WINTER 2025 SPOTLIGHT ON BENEFITS NEWSLETTER NOW AVAILABLE

IN THIS ISSUE:

• Board of Trustees Approves Initial Health Plan Changes to Address Healthcare Inflation. The nation is in the midst of a healthcare crisis and healthcare inflation raging for the past several years with the largest government shutdown in history (largely over health care subsidies and double digit increases in Medicare premiums). Our Health Plan is not immune to these factors. Over the past two decades, the Health Plan has built up reserves that allowed us to sustain our current level of benefits despite benefit expenses exceeding contribution income. These losses are projected to continue this year and compound in the coming years. Unless addressed, the Health Plan’s reserves will be depleted by the end of this decade. Accordingly, the Board has taken the initial steps outlined below to address these challenges. The Board of Trustees does not make benefits changes such as these without considerable deliberation and forethought. Future changes are being given the same careful consideration, with the main goal being to preserve the vitality of the Health Plan for years to come for you and your families.
  • Effective April 1, 2026: Minimum age for beginning Certified Retiree coverage will increase from age 60 to 62
  • Effective March 1, 2026: Non-network inpatient benefits will be eliminated. This does not apply to inpatient services received outside of the United States.
  • Effective January 1, 2027: Annual deductible will increase from $325 per person/$975 per family to $400 per person/$1,200 per family. The $325 per person/$975 per family deductible remains in place for calendar year 2026.
  • Effective earnings periods on or after January 1, 2026: Minimum earnings threshold for Health Plan coverage will increase from $39,820 to $41,215 for the DGA Choice Plan and from $129,150 to $133,670 for the DGA Premier Choice Plan.

  For additional details regarding these changes, read the full article here.

• All-Inclusive Out-of-Pocket Limit Increases Effective January 1, 2026 to Limits Established Annually Under the Affordable Care Act. The All-Inclusive Out-of-Pocket Limit sets a maximum on the amount you pay out of pocket per calendar year for network benefits, including deductibles, co-insurance and co-payments. The Health Plan evaluates this limit annually to ensure it remains in line with the amount established each year under the Affordable Care Act. Accordingly, effective January 1, 2026, the Health Plan’s All-Inclusive Network Out-of-Pocket Limit will increase from $9,200 per individual/$18,400 per family to $10,600 per individual/$21,200 per family.
• CVS Caremark Formulary 101: What is a Formulary? CVS Caremark, the Health Plan’s prescription drug manager, periodically negotiates drug prices with manufacturers. From these negotiations, a medication list, called the formulary, is developed. The formulary details which drugs are covered under the Health Plan and the brand or generic drugs that when prescribed can lower your out-of-pocket costs. Read this article to learn the importance of choosing drugs from the formulary, what to do if a medication that’s prescribed to you is not covered and how to find prescription drug savings.
• CVS Updates Its List of Covered Medications Effective January 1, 2026. Effective January 1, 2026, CVS Caremark is updating its list of covered medications, referred to as its formulary. CVS should have already contacted you if you are currently taking a medication that will be excluded from the updated formulary. The letter should also contain a list of covered alternatives. See the updated formulary here.
• Infertility and Contact Lenses Coverage Clarifications. The Vision Benefits section of the March 2025 Health Plan Summary Plan Description has been amended to clarify the maximum amount the vision benefit will cover for non-network contact lenses: $105 per elective pair of lenses and $210 per Medically Necessary pair of lenses. Additionally, the What’s Not Covered Under Medical Benefits section has been amended to clarify that an initial diagnostic workup to determine the cause of infertility prior to the start of any infertility treatment remains covered when performed by a non-Carrot provider. Read the full article for more information.
• COVID-19 and MMRV Vaccines Remain Covered Under the Health Plan’s Preventive Care Benefits. Recent changes to the CDC’s COVID-19 and MMRV (measles, mumps, rubella and varicella/chickenpox) vaccine recommendations have left many people confused. Regardless of what you decide for you or your child, the Health Plan continues to cover both the COVID-19 and MMRV vaccines at 100% when administered by a network provider under its preventive care benefit. Visit the Preventive Care Benefits Overview webpage for a full list of the preventive care vaccinations and services covered under the Health Plan.
• Be.Well. Aging Strong: Bone and Muscle Loss Can Be Prevented. Often bone loss, frailty, unexpected falls and related conditions like osteoporosis are associated with people of a certain age. Yet, everyone’s bones weaken over time, and after age 35, muscle loss occurs at a rate of 1-2% a year for the typical person. Simply put, we’re all at risk of weakening bones and muscles and the balance issues that come with them. This article explores the culprits of weakening mobility and muscle function and provides research-based information on how to maintain your strength as you age.
• What is Advance Care Planning? The thought of making emergency or end-of-life decisions for an incapacitated loved one is typically an unsettling one. What medical treatment would they want? For how long and to what degree? Advance care planning, which is the process of discussing questions like these and documenting your wishes for emergency medical treatment or incapacitation, is designed to prepare yourself, your loved ones and your medical team for these possibilities. It is recommended that every adult has an advance care plan for this reason. Read part one of the Spotlight on Benefits’ advance care planning series, to get introduced to the first two steps of the planning process: (1) understand your current health status and (2) reflect and prioritize your care goals. Keep an eye out for our next article covering the next advance care planning steps.
• Women’s Health and Cancer Rights Notice. This annual notice informs women who have had a mastectomy or expect to have one of the Health Plan benefits they may be entitled to under the Women’s Health and Cancer Rights Act of 1998.
• 2024 Summary Annual Reports. Each year, the Plans must provide reports to its participants on the financial status of the Supplemental Pension Plan and the Health Plan, including plan expenses, asset values and the total income of each plan. Read the reports here, or via your preferred Plans communication method (myPHP or mail).