Carleton offers two group health insurance plans. Participation is voluntary, the premiums are shared between Carleton and the employee, and are deducted on a pre-tax basis. 

AmeriHealth Administrators/BlueCross BlueShield (AHA/BCBS) is the health insurance provider for both the Blue and Maize plans. AHA process all medical claims for both the Blue and Maize plans. The provider network is through BCBS.

  • AmeriHealth Member Portal: This will allow you to see your claims, provide you resources to find care and support your wellness needs.
  • SmithRx is the Pharmacy Benefit Manager (PBM), they process your prescription claims that are covered by the health insurance, they work with AHA/BCBS. For additional information regarding SmithRx see below.
    • SmithRx Member Portal: This will allow you to see your pharmacy claims and find prescriptions at the lowest cost.
  • Insurance Cards will be issued by AHA/BCBS which will work for both your health care and SmithRx pharmacy benefit needs. Your cards will come in an AmeriHealth envelope.
  • Provider Network: All the major healthcare systems are covered by AHA/BCBS.
  • Teladoc (Virtual Healthcare): Carleton’s health plan members have access to Teladoc’s virtual healthcare services. These services offer convenient, comprehensive care from board-certified U.S. physicians at a reduced rate. For additional information see below.

Both Blue and Maize plans offer the following coverage:

  • Preventative services are covered at 100%,
  • In-network and Out-of-Network coverage.
  • Domestic partner coverage.

Blue Plan – High Deductible Health Plan (HDHP)

The Blue Plan is a High Deductible Health Plan (HDHP), which offers preventative and catastrophic coverage with an employer-funded health savings account (HSA). Prescriptions drugs are covered after your deductible has been met, however there are some preventative medications that may be free of charge.

  • Employees nearing age 65 need to notify Human Resources when enrolling in Social Security or Medicare as there are implications to your ability to make and receive contributions to your HSA plan.

Maize Plan – Copay and Deductible

The Maize Plan has a copay for office visits and a deductible for other types of care. You may participate in a Flexible Spending Account (FSA) if you enroll in the Maize plan.

SmithRx Additional Information

  • SmithRx uses Pareto Drug Formularies to optimize your prescription benefits and provide you with the best service and resources to make informed decisions regarding your prescriptions.
  • If your drug is not on the formulary list, you will have a grace period for the first 90 days of the 2025 plan year.
    • Make certain you speak with your pharmacist or provider to find alternative before the end of the grace period.
  • There are 5 tiers in the Formulary, they are as follows:
    • Tier 1 Generics 
    • Tier 2 Preferred Brands
    • Tier 3 Non Preferred Brands
    • Tier 4 Specialty Preferred
    • Tier 5 Specialty Non Preferred They utilize the Pareto Drug Formularies to optimize your prescription benefits and provide you with the best service and resources to make informed decisions regarding your prescriptions.

SmithRx has several cost savings programs including but not limited to:

  • SmithRx Assist
    • Simplified Medication Purchasing: Expanded coverage that applies cash prices and discount card programs, ensuring the lowest net cost.
    • Automatic Best Price: Your insurance card will automatically apply the best available price at the pharmacy.
    • Deductible and Out-of-Pocket Maximum Credit: All payments contribute towards your plan limits.
    • NOTE: SmithRx integrates many discount card programs, however, certain discount programs will not apply due to restricted access such as discount card programs that require membership fees and use pricing as a loss-leader for other product offerings they make available.
  • SmithRx Connect 360: A representative may reach out to let you know about ways to save money and help you enroll into the savings programs.
    • Access
      • Utilizes Drug Manufacturer Coupons: Reduces costs on both traditional and specialty medications.
      • Proactive Identification and Enrollment: SmithRx Connect 360 streamlines the process.
      • Significant Savings: Low or $0 copays on brand-name medications through Walmart Mail Order.
    • Access Plus
      • Leverages Advocacy Foundations and Grants: Reduces costs for eligible high-cost specialty medications.
      • Proactive Identification: SmithRx Connect 360 identifies eligible medications and assists with program enrollment.
      • Significant Savings: Low or $0 copays on brand-name medications.
    • Mark Cuban Cost Plus Drugs
      • Transparent Pricing: A pharmacy model that delivers medications at cost, plus a straightforward 15% markup, along with a $5 dispensing fee and shipping. 
      • Expanding Drug List: Over 1,000 medications and growing.
      • Proactive Identification and Enrollment: SmithRx Connect 360 assists with the process.
      • Significant Savings: Low or $0 copays on brand-name or generic medications.
  • Contact Information:
    • Member Support: 844.454.5201
    • Connect 360 Member Support: 844.385.7612
    • Chat: www.smithrx.com

Teladoc – Virtual Care

Carleton’s health plan members have access to Teladoc’s virtual healthcare services. These services offer convenient, comprehensive care from board-certified U.S. physicians at a reduced rate.

Teladoc physicians are equipped to diagnose symptoms and prescribe medications when appropriate, ensuring you receive timely and effective treatment.

Summary of the expanded services:

  • General Medical: Get 24/7 access to low-cost, high-quality virtual care for common medical conditions such as the flu, sinus infections, bronchitis, and more.
  • Dermatology: Address recent skin changes or manage chronic skin conditions with virtual dermatology consultations.
  • Mental Health: Receive support for stress, anxiety, grief, depression, and other mental health concerns.

Copays for both Blue and Maize plans are as follows:

  • General Telemedicine: $25
  • Dermatology: $35
  • Mental Health: $45

Teladoc can be accessed in the following ways:

  • Phone: 1-800-835-2362
  • Website: Teladoc Health site link
    • Please Note: You will need to create an account with Teladoc to access care.
    • Account Creation Tip: If prompted for a code, the code is not a required field, you should leave this unchecked and proceed.
  • Download the Teladoc mobile app
  • AmeriHealth (AHA) Member Portal

Links to Teladoc’s Help Center and FAQ’s.

Life Qualifying Event

If you experience a qualifying life event as defined by the IRS, you need to contact Human Resources. You have 31 days from the effective date of the event to make changes by adding or dropping benefits.