2021 Medical Plans

Costs
Saver Premier Contribution Services Saver Premier Contribution
Plan Plan Plan Only in-network benefits shown. Plan Plan Plan

Primary care 75% covered 75% covered

Associate only $33.90 $30.50 $86.10 doctor visit
$35 copay
after deductible after deductible

Your cost Associate + Specialist 75% covered 75% covered

spouse/partner
$161.30 $154.10 $291.30 Doctors doctor visit
$75 copay
per biweekly after deductible after deductible
paycheck
Tobacco-free Associate +
rates shown child(ren)
$53.30 $48.80 $121.40 Virtual $0 copay $0 copay $0 copay
doctor visit Doctor On Demand* Doctor On Demand* Doctor On Demand*

Associate + family $186.20 $180.80 $311.90 Eligible preventive 100% covered, 100% covered, 100% covered,
care no deductible no deductible no deductible

Associate only
HSA match:
None
$250 credited
Walmart’s up to $350 to your HRA Certain serious
conditions through
100% covered, 100% covered, 100% covered,
annual max after deductible no deductible no deductible
contribution Associate + HSA match: $500 credited Centers of Excellence
None
dependent(s) up to $700 to your HRA
75% covered 75% covered
Care Urgent care $75 copay
after deductible after deductible
Annual Associate only $3,000 $2,750 $1,750
deductible 100% covered 100% covered 100% covered
in-network Emergency after deductible after deductible after deductible
Associate +
care
dependent(s)
$6,000 $5,500 $3,500 and $300 copay and $300 copay and $300 copay

Annual Hospitalization
75% covered 75% covered 75% covered
Per person $6,650 $6,850 $6,850 after deductible after deductible after deductible
out-of-pocket
maximum
$4 copay
in-network
Entire family $13,300 $13,700 $13,700
Generic drugs $4 copay $4 copay
care after deductible

$50 or 25%
See the 2020 Associate Benefits Book with 2021 Summary of Material Modifications for more information about
Brand-name drugs
$50 or 25% $50 or 25%
these plans, your benefits, and eligibility. This document will control in the event of any conflict. To enroll, visit Pharmacy of allowed cost**
of allowed cost** of allowed cost**
One.Walmart.com/Enroll. after deductible
*We’re waiving the usual $4 copay because of COVID-19.
**Whichever is greater. The allowed cost of prescription drugs is $50 or 20%
determined by the plan’s pharmacy benefit manager, OptumRx. Specialty drugs
$50 or 20% $50 or 20%
of allowed cost**
of allowed cost** of allowed cost**
after deductible
compareplans-2021-001 | 100120A
Confidential – Internal Use Only  |  ©2020 Walmart Inc.