Medical

Overview

To support your health and financial wellness, LPL Financial provides valuable benefits that help you and your family stay healthy and pay for care in the event of illness or injury.

Medical Plans

LPL Financial offers you a choice of medical plans with a range of coverage levels and costs, so you have the flexibility to select the option that’s best for you. These plans are administered by Aetna or Kaiser Permanente, depending on your location.

All of LPL Financial’s medical plans offer:

Comprehensive, affordable coverage for a wide range of health care services.

Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in supplemental medical coverage.

Free in-network preventive care,

with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.

Prescription drug coverage

included with each medical plan. Prescription benefits are provided by Rx Benefits/Express Scripts or Kaiser Permanente depending on the medical plan you choose.

Financial protection

through annual out-of-pocket maximums that limit the amount you’ll pay each year.

Convenient Member Portals

and mobile apps for on the go access for registered members.

In-Network Plan Comparison

	Aetna				Kaiser
	Health Fund (HSA)	Traditional (PPO)	Atrium (ACO) (Charlotte metro only)	Select (EPO)	HMO (CA only)
LPL contribution to Health Savings Account (HSA)	$500 Ind $1,000 Fam	N/A	N/A	N/A	N/A
Deductible	$2,000 Ind $4,000 Fam	$1,100 Ind $3,300 Fam	N/A	$500 Ind $1,500 Fam	N/A
Out-of-pocket maximum	$3,500 Ind $7,000 Fam	$3,500 Ind $10,500 Fam	$1,500 Ind $4,500 Fam	$2,500 Ind $7,500 Fam	$1,500 Ind $4,500 Fam
Costs	Lower premiums, moderate out-of-pocket costs	Higher premiums, lower out-of-pocket costs	Lower premiums, lower out-of-pocket costs	Moderate premiums lower out-of-pocket costs	Lower premiums, lower out-of-pocket costs
Covered Services
Preventive care	Covered 100%	Covered 100%	Covered 100%	Covered 100%	Covered 100%
Primary care office visit	You pay 20%¹	$30	$25	$25	$25
Specialist office visit	You pay 20%¹	$45	$25	$35	$25
Teladoc/Kaiser Telehealth (24/7 Medical)	$56 (before deductible) $10 (after deductible)	$10	$10	$10	$0
Urgent care visit	You pay 20%¹	$35	$25	$35	$25
Emergency room visit	You pay 20%¹	$450	$250	$450	$150
In-patient hospital care	You pay 20%¹	You pay 20%¹	$250/admit	You pay 20%¹	$250/admit
Out-patient hospital care	You pay 20%¹	You pay 20%¹	$100	$35	$25
Chiropractic	You pay 20%¹ Comb. max 20 visits/cal year³	$45 Comb. max 20 visits/cal year³	$25 Max 20 visits/cal year	$35 Max 20 visits/cal year	$25 Max 40 visits/cal year²
Acupuncture	You pay 20%¹ Max 20 visits/cal year	$45 Max 20 visits/cal year	$25 Max 20 visits/cal year	$35 Max 20 visits/cal year	$25 Max 40 visits/cal year²
Prescription Drugs
Prescription drug coverage	RxBenefits/ Express Scripts	RxBenefits/ Express Scripts	RxBenefits/ Express Scripts	RxBenefits/ Express Scripts	Kaiser Permanente
Retail pharmacy: 30-day supply²
Generic	$10¹	$10	$10	$10	$10
Formulary (Preferred)	$40¹	$40	$40	$40	$30
Non-formulary (Non-preferred)	$60¹	$60	$60	$60	N/A
Specialty Prescriptions	20% up to $350^1,3	20% up to $350³	20% up to $350³	20% up to $350³	20% up to $250
Mail Order: 90-day supply
Generic	$20¹	$20	$20	$20	$20⁴
Formulary (Preferred)	$80¹	$80	$80	$80	$84
Non-Formulary (Non-preferred)	$120¹	$120	$120	$120	N/A

¹Your responsibility after deductible, except for preventive prescription drugs on the Health Fund (HSA).

²Depending on the type of services, a copayment, coinsurance or deductible may apply.

³Specialty drugs under RxBenefits/Express Scripts must be obtained through Accredo for all Aetna plans.

⁴Up to a 100-day supply.

Aetna Health Fund (HSA) Plan

A High Deductible Health Plan (HDHP) requires a larger deductible than our other health plans. In exchange, LPL Financial will contribute funds monthly to a tax-free Health Savings Account (HSA) that helps you save for future medical expenses. HSA plans encourage members to consider their health care decisions and costs.

How the Aetna Health Fund (HSA) Plan works

You pay the plan premium from your paycheck to have coverage.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Aetna Traditional (PPO) Plan

With a Preferred Provider Organization (PPO) plan you have greater flexibility and choice to use any medical providers. When you receive services from Aetna’s “in-network” doctors, specialists or facilities, your out-of-pocket expenses will be lower than if you visit an “out-of-network” provider.

