WF Plan overview flyer 2026 vf.pdf
2026 medical benefits from Centivo
Taking care of your health. And your budget.
A BETTER KIND OF HEALTH PLAN
FREE
primary care
No
deductible
Predictable
copays
High-quality
care
Emergency
coverage anywhere
Partnership makes this plan different
It’s proven that working with a primary care doctor can help keep you healthier, improve your healthcare experience and reduce emergency room visits, all of which keep your costs lower. That’s why this plan is focused on a relationship between you and your doctor, with FREE primary care and mental health visits.
For most specialist care, you’ll need a referral from your primary care doctor. This referral process makes sure you’ll get the right care for your needs from in-network doctors.
Eligibility and enrollment
These plans are eligible for HRA incentive dollars through Rally Health. Any balance you may currently have transfers with you when you switch to a Centivo plan.
When you go to enroll, look for the plan name that matches where you live:
• Local Copay Plan with HRA – Northeast
for those living in CT, NJ, NY and PA.
• Local Copay Plan with HRA – MercyOne
for those living in the Des Moines, IA metro area.
The doctors you can see
The Centivo Network is built on local, high-quality providers and health systems you know and trust. You’ll also have access to:
• Urgent care when outside the network area, covered as in-network
• Emergency care no matter where you are, covered as in-network
• Virtual options for behavioral health, urgent care, physical therapy and more
FREE Centivo Care
FREE Centivo Care Eligibility and enrollment
A virtual primary care practice with a dedicated doctor and care team, including mental health.
• Same and next-day appointments that aren’t rushed
• Wellness, sick care and chronic condition management
• Coordination with in-person doctors, labs and imaging
• Easy, secure app with chat feature
See who’s in the Centivo Network, view plan details and more. Scan or go to wellsfargo.centivo.com.
Your benefit highlight
| Local Copay Plan with HRA | |
|---|---|
| In-network | |
| Network | Centivo |
| Primary care doctor selection required | Yes |
| Primary care referrals to specialists required | Yes, with exceptions* |
| Deductible (you/you+spouse or partner/you+children/you+spouse or partner+children) | $500/$800/$700/$1,000 |
| Out-of-pocket maximum (you/you+spouse or partner/you+children/you+spouse or partner+children) | $2,500/$4,100/$3,500/$5,000 |
| Annual physical,vaccinations and screenings | FREE |
| Primary care(includes pediatricians) | FREE |
| Centivo Care virtual primary care | FREE |
| Mental health** | FREE |
| OB/GYN | FREE |
| Physical,occupational and speech therapy | FREE |
| Chiropractic care,acupuncture,naturopathy | FREE |
| Other specialists | $25 copay |
| Labs and basic imaging outside of a provider's office(such as X-rays) | Deductible+10% coinsurance |
| Advanced imaging(such as MRI) | Deductible+10% coinsurance |
| In-patient and outpatient surgery | Deductible+10% coinsurance |
| Urgent care(covered as in-network when traveling outside the Centivo Network area) | $50 copay |
| Emergency room***(same copay applies no matter where you are) | $250 copay |
*If you don't get a referral for a specialist office visit, a $25 penalty charge will apply. No referral needed for OB/GYN, mental health, urgent care, emergency care, chiropractic care, acupuncture, naturopathy, lab work or physical, occupational or speech therapy. **You can see an out-of-network mental health or substance use disorder provider (in-person only) at $0 copay, but your visit may be subject to balance billing. Balance bill amounts do not apply to the out-of-pocket maximum. ***If you visit an out-of-network emergency room and are admitted, your hospital stay will be covered as in-network.
Prescription coverage by Express Scripts
| Retail pharmacy(up to30-day supply)/Mail order pharmacy(90-day supply)++ | |
|---|---|
| Generic prescription+ | $12/$24 copay |
| Preferred brand prescription | $50/$100 copay |
| Non-preferred brand prescription | $90/$180 copay |
| Specialty prescription(90-day supply)+++ | $150 generic,$285 brand,$435 non-preferred |
- A small number of generic drugs may fall under the preferred brand tier. Please check the prescription drug list or contact Express Scripts with questions about specific medications. ++You are required to get your maintenance medication prescriptions as a 90-day supply from Express Scripts Home Delivery or at a CVS or Walgreens pharmacy. +++Must be obtained through Accredo Specialty Pharmacy. Copay prorated for 30-day supply when a 90-day supply isn’t available.
Defining key terms:
Deductible: The amount you pay out-of-pocket before the plan pays towards your healthcare costs.
Copay: A fixed dollar amount you pay for a healthcare service or visit.
Coinsurance: The percentage of costs you’re responsible for after you meet your deductible.
Out-of-pocket maximum: The most you’ll pay for any covered healthcare and pharmacy expenses during the plan year.