FAQs
Medical, Prescription, Dental & Vision Benefits

Frequently asked questions about 2020 benefits plans.
 

2020 Dental Benefits

Why do I have to keep dental coverage for two full calendar years?

In order to keep costs low for all eligible associates, we need to avoid having people join the dental plan, use high-priced services, then drop coverage.

If I drop dental coverage, what happens if I want to reenroll next year?

You are free to reenroll in dental coverage if you have dropped coverage in the past. Note, however, that orthodontia coverage under the Plan begins only after you have participated in the dental plan for 12 months. If you drop coverage and then reenroll (due to a qualified status change event or during the next Annual Enrollment period), your waiting period will restart for orthodontia, and you will have to wait for one full year after reenrolling before your care is covered.

What if an associate or family member has coverage under more than one dental plan?

If you have coverage under more than one dental plan—for example, under both the Walmart Plan and your spouse/partner’s employer-sponsored dental plan, the coordination of benefits provision will apply. The dental plan has the right to coordinate with other plans under which you are covered so the total dental benefits payable will not exceed the level of benefits otherwise payable under the dental plan. “Other plans” are fully described in the 2020 Associate Benefits Book. Dental benefits will not exceed annual or lifetime maximums.

How can I find a network provider?

Call Delta Dental at 800-462-5410 or go to the dental directory and look up a dental provider. You’ll find the directory at One.Walmart.com/Dental. Because the list changes frequently, the most up-to-date list is on Delta Dental’s website. You can also ask your dentist if he or she is a Delta Dental PPO provider.

2020 Vision Benefits

Are there any changes in the vision plan for 2020?

No. There are no changes to the vision plan in 2020.

What happens if I don't enroll in the vision plan?

You'll continue to have eyewear discounts at Walmart Vision Centers and Sam’s Club Optical. Here is how the discounts work:

  • You can receive a 20% discount at Walmart Vision Centers and a 10% discount at Sam’s Club Optical on eyeglasses, contacts, sunglasses, and accessories for yourself and any covered family member.
  • You must use your Associate Discount Card to receive your discount.
Can I enroll in the vision plan without enrolling in any other plan?

Yes. The vision plan is a separate plan, so you can enroll in it without enrolling in any other benefit plan.

Is routine vision care covered under any of the Walmart medical plans?

No. However, routine vision care is considered a qualified medical expense for associates who are enrolled in the Saver Plan and have a Health Savings Account.

What kinds of exams are covered by the vision plan?

Routine exams for refractive error are covered once every calendar year

What happens if I break my glasses or lose them before I'm eligible for a new pair?

If you break or damage eyewear within the first year of purchase, you can return it to Walmart, Sam’s Club, or your VSP provider for replacement or repair. Some warranties on eyewear are longer than one year. Check with your eyewear provider for specific warranties.

Lost eyewear is your responsibility and cannot be replaced under the vision plan.

If I enroll in the vision plan, do I still get the discount at Walmart Vision Centers and Sam’s Club Optical?

No. You cannot use your discount card to reduce the cost of eyewear after the vision plan reimbursement. However, you can use it for certain expenses not covered under the vision plan, such as a second pair of glasses.

What if I want a second pair of glasses or prescription sunglasses?

These are not covered expenses under the vision plan—you will need to pay for these glasses with your own funds. However, you can still get the discount if you use a Walmart Vision Center or Sam’s Club Optical. 

What are the guidelines for where I can get vision care under the vision plan?

You can go to any VSP network provider under the vision plan, including a Walmart Vision Center or Sam’s Club Optical, and receive the same reimbursement rate. Non-VSP providers are not covered under the vision plan.

How can I find out which network providers I can use?

Go to VSP.com or VSP.com/go/Walmart and type in your Benefit Identification Number (BID). Find your BID on the back of your plan ID card. 

I’m enrolled in the Contribution Plan. Can I use my Walmart dollars to pay my share of the vision expenses?

No. Walmart dollars may not be used toward out-of-pocket vision expenses.

I’m enrolled in the Saver Plan. Can I use my Health Savings Account dollars to pay my share of the vision expenses?

Yes. You can use Health Savings Account dollars to pay your share of expenses covered under the vision plan.

When can I enroll in or drop the vision plan?

The rules are the same as for the medical plan— when you first become eligible for benefits, during Annual Enrollment, or if you have a qualifying status change event like getting married or having a baby.

Who is eligible for the vision plan?

All associates are eligible for the vision plan, regardless of hours worked. Part-time and temporary associates are eligible following 12 months of employment.

Does the company contribute to the cost of the vision plan?

No. You pay the full cost of the vision plan.

Are there tobacco-user rates for the vision plan?

No. Tobacco-user rates only apply to Walmart’s medical coverage, optional associate life insurance, optional dependent life insurance for a spouse, and critical illness insurance. 

Will I get a vision ID card?

Associates who are enrolled in a Premier, Contribution, Saver, or Local Plan can use your plan ID card if you are enrolled in the vision plan.

If you are not enrolled in one of these plans, or if you are enrolled in an HMO Plan, you will receive a separate vision plan ID card.

Will the Walmart vision plan coordinate with other vision plans?

Yes. VSP will coordinate with other plans that are administered by VSP. Our vision plan does not have out-of-network coverage, so if a vision provider is not in the VSP network, we cannot coordinate with that provider.

If I am enrolled in an HMO with a vision plan, can I still enroll in this vision plan?

Yes. Howerver, you should review the vision coverage under your HMO Plan to see if you need the additional coverage provided through the vision plan.

Will the $4 lens material copay apply to single vision, bifocal, and trifocal lenticular lenses or will there be additional costs?

Yes, it does apply. Additional costs to you are for extras like optional cosmetic processes; specialty coatings; blended, cosmetic, laminated, oversized, photochromic, progressive multifocal, and tinted lenses (except pink #1 and pink #2).

Does the $4 eye exam copay include dilation for someone with diabetes?

The vision plan only covers routine refractive error exams. Exams for diseases of the eye or other medical diagnoses may be covered under the medical plan.

Are all Walmart Vision Centers and Sam’s Club Optical part of the VSP network?

No. Some optometrists are not participating. To find participating vision centers in the VSP network, go to One.Walmart.com/Vision.

2020 Pharmacy/Prescription Drug Benefits

How does the pharmacy benefit work?

The pharmacy benefit offers discounted prescription drugs, including generic, and eligible brand-name and specialty drugs at retail pharmacies and through mail-order services. This benefit comes automatically when you enroll in a medical plan. In general, covered medications are part of a formulary, or list, of prescription drugs covered by the pharmacy benefit. 

Who manages the pharmacy program?

OptumRx is the pharmacy benefit manager for the Premier, Contribution, Saver, and Local Plans. This means you manage claims and maintain the formulary—the list of drugs covered by the plans. HMO Plans have your own pharmacy benefit plans. You can reach OptumRx at 844-705-7493 or through the OptumRX website.

Does it matter where I fill my prescriptions?

Yes. Most associates can only receive a benefit if you use a Walmart or Sam’s Club pharmacy. If however, your work location is more than five miles from a Walmart or Sam’s Club pharmacy and you have medical coverage under the Premier, Contribution, or Saver Plan, you have the option to have your prescriptions filled at an OptumRx network pharmacy as well. Specialty drugs must be purchased from Walmart Specialty or OptumRx Specialty Pharmacies.

What do prescriptions cost?

