Your Medical Plan Options
You have a choice of two medical plan options: Choice Plus PPO-BSI and HSA Choice Plus, both administered by United Healthcare (UHC). Both plans provide comprehensive coverage, including benefits for prescription drugs, 100% coverage for in-network preventive care and convenient access to virtual visits. With both plans, you can choose to see any doctor or other healthcare professional or facility (a “provider”) of your choice, but you’ll pay less for medical services if you visit a provider that is a member of the UHC network. There are, however, important differences between the plans, primarily around how you pay for care.
Below is a summary of how the plans work. To learn more about the comprehensive medical services available for preventive, emergency and other care under both the Choice Plus PPO BSI and HSA Choice Plus plans, visit the myuhc.com website or access the UHC mobile app. If you have not yet enrolled in medical coverage, visit the UHC pre-enrollment website.
Family Coverage: Embedded vs. Aggregate Deductibles and Out-of-Pocket (OOP) Maximums
The Choice Plus PPO BSI Plan has an embedded deductible, while the HSA Choice Plus Plan has an aggregate deductible.
Both medical plans offer an embedded out-of-pocket maximum, which means that no one individual must pay more than the individual out-of-pocket maximum.
Network Care
Under both plans, you have the option of visiting an in-network or out-of-network doctor, hospital or other provider. If you receive care in-network, the amount you and Santander will pay will be lower, as it will be based on a discounted rate UHC has negotiated with the doctor or hospital.
In-Network Care
To find doctors, hospitals and other providers that are in-network, use the Find a Doctor locator tool on the myuhc.com website or search on the UHC mobile app. (If you have not yet enrolled in medical coverage, visit the UHC pre-enrollment website) In many cases, you’ll search using the Choice Plus network. If you’re looking for a doctor, hospital or other provider in Massachusetts, New Hampshire or Maine, you’ll search using the Harvard Pilgrim network, as that’s the network UHC uses to get the lowest negotiated rate in these states.
For some services and treatments, a prior authorization may be needed to determine if the service, test or procedure is medically necessary and eligible for coverage under the plans. Generally, if you are receiving in-network care, your doctor, hospital or other in-network provider will obtain any necessary prior authorizations from UHC before providing treatment.
Out-of-Network Care
If you choose to receive care from an out-of-network doctor, hospital or other provider, you will need to contact UHC at (833) 209-6463 to confirm the services are covered, and obtain any necessary prior authorizations that may be needed to determine if the service, test or procedure is medically necessary and eligible for coverage under the plans. In addition, keep in mind that you’ll pay more out-of-pocket for covered services you receive that are outside of the UHC network.
Contact UHC at (833) 209-6463 with any questions you may have about what services are covered under the plans, when prior authorizations may be needed or how to find out if your doctor is a member of the network.
Additional Resources through UHC
If you enroll in one of the Santander medical plans, you’ll also have access to the following programs and resources available through UHC.
UHC Advocates
Sometimes, navigating the healthcare system can be confusing, time consuming and stressful. UHC has a team of Advocates who are available to help answer questions you may have about the plans, including what’s covered and what your share of the costs may be. They also can help you confirm if your doctor is in network or look for an in-network doctor.
Call (833) 209-6463 to speak with a UHC Advocate today. They are available Monday – Friday from 8 a.m. to 8 p.m. in your local time zone.
Virtual Visits
Through UHC’s Virtual Visits model, you will have access to 24/7 care and have the flexibility to see a doctor without an appointment or the hassle of leaving your house. You can initiate a virtual visit from the myuhc.com website or through the UHC mobile app.
Maternity Support Program
If you or a covered family member may be thinking about having a baby or have one on the way, UHC’s Maternity Support Program will provide support during and after the pregnancy. You have access to an experienced maternity nurse who will provide assistance and guidance, including if you have unique health needs and/or a high-risk pregnancy. The Maternity Support Program also includes a comprehensive pregnancy app that provides personalized content and allows you to connect in real time with a nurse 24/7.
Quit For Life® Smoking Cessation Program
UHC’s Quit For Life© program is a clinically proven smoking cessation program that’s offered in collaboration with the American Cancer Society. You and your covered family members have access to a Quit Coach whom you can work with to create a plan that’s personalized and tailored to your needs. Working with the Quit Coach, you’ll set a quit date and receive ongoing support, including text messages and access to online resources.
Health and Wellness Portal – Rally®
You and your covered family members (age 13 and older) also have access to UHC’s health and wellness portal called Rally®. Rally is designed to help you make changes to your daily routine, set smart goals and track your progress. You’ll get personalized recommendations to help you move more, eat better and improve your health — and have fun doing it. You can access Rally from the myuhc.com website or the Rally mobile app.
Cancer Resources Services
Through UHC’s Cancer Resources Services, you and covered family members will get personal support from an experienced cancer nurse who will help you make informed decisions about your care in conjunction with UHC’s team of cancer experts. The cancer nurse will build a relationship with you and your family, helping you focus on getting and staying healthy. They also provide tools and support for managing symptoms and side effects; collaborate with treating physicians to help promote treatment education; help manage the health care system and pharmacy costs; and much more.
