Medical
For benefit coverage March 1, 2026 – February 28, 2027
Weis Markets’ medical and prescription plans administered by Capital Blue Cross are designed to help you maintain good health and offer protection from the financial burden of serious illness or injury. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
- Premium – The amount you pay for your health insurance every pay period.
You always pay the deductible and copayment ($). The coinsurance (%) shows what you pay after the deductible. MyCare Finder helps you find in-network providers, facilities, services, and more. Go to CapBlueCross.com/finder to get started.
The deductible and out-of-pocket maximum for both the Silver and Gold plans apply to the plan year running from January 1, 2026 through December 31, 2026. The out-of-pocket maximum is combined, meaning medical and prescription drug expenses count together toward the same limit.
Preventive Care
You take your car in for maintenance; why not do the same for yourself?
Annual preventive checkups can help you and your doctor identify your baseline level of health and detect issues before they become serious.
Health plans are required to cover a set of preventive services at no cost to you, even if you haven’t met your deductible. The preventive care services you’ll need to stay healthy vary by age, sex, and medical history.
Be aware: Not all exams and tests are considered preventive care
Certain screenings may be considered diagnostic, rather than preventive, based on your current medical condition. You may be responsible for paying all or a share of the cost of those services.
In addition, exams performed by specialists are generally not considered preventive care and may not be covered at 100%.
If you have a question about whether a service will be covered as preventive care, contact your medical plan.
Typical Screenings for Adults
• Blood pressure
• Cholesterol
• Diabetes
• Colorectal cancer screening
• Depression
• Mammograms
• OB/GYN screenings
• Prostate cancer screening
• Testicular exam
Telemedicine
For when you can’t get to the doctor’s office, get the care you need through our NEW provider Teladoc, anytime, anywhere for non-emergency illnesses, such as the flu, pink eye, or strep throat.
How Can Telemedicine Help?
- If you don’t have a primary care provider, you can complete your annual physical virtually through Teladoc, and have an ongoing relationship with that provider
- Providers can diagnose and treat minor conditions
- Prescriptions can be sent straight to your pharmacy
- Services also include counseling, psychiatry, nutrition counseling, and more
Why should I use it?
- Available 24/7, 365 days a year from any device
- No appointment necessary for urgent care visits
- Easy scheduling for primary care visits
- Less costly that a trip to an urgent care or ER
- Doctors have an average of 20 years of experience
How do I get started?
- Download the Teladoc app or visit teladochealth.com
- $10 per virtual visit, regardless of the reason for your visit
Gold PPO Plan
Benefit Highlights
In-Network
Medical Deductible (Individual/Family)
$1,700/$3,400
Rx Deductible (Individual/Family)
$50/$150
Out-of-Pocket Max (Individual/Family)
$5,500/$12,000
Preventive Care
$0
Primary Care Visit
25%*
Specialist Visit
25%*
Urgent Care
25%*
Emergency Room
25%*
Hearing Aid Coverage
$2,500 maximum every 36 months
Retail Rx (Up to 30-Day Supply)
Generic
20%* with $5 minimum
Preferred Brand
20%* with $10 minimum
Non-Preferred Brand
30%* with $25 minimum
Specialty
20%*–30%* with $5–$25 minimum
Mail-Order Rx (Up to 90-Day Supply)
Generic
20%* with $5 minimum
Preferred Brand
20%* with $10 minimum
Non-Preferred Brand
30%* with $25 minimum
Specialty
20%*–30%* with $5–$25 minimum
*After deductible
Out-of-Network
Medical Deductible (Individual/Family)
$2,800/$5,600
Rx Deductible (Individual/Family)
Not covered
Out-of-Pocket Max (Individual/Family)
$9,900/$24,000
Preventive Care
50% (pediatric and adult preventive care coinsurance applies after deductible)
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
25%*
Emergency Room
25%*
Hearing Aid Coverage
$2,500 maximum every 36 months
Retail Rx (Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Weekly Plan Cost*
Associate Contribution
Associate Only: $56.79
Associate +1: $119.47
Family: $165.89
Employer Contribution
Associate Only: $144.43
Associate +1: $282.97
Family: $437.73
Weekly Plan Cost + Tobacco Surcharge*
Associate Contribution
Associate Only: $77.94
Associate +1: $140.62
Family: $187.04
Employer Contribution
Associate Only: $127.30
Associate +1: $269.87
Family: $428.65
If you complete the Quitting Tobacco course by Feb. 29, 2027, the tobacco surcharge will be removed, and a reimbursement will be issued for any deductions made during the 2026 plan year.
Silver PPO Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,200/$4,400
Out-of-Pocket Max (Individual/Family)
$7,200/$13,400
Preventive Care
$0
Primary Care Visit
30%*
Specialist Visit
30%*
Urgent Care
30%*
Emergency Room
30%*
Hearing Aid Coverage
$2,500 maximum every 36 months
Retail Rx (Up to 30-Day Supply)
Generic
20%* with $10 minimum
Preferred Brand
25%* with $20 minimum
Non-Preferred Brand
35%* with $25 minimum
Specialty
20%*–35%* with $10–$25 minimum
Mail-Order Rx (Up to 90-Day Supply)
Generic
20%* with $10 minimum
Preferred Brand
25%* with $20 minimum
Non-Preferred Brand
35%* with $25 minimum
Specialty
20%*–35%* with $10–$25 minimum
*After deductible
Out-of-Network
Deductible (Individual/Family)
$4,400/$8,800
Out-of-Pocket Max (Individual/Family)
$13,400/$26,800
Preventive Care
50% (pediatric and adult preventive care coinsurance applies after deductible)
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
30%*
Emergency Room
30%*
Hearing Aid Coverage
$2,500 maximum every 36 months
Retail Rx (Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Weekly Plan Cost*
Associate Contribution
Associate Only: $39.86
Associate +1: $83.47
Family: $122.06
Employer Contribution
Associate Only: $127.24
Associate +1: $250.74
Family: $379.25
Weekly Plan Cost + Tobacco Surcharge*
Associate Contribution
Associate Only: $61.01
Associate +1: $104.62
Family: $143.21
Employer Contribution
Associate Only: $109.43
Associate +1: $236.27
Family: $368.13
If you complete the Quitting Tobacco course by Feb. 29, 2027, the tobacco surcharge will be removed, and a reimbursement will be issued for any deductions made during the 2026 plan year.
