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.

Aetna Health Fund (HSA)

Administered by: Aetna

Plans that put you in charge of your spending through lower premiums, higher deductibles, and a tax-free Health Savings Account (HSA) (with contributions from LPL Financial) that you own for life.

Aetna Traditional (PPO)

Administered by: Aetna

A plan that offers greater predictability of costs through copays for doctor’s visits and prescriptions, along with a low deductible.

Aetna Select (EPO)

Administered by: Aetna

An Exclusive Provider Organization (EPO) plan that provides coverage for in-network care only, coordinated by your primary care provider (PCP).

Kaiser HMO

(available in California) Administered by: Kaiser Permanente

A Health Maintenance Organization (HMO) plan that provides coverage for Kaiser Permanente providers only, coordinated by your PCP.

Key features

All of LPL Financial’s medical plans offer:

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 Health Fund (HSA) Aetna Traditional (PPO) Aetna Select (EPO) Kaiser HMO
Annual deductible
(calendar year)
$1,800 individual
$3,600family
$1,000 individual
$3,000 family
$500 individual
$1,500 family
N/A
Annual out-of-pocket maximum (calendar year) $3,300 individual
$6,500 family
$3,250 individual
$9,750 family
$2,100 individual
$6,400 family
$1,500 individual
$4,500 family
LPL Financial contribution to HSA $500 individual
$1,000 family
N/A N/A N/A
Physician services: Your costs
Preventive care Covered 100% Covered 100% Covered 100% Covered 100%
Primary care office visit You pay 20%1 $30 $25 $25
Specialist office visit You pay 20%1 $45 $35 $25
Telemedicine visit $49 for general medical consults
$47 for all other consults
$10 $10 $0
Chiropractic You pay 20%1
Combined max 20 visits/cal year3
$45 Combined max 20 visits/cal year3 $35 Max 20 visits/cal year $25 Max 402 visits/cal year
Acupuncture You pay 20%1
Max 20 visits/cal year
$45 Max
20 visits/cal year
$35 Max
20 visits/cal year
$25 Max 402 visits/cal year
Hospital services: Your costs
Inpatient You pay 20%1 You pay 20%1 You pay 20%1 $250/admit
Outpatient You pay 20%1 You pay 20%1 You pay 20%1 $100 copay
Emergency room You pay 20%1 $450 $450 $150
Urgent care You pay 20%1> $35 $35 $25
Mental health care: Your costs
Inpatient You pay 20%1 You pay 20%1 You pay 20%1 $250/admit
Outpatient You pay 20%1 $45 $35 $25
Prescription drugs: Your costs
Retail pharmacy (30-day supply)
Generic $101 $10 $10 $10
Brand Name $401 $40 $40 $30
Non-Formulary $601 $60 $60 N/A
Specialty Drug Co-Pay (30-day supply)4
Specialty 20% up to $3505 20% up to $350 5 20% up to $3505 20% up to $250
Mail order (90-day supply)
Generic $201 $20 $20 $206
Brand Name $801 $80 $80 $606
Non-Formulary $1201 $120 $120 N/A

1EMPLOYEE’S RESPONSIBILITY AFTER DEDUCTIBLE, EXCEPT FOR PREVENTIVE PRESCRIPTION DRUGS ON THE HEALTHFUND (HSA) OR TRADITIONAL (PPO) PLAN.
2COMBINED MAX OF 40 VISITS/CALENDAR YEAR INCLUDES IN-NETWORK CHIROPRACTIC AND ACUPUNCTURE SERVICES.
3COMBINED MAX OF 20 VISITS/CALENDAR YEAR INCLUDES IN-NETWORK PLUS OUT-OF-NETWORK CHIROPRACTIC SERVICES.
4DEPENDING ON THE TYPE OF SERVICES, A COPAYMENT, COINSURANCE OR DEDUCTIBLE MAY APPLY. MATERNITY CARE MAY INCLUDE TESTS AND OTHER SERVICES (I.E. ULTRASOUND).
5SPECIALTY DRUGS UNDER RXBENEFITS / EXPRESS SCRIPTS MUST BE OBTAINED THROUGH ACCREDO FOR ALL AETNA PLANS.
6UP 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.

HSA

You can set aside tax-free money from your paycheck (and receive company contributions) to help cover your costs — now, or in the future.

Deductible

You pay 100% of your medical and prescription costs until you meet the annual deductible.

Coinsurance

After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.

Out-of-pocket maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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

Money-Saving Tip

Use the annual contribution LPL Financial makes to your HSA, as well as your own before-tax HSA contributions, to help you pay for your out-of-pocket costs.

 

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.

Copay

You pay a small fee at the time of service for doctor visits and prescriptions.

Deductible

For care that doesn’t charge a copay, such as hospital services, you pay 100% of the costsuntil you meet the annual deductible.

Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.

Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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.

Copay

You pay a small fee at the time of service for doctor visits and prescriptions.

Deductible

For care that doesn’t charge a copay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.

Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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.

Copay

You pay a small fee at the time of service for in-network medical care and prescriptions.

Deductible

This plan has no annual deductible for in-network care. The plan pays 100% of the costs after you pay your copay.

Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

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.

Drug tiers

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.

Why use mail order?

  • 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.

Why use retail fill?

  • 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.

Save money

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.
RxBenefits/Express Scripts Prescription Coverage Provisions

For members covered under one of the three Aetna medical plans, there are a few provisions included in your Rx Benefits/Express Scripts prescription drug coverage plan to keep in mind:

  • If you are taking or are prescribed a medication with a cost of over $1,000 for a 30-day fill, there will be a Clinical Review prior to processing your fill request, which will require supplemental information from your prescriber.
  • In most states, when your doctor writes a prescription for a brand-name drug, your pharmacy can substitute the generic drug. However, if your prescriber designates the prescription as “Dispense As Written” (or DAW) the pharmacist is not allowed to substitute a generic and must fill the more expensive brand name drug. If your prescriber does not mark your prescription as “DAW” and you choose to receive the brand-name drug rather than the generic, you will be required to pay the brand name co-pay plus the difference in cost between the generic drug and the brand name drug.
  • Low Clinical Value prescription medications are excluded.
  • Cost-savings option for members who receive prescriptions with Manufacturer Co-pay Assistance Programs. If you are eligible for this program, RxBenefits will coordinate the savings program with you.
 

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.

 

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 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.

 

Teladoc Medical Experts

When you need health care answers, Teladoc Medical Experts can help. If you are enrolled in one of the Aetna medical plan options that LPL offers, you and your covered dependents have no-cost access to Teladoc Medical Experts. An expert medical opinion from world-renowned specialists can give you the answers and confidence you need to make informed decisions about your health.

Here's how it works:

  1. Start a case: Submit your request online, in the Teladoc mobile app or by calling 1-800-835-2363.
  2. Access expert guidance: Connect with your advocate physician, who guides you through every step in the process and coordinates your review with a team of specialists and your existing physician.
  3. Receive collaborative care: Your team of doctors works with you to develop and deliver a clear diagnosis and treatment plan that’s right for you.

You can start a case from wherever you are. Call 1-800-835-2363, go online or download the Teladoc app to start a case and connect with a physician.

Watch the video below to learn more about how Teladoc medical experts can support you.

 

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

  • Login to the Aetna Member Portal via www.aetna.com
  • Select “Find Care & Pricing” from the main navigation
  • For a list of providers, enter the type of provider (PCP, Pediatrician, Allergist, etc.) and choose a location
  • To determine if a doctor is in-network, enter the name and choose a location

-Or-

  • Go to https://www.aetna.com/individuals-families/find-a-doctor.html
  • In the "Guests" tile, choose "Plan from an employer"
  • Under “Continue as a guest,” enter the zip code where you wish to find a doctor
  • Select the distance (number of miles) you are willing to travel from the specified zip code
  • Click "Search"
  • Select your plan from the list
    • For the Aetna Select (EPO), scroll then select "Aetna Select (Open Access)"
    • For the Aetna Traditional (PPO), scroll then select "Aetna Choice POS II (Open Access)"
    • For the Aetna Health Fund (HSA), scroll then select "Aetna Choice POS II (Aetna Health Fund)"
  • Type in a provider name or specialty -OR- choose from one of the categories listed
  • If you need to speak with a representative, call Aetna at 877.204.9186

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.
Don’t have a personal doctor? You should. Here’s why.

  • Better health. Getting the right health screenings each year can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it.
  • A healthier wallet. Having a doctor you can call and in some cases, email, helps you avoid costly trips to the emergency room and decide when you really need to see a specialist.
  • Peace of mind. Advice from someone you trust ... it means a lot when you’re healthy, but it’s even more important when you’re sick. Your personal doctor gets to know you and your health history and can help coordinate any care you need.

 

 

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:

  1. 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.

  2. 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.

  3. 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 up to $550 of unused money to the next year; you will forfeit amounts above $550. Unused Dependent Care FSA funds do not carry over to the next plan year; you must “use it or lose it.”

  4. 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.

  5. 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!

  6. 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.

  7. Download the mobile app. Convenient on the go access to plan information, ID cards, member services, cost saving tools and more.

  8. 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: $
$34
Average price: $
$0 (preventive);
$176 (nonpreventive)
Average price: $$
$229
Average price: $$$
$821 (minor); $1,644 (moderate); $3,069 (severe)
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

*Average costs are from healthcarebluebook.com. Contact your health insurance carrier for your specific costs.