Medical Important Information
Important information about the full-time medical plan:
When Pre-Certification is Required for the Lowe’s Medical Plan Options
In Lowe’s self-funded plans (Option 1, Option 2, Choice Account Plus, and Choice Account) all hospital admissions and certain outpatient surgeries and medical services must be approved before you receive care. Emergency admissions must be reported within 48 hours. If you enroll in an HMO, check with your medical plan provider for pre-certification requirements. You should reference the Summary Plan Descriptions (SPDs) for a full list of services that require pre-certification.
Maternity Management Program
A maternity program is available to expectant mothers enrolled in the Option 1 or Option 2 medical plans. The program is designed to promote healthy habits during pregnancy and identify possible risk factors. The program is company-provided and no cost to members.
The program helps expectant mothers and their babies receive the best possible healthcare during pregnancy. It’s available to all expectant mothers, regardless of whether the pregnancy is normal or high-risk. Lowe’s will waive the newborn’s initial calendar-year deductible when you enroll within the first 24 weeks of pregnancy and complete the maternity program. To enroll in the maternity program please contact the medical vendor on the back of your insurance card.
Maternity Hospital Length of Stay
Group health plans and health insurance issuers offering group health insurance coverage generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to fewer than 48 hours following a normal vaginal delivery, or fewer than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 or 96 hours, as applicable. In addition, no group health plan or issuer may require that a provider obtain authorization from the plan or insurance issuer for prescribing a length of stay not in excess of the above periods.
Reconstructive Surgery After a Mastectomy
Under federal law, all group health plans are required to provide medical and surgical benefits following a mastectomy — and communicate this coverage to plan participants. All medical options provide coverage for these services, including reconstructive breast surgery needed after mastectomy, prostheses, and treatment of any physical complications after a mastectomy. These services are covered in the same way as other surgery or services under each medical option.
Prescription Drug Plan Design
Prescription drug coverage is provided under all medical plans. CVS Caremark administers the prescription drug plan for the Option 1, Option 2, Choice Account Plus, and Choice Account medical plans. Kaiser administers its own prescription drug benefit.
For employees working at locations with access to an onsite health center:
For the 2017 plan year, employees covered under Lowe’s Choice Account Plus and Choice Account plans (High Deductible Health Plans), there will be a $40 charge, per illness/injury visit for onsite health centers. This is an IRS regulation due to the tax-free Health Savings Account associated with the HDHP medical plans. The $40 charge will count towards employees’ deductibles and out of pocket maximums under the Choice Account Plus and Choice Account plans. When an employee meets their deductible under this plan, there will be no charge for the onsite health center visit. All wellness and preventive visits remain at no cost, for any Lowe’s onsite employee, regardless of the insurance plan they are enrolled in. This will include annual physicals and biometric screenings.