Generic drugs
• Up to 30-day supply | $4 copay
• 31- to 60-day supply | $8 copay
• 61- to 90-day supply | $12 copay

Brand-name drugs
• Up to 30-day supply |
25% of allowed cost

Specialty drugs
• Available only at Walmart Specialty Pharmacy or OptumRx Specialty Pharmacies |
20% of allowed cost

Mail order drugs:
• Your cost for a 90-day supply is three times the cost of a 30-day supply purchased at a Walmart or Sam’s Club pharmacy, as listed above. For more information, call Walmart home delivery at 800-2REFILL (800-273-3455), or Walmart Specialty Pharmacy at 877-453-4566. 
• For brand-name drugs, 31-day supplies or greater must be purchased through mail order, Walmart, or OptumRx Mail Order.

Under the Saver Plan:
• The copays listed above apply after the Saver Plan’s network annual deductible has been met, with the exception of medications that are on the OptumRx list of approved preventive medications, which are not subject to the deductible. See Preventive medications not subject to the Saver Plan’s network annual deductible later in this chapter for details.

What is a formulary, and where can I find it?

The formulary is the list of prescription drugs covered by the pharmacy benefit. Because new drugs become available throughout the year, the formulary is reviewed four times a year by a group of physicians and pharmacists to ensure the most clinically effective medications are available to associates.

You can visit the OptumRx website to look up prescription drugs that are covered under the formulary.

What will the pharmacy benefit cover if generic drugs are not effective for me?

In most cases, generic drugs are just as effective as brand-name drugs. If a generic is not effective in particular circumstances, clinical review may be available and a brand-name drug may be approved. Contact OptumRx for more information. You should also discuss alternative drug therapy with your physician.

What is step therapy?

Step therapy is an approach that requires the patient to try preferred medications that are clinically safe and effective as the initial step in treatment. Brand-name drugs may then be covered after the you:
• Have tried the similar generic drugs covered on the formulary
• Have established that you cannot tolerate a generic drug

How do I get a non-covered drug covered by my plan?

If your drug is not covered, you can request clinical review or appeal with OptumRx for the medication you have been prescribed.

What happens if the discounted pharmacy price is lower than the copay amount?

If the discounted price available at the time your prescription is filled is lower than the copay, you will be charged the lower amount. You will never be charged more than the retail cost of any prescription. The cost you actually pay is applied to your out-of-pocket maximum.

Does the pharmacy copay apply to my out-of-pocket maximum?

Yes. Pharmacy copays apply to your out-of-pocket maximum.

Does the pharmacy copay apply to my deductible?

If you are enrolled in one of the Premier, Contribution, or Local Plans, the pharmacy copay does not apply toward meeting your deductible. If you are enrolled in the Saver Plan, you generally must pay full cost for prescriptions until you meet your annual deductible (with the exception of approved preventive medications, which are not subject to the Saver Plan’s annual deductible). With the exception of these charges for approved preventive drugs, your pharmacy charges under the Saver Plan do count toward your network annual deductible.

2020 Expanded Medical Programs

What is the Centers of Excellence program?

Are you or your covered dependent facing major surgery or cancer? You should get the very best, most appropriate care possible. Walmart’s Centers of Excellence program gives access to world-class specialists for certain serious conditions and procedures, including many heart and spine surgeries, hip and knee replacements; and medical record review for some types of cancer, end-stage renal disease, transplants, and weight loss surgeries.

Most of these conditions are covered at 100% before meeting the deductible. In general, preauthorized services received at the facility are covered by the program, while those received before or after are covered according to the medical plan. If you’re enrolled in the Saver Plan, you must first meet your annual deductible. Travel benefits are also provided for the patient and a companion caregiver.

What are Centers of Excellence?

The Centers of Excellence facilities are chosen to provide certain services for Walmart associates and their families because they provide the highest-quality care for the patient. For many services, the plan also provides travel, lodging, and an expense allowance for the patient and a caregiver.

How are the participating hospitals chosen?

To assure that the highest-quality care is available to participants nationwide who are enrolled in one of the Premier, Contribution, Saver, or Local Plans, the company considers many factors, including medical expertise and each facility’s geographic location. The main criteria used to select participating hospitals are that each facility must:

  • Possess very high-quality indicators
  • Foster a culture of following evidence-based guidelines and, as a result, perform surgeries only when necessary, and
  • Structure your surgeons’ compensation so that they are not incentivized to do surgery strictly based on money, but rather on what’s the most appropriate care for each individual patient.
What procedures and services are included in the Centers of Excellence program?

Heart procedures:
• Open heart surgery for coronary artery bypass grafting (CABG)
• Heart valve replacement/repair (inpatient procedures)
• Closures of heart defects (inpatient procedures)
• Aneurysm repair—thoracic and aortic
• Other inpatient complex cardiac surgeries

Spine procedures:
• Spinal fusion (cervical and lumbar)
• Total disk arthroplasty (artificial disk)
• Removal of vertebral body
• Laminectomy
• Discectomy
• Spine surgery revisions
• Other inpatient complex spine surgeries

Hip and knee replacement:
• Total hip replacement
• Partial hip replacement
• Total knee replacement
• Partial knee replacement

Weight loss surgery:
You and your covered dependents age 18 and above enrolled in one of the Premier, Contribution, Saver, or Local Plans may have specific surgeries for weight loss covered when Plan eligibility requirements and medical criteria are met.

Cancer services:
Participants diagnosed with certain cancers may have your medical records reviewed by Mayo Clinic specialists to evaluate the benefit of an on-site visit. If an on-site visit at Mayo Clinic is recommended, the visit will be covered at 100% and will include a travel allowance. At this time, the program includes the following types of cancer:

• Breast cancer
• Lung cancer
• Colorectal cancer
• Prostate cancer
• Blood cancer (including multiple myeloma, leukemia, and lymphoma)

Kidney services:
You and your covered dependents diagnosed with end-stage renal disease (ESRD) are eligible to have your medical records reviewed by Mayo Clinic specialists to determine the most appropriate course of treatment. If an on-site visit is recommended, the visit will be covered at 100% and will include a travel allowance.

Transplants:
All organ and tissue transplants (except cornea and intestinal) are covered when Plan eligibility requirements and medical criteria are met. This benefit also applies to lung volume reductions, ventricular assist devices (VADs), total artificial hearts, and CAR-T cell therapy.

If I participate in the Centers of Excellence program, where could I be traveling?

The medical center in which you receive services is determined by where the you live, medical plan type, and the indicated surgery or service. Here are some of the facilities in the program:
• Cleveland Clinic (Cleveland, Ohio)

• Geisinger Medical Center (Danville, Pennsylvania)

• Virginia Mason Medical Center (Seattle, Washington)

• Emory University Hospital (Atlanta, Georgia)

• Mayo Clinic Arizona (Scottsdale, Arizona)

• Mayo Clinic Florida (Jacksonville, Florida)

• Mayo Clinic Minnesota (Rochester, Minnesota)

• Mercy Springfield (Springfield, Missouri)

• Memorial Hermann-Texas Medical Center (Houston, Texas)

• Johns Hopkins Bayview Medical Center (Baltimore, Maryland)

• Kaiser Permanente Irvine Medical Center (Irvine, California)

• Ochsner Medical Center (New Orleans, Louisiana)

• Scripps Mercy Hospital (San Diego, California)

• University Hospital (Cleveland, Ohio)

• Northwest Medical Center (Springdale, Arkansas)

Do I need to enroll in the Centers of Excellence program?

