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Pelican HRA1000

Overview

The Pelican HRA1000 plan is designed to provide financial support for your healthcare expenses through a health reimbursement account (HRA).

Annual Employer Contributions

Receive $1,000 for employee-only plans and $2,000 for employee plus dependent(s) plans deposited into your HRA each year.

Offset Healthcare Costs

Use these funds to help cover your deductible and other out-of-pocket healthcare expenses throughout the year.

Rollover Benefits

Any unused funds in your HRA will roll over to the next plan year, up to the In-Network out-of-pocket maximum, as long as you stay enrolled in the Pelican HRA1000 plan. This allows you to accumulate funds for future medical expenses. Funds are forfeited when you leave the HRA plan or the plan is no longer offered.

Provider Access

Visit the LABlue website to easily view and select from their network providers.

The Pelican HRA1000 plan offers a practical way to manage and reduce your healthcare costs with the added benefit of building a financial cushion for future medical needs.

Amount For Employee Family
Annual Employer Contributions to HRA $1,000 $2,000
Deductible (In-Network) $2,000 $4,000
Deductible (Out-Of-Network) $4,000 $8,000
Out-Of-Pocket Maximum (In-Network) $5,000 $10,000
Out-Of-Pocket Maximum (Out-Of-Network) $10,000 $20,000
Coinsurance (In-Network) 20% 20%
Coinsurance (Out-Of-Network) 40% 40%

Pharmacy Benefits

OGB uses a Formulary to help members select select the most appropriate, lowest-cost options. The Formulary is reviewed regularly to reassess drug tiers based on the current prescription drug market. Members will continue to pay a portion of the cost of their prescriptions in the form of a copay or coinsurance. The amount members pay toward their prescription depends on whether or not they receive a generic, preferred, non-preferred, or specialty brand drug.

*Member responsibility is for a prescription drug benefit of up to a 31-day supply.
Tier Member Responsibility*
Generic 50% up to $30
Preferred 50% up to $55
Non-Preferred 65% up to $80
Specialty 50% up to $80
After the out-of-pocket threshold amount of $1,500 is met by you and/or your covered dependent(s):
Generic $0 copay
Preferred $20 copay
Non-Preferred $40 copay
Specialty $40 copay

Contact Information

Resources / Forms

  • 2026 Benefit Plan Document
  • 2025 Benefit Plan Document
  • Schedule of Benefits
  • SilverScript Benefits for Medicare Retirees
  • SilverScript Formulary (2026 602 4T Platinum)
  • Liviniti Formulary (OGB-July-2026-Core-Formulary)
  • Benefit Comparison
  • National Provider Directory
  • Advanced Control Specialty Formulary
  • Performance Drug List
  • Premium Rates
  • Forms