Medical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://www.auxiant.com/.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$5,000/$10,000 |
$5,000/$10,000 |
Out-of-Pocket Max |
$5,000/$10,000 |
$10,000/$20,000 |
Member Coinsurance |
O% |
30% |
Office Visits |
||
Preventive Care |
Covered at 100% |
Deductible, then 30% |
Primary Care Visit |
Deductible |
Deductible, then 30% |
Specialist Visit |
Deductible |
Deductible, then 30% |
Telemedicine |
Covered at 100% |
N/A |
Hospital Services |
Deductible |
Deductible, then 30% |
Emergency Room |
Deductible |
Deductible |
Urgent Care |
Deductible |
Deductible, then 30% |
*Preventive Care services are generally linked to annual wellness exams. Non-preventive services are those services that are considered treatment |
Retail Prescriptions (30-Day Supply) |
In-Network |
Out-of-Network |
|---|---|---|
Generic |
Deductible |
Not Covered |
Preferred Brand |
Deductible |
Not Covered |
Non-Preferred Brand |
Deductible |
Not Covered |
Mail Order Prescriptions (90-Day Supply) |
||
Generic |
Deductible |
Not Covered |
Preferred Brand |
Deductible |
Not Covered |
Non-Preferred Brand |
Deductible |
Not Covered |
Weekly Cost |
|
|---|---|
Employee Only |
$32.55 |
Employee + Spouse |
$129.52 |
Employee + Child(ren) |
$111.30 |
Employee + Family |
$200.70 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://www.auxiant.com/.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$3,000/$6,000 |
$3,000/$6,000 |
Out-of-Pocket Max |
$5,000/$10,000 |
$10,000/$20,000 |
Member Coinsurance |
10% |
40% |
Office Visits |
||
Preventive Care |
Covered at 100% |
Deductible, then 40% |
Primary Care Visit |
$30 Copay |
Deductible, then 40% |
Specialist Visit |
$60 Copay |
Deductible, then 40% |
Telemedicine |
Covered at 100% |
N/A |
Hospital Services |
Deductible, then 10% |
Deductible, then 40% |
Emergency Room |
$250 Copay, then 10% |
$250 Copay, then 10% |
Urgent Care |
$60 Copay |
Deductible, then 40% |
*Preventive Care services are generally linked to annual wellness exams. Non-preventive services are those services that are considered treatment |
Retail Prescriptions |
In-Network |
Out-of-Network |
|---|---|---|
Retail: 30-Day Supply |
||
Generic |
$10 Copay |
Not Covered |
Preferred Brand |
$35 Copay |
Not Covered |
Non-Preferred Brand |
$60 Copay |
Not Covered |
Mail Order Prescriptions |
||
Mail Order: 90-Day Supply |
||
Generic |
$25 Copay |
Not Covered |
Preferred Brand |
$87.50 Copay |
Not Covered |
Non-Preferred Brand |
$150 Copay |
Not Covered |
Weekly Cost |
|
|---|---|
Employee Only |
$65.06 |
Employee + Spouse |
$215.47 |
Employee + Child(ren) |
$165.80 |
Employee + Family |
$285.72 |
OneMed Clinic Surcharge
Western Forms cares about your health: we provide FREE access to One Medical Clinics located in MO & KS for all our employees and their family members who are enrolled in one of our Medical Plans. Biometric screenings/Physical must be completed by April 1, 2026.
Download the One Medical app
Download the app at onemedical.com/mobile to easily book visits, request prescription renewals, message with providers, and more.
Sign up now at onemedical.com/mybenefit
Use the enrollment code provide by your employer
Use code: WESTERNKC
GoodRx
Shop around for lower-cost Prescriptions.
• Did you know that you can save money by using GoodRx?
• For most prescriptions, GoodRx will provide you the closest and least expensive option.
• You will need to file a paper claim so that it may be applied to your deductible and out-of-pocket maximums.
Individual Deductible Example
When enrolling in the Base plan you will be reimbursed 50% of your $5,000 deductible up to a maximum of $2,500. Reimbursement will occur as Auxiant processes claims.
How do I receive reimbursements?
Reimbursements will automatically be processed once claims are submitted for payment. Medical expenses are processed weekly. Prescription expenses are processed bi-monthly. Payment is issued to you via check or direct deposit (if elected).
Example of year expenses:
Doctor’s Appointment 1/31 $250
(This is the amount listed on your Explanation of Benefits as the amount you owe).
This amount will sometimes be different than the amount listed on your doctor’s bill due to the discount that is given due to our insurance agreements.
You would pay the full amount of $250.00.
Western Forms (Auxiant) will send you a reimbursement of $125.00.
Prescriptions for a month $100
You would pay the full amount of $100.00.
Western Forms (Auxiant) will send you a reimbursement of $50.00.
Break your leg 6/30 $10,000
(This is the amount listed on your Explanation of Benefits as the amount you owe).
This amount will sometimes be different than the amount listed on your doctor’s bill due to the discount that is given due to our insurance agreements.
You would pay $4,150 (You met $850 of your deductible to this point).
Western Forms (Auxiant) will send you a reimbursement of $2,075.
Insurance will pay $5,850.
The remaining of the year:
Medical Expenses you will owe nothing.
Prescriptions you will owe:
Individual:
When these prescriptions copays add up to $1,000, you will pay nothing for prescriptions after that.
Family:
When these prescriptions copays add up to $2,000, you will pay nothing for prescriptions after that.
Single Coverage |
Family Coverage |
|---|---|
Western Forms Inc. pays $2,500 |
Western Forms Inc. pays $5,000 |
HRA available for employees enrolled in the Base Medical Plan |