The Centers of Excellence program is part of Walmart’s medical coverage, so there’s no need to enroll separately. If you are enrolled in one of the Premier, Contribution, Saver, or Local Plans, you are automatically eligible for the Centers of Excellence program if you meet program requirements. To participate in the program, call a health care advisor at the number on the plan ID card.

Can my doctor recommend treatment at a Centers of Excellence facility?

If your physician indicates that you need heart or spine surgery, a hip or knee replacement, transplant services, weight loss surgery, or that you have been diagnosed with breast, lung, prostate, blood, or colorectal cancer, then your physician or health care advisor should initiate the process by calling the number on your plan ID card.

Is there a waiting period before the Centers of Excellence program is available?

Generally not, however you or your covered dependent must be enrolled in coverage for one year before becoming eligible for the weight loss surgery and transplant benefits.

What exactly does the Walmart plan cover when you get Centers of Excellence care?

For most Centers of Excellence services, patient care for eligible services at a Centers of Excellence facility is covered at 100%, which means you don’t have to use your other benefits to cover your medical costs. Weight loss surgery is covered at 75% after you meet your medical plan deductible; your claims will be handled for weight loss surgery the same as other medical services. Due to federal tax law, if you are enrolled in the Saver Plan, you will receive the benefit coverage available under the Centers of Excellence program after you meet your deductible. For all plans, services must be preauthorized to be covered.

Does the Centers of Excellence program cover additional costs like travel and lodging?

For most eligible services, yes. This benefit includes travel, lodging, and an expense allowance for the patient and a caregiver. For the cancer services, medical records are reviewed and if an on-site visit at Mayo Clinic is recommended, the visit will be covered at 100% and will include a travel allowance (subject to annual deductible for you covered by the Saver Plan). No travel benefit is available for weight loss surgery or for associates obtaining certain Centers of Excellence services through your Local Plan. You or covered dependents should contact your health care advisor for more information.

What is the weight loss surgery benefit?

The weight loss surgery benefit covers gastric bypass surgery and gastric sleeve surgery as part of your regular medical benefits. As a Plan participant, you must meet all requirements to qualify for coverage and your surgery must be performed by a designated physician and facility.

How do I learn more about the weight loss surgery benefit?

To learn more about this benefit, you or your covered dependents should contact your health care advisor. In most cases, your health care advisor will work with another vendor partner, Health Design Plus, to manage the intake and approval process, as certain qualifications are required in order to be eligible for weight loss surgery. Health Design Plus will also manage the processing of claims from the surgical facility.

If you are covered under any of the Local Plans, contact a health care advisor who will manage the approval process.

How does Doctor On Demand work?

Doctor On Demand lets physicians, behavioral health providers and lactation consultants provide focused care during a video-chat session—without you having to leave your home. With video, you can look, listen, examine, and engage with you to diagnose your issues and provide an effective treatment plan.

What are common medical conditions that Doctor On Demand can treat?

Doctor On Demand can treat many common medical conditions including cough, cold, flu, allergies, sore throat, skin issues and rashes, and some eye issues. Visit www.DoctorOnDemand.com/Walmart.

What medical conditions does Doctor On Demand not treat?

Doctor On Demand does not treat complex medical issues or chronic conditions. For the most effective treatment of chronic conditions, see a primary care physician. Doctor On Demand is not intended to replace the care you receive from your primary care physician.

What are the hours of operation for Doctor On Demand?

Doctor On Demand is available 24/7, 365 days a year, or you can set an appointment with a physician for a time that will work best for you. When using Doctor On Demand psychology and/or psychiatry services, you will need to set up an appointment in advance.

How do I use the Doctor On Demand service?

First, you’ll need to download the app or register at DoctorOnDemad.com/Walmart. Then just use the app on your phone or tablet. Although it is recommended that you use Wi-Fi for the best possible experience, it is not required. As long as your connection is 4G or LTE, you should be fine.

How much does Doctor On Demand cost?

• It’s just a $4 copay in the Premier, Contribution, or Local Plans.

• For the eCommerce PPO Plan, there’s a similar service through Teladoc and a $15 copay per medical visit and $25 copay per behavior health visit.

• Covered by an HMO? Check with your HMO for telehealth options.

• Covered by the Saver Plan? You can video-chat with a doctor or behavior health specialist for $4 after your deductible is met. Before your deductible is met, the cost is $49 for medical visits, $79/$119 for 25/50 minute sessions with a psychologist and $229 for a 45 minute psychiatry visit.

Can the doctors prescribe medication?

Yes. The physicians with Doctor On Demand are able to prescribe a wide range of drugs for infections, allergies, skin conditions, travel, and sports injuries. They do not, however, prescribe narcotics or pain medications designated as U.S. controlled substances as a Schedule I, II, III, or IV drug. Otherwise, many of the prescriptions available in an office setting or urgent care can be prescribed.

Can the physicians complete paperwork, such as leave of absence paperwork and work notes?

Generally speaking, no. While Doctor On Demand’s clinicians may be able to provide simple forms such as work/school excuses or return to work/school documents in limited circumstances, you should always visit a doctor in person if you have paperwork to be completed.

What happens if I go over the time limit for a consultation?

When you are near the time limit for a consultation, Doctor On Demand will ask if you’d like to extend the call for a specified amount of time for an additional charge.

How is personal information and medical history stored? Is it safe?

Your information is stored on the Doctor On Demand’s encrypted servers inside encrypted databases, which meet strict government regulations regarding privacy and security.

What payment methods does Doctor On Demand accept?

Doctor On Demand accepts all major credit cards, such as VISA, MasterCard, American Express, and Discover. You can also pay using your Health Savings Account debit card, if you have an account.

What is the Personal Online Doctor program?

A new optional program with your own dedicated online doctor, provided by our partner for telehealth, Doctor On Demand. Get the treatment you need anytime from your doctor online, who can order lab work, write prescriptions, and coordinate care with other doctors covered by your plan.

What can I expect when I use the Personal Online Doctor program?

Here’s what you can expect once you sign up for the program:

• Your profile for health—establish your patient profile that gives you a real-time view of your health care and allows data to be shared securely across provider networks.

• Expanded access to care online—get services such as preventive health, urgent care, behavioral health, and chronic disease management for conditions such as diabetes, hypertension, asthma, and behavioral health.

• Referrals to specialists—your care team will make network referrals for in-person visits and work with your existing providers to support your total well-being.

How much does it cost to use the Personal Online Doctor program?

There’s no additional cost to participate in the program. Each virtual visit is just $4, including doctors, psychologists, and psychiatrists. If you’re in the Saver Plan, you’ll pay full price for the cost of care through the online program until you meet your deductible.

When and where is the program available?

Beginning Jan. 1, 2020, the program is available in parts of Colorado, Minnesota, and Wisconsin. You’re eligible if you see “HealthSCOPE Benefits” on the back of your new plan ID card.

I like my current doctor. Do I have to change doctors to use the Personal Online Doctor program?

No. While we encourage you to use the program as your regular primary care doctor, you can also think of it as a complement to your current care. It provides access to care outside of typical doctor’s office hours, and it’s much more convenient to connect from home.

What types of doctors are available online?

The program has a whole care team of doctors, psychiatrists, psychologists, nurses, and other health care providers available 24/7.

I have a chronic medical condition requiring ongoing treatment and medication. Is the Personal Online Doctor program for me?