How the Aetna Traditional (PPO) Plan works

You pay the plan premium from your paycheck to have coverage.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Aetna Select (EPO) Plan

An EPO (Exclusive Provider Organization) requires you and enrolled dependents to select a Primary Care Physician (PCP) who will direct the majority of your health care needs. With the Aetna Select (EPO), all services must be provided by in-network providers. You and enrolled dependents select a Primary Care Physician (PCP) who will direct the majority of your health care needs.

How the Aetna Select (EPO) Plan works

You pay the plan premium from your paycheck to have coverage.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Aetna Atrium (ACO) Plan

This accountable care organization (ACO) plan option is offered in partnership with Atrium Health to deliver high-quality care at a lower cost for those in the Charlotte metro area of NC/SC*. It features: low payroll deductions, low copays, no deductibles, and no PCP referral from Aetna required to see an Atrium Health specialist. If you have dependents who live outside the Charlotte metro area, or if you need urgent care when you are traveling, the Aetna PPO network is considered in-network.

If you're already using Atrium Health hospitals and providers, then the Aetna Atrium (ACO) plan option may be a great choice for you.

*Eligible NC and SC employees can select this option if they live in: Anson, Cabarrus, Cleveland, Gaston, Lancaster, Lincoln, Mecklenburg, Stanly, Union or York county.

How the Aetna Atrium (ACO) Plan works

You pay the plan premium from your paycheck to have coverage.

Keep in mind: You pay nothing for in-network preventive care — it's covered in full.

Kaiser Permanente HMO (CA) Plan

The HMO Plan provides coverage only when you receive care from providers within the Kaiser Permanente network. Your Primary Care Provider (PCP) will coordinate your care to help manage costs.

How the Kaiser Permanente HMO Plan works

You pay the plan premium from your paycheck to have coverage.

Keep in mind: You pay nothing for in-network preventive care — it’s covered in full.

Prescription Drugs

If you are enrolled in the Kaiser Permanente HMO, your pharmacy benefits will be accessed through Kaiser Permanente. If you are enrolled in the Aetna Select (EPO) Plan, the Aetna Traditional (PPO) Plan or the Aetna Health Fund (HSA) Plan, your pharmacy benefits will be accessed through Rx Benefits/Express Scripts.

Many FDA-approved prescription medications are covered through the benefits program. Regardless of the plan you have, you will save money by filling prescription requests at participating pharmacies.

Each plan has a drug formulary, or list of prescription drugs including both generic and brand-name medications that are preferred. Each plan has four drug tiers. The cost of your prescription drugs under each medical plan depends on the tier of the medication:

Tier 1 covers generic formulary medications.

Generic drugs are required by the FDA to contain the same active ingredients as their brand-name counterparts.

Tier 2 covers brand-name formulary.

Brand-name medications are protected by a patent and can only be produced by one specified manufacturer.

Tier 3 covers non-formulary medications which are not included on the plan’s drug formulary.

These drugs will often have a Tier 1 or Tier 2 equivalent drug available at a lower cost.

Tier 4 covers specialty medications.

Specialty medications most often treat chronic or complex conditions and may require special storage or close monitoring.

Mail order

If you regularly take medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — you can take advantage of the convenience and cost savings of using the Rx Benefits/Express Scripts or Kaiser Permanente mail order program.

Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
You save money with a reduced cost for a three-month supply.
You can set up automatic refills.

Retail 90-day Fill

If you are enrolled in Aetna medical coverage, you have another cost-saving option available to you for filling maintenance medications via the CVS Exclusive Smart90 prescription program through RxBenefits/Express Scripts.

Aetna members may fill up to a 90-day (three-month) supply at more than 90,000 participating CVS network pharmacies.
With many of these pharmacies open 24/7, you can fill at a time of your convenience.
You save money with a reduced cost for a 90-day supply.

The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save:

Ask your doctor about generic medications. Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
Use the mail order or retail fill feature. For ongoing maintenance medications, the mail order or retail fill prescription programs through Rx Benefits/Express Scripts and Kaiser Permanente will save you time and money.

Telemedicine

You have access to medical advice from board-certified physicians 24/7, 365 days a year through your plan’s telemedicine service. Teladoc from Aetna and Virtual Care with Kaiser offer you fast, convenient diagnosis and treatment for many common conditions through video consult on your smartphone or computer. Visit the Teladoc from Aetna or Virtual Care with Kaiser website to enroll or learn more.

The cost of a Telemedicine visit is based on the medical plan you select.

Virta Health

Diabetes Reversal Program

The Virta Health program helps reverse type 2 diabetes with treatment through a virtual clinic. Virta Health offers a personalized care plan with a health coach and medical provider to help participants lose weight, lower blood sugar, and reduce or eliminate medications. From a 10-week clinical study, 87% of participants stopped or reduced insulin.

Participants will receive a nutrition plan with recipes and food lists, daily health coaching, health tracking tools (e.g, scale, meter, test trips), access to Virta's care app, and more!

This program is available to LPL employees and eligible dependents enrolled in an Aetna medical plan who are type 2 diabetes patients at no extra cost. To learn more about eligibility and enrollment, visit the Virta Health website.

For additional support, email Virta Health and view the FAQs.

