2013 Sprint Benefits Guide

Medical/Prescription Drug coverage levels
When you enroll in Medical/Prescription Drug coverage, you will be able to sign up for one of four coverage levels depending on which eligible dependents you cover:
• Employee Only
• Employee + Spouse/Domestic Partner
• Employee + Child(ren)
• Employee + Family
About Medical/Prescription Drug premium costs
Your before-tax per-paycheck premium costs for Medical/Prescription Drug coverage are based on the plan you select as well as your Benefits Eligible Earnings, dependentcoverage
level and Healthy Living Discount status. These costs can be found in the Costs section of this guide, which begins on page 18.
The details… Medical/Prescription Drug plans
Note: HMO availability and coverage varies by region. For information more information on HMOs, please visit i-Connect > My Life & Career > Benefits.
The details… National Medical/Prescription Drug plans
Features Sprint Basic Plan Sprint Health Account Plan Sprint Consumer Access Plan
Medical coverage claims
administrator
BlueCross BlueShield of Illinois UnitedHealthcare BlueCross BlueShield of Illinois
Per-paycheck premiums Lowest Medium Highest
Expected out-of-pocket costs Highest Medium Lowest
Network/Out-of-network Network Non-network Network Non-network Network Non-network
Choice of doctor/facility
May use any doctor/facility; however, plan pays higher
benefits with network providers
May use any doctor/facility; however, plan pays higher
benefits with network providers
May use any doctor/facility; however, plan pays
higher benefits with network providers
For preventive medical
services, plan generally
pays…
100% even if deductible
not met (examples: wellchild
visits up to age 6
and adult screenings as
defined in the Summary
Plan Description)
Routine physical
exams, well-child visits
through age 5 and
preventive screenings
for adults covered at
60% co-insurance of
allowable charges (after
deductible met); other
services not covered
100% even if deductible
not met (examples: wellchild
visits up to age 6
and adult screenings as
defined in the Summary
Plan Description)
Routine physical exams,
well-child visits through age
5 and preventive screenings
for adults covered at 60%
co-insurance of allowable
charges (after deductible
met); other services not
covered
100% even if
deductible not met
(examples: well-child
visits up to age 6
and adult screenings
as defined in the
Summary Plan
Description)
Routine physical
exams, well-child
visits through age
5 and preventive
screenings for adults
covered at 60% coinsurance
of allowable
charges (after
deductible met); other
services not covered
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