You may be a great fit for the Personal Online Doctor program. Here are just a few of the services available to help you manage your health through video visits, phone calls, or messaging:

• Personalized, dedicated coaching support for managing your chronic disease

• Regular check-ins on your condition, well-being, and treatment success

• Tips for healthy ways to manage your chronic disease

• Care coordination with your in-person doctor when you need a referral to a specialist for additional treatment.

What happens if I need a referral to a specialist or can’t be treated by the Personal Online Doctor program?

Your online doctor will assess your needs and after careful evaluation, will connect you with a specialist in your medical plan’s network. You may continue to connect with your online doctor for support during your care.

What are typical medical conditions for which I can use the Personal Online Doctor program?

The Personal Online Doctor program is available to help both mind and body. Here are a few conditions where the program can help you:

• Urgent care—available 24/7 for conditions such as headaches, sore throats, colds, and flu. Providers can help get you on track as well as order prescriptions, if needed.

• Behavioral health—licensed psychologists and board-certified psychiatrists provide emotional support while you’re in the privacy and ease of your home. From talk therapy to medication management, the team can support your complete mental well-being.

• Preventive health—the care team partners with you to support your day-to-day health and self-care routines. From healthy eating to preventive lab screenings, you bring together simple solutions to stay on a track.

• Ongoing chronic disease support—get easy online access to a care team who can answer your treatment questions, help you learn more about prescription options, and help you manage your condition.

Am I charged for every time I use the Personal Online Doctor program? How does the pricing work?

Yes. Each virtual visit is just $4. Additional services and other treatment may be an additional cost. Any additional cost for the visit will be shared with you up front, and you’ll have the option to continue with the care or end the session before you are charged. Please note: if you’re in the Saver Plan, you’ll pay the full cost of care until you reach your plan’s deductible. 

Will I be billed for the $4 copay or do I have to pay upfront?

You have a few options for payment. The $4 copay needs to be paid at the time of treatment. 

I’m new to using online doctors and wondered if it is safe? Will my medical information be secure?

Yes. Be assured your medical information is secure and the service is safe and confidential. Doctor On Demand meets our high standards for security, privacy, and quality.

Where do I go to learn more about the Personal Online Doctor program?

Here are a few resources:

• Online: go to One.Walmart.com/VideoDoctor
• Call the People Services team at 800-421-1362

What is Grand Rounds?

Grand Rounds is your go-to resource to find a doctor. This online and phone-based service connects you to the right doctor for your needs, in-network and close to home, and lets you know if the fees a doctor charges are fair. It also offers expert second opinions from top physicians, an in-house clinical care team, and other assistance to help you get the care you need.

When should I use Grand Rounds?

Use Grand Rounds when:

• You need a primary care doctor or specialist for an in-person visit. Grand Rounds can even schedule the appointment.

• You received a diagnosis or have been recommended for surgery or a certain treatment. Grand Rounds can provide a medical second opinion from a leading specialist in your area of need.

• If you would like to double-check that your doctor is charging reasonable rates.

Who can use Grand Rounds?

Grand Rounds is available to you if you're enrolled in the Premier, Saver, Contribution, and Local Plans. Please keep in mind that if you're in Central Florida, Dallas/Fort Worth, Texas, and Northwest Arkansas, you need to use the Provider Guide website instead.

How much does it cost?

Grand Rounds is part of our medical plans, and available at no cost to you.

How do I get started with Grand Rounds?

It’s easy:

• Visit the Grand Rounds website at GrandRounds.com/Walmart
• Download the mobile app from the Apple or Android App Store • or call 800-941-1384

What is the Personal Healthcare Assistant program?

We’re rolling out a unique approach to help you navigate your health and benefits. In parts of North Carolina and South Carolina, most of you will have access to a Personal Healthcare Assistant at no cost when you’re enrolled in a medical plan. Here are a few highlights:

• Care and benefits simplified–help making the most of your health benefits, from setting appointments and collecting records to making sense of medical bills.
• Support for getting to medical appointments–help finding childcare and transportation.

When does the program start?

Jan. 1, 2020. If you need help before the official start, please contact Grand Rounds to learn more about your options at One.Walmart.com/HealthAssist.

What can I expect when I sign up for the program?

Here’s what you can expect with the Personal Healthcare Assistant program:

Sign up and create your account–sign up with Grand Rounds by going here One.Walmart.com/HealthAssist or calling 855-377-2200.
Find ways to save–contact your Personal Healthcare Assistant to better understand and manage your medical costs.
Personalize your experience–let your Personal Healthcare Assistant know more about your medical history, health care needs, barriers to getting care, and any other concerns.
Use your Personal Healthcare Assistant to get better care–reach out to your Personal Healthcare Assistant when you’re ready to get care, are experiencing symptoms, need help with a chronic disease, or are just looking for a doctor for you or your family.
Get a second opinion on medical conditions–recently diagnosed with a medical condition and have questions about care or treatment options? Get a second opinion from your Personal Healthcare Assistant.
Get help getting the care you need–from finding transportation to help with paperwork, your Personal Healthcare Assistant has you covered.

Do I have to pay to use the Personal Healthcare Assistant program?

No. This program is offered at no cost to you as part of your medical plan.

Is the program available to my covered family members?

Yes. The program is available to any family members you cover with your plan, and who live in parts of either North Carolina or South Carolina.

Some of my medical expenses don’t add up. Can the Personal Healthcare Assistant help me figure it out?

Yes. Once you sign up, you can have all your medical expenses reviewed and documented by a team of health care and medical billing experts. Then you’ll get a summary of what you owe.

Can this program help me schedule doctor appointments?

Yes. We know it can be hard to get appointments with some doctors, so we asked Grand Rounds to help. This program is designed to help you get appointments scheduled quickly.

Sometimes it’s hard to find childcare when I need to see a doctor. Can the Personal Healthcare Assistant help?

Yes. The Personal Healthcare Assistant can help you find childcare and make it easier to get to appointments.

What is a health care advisor?

All of our medical claims administrators have provided a health care advisor who serves as the medical plan’s primary health care contact for you and your family. The health care advisor is a trained professional who can help you have a better overall experience when using your health care benefits.

Why do I have a health care advisor?

The health care advisor brings a consistent and personal touch to your health care benefits, administrative issues, and questions. The health care advisor is there for you and your dependents and will work with you to find the appropriate solution for your needs.

What is the phone number for my health care advisor?

The health care advisor’s phone number is listed on your plan ID card. Those numbers are:

Aetna: 855-548-2387
BlueAdvantage Administrators of Arkansas: 866-823-3790
HealthSCOPE Benefits: 800-804-1272
UnitedHealthcare: 888-285-9255

What are the hours of operation of the health care advisors?

Aetna: Monday–Friday: 6 a.m.–10 p.m. CT Saturday: 6 a.m.–3 p.m. CT (Nurse line is available 24/7) 855-548-2387
BlueAdvantage Administrators of Arkansas: Monday–Friday: 6 a.m.–10 p.m. CT Saturday: 6 a.m.–3 p.m. CT (Nurse line is available 24/7) 866-823-3790
HealthSCOPE Benefits: Monday–Friday: 7:30 a.m.–6 p.m. (Nurse line is available 24/7) Check the back of your plan ID card for nurse line phone number
UnitedHealthcare: Monday–Friday: 7 a.m.–10 p.m. CT Saturday: 7 a.m.–4 p.m. CT (Nurse line is available 24/7) 888-285-9255

Is the health care advisor a nurse? How can I speak with a nurse?

