Health Connect Plan (HCP)

Microsoft provides comprehensive medical coverage for you and your eligible dependents with zero paycheck premiums. The Health Connect Plan (HCP) with Premera Blue Cross is designed to offer personalized and coordinated care, along with cost predictability, to simplify managing your health. This plan is only available to employees and their dependents residing in the Eastside of the Puget Sound region (Kirkland/Redmond/Bellevue).

Quick tip! Check out the Health Connect Plan page to learn more about the plan and its benefits.

You are eligible for the benefits described in this SPD if you are a full- or part-time employee on the Microsoft U.S. payroll, and are not an intern, visiting researcher, or employee of a Microsoft retail store. For additional details, review the full definition of eligible employee and the explanation of workers who are not eligible for coverage. You are eligible to participate in the Health Connect Plan if you are a benefit-eligible corporate employee on the Microsoft US payroll and reside in King or Snohomish county in Washington state.

Eligible dependents

When you sign up for medical coverage, you can also enroll eligible dependents including your:

Spouse:

  • You must be lawfully married (whether the same or opposite sex of the employee) and not legally separated. You will be considered lawfully married if either of the following is true:
  • You were married in a state, possession, or territory of the U.S. and you are recognized as lawfully married by that state, possession, or territory of the U.S.; or
  • You were married in a foreign jurisdiction and the laws of at least one state, possession, or territory of the U.S. would recognize you as lawfully married. In no event will the Plan recognize more than one spouse at any time.

Domestic partner:

  • You and your domestic partner (either of the same or opposite sex) must meet all of the following requirements:
  • You are each other's sole domestic partner and intend to remain so indefinitely
  • Neither of you is legally married
  • You are both at least 18 years of age and are mentally competent to consent to contract
  • You are not related by blood to a degree of closeness that would prohibit legal marriage in the state in which you legally reside
  • You reside together in the same residence and intend to do so indefinitely (excepting a temporary residence change of not more than 90 days during which you and your domestic partner reside in separate homes)
  • You are mutually responsible (financially and legally) for each other's common welfare

Dependent children under age 26 Includes your:

  • Biological child and/or your spouse’s/domestic partner’s biological child
  • Child for whom you or your spouse/domestic partner has been named legal guardian as appointed by the courts (or recognized as guardian by the state of residence)
  • Legally adopted child, or child who has been placed with you for adoption, but not a foster child
  • A child’s eligibility as a dependent child under age 26 does not rely on the child’s financial dependency (on you or any other person), residency with you or with any other person, student status, employment, eligibility for other health plan coverage, or any combination of these factors.

Incapacitated dependent children age 26 or over:

  • An incapacitated dependent resides with the employee for more than half of the year, and is unable to sustain employment due to a developmental or physical disability that existed before the child reached age 26. The individual is chiefly dependent on the employee (or the employee’s spouse or domestic partner) for support.
  • Proof of incapacity must be submitted to the plan administrator:
  • Within 90 days of the latest of the child's 26th birthday, your date of hire, or the date that you enroll the child in coverage if the child is already over age 26, and then annually thereafter.

Workers who are not eligible for coverage

The following persons are not eligible to participate as employees in the plan under this SPD even if they meet the definition of an eligible employee:

  • Interns and visiting researchers
  • Cooperatives
  • Apprentices
  • Nonresident aliens receiving no U.S. source income from Microsoft
  • Employees covered by a collective bargaining agreement resulting from negotiations with Microsoft in which retirement benefits were the subject of good faith bargaining and participation in this plan was not provided for
  • Persons providing services to Microsoft pursuant to an agreement between Microsoft and any other individual or entity, such as a staff leasing organization (leased employees)
  • Temporary workers engaged through or employed by temporary or leasing agencies
  • Workers who hold themselves out to Microsoft as being independent contractors or as being employed by or engaged through another company while providing services to Microsoft
  • Project-based employees. For purposes of the plan, a project-based employee is one who is hired to work on a project or series of projects, is employed for a limited term, and has signed a Project-Based Employment Agreement.
  • All other workers who Microsoft does not classify as being either a full-time or part-time employee on the Microsoft U.S. payroll, even if that classification is later determined to be incorrect or is retroactively revised.

No duplicate coverage

If both you and your spouse or domestic partner are employed by Microsoft and are eligible for benefit coverage, you are only allowed to be covered under one plan. You can either enroll as a dependent under your spouse or eligible domestic partner's plan or enroll in your own separate coverage, but not both. Your eligible children must be enrolled under only one employee's coverage.

Important Note: If you have other coverage, learn how Coordination of Benefits (COB)  applies to you and your enrolled dependents.

The Health Connect Plan provides the highest level of coverage when care is received within the HCP networks, including key providers such as Eastside Health Network (EHN), EvergreenHealth, Overlake Medical Center and Clinics, Microsoft’s onsite clinic, the Living Well Health Center, and Allegro Pediatrics.

