Medical Plans

Contributions to Your Health Savings Account:*
	HSA Plus		HSA Basic		PPO
	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
Individual	Transocean contributes $400		Transocean Contributes $150		N/A
Individual	You can contribute up to $3,900		You can contribute up to $4,150		N/A
Family	Transocean contributes $800		Transocean contributes $300		N/A
Family	You can contribute up to $7,750		You can contribute up to $8,250		N/A
Deductible: You pay up to this amount before coinsurance.
Individual	$1,750	$3,500	$3,300	$5,600	$800	$1,600
Family	$3,500	$7,000	$5,600**	$11,200	$1,600	$3,200
Coinsurance***: After you meet the deductible, Transocean pays the majority of the cost.
Transocean pays:	90%	60%	80%	60%	80%	60%
Out-of-Pocket Maximum (includes deductible and medical/Rx copays): After you meet the out-of-pocket maximum, Transocean pays 100%.
Individual	$3,500	$7,000	$5,000	$10,000	$5,000	$10,000
Family	$6,850	$14,000	$10,000**	$20,000**	$10,000	$20,000
Preventive Care: Annual physicals, screenings, immunizations, etc.
Transocean covers:	100%	60% after deductible	100%	60% after deductible	100%	60% after deductible
Medical Services:
Virtual Visits	$49 max before deductible and 90% after deductible	N/A	$49 max before deductible and 80% after deductible	N/A	$15 copay	N/A
PCP Office Visit	90% after deductible	60% after deductible	80% after deductible	60% after deductible	$40 copay	60% after deductible
Specialist	90% after deductible	60% after deductible	80% after deductible	60% after deductible	$50 copay	60% after deductible
Urgent Care	90% after in-network deductible		80% after in-network deductible		$50 copay	80% after deductible
Hospital Inpatient & Outpatient	90% after deductible	60% after deductible	80% after deductible	60% after deductible	80% after deductible	60% after deductible
Emergency Room	90% after in-network deductible		80% after in-network deductible		80% after deductible
Prescription Drugs:****
Retail (30-day)
Preventive	100% generic only (If no generic is available, the brand-name preventive prescription drug will be paid at 100%.)		100% generic only (If no generic is available, the brand-name preventive prescription drug will be paid at 100%.)		Covered the same as any other prescription drug
Tier 1	90% after deductible		80% after deductible		$15 copay
Tier 2					70% ($30 min/$100 max)
Tier 3					50% ($50 min/$200 max)
Mail (90-day)
Preventive	100% generic only (If no generic is available, the brand-name preventive prescription drug will be paid at 100%.)		100% generic only (If no generic is available, the brand-name preventive prescription drug will be paid at 100%.)		Covered the same as any other prescription drug
Tier 1	90% after deductible		80% after deductible		$30 copay
Tier 2					70% ($60 min/$250 max)
Tier 3					50% ($100 min/$400 max)
If you are over age 55, you can contribute an additional $1,000 in catch-up contributions each year. Includes embedded deductible and out-of-pocket maximum at the Individual level. Coinsurance is the amount that the employee owes after the deductible has been met. This chart reflects Transocean’s portion of the coinsurance amount. **All prescription drugs must be FDA approved to be covered. If a generic drug is available and you elect to purchase the brand-name drug instead, you will pay the difference between the generic and brand-name drug cost. If your doctor prescribes a brand-name drug, or if no generic is available, brand-name prescription drug will be paid per the plan. For some conditions, you may be required to try an equivalent but lower-cost drug first. PPO only: Prescription drug costs apply to out-of-pocket maximum, not deductible. ‍