UL - 2023-24 Benefits Guide (FINAL 11.1.2023) SP

2023 Gerresheimer Salary Benefits Bulletin • 7

HEALTH PLAN OVERVIEWS

2023 Prescription Drug Coverage Administered by Express Scripts

Website: http://www.express-scripts.com Phone: 1-800-251-7690

GOLD PLAN HIGH DEDUCTIBLE HEALTHCARE PLAN IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK

PRESCRIPTION BENEFIT

RETAIL - Acute Care Generic Preferred Brand Non-Preferred Brand

$20 co-pay $35 co-pay $45 co-pay

75% reimbursement of retail, less co-pay

You pay 30% You pay 50%

MAIL ORDER / WALGREENS - Maintenance Generic Preferred Brand Non-Preferred Brand

$40 co-pay $70 co-pay $90 co-pay

N/A

You pay 30% You pay 50%

Maximum Out-of-Pocket (Individual / Family)

$3,100 / $6,200

N/A

Combined with Medical

Price Breakdown of Medical Plan Options

Spousal Surcharge Although it’s becoming more common for employers to deny an em ployee the opportunity to enroll a spouse or domestic partner for cov erage with them if their own employer offers coverage, Gerresheimer has not put this restriction in place for 2023. Instead, an employee whose spouse has other coverage opportunities may still be enrolled for coverage in one of the plans available through the Company. However, in that case, a surcharge of $100 per month may apply. The surcharge helps ensure that other employers aren’t saving at the expense of our medical plans. Additionally, since survey data in dicates that spouses traditionally incur greater healthcare expenses than employees, the surcharge will help offset the increased cost of providing coverage for those spouses enrolled. Note that a spousal surcharge will not apply if the only other cover age available is either Medicare or COBRA. Similarly, it does not apply when your spouse is not employed. To avoid the surcharge for any of these reasons, you must certify on-line annually that you are eligible for one of these exceptions . When you do so, you will be granted a “waiver” of the surcharge. If you enroll for cov erage to include your spouse under the High Deductible Healthcare Plan, the surcharge will automatically be excluded.

Effective January 1, 2023 Employee Per Pay Contributions Will Be As Follows: Note: Domestic Partner per pay contributions are available by contacting Human Resources. GOLD PLAN HDHP Employee Only $178.06 $127.73 Employee + 1 $325.81 $233.72 Family $386.86 $277.51