The health care advisor is not a nurse, but you do have options for speaking with health care providers:

Doctor On Demand—An online and mobile service that’s an easy way to talk to a doctor using video on your smartphone, tablet, or computer. Access this program by going to DoctorOnDemand.com/Walmart or downloading the Doctor on Demand App on your smartphone.
24-hour nurse line—BlueAdvantage, Aetna, the Local Plans, Select Plan, and United Healthcare all offer a 24-hour nurse line to help when you have questions about illnesses, injuries, or medical concerns. If you are not sure whether your symptoms mean you should seek care immediately or wait and call your doctor in the morning, a call to the nurse line may help you decide. The nurse line can assist with issues that are urgent, short-term, or after-hours. The nurse line can be reached at the number on your plan ID card.

If I have questions when enrolling for benefits, should I call People Services or the health care advisor?

You should call People Services at 800-421-1362 if you have questions about benefits enrollment.

You should contact the health care advisor if you are enrolled in a Premier, Contribution, Saver, or Local Plan, and have questions specific to your plan’s benefits, preauthorization requirements, or general questions about your family’s medical needs.

What is care management?

Successful care management looks at the whole individual rather than just the symptoms or conditions being diagnosed, so it can result in higher quality of care and an improvement in your experience with your doctors and administrator, as well as potentially lower out-of-pocket medical expenses.

Who provides care management services?

A specially trained, registered nurse care manager provides this service. They will help you and your covered dependents deal with the difficulties associated with an illness or injury and can help with routine questions and interactions with medical providers.

How can I get care management services?

To reach a nurse care manager, call the telephone number on the plan ID card. Please keep in mind that you who work in parts of Colorado, Minnesota, North Carolina, South Carolina, and Wisconsin have care management services provided by special Personal Online Physician or Personal Healthcare Assistant programs.

Aetna: 855-548-2387
BlueAdvantage Administrators of Arkansas: 866-823-3790
HealthSCOPE Benefits: 800-804-1272
UnitedHealthcare: 888-285-9255

Would the plan contact me directly about care management?

Based on your medical claim history, the nurse care manager may reach out to you; for example, to invite you to participate in a health management program that may be appropriate for you or a covered family member.

What is the Life with Baby program?

If you are pregnant, or think you might want to be someday, Walmart’s Life with Baby program is for you. It’s designed to promote healthy pregnancies and babies by giving you one-on-one attention, information, and services through your pregnancy and beyond. When you enroll in Life with Baby, you’ll receive the following at no cost:

• A personal registered nurse to talk with before, during, and after your pregnancy
• Materials timed to your pregnancy progress
• Gifts for you and your baby

Who is eligible for the Life with Baby program?

Any associate, spouse or dependent who is pregnant, or thinking about becoming pregnant, and enrolled in one of the Premier, Contribution, Saver, Select Local or Banner Local Plans is eligible for the Life with Baby program. If you are covered under one of the Mercy Local Plans, you will have access to Mercy’s maternity program. Emory Local Plan, Ochsner Local Plan, Memorial Hermann Local Plan, and UnityPoint Local Plan members will have access to support from a maternity care manager.

How do I enroll in the Life with Baby program?

To enroll in Life with Baby or Mercy’s maternity program, call the telephone number on the plan ID card. You’ll be assigned a registered nurse who will contact you throughout your pregnancy. The assigned nurse will answer your questions or address any concerns.

What is preventive care?

Preventive care includes things like immunizations for children (through age 18), annual checkups for all covered family members, Pap tests and mammograms for women, colonoscopies, flu and pneumonia vaccines, and more. For a complete list of eligible preventive care, go to OneWalmart.com/Preventive, or see the medical plan chapter of the 2020 Associate Benefits Book.

Are mammograms covered before age 40, with or without a history of cancer?

Mammograms are covered once a year beginning at the age of 40, but screening may begin earlier if there is a personal or family history of breast cancer. 

Is PSA (prostate-specific antigen) testing covered by the preventive benefit?

No. In accordance with the recommendations of the United States Preventive Services Task Force, Walmart does not include prostate-specific antigen (PSA) testing in our preventive care program. Please note that routine PSA tests are not covered under the Associates’ Medical Plan.

What is preauthorization?

Preauthorization, also known as or “prior authorization” or “precertification,” is a way of making sure a service, supply, therapy, or medical procedure will be covered before you get care. It may also specify conditions or limitations of coverage. It’s typically required for things like inpatient admissions, home health care, outpatient mental health treatment, and all services covered under the Centers of Excellence program.

How do I know if I need to have a service or procedure preauthorized?

Each medical plan administrator has its own requirements and handles the process differently; see the preauthorization section in the 2020 Associate Benefits Book for more information.

Your medical plan’s health care advisor will guide you through the preauthorization process. The network administrator should be notified at least 24 hours in advance, or 24 hours afterward for emergency care.

Who do I call if I need preauthorization?

Call the number on your plan ID card or at one of the following numbers:

Aetna (includes Select Local Plan, Banner Local Plan, and St. Luke’s Local Plan): 888-252-2734
• BlueAdvantage Administrators of Arkansas: 866-823-3790
• HealthSCOPE Benefits (includes all other Local Plans): 800-804-1272
• United Healthcare: 888-285-9255

Is it possible that a claim could be denied or that a service or procedure could fail to be preapproved?

Yes, to both questions. Coverage under your medical plan may be limited or denied for a number of reasons, including eligibility, limitations or exclusions, or network limitations.

The preapproval process helps you make sure a service is covered before you get care to avoid having a claim denied afterward.

2020 Medical Plans and Pricing

How does the Premier Plan work?

The Premier Plan features simple and affordable copays for doctor visits. Like all our plans, it covers a wide range of medical services including prescriptions, and eligible preventive care is covered at 100%.

Here’s how the plan works:
• When you get care from a network doctor, you pay just $35 for primary care, or $75 for specialists and urgent care. Routine same-day tests are performed in the office are included. For other services, you pay the full cost until you reach your annual network deductible.
• After you have spent enough to reach the deductible, you pay 25% coinsurance for eligible network expenses, and Walmart pays the other 75%. These can include advanced imaging, outpatient surgery, and hospitalization.
• If you or a covered dependent meets your individual out-of-pocket maximum, Walmart pays 100% of any eligible network expenses, including copays, medical services, and prescription drugs for the rest of the year. If your total family spending reaches the family out-of-pocket maximum, Walmart pays 100% of eligible network expenses for the whole family for the rest of the year.
• If you choose to get care from non-network doctors or other providers, you pay the full cost until you meet your out-of-network deductible. After that, Walmart pays 50% of the maximum allowable charge and you pay the rest. There is no out-of-pocket maximum for out-of-network charges.

Where is the Premier Plan available?

The Premier Plan is available nationwide.

What’s a copay?

A copay is a fixed amount you pay for a particular service such as an office visit. The copay amount is normally due at the time of the visit. For some services, you may have both a copay and coinsurance portion of the services.

Do copays apply to the deductible and out-of-pocket maximum?

The copay amount is not subject to deductible and does not apply to the annual deductible. However, the copay amount does apply to the annual out-of-pocket maximum.

What’s the cost for an emergency room visit?

After a $300 copay and your deductible, emergency room visits are covered at 100%. The copay is waived if you’ve been admitted to the hospital. However, any other services you’ve received in the emergency room that are typically billed separately, like any testing that is done or the physician’s portion of the bill. Those claims will be processed subject to deductible and coinsurance.