Alight Health Pro

Health benefits can be confusing, medical costs are rising, and finding the right care for you and your family can be frustrating and time consuming. We are here to simplify your healthcare experience and help you take control of healthcare costs. Your personal Health Pro consultant will take care of you, so you can spend more time on what matters most. This service is available at no cost to all employees and dependents enrolled in any LPL medical plan option. Visit the Alight Health Pro Connection website or call 800.513.1667 ext 4402 to learn more.

Watch the video below to learn more about Alight and how a Health Pro can provide you access to simpler, smarter healthcare.

Programs & Resources

TeleHealth – You have access to medical advice from board-certified physicians 24/7, 365 days a year through your plan’s telemedicine service. Teladoc from Aetna and Virtual Care with Kaiser offer you fast, convenient diagnosis and treatment for many common conditions through video consult on your smartphone or computer. Visit the Teladoc from Aetna or Virtual Care with Kaiser website to enroll or learn more.

Medical plan website – Find a doctor, compare costs, manage claims, and more. Visit:

Prescription website – Order or refill prescriptions, sign up for mail order, and more. Visit:

HSA/FSA tools – Manage your Health Savings Account or Flexible Spending Account online.

Find a Doctor

Using in-network providers will save you money due to the negotiated discount they accept for their services. Here’s how to find doctors in your medical plan network.

Aetna

Go to https://www.aetnadocfind.com/lpl/ and enter your zip code within the appropriate plan tile to search by plan.
Call Aetna at 877-204-9186 to get help finding a doctor or facility.

Kaiser Permanente

Go to kp.org/searchdoctors to browse our doctor profiles and select a doctor who matches your needs.
Call Kaiser Permanente at 1.510.675.2663, M-F 8:30 a.m. to 5:00 p.m. to get help finding a doctor.

Money-Saving Tips

5 tips to save money

Get the most value from your medical plan and help reduce your health care spending by following these consumer-smart tips:

Use in-network providers. They’ve agreed to charge only up to negotiated rates and bill your insurance company directly, which saves you money and time. Also, check with your insurance company to ensure that a service is covered before you receive care. Note: If you’re enrolling in an HMO or EPO plan (if available in your area), the plan only pays benefits for care received in network.
Keep up with preventive care. It’s covered in full by all of our medical plans and can help detect and prevent potentially costly health issues early. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.
Use tax-free money to pay for eligible health expenses. Contributing to a Health Savings Account (HSA) and/or a Flexible Spending Account (FSA) is easy and saves you money. You can set aside before-tax dollars from your paycheck to use for your out-of-pocket costs. Keep in mind that with an HSA, you can only spend contributions that have actually been deposited into your account. And with a Healthcare or Limited Purpose FSA, you can only carry over a limited amount of unused money set by the IRS every year to the next year; you will forfeit amounts above the limit. Unused Dependent Care FSA funds do not carry over to the next plan year; you must “use it or lose it.”
Shop smart for prescriptions. Using generic alternatives will almost always save you money — and they’re just as effective as brand name prescriptions. Also, login to your member portal (Kaiser Permanente or Rx Benefits/Express Scripts) and use the prescription pricing tools, use GoodRx or other pharmacy comparison app, or try calling a few local pharmacies to compare prices before deciding where to fill a prescription. For your ongoing prescriptions, use the mail-order or retail fill service to save money and time.
Take advantage of the LPL Financial wellness program. It offers valuable resources to help you improve your health, which could prevent the need for costly care. Plus, you can earn rewards when you participate in wellness activities and challenges!
Use your plan’s website. Register and log in to the Aetna or Kaiser Permanente website to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.
Download the mobile app. Convenient on the go access to plan information, ID cards, member services, cost saving tools and more.
Choose the right place to get care. Facilities charge different amounts for the same services, so think about your options when you or a family member needs medical attention. Use the guide below to help you save money and choose the most appropriate care for your situation:

Telemedicine	Doctor’s office	Urgent care clinic	Emergency room
Use it for
A common, non-emergency medical issue that can be diagnosed by phone or online	A condition that doesn’t need immediate attention and can wait until the next day	A condition that needs immediate care but is not life- or limb-threatening	A life-threatening or potentially crippling condition that needs immediate attention
Examples
Colds and allergies, flu/cough Ear infections, pink eye Behavioral health	Sore throat, fever Routine exam, screening Checkup, vaccine, prescription refill	Broken bone, severe sprain or strain Cut requiring stitches Anxiety attack	Sudden weakness, dizziness, or loss of consciousness Uncontrollable bleeding Chest pain, difficulty breathing
Cost
Average price: $	Average price: $	Average price: $$	Average price: $$$
Find it
Teladoc from Aetna or Virtual Care with Kaiser	Call your regular doctor or search for an in-network provider on your medical plan carrier’s website	Search for urgent care clinics near you at urgentcarelocations.com	Call 911 or search online for the nearest hospital

The Transparency in Coverage Final Rules require certain group health plans to disclose on a public website information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services in two separate machine-readable files (MRFs).

The MRFs for the benefit package options under The LPL Financial Group Medical Plan are linked here.