Fertility Solutions
If you or a covered family member is considering fertility treatments, you have access to the UHC Fertility Solutions Program. Through this program, you’ll work with UHC specially trained fertility nurses who will provide you with clinically guided support and education, and help you identify UHC Centers of Excellence (COE) for fertility treatment(s). Both plans cover in-network medically necessary fertility treatment(s) at a COE, up to a $35,000 combined lifetime maximum for medical and prescription drugs.
Bariatric Resource Services
If you or a covered family member is considering weight-loss surgery, you have access to the UHC Bariatric Resource Services Program. Through this program, you’ll work with a UHC case manager who will provide you with education and personal support, and help you identify UHC Centers of Excellence (COE) for bariatric surgery. Both plans will cover in-network medically necessary bariatric surgery at a COE, one per lifetime.
TalkSpace- message a licensed therapist, 24/7
With Talkspace online therapy, you can regularly communicate with a therapist, safely and securely from your phone or desktop. No office visit required.
- Find a therapist with an online matching tool.
- Start therapy within hours of choosing your therapist.
- Therapists respond daily, five days a week.
- Schedule live video sessions, when needed.
- Download the Talkspace app on your mobile phone or desktop computer. It’s private, confidential and convenient.
Talkspace sessions are processed through the Santander medical plans – you can find out more about cost when you register for the app.
Say Hello to Sanvello- On-demand help for stress, anxiety, and depression
Sanvello is a free app when you enroll in Santander medical benefits that can help you with stress, anxiety, and depression. Created by psychologists, Sanvello uses clinically validated techniques designed to work together to relieve symptoms and improve your mental well-being — anywhere, anytime. Learn cognitive behavioral therapy (CBT) techniques, access on-demand coping and meditation tools, and find support in a vibrant peer community. You can download the app from myuhc.com.
Coverage Outside the United States
If you travel outside the United States, coverage is available under both plans, although you typically will pay for services out-of-pocket and then submit requests for reimbursement using the International Claims Transmittal form, which is available on the myuhc.com website.
- Emergency services outside the U.S. are covered at the in-network level based on billed charges and are subject to the annual deductible.
- Non-emergency services are covered at the out-of-network level based on billed charges and are subject to the annual deductible.
If you have questions about coverage while traveling outside the U.S., or if you need assistance with care while you are out of the country, you can call UHC at (833) 209-6463.
If you have questions or would like to learn more about any of these programs, resources and services, contact a UHC Advocate at (833) 209-6463. Advocates are available 8 a.m. to 8 p.m. in your local time zone.
Prescription Drug Coverage
Preventive Medications
Both Santander medical plans provide prescription drug coverage through the OptumRx pharmacy network and through the home delivery program for a wide range of generic and brand-name prescription medications. You have the choice of more than 67,000 pharmacies nationwide, including CVS, Walgreens, Rite Aid, Walmart and Costco.
To locate a network pharmacy near you, go to the optumrx.com website or OptumRx mobile app. (If you have not yet enrolled in coverage, you can visit the pre-enrollment site at optumrx.com/enroll/santandermiami.)
Smart Consumer Tips!
- Use generics—they’re less expensive and can be just as effective. When a generic isn’t available, ask for a formulary or a “preferred” medication, which will help reduce your costs.
- If you’re enrolling in the ChoicePlus PPO - BSI Plan, consider contributing to a Healthcare Flexible Spending Account (FSA) to pay for prescription drug expenses. If you’re enrolling in the HSA Choice Plus Plan, you can use your Health Savings Account (HSA) funds.
Understanding Your Prescription Drug Coverage
List of Covered Medications – OptumRx ’Formulary’ The medications covered under the Santander medical plans are listed on the OptumRx formulary, which is available on the optumrx.com website and OptumRx mobile app. (If you have not yet enrolled in coverage, you can visit the pre-enrollment site at optumrx.com/enroll/santandermiami.) Here are a few things to keep in mind as you review the list:
- Medications are identified for certain conditions, and they are organized into cost levels called tiers (generic, brand-name preferred and brand-name non-preferred).
- Some medications may require prior authorization or step therapy, which may affect how they are covered.
- Additional information is included for those medications that may have quantity limits, or that are considered specialty.
- OptumRx updates the formulary from time to time — if one of your regular prescriptions is impacted, OptumRx will contact you.
Generic Medications Generic medications have the same strength and safety standards as brand-name prescription drugs. Under both Santander medical plans, you’ll automatically receive a generic version of the drug when filling your prescription if a generic is available. If your doctor specifically requests a brand-name drug when a generic is available by indicating "Dispense as Written" on the prescription, you’ll pay the applicable copay or coinsurance, as well as the cost difference between the generic and brand-name drugs. If you enroll in the HSA Choice Plus Plan and have not yet reached the deductible, this cost difference will not apply to the deductible. If your doctor has determined that it is medically necessary for you to receive the brand-name drug, your doctor can request an exception from OptumRx on your behalf.