*Associates can complete an annual physical and biometric screenings to avoid paying a $1,500 wellness surcharge in 2027 (this does not apply if you are hired after May 31, 2026)
Prescription Drug Coverage
The pharmacy deductible applies from January 1, 2026 through December 31, 2026.
Weis Markets Pharmacy or Designated Pharmacies
Weis Markets’ medical plans include Capital Blue Cross prescription drug coverage for drugs dispensed from a Weis Markets pharmacy or designated pharmacies within Capital Blue Cross’ pharmacy network. The price of your medication is based on whether it’s listed as generic, preferred brand, or non-preferred brand on the Capital Blue Cross Advantage Formulary. To check your prescription’s coverage, you can call Capital Blue Cross at 1-855-300-2273 or visit capbluecross.com. You’ll save the most money with generic drugs, which are required by the Food and Drug Administration (FDA) to be as effective as brand-name drug equivalents.
Weis Markets has pharmacies in most of our stores. Prescription drug benefits cover drugs dispensed only at a Weis Markets pharmacy or designated in-network pharmacy. If you are trying to fill a prescription and you are more than 20 miles from a Weis or designated in-network pharmacy, you may use any Capital Blue Cross Network pharmacy. In addition, your prescription can be shipped from our Central Fill Weis Markets Pharmacy to your home free of charge. For maintenance medications, you may get up to two fills at a non-Weis pharmacy and thereafter must use the Central Fill mail order or a Weis Markets pharmacy. For more information on mail order, please go to weismarkets.com/associaterx or call 1-833-742-6500.
Reminder: If you fill your prescription with a brand-name drug when a lower-cost generic equivalent is available, you will pay a higher cost, even if your doctor or other prescriber writes “Dispense as Written/DAW” on your prescription. This higher cost will be the brand-name drug coinsurance plus the difference in cost between the brand and generic drug. This additional cost does not count toward the annual deductible or out-of-pocket maximum.
Note: GLP-1’s for diabetes are dispensed up to a 30-day supply.
You will not receive new medical or prescription drug ID cards unless you are new to the plan. You can print a medical/Rx ID card at any time at capbluecross.com.
Know Where to Go
Where you get medical care can significantly affect the cost. Here’s a quick guide to help you know where to go based on your condition, budget, and time.
Visit type: Online visit ($)
Availability: Often available 24/7
Use it for…
• Non-emergency health issues:
○ Routine medical care
○ Minor injuries
○ Mental health concerns
○ Cold, flu, allergies, headache, migraine
○ Rashes, skin conditions
Visit type: Office visit ($$)
Availability: Typically open during regular business hours
Use it for…
• Routine medical care and management:
○ Preventive care
○ Illnesses and injuries
○ Existing conditions
Visit type: Urgent care ($$$)
Availability: Typically open with extended evening and weekend hours
Use it for…
• Urgent but not life-threatening conditions:
○ Sprains or stitches
○ Animal bites
○ High fever or respiratory infections
Visit type: Emergency room ($$$)
Availability: Open 24/7
Use it for…
• Life-threatening conditions requiring immediate care:
○ Suspected heart attack or stroke
○ Broken bones
○ Excessive bleeding
○ Severe pain
○ Difficulty breathing
Alternative Facilities
If you have time to evaluate your options for non-emergency health treatments, these alternative facilities can provide the same results as a hospital at a fraction of the cost.
Procedure: Surgery
Alternative: Ambulatory surgical center
Features:
• Specializes in same-day surgeries
• Cataracts, colonoscopies, upper GI endoscopy, orthopedic surgery and more
• Held to same safety standards as hospitals
Savings*
Up to 50% vs. a hospital stay
Procedure: Physical therapy
Alternative: Outpatient facility
Features:
• Most cases are suited for outpatient physical therapy
• Same types of treatments and similarly skilled therapists as inpatient facilities
Savings*
40 to 60% vs. a hospital setting
Procedure: Sleep study
Alternative: Home testing
Features:
• Diagnoses obstructive sleep apnea
• Cost is often covered by insurance if considered medically necessary
Savings*
Up to $4,500 vs. a lab
Procedure: Infusion therapy
Alternative: Home or outpatient infusion
Features:
• For drugs that must be delivered by intravenous injections, or epidurals
• Delivered by licensed infusion therapy provider
• Maintain normal lifestyle and comfort of home or outpatient center
Savings*
Up to 90% vs. a hospital stay
How to Find an Alternative Treatment Facility
Ask your doctor if your treatment must be delivered in the hospital. You can also search for surgical centers, physical therapy, and similar services on your plan’s website, or call member services for assistance. Some alternative facilities include a fee to cover overhead costs. To avoid a surprise on your bill, ask about facility fees before you schedule your appointment.