Your Health
The ADA’s comprehensive benefits program is designed to support every aspect of your well-being, ensuring you have the resources needed to thrive both personally and professionally.
Medical
Your health benefits are an important part of your compensation. Plus, they give you and your family access to health services through CareFirst. All eligible employees can choose between the three comprehensive medical plans through CareFirst’s BluePreferred PPO network:
- Buy-Up PPO Plan
- Core PPO Plan
- CDHP with HSA Plan
Note: When selecting a medical plan, you’ll want to consider whether you want to pay more out of your paycheck and less when you receive care or less out of your paycheck and more when you actually receive care.
Find a Doctor
Our medical plans have contracted with a network of providers, including physicians, hospitals, and other types of providers. In order to receive the highest level of benefits and pay the least amount out of your pocket, you need to access care from the providers who have elected to be a part of the network.
All medical plans use CareFirst’s BluePreferred PPO network. Go to member.carefirst.com to check to make sure your providers are in the appropriate network to avoid costly out-of-network expenses later.
Note: When selecting a medical plan, you’ll want to consider whether you want to pay more out of your paycheck and less when you receive care or less out of your paycheck and more when you actually receive care.
Medical Plan Design & Rates Per Pay Period
- Individual
- Individual on a Family plan
- Family
- Individual
- Individual on a Family plan
- Family
- Primary Care Physician (PCP)
- Specialist
- Preventive Care
- Individual
- Individual on a Family plan
- Family
- Individual
- Individual on a Family plan
- Family
$500
$500
$1,000
$2,500
$2,500
$5,000
$30 copay
$40 copay
No charge
$1,500
$1,500
$3,000
$3,000
$3,000
$6,000
$1,000
$1,000
$2,000
$3,500
$3,500
$7,000
$30 copay
$50 copay
No charge
$5,000
$5,000
$10,000
$10,000
$10,000
$20,000
$2,000
$4,000
$4,000
$4,500
$4,500
$9,000
20% after deductible
20% after deductible
No charge
$5,000
$10,000
$10,000
$10,000
$10,000
$20,000
Rates Per Pay Period
CareFirst Programs
As a CareFirst member, you have access to a range of supportive programs designed to help you feel your best—mentally, physically, and emotionally.
Inspirations
Available through CareFirst Wellbeing, Inspirations offers relaxation tools and wellness videos. This resource is available 24/7 and offers video content for stress reduction, soothing music/sounds, yoga and meditation. If you have any questions, call CareFirst Wellbeing support at 877-260-3253.
7 Cups
7 Cups is a mobile app that uses technology to break down barriers that prevent people from receiving care. The app provides members with access to therapists and volunteer active listeners, along with communities and guided growth paths.
CloseKnit
CloseKnit provides 24/7 access to virtual primary and urgent care from your smartphone, tablet or computer. Primary care services include well care, preventive and sick visits and mental health counseling. Urgent care services include visits for common conditions and minor injuries. Register at closeknithealth.com and click Get Started.
Mental Health Support Line
The mental health support line connects you with a team of specialty-trained registered nurses and licensed behavioral health clinicians. Call 800-245-7013 for support or help making an appointment.
Lifestyle Coaching
Lifestyle coaches can help you identify ways to improve your health and well-being in daily life. This voluntary and confidential phone-based program is personalized, and the coaching is provided by trained health coaches. To learn more or to join, call 877-260-3253 and press option 7.
Noom
The Noom mobile app is designed to support healthy lifestyle changes and long-term wellness. Noom’s personalized, psychology-based techniques will help you better understand your relationship with food. Plus, Noom is available to CareFirst members at no cost. Log in to CareFirst to get started; Noom can be found under Health & Fitness.
Care Management
CareFirst’s care management team can help support you through significant health challenges, including cancer, diabetes, behavioral health or an at-risk pregnancy. Care managers can coordinate the services you need and answer questions as you navigate treatment. To learn more, call 888-264-8648.
Blue365 Discounts
Blue365 offers health and wellness discounts on fitness gear, gym memberships, family activities and more. Visit blue365deals.com/CarefirstBCBS for more details.
SmartDollar
Take control of managing your finances with SmartDollar, a free online financial program available through CareFirst Wellbeing. Support is available to help you stop living paycheck to paycheck, get out of debt, save for retirement or your child’s education and more. Visit carefirst.com/wellbeing or call 877-260-3253.
Understand the Medical Plan Lingo
We know not everyone understands the lingo, so here are some important terms to know as you decide which medical plan to choose, as well as how to use it during the year:
Copay
A copay is the fixed amount you pay for a covered health care service (e.g., primary care physician office visit or emergency room visit).
Annual Deductible
Your annual deductible is the amount you pay for office visits, prescription drugs and other covered services before your plan begins sharing the cost.