What’s the cost for urgent care?

Urgent care costs just a $75 copay, and includes routing same-day tests if they're  performed on site. This makes urgent care a great alternative to the ER—as long as the condition is not life-threatening.  

I had the HRA Plan in 2019 and I’ll have the Premier Plan for 2020. If I have Walmart dollars left over, can I still use them?

Yes. If you were enrolled in the HRA Plan or HRA High Plan in 2019 and have Walmart dollars remaining after Jan. 1, 2020, you can use them in the Premier Plan on copays for things like doctor’s office visits, Doctor On Demand, or urgent care through the end of 2021. Walmart dollars can’t be used for the emergency room copay. If you’re in the Contribution plan you can use them as usual. You must be enrolled in the Premier Plan or the Contribution Plan to continue using your Walmart dollars. However, if you change from the Contribution Plan to the Premier Plan during 2020 due to a status change event, you won’t be able to carry over any Walmart dollars.

How does the Contribution Plan work?

The Contribution Plan features money from Walmart to help you pay for eligible medical expenses. 

Here’s how the plan works:

• Each year, the company sets aside money in a health reimbursement account (HRA) for each associate in the plan. This helps pay for your eligible medical expenses before you have to pay anything out of your own pocket (except for prescription drugs). Walmart puts in $250 for associate-only coverage or $500 if you cover yourself and dependents. Money in your HRA is automatically used to pay for eligible medical expenses like doctor visits or lab work.

• If you have money left in your HRA at the end of the year, the unused amount, up to your annual network deductible, rolls over from year to year as long as you stay enrolled. However:

– If your HRA balance is near your network annual deductible for 2020, you will still receive the full company credit, but amounts in excess of your annual network deductible will be subtracted from your rollover dollars.
– If your HRA balance is already equal to your annual network deductible, you will still receive a company HRA credit for 2020, but amounts in excess of your annual network deductible will be subtracted from your rollover dollars.
– Walmart dollars can only be used for medical expenses incurred in the same calendar year; e.g., expenses incurred in 2019 cannot be paid from the 2020 credit amount.

• You use your HRA and your own money to meet your annual deductible. You pay the full cost of your medical expenses using your 2020 Walmart dollars, including any HRA money rolled over from 2019, and your own money until you reach your annual deductible.

• After you reach your annual network deductible, you pay 25% coinsurance for eligible network expenses; Walmart pays 75%.

• Once you meet your network out-of-pocket maximum for the year, Walmart pays 100% of any eligible network expenses (medical and prescription drugs) you and your covered family members have for the rest of the year.

• Once you meet your out-of-network deductible, if you use providers who are not in the network, in most areas Walmart pays 50% of the maximum allowable charge and you pay the rest, even after you’ve met your network outof-pocket maximum. (There is no out-of-pocket maximum for out-of-network charges.)

• Keep in mind that network providers charge a negotiated rate for medical services for Walmart associates and their covered dependents. Therefore, providers who are in the network have agreed to accept a discounted allowable amount, so you will save money if you use a provider who is in the network.

Where is the Contribution Plan available?

The Contribution Plan is available nationwide.

What applies to my out-of-pocket maximum?

Walmart dollars apply toward your annual deductible and also toward your out-of-pocket maximum. Any other amount you pay before reaching your annual deductible, the 25% coinsurance you pay for eligible expenses, and your out-of-pocket copays for prescription drugs also count toward your out-of-pocket maximum.

If I go to an out-of-network doctor, do I need to meet the out-of-network deductible first?

Yes. Even if you have met your network out-of-pocket maximum, you have to meet your out-of-network deductible before claims will be paid at 50%.

How much money will Walmart credit to my Contribution Plan in 2020?

Each Jan. 1, Walmart credits $250 (if you cover only yourself) or $500 (if you cover yourself and any dependents).

If you enroll in the Contribution Plan at any time other than Annual Enrollment, you will receive a prorated credit based on when your coverage becomes effective. See the 2020 Associate Benefits Book for more information. 

If I enroll my family, will my account dollars be divided among my family members?

Walmart dollars are allocated to your entire HRA—you are not separated out by family member. The money pays for eligible medical expenses as claims are filed and until it’s gone, regardless of which covered family member incurs the expense.

Will the Contribution Plan pay expenses for providers who are not in the network?

Yes. Your Walmart dollars can pay for care from network or out-of-network providers. However, Walmart dollars cannot pay for care above the maximum allowable charge, which may be less than the actual cost.

Do Walmart dollars apply toward network and out-of-network deductibles?

Yes. The amount in your HRA will help you meet your annual network and out-of-network deductibles.

Are the family deductibles per person or for the whole family?

Your family deductible can be met by one or any combination of family members. Remember, annual deductibles must be met in full before Walmart begins to pay a portion of your medical expenses.

Does the cost of prescriptions apply to annual deductibles?

No. Your prescription drug copay/coinsurance charges do not apply to your deductibles, and you cannot use your Walmart dollars to pay for prescription drugs. These charges do apply toward your annual out-of-pocket maximum.

What kinds of expenses will not be paid by the Contribution Plan?

Only eligible medical expenses can be paid using Walmart dollars. Prescription drugs and items like over-the-counter medications, cosmetic surgery, dental expenses, and vision care cannot be paid using Walmart dollars. For a list of eligible expenses, see the 2020 Associate Benefits Book.

What kinds of expenses do not apply to the Contribution Plan’s annual deductible?

All eligible medical expenses, except prescription and telehealth copay/coinsurance charges and preventive care apply toward your annual deductible. You can find a list of eligible expenses in the 2020 Associate Benefits Book.

What happens after my Walmart dollars are used up?

Once your Walmart dollars are gone, you pay 100% of the cost for eligible care until you reach your annual deductible. After you meet your annual in-network deductible, Walmart pays 75% of the cost of your eligible in-network expenses, and you pay 25% until you reach your out-of-pocket maximum. Walmart then pays 100% of eligible in-network medical expenses for the rest of the plan year.

After you meet your annual out-of-network deductible, in most areas Walmart pays 50% of the maximum allowable charge when you use an out-of-network provider. You will pay the other 50%, plus any charges over the maximum allowable charge. For the Contribution Plan, there is no out-of-pocket maximum for out-of-network care.

Can I save my Walmart dollars for future expenses?

Walmart dollars are used automatically to pay for care. You cannot choose how your Walmart dollars are used.

What happens to any Walmart dollars left in the HRA at the end of the year?

Any money left in your HRA at the end of the year rolls over up to the amount of your annual in-network deductible for the plan year, provided you remain enrolled in the Contribution Plan.

I enrolled in a different plan for 2020, but was in the HRA High Plan in 2019. What happens to the money left in my HRA?

If you change from the HRA High Plan in 2019 to the Saver Plan, a Local Plan or an HMO, any money left in your HRA is forfeited. If you change to the Premier Plan during Annual Enrollment, you can still use Walmart dollars for copays through 2021, except the emergency room copay. But if you switch to the Premier Plan later on due to a status change event, you’ll forfeit any remaining funds.

How can I check my HRA balance?

Call the number on your plan ID card. You can also see your HRA balance through Grand Rounds, either on GrandRounds.com/Walmart or the mobile app.

If I had a doctor’s visit in 2019, but the claim was not processed until 2020, will my 2020 Walmart dollars count toward my 2019 claim?