Where You Can Fill Your Prescriptions
Retail Pharmacies To fill your prescriptions, simply visit an in-network retail pharmacy; OptumRx has over 67,000 network pharmacies, including CVS, Walgreens, Rite Aid, Walmart and Costco. If you need help finding an in-network pharmacy, visit the optumrx.com website or the OptumRx mobile app (If you have not yet enrolled in medical coverage, to learn more about prescription drug coverage take a look at the OptumRx pre-enrollment website.) If you fill your prescription at an out-of-network pharmacy, you’ll need to pay the full retail price of the prescription and submit a claim for reimbursement.
OptumRx Home Delivery If you’re taking a maintenance medication (90-day supply), you can either fill your prescription at a local CVS retail pharmacy, or you can sign up for OptumRx home delivery to:
- Order up to a 90-day supply.
- Submit your order online through the OptumRx app, or by phone or mail.
If you enroll in the Automatic Refill Program, OptumRx will automatically refill and deliver your eligible maintenance medications to you.
Specialty Medications – Optum Specialty Pharmacy Specialty medications treat chronic conditions such as cancer, multiple sclerosis and rheumatoid arthritis, and can come in the form of an injectable, oral or inhaled medication. If you’re taking a specialty medication, you will fill your prescriptions using the Optum Specialty pharmacy. With the Optum Specialty pharmacy, you:
- Don’t have to worry about filling specialty medications at any other location, such as a retail pharmacy or your doctor’s office.
- Have access to experienced pharmacists and nurses who can provide information about your medication
- Receive customer service support from specialty. experts who are available to answer any questions you may have.
Optum Specialty pharmacy will ship your medication to you in safe, temperature-controlled and tested packaging. You can contact the Optum Specialty pharmacy by calling the general toll-free number at (833) 209-6463, or you can call the Optum Specialty pharmacy directly at (855) 427-4682.
Enhanced Savings Program for Medications Not Covered Under the Plans
If you’re taking a medication that’s not covered under the Santander medical plans, you still may be able to purchase the medication, as well as over-the-counter medications (with a valid prescription), at a reduced price through the Enhanced Savings Program available to OptumRx members. Simply present your combined medical/pharmacy member ID card with your valid prescription to the pharmacist and they will let you know if a discount is available. Note: Any discounted amounts you pay through the Enhanced Savings Program will not count toward your deductible in the HSA Choice Plus Plan or toward your out-of-pocket maximum in either plan.
Critical Illness Insurance Coverage Options from MetLife
Critical illness insurance can help ease the financial burdens of serious illnesses like heart attack, cancer, Alzheimer’s Disease and more. Though medical coverage can be a big help in covering the costs of medical treatments, it doesn’t cover other expenses you may continue to face - like housing costs, school tuition, and the cost of food.
You can choose to enroll in MetLife’s critical illness insurance that provides a lump-sum cash benefit if you’re diagnosed with a serious health condition. You can use the money as you see fit. Two levels of coverage are available ($15,000 and $30,000). An annual $50 wellness credit is also available if you complete certain screenings and prevention checks. You pay the full cost on an after-tax basis through payroll deductions.
Dental
Santander offers you the choice of two dental plans administered by MetLife Dental: the Basic Dental Plan and the Buy-up Dental Plan.
The Basic Dental Plan has lower employee contributions, a lower annual maximum benefit and does not cover orthodontia. The Buy-up Dental Plan has higher employee contributions, a higher annual maximum benefit and provides orthodontia coverage.
Both plans allow you to visit any dentist of your choice, but you will pay less when you visit a dentist who is a member of the MetLife network because they provide services at discounted rates. Visit www.metlife.com/mybenefits to find a MetLife network dentist.
Smart Consumer Tips!
- Get free preventive care* that’s covered at 100%* — it could save you time and money in the long run.
- You can use a Healthcare FSA to pay for eligible out-of-pocket dental expenses on a pre-tax basis. Learn more about FSAs.
*Preventive care is subject to and counts toward the annual benefits maximum.
Vision
Santander offers you a choice of two vision plans — the Basic Vision Plan and the Buy-up Vision Plan — administered by Vision Service Plan (VSP). The Basic Vision Plan is a lower-cost plan with slightly lower allowances for frames and other vision care services. The Buy-up Vision Plan offers higher levels of coverage.
If you enroll in one of the Santander vision plans, you and any covered dependents will have access to 30% – 60% discounts on hearing aids through VSP’s relationship with the TruHearing discount medical health organization for hearing technology. For questions about the hearing aid discounts, call TruHearing at (877) 396-7194.
Smart Consumer Tips!
- You can use a Healthcare FSA to pay for eligible out-of-pocket vision expenses on a pre-tax basis. Learn more about FSAs.
- To find participating doctors, visit www.vsp.com.
This site describes certain Santander benefit plans and policies. Your eligibility for and entitlement to a benefit mentioned herein are governed by the terms of the official plan document or policy. Santander reserves the right to amend or terminate its plans and policies in full or in part at any time for any reason. In the event of a conflict between this site and the official plan document or policy, the official plan document or policy will control. Your employment is at will.