Here’s a quick breakdown:

What you pay

 

Health Connect Network

Extended Network

Annual deductible

None

$1,000 per person; $3,000 per family

Copayments

$20 primary care visit; $40 specialist visit
$250 emergency room (waived if admitted)

Not applicable

Annual out of pocket maximum

$2,000 per person; $6,000 per family

Out of network care

Not applicable

Covered at 50% of allowed costs after the deductible

Check out the Summary Plan Description for all the details.

The Health Connect Plan provides comprehensive medical coverage. Here’s a snapshot of the most commonly used benefits but be sure to reference the Summary Plan Description for full details.

Benefit

Health Connect Network Coverage

Extended Network Coverage

Ambulance

90%

90%

Autism/ABA therapy

90%

90%

Childbirth classes and education

100%

Not applicable

Chiropractic, massage, and acupuncture services (medically necessary)

100% after $40 copay

100% after $40 copay

Combined 24 visit limit per person per calendar year

Contraception

100%

100%

Devices and injections administered by a physician; prescription contraception is covered under preventive care

Diabetes health education

100%

100%

Emergency room

100% after $250 copay (copay is waived if you’re admitted)

100% after $250 copay (copay is waived if you’re admitted)

Hearing care and hardware

Exams: 100% after $40 copay

Exams: 100% after $40 copay

Hardware: 90% after deductible
$10,000 hardware limit per enrollee for three consecutive calendar years

Home health care

90%

60% after deductible

Hospice care

90%

60% after deductible

Hospital inpatient and outpatient

90%

60% after deductible

Infertility (fertility and family building)

90% for services within Progyny  provider network, subject to certain limits

Not applicable

Lab tests and X-rays

90%

90%

Maternity care (routine) – includes professional prenatal care, labor, and delivery charges

100% after a $500 copay

60% after deductible

Maternity (non-routine)

90%

60% after deductible

Maternity virtual support

Free virtual care and on-demand support through Maven Clinic

Not applicable

Medical equipment and supplies

90%

90%

Mental health, ADHD, substance abuse, chemical dependency, and alcoholism treatment - inpatient/outpatient

Outpatient professional: 100% after $20 copay

Inpatient and outpatient facility: 90%

Outpatient professional: 100% after $20 copay

Inpatient and outpatient facility: 90%

Mental health outpatient services through Spring Health (MS CARES employee assistance program)

100%

Up to 24 sessions per calendar year

Office visits (primary and specialist)

$20 primary care visit; $40 specialist visit

60% after deductible

Prescription drugs

(Retail – 30-day supply)

See the HCP drug formulary

Generic: 100% after $10 copay

Preferred brand: 100% after $30 copay

Non-preferred brand: 100% after $60 copay

Prescription drugs

(Mail order – 90-day supply)

Generic: 100% after $20 copay

Preferred brand: 100% after $60 copay

Non-preferred brand: 100% after $120 copay

Preventive care (services and prescription drugs)

100%

100%

Urgent care

100% after $40 copay

60% after deductible

Weight loss prescription drugs

(prior authorization required)

90%

90% after deductible

For a detailed list of what’s covered, as well as exclusions and limitations, refer to the Summary Plan Description.

You can fill a prescription at any retail pharmacy in the HCP (Express Scripts) network, including the on-campus Living Well Health Center Pharmacy  at  Building 21. If you take medications on an ongoing basis, you can also use the mail-order option that delivers medications to your home.

Your prescription copay depends on the tier your medication falls under: generic, preferred brand, or non-preferred brand. Preventive prescription drugs are covered in full. Prescription drugs may be subject to quantity limits and/or prior authorization. Check out the HCP Preventive Drug List  and the HCP Prescription Formulary  for all the details.

The Health Connect Plan makes it easy to get the care you need when you need it. For urgent needs that aren’t life-threatening, you can talk with a licensed nurse anytime, night or day, by calling 1 (800) 676-1411.

Another option is a virtual visit with Teladoc Health. Teladoc Health doctors are board-certified physicians who can diagnose and treat your health issues, and send prescriptions to the pharmacy of your choice, without you or your family members leaving your home. You can reach Teladoc Health anytime by calling 1 (855) 398-6268.

Living Well Health Center

Microsoft designed the Living Well Health Center and Pharmacy  to offer you convenient access to high quality, comprehensive care. Whether you need to visit the doctor, fill a prescription, or seek counseling, you can access these services and more, right on campus. Employees and family members over 13 years old who are enrolled in the Premera Health Connet Plan are eligible to access the health center and pharmacy. 

You can only enroll in or make changes to your medical insurance election as a new hire, during the annual open enrollment period, or if you have a qualifying status change (like a marriage, divorce, or the birth of a child). To learn more, go to Qualified Status Change.

If you want to:

Go here:

Contact the Health Connect Plan’s dedicated service center, the Health Connect Navigator, for personalized assistance

(800) 676-1411, option 2

Learn more about the Health Connect Plan (Premera)

Health Connect Plan

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Find out the cost of prescription medication

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Ask questions about the Health Connect Plan (Premera)

microsoft@premera.com
(800) 676-1411
Group number: 1000010