Coinsurance
Coinsurance is the percentage you and your plan each pay when you’re sharing costs. Coinsurance kicks in after you meet your annual deductible.
Out-of-pocket maximum
The most you pay in a year for health care services is called the out-of-pocket maximum. After you reach the out-of-pocket maximum, the plan covers 100% of eligible services for the remainder of the plan year.
Rx Coverage and Prescription Drugs
Prescription drug coverage is embedded within each of our medical plan options.
Pharmacy Plan Design
(filled through CVS Specialty Pharmacy)
Note: If you are enrolled in the CDHP plan, you must reach the deductible before insurance starts to cover a portion of your medications; however, there is never a copay for insulin and all other diabetes medications, even if you haven’t met the deductible.
How the Prescription Drug Tiers Differ
The amount you pay for a prescription drug is based on the type of drug you fill, whether it’s a generic, preferred brand, non-preferred brand or specialty. Here’s how the costs compare based on the tier of drug you fill:
Tier 1 – Generic
Lowest Copay Option. Always consider tier one medications if you and your doctor decide they are right for your treatment.
Tier 2 – Preferred
Middle Copay Option. Consider tier two medications if you and your doctor decide there are no tier one options appropriate to treat your condition.
Ask your doctor if there are tier one alternatives or over-the-counter brands that are equivalent to tier two medications. They may be used to treat the same condition but are less expensive.
Tier 3 – Non-Preferred
Highest Copay Option. If you are currently taking a medication in tier three, ask your doctor whether there are tier one or two alternatives appropriate for your condition.
Compounded medications containing one or more ingredients that are prepared on-site by a pharmacist are classified at the tier three level, provided that the individual ingredients used in compounding are covered under the pharmacy benefit.
Tier 4 – Specialty
$0 with enrollment through PrudentRx / $0 after deductible with enrollment through PrudentRx. These are typically high-cost drugs used to treat complex or chronic conditions. If you are prescribed a specialty medication, you should enroll in PrudentRx* or ask your doctor whether there are tier one, two or three alternatives that may be clinically appropriate and more cost-effective.
Maintenance Choice – Mandatory Program for Maintenance Drugs
Maintenance medications must be filled at select pharmacies, including CVS (including CVS locations within Target), Costco, Kroger, select independent pharmacies or via CVS Caremark mail order. Maintenance medications will be filled at a 90-day supply, at a cost of 2.5x the 30-day retail copay, saving you time and money. To ensure your prescription is covered, please identify a participating pharmacy and have your provider send a 90-day prescription to that location. To confirm participating pharmacies and other benefits, log in to your CVS account at caremark.com.
Pharmacy Care Management Programs
We know not everyone understands the lingo, so here are some important terms to know as you decide which medical plan to choose, as well as how to use it during the year:
Diabetes Supplies
The ADA has created a unique program that allows medical plan members to obtain insulin and diabetes supplies at no cost.* All supplies should be obtained through CVS Caremark. Covered supplies include:
- Non-coring needle or stylet
- Supplies for maintenance of insulin infusion catheter
- Supplies for external insulin infusion pump, syringe type cartridge
- Infusion set for external insulin pump, non-needle cannula type
- Platforms for home blood glucose monitor
- Normal, low, and high calibrator solution/chips
- Replacement lens shield cartridge for use with laser skin piercing device
- Skin barrier, wipes or swabs
- Transparent film
- External ambulatory insulin delivery system
- Transmitter; external, for use with interstitial continuous glucose monitoring system
- Insulin delivery device
- Insulin cartridge for use in insulin delivery device
other than pump - Insulin delivery device, disposable pen
- Insulin syringes and needles
- Lancets
- Test strips and alcohol swabs
- Glucose meters
*If you are on the CDHP plan: note that due to IRS requirements, you may be required to meet the deductible before the plan pays for diabetic supplies. The deductible does NOT apply to items on CVS Caremark’s expanded preventive list. Contact RxBenefits for questions about how diabetic and preventive medications and supplies are covered.
PrudentRx: Cost Management for Specialty Rx
Specialty medications treat complex chronic conditions; they are typically biology-based, highly complex, and very expensive. ADA has partnered with PrudentRx to manage the cost of specialty medications by applying financial copay assistance from drug manufacturers. If you take an eligible medication, PrudentRx will contact you via phone and mail with specific information about the program and instructions on how to enroll.
By enrolling in this plan, your out-of-pocket costs for eligible specialty medications will be reduced to $0. (On the CDHP plan, your cost will be $0 after the deductible is met.) For more information, contact PrudentRx at 1-888-203-1768, Monday through Friday, 8 a.m. to 8 p.m. ET.
Expanded Preventive Therapy Drug List
The ADA offers the most expansive preventive drug list available, enabling participants to get certain preventive medications at no charge (even if you are on the CDHP plan). This list is subject to change; please register at caremark.com to see the most up-to-date list.