No. Current-year Walmart dollars can only be used for medical expenses incurred in the same calendar year. Expenses in 2020 can be paid from the 2020 HRA credit amount only.

How does the Saver Plan work?

The Saver Plan offers a unique opportunity to open and contribute to a Health Savings Account (HSA) and receive matching contributions from Walmart. Because of IRS rules related to this feature, its coverage details differ from other Walmart plans. 

Here’s how the Saver Plan works:

• If you enroll in the Saver Plan, you can open an HSA (Health Savings Account), make contributions, get matching contributions from Walmart, and use money in that account to pay for qualified health care expenses (as determined by the IRS), including prescriptions. Your HSA contributions are tax-free.
• When you contribute to an HSA, Walmart will match your contributions up to $350 for associate-only coverage or up to $700 if you cover yourself and dependents. The 2020 maximum contribution to an HSA for you only is $3,550 ($4,550 if 55+) and for you plus dependents is $7,100 ($8,100 if 55+).
• You can use the money in your HSA to help meet your annual deductible. You pay 100% of the cost of medical care and prescription drugs out of your own pocket or with money in your HSA until you reach your annual deductible. Some preventive medications are exceptions; see below for details.
• After you reach your in-network deductible, you pay 25% coinsurance for eligible network expenses; Walmart pays 75%.
• If you meet your in-network out-of-pocket maximum for the year, Walmart pays 100% of any eligible in-network expenses (medical and prescription drugs) you and your covered family members have for the rest of the year.
• If you see out-of-network doctors, once you meet your out-of-network deductible, in most areas Walmart pays 50% of the maximum allowable charge and you pay the rest, even after you’ve met your network out-of-pocket maximum. (There is no out-of-pocket maximum for out-of-network charges.)

Where is the Saver Plan available?

The Saver Plan is available nationwide.

How are prescriptions covered by the Saver Plan?

In general, when you enroll in the Saver Plan, you pay the full retail/mail-order price for your prescriptions until you meet their Saver Plan network annual deductible. You may use your HSA money to pay for these medications.

Once you have met your network annual deductible, you pay the copays listed in the chart in the pharmacy/prescription drug benefits section of this document. Note, however, that any prescription drug charges paid with funds to pharmacies by drug manufacturers or any third parties to assist you in purchasing prescription drugs do not count toward your annual deductible or your out-of-pocket maximum.

Certain preventive medications (as defined by our pharmacy plan administrator, OptumRx) are paid at the appropriate copay before you meet your annual deductible.

How do I pay for expenses with my HSA?

The HSA administrator (HealthEquity) will mail you a debit card. You can then use the debit card to pay for qualified medical expenses with your Health Savings Account. You can also pay online through HealthEquity’s online service tool at One.Walmart.com/HSA.

What expenses can be paid for with an HSA?

Qualified medical expenses generally include medical, dental, and vision expenses, prescription medications, chiropractic care, and acupuncture. Go to IRS.gov to find a list of qualified expenses. Over-the-counter medications are considered qualified medical expenses only if they are prescribed by a doctor.

What happens to any money left in an HSA at the end of the year?

You don’t lose it. Any money in your Health Savings Account is yours, even if you change medical plans or leave the company. You will only receive matching contributions as long as you’re still enrolled in the Saver Plan. The money in your Health Savings Account rolls over year-to-year and continues to accumulate.

What are the advantages of contributing to an HSA?

There are several advantages to contributing to a Health Savings Account:

• You have more control over spending because you can choose to pay out of your own pocket or with money in your Health Savings Account.
• You set aside money before income taxes are withheld to pay medical expenses, so your tax bill may be lower.
• You receive Walmart’s matching contributions in your Health Savings Account when you contribute.
• You always own the money in your Health Savings Account, even if you leave the company.

Can any associate contribute to an HSA?

No. There are some restrictions regarding who can open and contribute to a Health Savings Account. The most important are:

• You must be enrolled in the Saver Plan.
• You are not enrolled in Medicare, Medicaid, TRICARE, or any other health plan that is not a qualified high-deductible health plan.
• You cannot have received services from the U.S. Department of Veterans Affairs within the past three months for anything other than care for a service-related disability or preventive care.

For more information about how a Health Savings Account works, visit HealthEquity.com/ed/Walmart

My spouse and I are both Walmart associates. What is the maximum we can contribute to the HSA?

Your combined total contribution to the Health Savings Account cannot exceed the family maximum of $7,100.

How do the Local Plans work?

The Local Plans are built around leading local health systems that can provide care specifically coordinated to your needs to ensure you get the right high-quality care at the right time. This type of health care is designed to improve the quality of care, provide a better experience for you and your family—and do it while saving you money. The Local Plans are available to Walmart you only in select areas.

For many services, you pay just a simple copay—$35 for an office visit for primary care or behavioral health or $75 for a specialist or urgent care.

The Local Plans do not cover the services of doctors, hospitals, or other providers who are not in the Local Plan’s network, except in cases of emergency.

What are the advantages to enrolling in a Local Plan?

The Local Plans offer simple copays for office visits, including specialists, with no need to meet a deductible first. That makes getting care easier. The Local Plan approach is based on a partnership between you and your doctor, who coordinates care among everyone who takes care of you and monitors your results. And the doctors and other providers in each Local Plan’s network are from a local health system that can deliver higher-quality care at a lower cost. You can still see a doctor outside the network for medical emergencies, but if you choose to go out-of-network for non-emergency services, you’ll pay the full cost.

How are the Local Plans different from the other plans?

Predictable copays cover office visits, including specialists, with no need to meet your deductible first. The coordinated care approach means care is centered around you, and coordinated among everyone who takes care of you. And each plan is built around a local health system that can deliver higher-quality care at a lower cost. However, the Local Plans offer no out-of-network coverage except in an emergency.

How big are the Local Plan provider networks?

The provider networks for the Local Plans include all types of medical providers and are designed to give you a wide choice of doctors. If you’re enrolled in a Local Plan, you can easily see if a doctor is in the network by checking Grand Rounds. Register at GrandRounds.com/Walmart.

What happens if I go to a provider who is not in-network?

If you choose to see a provider who is not in-network, or seek non-emergency care while traveling outside the coverage area, you will pay the full cost yourself.

Why are only certain providers included in-network?

The Local Plans are served by special networks of doctors and hospitals who work together to coordinate efficient and effective care for you and your covered dependents in specific service areas. These providers are carefully selected for the highest quality and a commitment to keep costs as low as possible for you and the Plan. Because the plan is built around this network, coverage is limited to providers within this new network, except in certain emergency situations.

How can I find out if a provider is in-network?

Check Grand Rounds to connect with network doctors. Register at GrandRounds.com/Walmart.

What is a primary care physician? Why is it important?

A primary care physician (PCP) is a doctor that usually specializes in family practice, pediatrics, or internal medicine. A PCP will get to know you and your medical history and see you for regular preventive visits. When you get sick, your PCP can treat you and help guide your health decisions. You can also direct care across all the other Local Plan network specialists and facilities.

Do I have to select a primary care physician?

Selecting a primary care physician (PCP) is not required, but it is highly encouraged. By having this point of contact, you may receive more personalized care.

Where are Local Plans available?

