
Speech therapy
Outpatient surgery
Hospitalization
HDHP Saver Plan (HSA eligible)
Covered 100%, no deductible
10% after deductible
10% after deductible
10% after deductible
10% after deductible
10% after deductible
10% after deductible
$150 per visit after deductible is met (copay waived if admitted)
10% after deductible
10% after deductible
10% after deductible
10% after deductible
PPO Plan
Covered 100%
$35 per visit primary care
$35 per visit specialist
$35 per visit specialist
$35 per outpatient visit
$0 after deductible
$20 per visit
$0 after deductible
$35 per visit
$150 per visit after deductible is met (copay waived if admitted)
$35 per visit
$35 per visit
0% after deductible
0% after deductible
HMO Plan
Covered 100%
$35 per visit primary care
$35 per visit specialist
$35 per visit specialist
$35 per outpatient visit
$0 after deductible
$20 per visit
$0 after deductible
$35 per visit
$150 per visit, no deductible (copay waived if admitted)
$35 per visit after deductible
$35 per visit after deductible
0% after deductible
0% after deductible