Dental
The ADA provides a choice of two dental plans, both of which use MetLife’s PDP network. Although you can choose any provider, your benefits will go further if you use an in-network dentist. We encourage you to visit your dentist regularly—in-network preventive care is covered 100% on both plans.
ID Card
No ID card needed! MetLife does not provide member ID cards.
Dental Plan Design & Rates Per Pay Period
(routine exams, cleanings, xrays)
(fillings, endodontics, periodontics)
(crowns, bridges, dentures, implants)
(combined with in-network)
(combined with in-network)
Rates Per Pay Period
Vision
The ADA offers two vision plans, a core and a buy-up option. Both of these plans use the same VSP Signature network. Note that both plans provide limited reimbursement for services obtained out of network, so it’s best to see an in-network provider.
ID Card
No ID card needed! VSP does not provide member ID cards.
Vision Plan Design & Rates Per Pay Period
In-Network
In-Network
Rates Per Pay Period
Both plans provide limited reimbursement for services obtained out of network. See the plan summaries for more details.
Supplemental Medical Benefits
Accident, Critical Illness and Hospital Indemnity Insurance
The ADA offers three supplemental medical plans to fill any gaps in your medical coverage if you have a critical illness, accident or hospital stay, providing you with added financial protection. All three plans pay lump sum cash benefits directly to you for you to spend however you wish. Payments are based upon the medical event and are unrelated to your actual out-of-pocket medical costs.
Critical Illness
UHC’s Critical Illness Insurance pays a lump-sum benefit payment in the event you experience a covered critical illness condition. Covered conditions include cancer, heart attack, stroke, chronic renal failure and more. The plan pays up to $30,000 per diagnosis. Coverage is available for you, your spouse and your children. Rates are based on age and are visible in Paychex.
Accident
Accident Insurance pays cash benefits for injuries resulting from an accident and the associated medical events. Benefits are paid based on a schedule and according to the severity of the injury—for example, the payment is higher for a broken leg than for a broken toe. Benefits are also paid for treatments received, such as an ER visit, follow-up physical therapy or a cast. If you (or your child) are injured during organized sports, plan benefits are increased.
Hospital Indemnity
Even with good medical insurance, a hospital stay can mean many added expenses—not just your deductible or coinsurance, but childcare, transportation and other unexpected costs. Hospital Indemnity coverage pays $2,000 if you are admitted to the hospital due to injury, illness or maternity, and $100 per day for each day after ($400 if confined to the ICU). Benefits are paid directly to you, regardless of the actual cost of treatment.
Wellness Benefits: Earn $50 Each Calendar Year!
Each of the three supplemental medical plans allows you and your covered spouse to earn a $50 wellness benefit annually if you get your recommended preventive screenings. Remember: Preventive screenings are always covered at no cost to you.
Accident
Hospital Indemnity
CareFirst Wellbeing
CareFirst Wellbeing, ADA’s wellbeing program, is available to all employees regardless of coverage with CareFirst. This program is your personalized digital connection to your healthiest life, catering to your unique health and wellness goals.
Key Features
Your wellbeing program provides a wealth of tools and resources, as well as easy-to-understand recommendations and insights that reflect your individual interests and needs. With CareFirst Wellbeing, you can access:
- RealAge Questionnaire: In just a few minutes, the RealAge online health questionnaire will help you determine your body’s physical age compared to your calendar age.
- Personalized Timeline: Receive content based on your health and well-being goals, motivation and interests.
- Trackers: Connect your wearable devices or enter your own data to monitor daily habits like stress, sleep, steps, nutrition and more.
- Challenges: Stay motivated to achieve your health goals by joining a challenge.
- Health Profile: Access your health data, such as biometric and lab results, vaccine information and medications, all in one place.
- Blue Rewards: Earn financial incentives for participating in activities like the RealAge questionnaire, consenting to receive wellness emails, selecting a primary care provider and completing a health screening.
Rewards
After registering, you can receive rewards by completing a number of incentivized challenges. You can earn up to $400 a year by completing the activities below:
- Earn $75: Complete the RealAge questionnaire and consent to receive wellness information.
- Must be completed by 11/15/2026
- Earn $150: Select a PCP and complete a Health Screening.
- Must be completed by 11/15/2026
- Earn $75: Retake the RealAge questionnaire.
- Must be completed no earlier than 180 days after the original questionnaire and no later than 11/15/2026
- Earn up to $250: Complete five ADA monthly challenges.
- Must be completed by 10/31/2026
Get Started
Register at carefirst.com/wellbeing and click Get Started or call 877-260-3253 for more information.
Here to Help
Questions?
We want you to feel confident that you’re making the right choices. Use this website to explore your benefits and access helpful resources, so you can make the best decisions for you and your family. In addition, the benefits team is ready to help answer your questions. Please email benefits@diabetes.org for additional help.