Local Plans are available only in the areas shown here:

Plan Available for you who work at designated facilities in these areas Third party administrator
Banner Local Plan Phoenix, Arizona metropolitan area Aetna
Emory Local Plan Atlanta, Georgia metropolitan area HealthSCOPE Benefits
Mercy Arkansas Local Plan Portions of Arkansas and McDonald County, Missouri HealthSCOPE Benefits
Mercy Oklahoma Local Plan Oklahoma City metropolitan area, Ada, and Ardmore areas HealthSCOPE Benefits
Mercy Southwest Missouri Local Plan Springfield, southwest and east-central Missouri HealthSCOPE Benefits
Mercy St. Louis Local Plan St. Louis metropolitan area and portions of eastern Missouri HealthSCOPE Benefits
St. Luke’s Local Plan Boise, Idaho metropolitan area Aetna
UnityPoint Local Plan Portions of Iowa, western Illinois and Peoria, Illinois area HealthSCOPE Benefits
Memorial Hermann Local Plan Houston area HealthSCOPE Benefits
Ochsner Local Plan New Orleans, Baton Rouge, and Slidell, Louisiana areas HealthSCOPE Benefits
How do you reach a health care advisor for a Local Plan?

Banner Local Plan
   Aetna: 855-548-2387
   Monday–Friday: 6 a.m.–10 p.m. CT
   Saturday: 6 a.m.–3 p.m. CT
   Nurse line is available 24/7: 855-548-2387

Emory Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 888-546-8463

Mercy Arkansas Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 844-841-3875

Mercy Oklahoma Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 844-841-3875

Ochsner Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 800-231-5257

Mercy Southwest Missouri Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 844-841-3875

Mercy St. Louis Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 844-841-3875

St. Luke’s Local Plan
   Aetna: 855-548-2387
   Monday–Friday: 6 a.m.–10 p.m. CT
   Saturday: 6 a.m.–3 p.m. CT
   Nurse line is available 24/7: 855-548-2387

UnityPoint Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 844-238-1032

Memorial Hermann Local Plan
   HealthSCOPE Benefits: 800-804-1272
   Monday–Friday: 7:30 a.m.–6 p.m. CT
   Nurse line is available 24/7: 713-338-4850

What is the Select Local Plan?

The Select Local Plan is built around a network that’s designed to help you receive greater discounts on medical care in order to save money for both you and Walmart. It’s similar to the other Local Plans, with features such as simple copays for most medical services, and no out-of-network coverage except in an emergency. But unlike these plans, the Select Local Plan is the same wherever it is offered. You can learn more at One.Walmart.com/SelectLocal.

Which areas have the Select Local Plan?

The Select Local Plan is available to you who work in:

• Illinois (Chicago area)
• Texas (Austin, Dallas, El Paso, San Antonio, and portions of southeast Texas)
• Parts of New Jersey/New York

How can I find out if a doctor is in-network?

You should use Grand Rounds to connect with network doctors and other providers. Go to GrandRounds.com/Walmart or download the mobile app at no cost. 

How are doctors chosen to participate in the Select Local Plan?

Doctors and providers have been specially chosen for the Select Local Plan based on quality and performance criteria. 

What is the individual out-of-pocket maximum and how does it work?

The individual out-of-pocket maximum caps the amount you pay for medical expenses in any calendar year. You and any family member you enroll for coverage each have an individual out-of-pocket maximum. Once any individual’s share of the cost for covered services adds up to the out-of-pocket maximum, that participant’s eligible in-network expenses will be paid at 100% for the remainder of the calendar year. 

What is the family out-of-pocket maximum?

There’s also a cap on the amount your entire family can pay for medical expenses. When the combined expenses of all family members reach this amount, everyone’s eligible in-network expenses will be paid at 100% for the rest of the calendar year. 

What are each plan’s out-of-pocket maximums?

• Premier, Contribution, Select Local, and Local Plans: $6,850 per individual enrolled; $13,7000 for your entire family.
• Saver Plan: $6,650 per individual enrolled; $13,300 for your entire family. 

Which medical expenses count toward the out-of-pocket maximum?

• Office visit copays
• Your network and out-of-network annual deductibles
• Your coinsurance when using in-network providers
• Pharmacy copays/coinsurance 

Which medical expenses do not count toward the network out-of-pocket maximum?

The medical expenses that are not credited toward your out-of-pocket maximum vary slightly based on your medical plan. Refer to the medical chapter in the 2020 Associate Benefits Book for detailed information about the out-of-pocket maximum for each available plan. 

What’s a network provider?

A network is a group of medical providers, including doctors, hospitals and clinics, that have agreed to provide health care services at certain rates to you enrolled in one of our medical plans. Depending on where you work, you will have access to the BlueAdvantage Administrators of Arkansas (Blue Cross Blue Shield) PPO or Alt network; the Aetna Network or its Select Network; the UnitedHealthcare network or its Medica Choice network or Harvard Pilgrim network. The Local Plans and the HMOs each have your own network of providers. 

What happens if I go to a provider who is not in the network?

If you are enrolled in the Premier, Contribution, or Saver Plans, Walmart will pay 50% of the maximum allowable charge after your deductible has been met. You will be responsible for the other 50%, plus any charges above the maximum allowable charge.

The Local Plans and Select Local Plan do not cover out-of-network providers except in cases of emergency. HMOs also typically do not cover out-of-network care except in emergencies. 

How can I find out if a doctor is in the network?

You in most areas should use Grand Rounds to get connected with network doctors near you. You can register at GrandRounds.com/Walmart. You in certain areas shown below should use your Provider Guide instead.

• Grand Rounds: 800-941-1384 

How does BlueAdvantage Administrators of Arkansas’ Alt network work?

In certain areas, you who have Blue Cross Blue Shield as your medical claims administrator are part of the Alt network. The Alt network is a subgroup within the Blue Cross Blue Shield network designed to help you receive greater discounts on medical care in order to save money for you and Walmart.

If you are part of the Alt network, you should review the network list to determine if your medical provider is part of the Alt network before scheduling an appointment. If you visit a provider outside of the Alt network, services will be treated as out-of-network and covered accordingly. 

Does Walmart offer HMOs?

Yes. Walmart offers HMO plans to you in eleven states (California, Colorado, Georgia, Hawaii, Maryland, Michigan, New York, Oregon, Pennsylvania, Virginia, and Washington) as well as the District of Columbia.

If you work in a facility that offers HMOs, you can find rates at One.Walmart.com/Rates. You should ask your People Partner for information if you’d like to know more about HMOs offered in your area. 

Where can I find a list of HMOs offered for 2020?

You can find the HMOs available where you work with the Plan Availability Tool. You can also ask your People Partner for information about HMOs offered in your area. 

How do HMO plans work?

HMO plans typically offer copays for doctor visits and outpatient hospital care. You may have an annual deductible and out-of-pocket maximum. HMOs usually only pay benefits when care is provided or authorized by an HMO plan doctor. 

How are decisions made on where Walmart offers HMOs?

Each year, we carefully evaluate the types of features and plans we offer. We also study demographic data about health care quality and availability where you live and work. 

Why have associates’ medical plan rates gone up?

Walmart works hard to keep our associates’ costs low. But because the cost of health care continues to rise nationwide, rates for most plans increased for 2020. For example, associate-only coverage in the Premier Plan is $1.40 per paycheck higher than the HRA Plan in 2019. 

How much of associates’ health care costs does Walmart pay? What do other companies pay?

Walmart pays approximately 60% of the cost of health care for associates enrolled in our plans. Despite the increasing cost of health care in the U.S., Walmart is proud that, on average, you pay about 14% less than other retail employees and about 22% less than employees in other industries.

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