FAQs

Are there changes to my medical plan for 2027?

Yes. You will have three medical options for 2027. The options are designed to fit your life–providing options to fit your unique needs and budget.

What led to the change?

You asked, we listened–you have led the charge and asked for different medical plan options, particularly an option with a lower deductible. Our goal was to provide meaningful choice, while continuing to manage rising health care costs and support your health.

Are all three medical plans administered by Aetna?

Yes. All three M&T medical plan options are administered by Aetna.

Can I stay with my doctor?

Provider participation can change each year. With new plan and network options available in 2027, verify that your doctors, specialists and hospitals participate in the Aetna Choice® POS II (Open Access) network before enrolling.

Use Aetna DocFind to check provider participation. If you are considering the Premier PPO, look for preferred providers with the Quality & Effective Care badge to help lower your out-of-pocket costs.

Staying in network can help you save money. If you are receiving complex or ongoing care, contact Aetna for assistance.

What is a preferred provider?

Under the Premier PPO, preferred providers are primary care physicians and specialists that Aetna has identified for delivering high-quality, cost-effective care. Using a preferred provider generally results in lower out-of-pocket costs.

To find preferred providers, go to Aetna DocFind, search the Aetna Choice® POS II (Open Access) network and look for the providers that have a Quality & Effective Care badge.

What is the difference between a preferred provider and another in-network provider?

An in-network provider participates in the Aetna Choice® POS II (Open Access) network. A preferred provider is an eligible primary care physician or specialist who is in network and has Aetna's Quality & Effective Care designation. Under the Premier PPO, preferred providers have lower copays for applicable office visits.

What if I cannot find a preferred provider, or my primary care physician/specialist isn't a preferred provider?

You can still see an in-network provider who is not designated as preferred. For applicable office visits under the Premier PPO, you would pay the standard in-network copay: $50 for a PCP visit or $80 for a specialist visit.

Does my provider have to be a preferred provider for me to use them?

No. You can still use an in-network provider who does not have the Quality & Effective Care badge. Under the Premier PPO, you would pay the in-network copay for certain office visits when you use an in-network provider who is not designated as preferred.

Does every type of provider qualify for the Quality & Effective Care designation?

No. The designation is only available to certain types of providers. If you search for a particular specialty and do not see any providers with the Quality & Effective Care badge, that specialty may not be eligible for the designation.

How much do I pay when I use a preferred provider?

For applicable office visits under the Premier PPO:

• Preferred PCP: $30 copay
• In-network PCP: $50 copay
• Preferred specialist: $50 copay
• In-network specialist: $80 copay

Do I need to look for the Quality & Effective Care badge if I enroll in the Basic HDHP or Core HDHP?

No. The Quality & Effective Care designation is important for Premier PPO cost-sharing for office visits with a primary care. All three medical plans use the Aetna Choice® POS II (Open Access) network, but the preferred-provider cost-share applies specifically to the Premier PPO.

What if my doctor is not in-network?

If your doctor does not participate in the plan's network, you may choose to continue seeing that provider. However, out-of-network care typically costs more than in-network care. It will result in higher deductibles, coinsurance and out-of-pocket expenses. Coverage and out-of-network benefits vary by plan.

If you are receiving complex or ongoing care, contact Aetna for assistance.

How does the family deductible and out-of-pocket maximum work?

It depends on the medical plan you choose:

• Basic HDHP: The deductible and out-of-pocket maximum are embedded—each covered family member can reach their individual deductible or out-of-pocket maximum before the family reaches the corresponding family limit.
• Core HDHP and Premier PPO: The deductible and out-of-pocket maximum are non-embedded. When you cover more than one person, the full family deductible or family out-of-pocket maximum must be met before the applicable family-level threshold is satisfied.

After the Premier PPO deductible is met, do office visit copays continue to apply?

Yes, copays would apply until the out-of-pocket maximum is met.

How many preferred providers are available?

Availability varies by location and specialty. To find a provider, go to Aetna DocFind.

What if I choose the Basic HDHP and become seriously ill?

The Basic HDHP has the lowest paycheck deductions, but you will pay more out of pocket before the plan begins sharing costs. If you experience a serious illness or injury, your healthcare expenses could be significantly higher than under the other medical plan options.

When comparing plans, consider whether you could comfortably afford the deductible and out-of-pocket maximum if an unexpected medical event occurred. If you enroll in the Basic HDHP, you may also want to consider the Critical Illness and Accident Plans for additional financial protection. Employees earning less than $100,000 annually receive Critical Illness and Accident Plan coverage at no cost.

What are frozen earnings?

If you receive commission, your frozen earnings for a “plan year” (January 1 - December 31) is the sum of your annual (base) draw as of the July 1 of the preceding plan year plus 75% of paid commissions for the 12 months ending on that July 1. If you are recently hired and you do not have a commission history for that 12-month period, your frozen earnings for a plan year is your annual (base) draw.

If you are not a commissioned employee as described above, your frozen earnings for a plan year (January 1 - December 31) is your annual base pay rate, excluding bonuses, overtime or any other form of additional compensation, as of July 1 of the preceding plan year. If you are a new hire, your frozen earnings is your base rate of pay as of your most recent date of hire.

Is there additional support if my frozen earnings are below $100,000?

If you make under $100,000 per year (frozen earnings), you will automatically receive:

• Up to $2,000 to your HSA from M&T Bank (dependent on frozen earnings, and if enrolling in one of the HDHP plans).
• Critical Illness and Accident Plans at no cost (if enrolling in the Basic HDHP).

For the Premier PPO plan, do I need to meet my deductible before I pay the copay?

No, you would not need to meet your deductible. You would only be responsible for the copay for the visit.

For the Premier PPO plan, do copays go towards the deductible?

No, your copays would not go towards the deductible, but do go towards the out-of-pocket maximum.

Where can I get help deciding which medical plan may fit my needs?

Review the medical comparison and how to choose a medical plan. You can also contact the HR Service Center or attend a Benefits Office Hours session for additional help. Benefits representatives can explain how the plans work, but you should consider your expected care, prescriptions, preferred providers and total potential costs when making your election.

Where can I find additional plan details and how services are covered?

Review the medical comparison and Summary of Benefits Coverage (SBC) documents.

Is CVS Caremark still the pharmacy benefit provider?

Yes. CVS Caremark will continue to administer the pharmacy benefit.

Is GLP-1 coverage changing for 2027?

There is no change to GLP-1 coverage for 2027. It will continue to be covered for diabetes management. CVS Caremark® offers a discount program for certain non-covered drugs to help you save on out-of-pocket expenses; this program includes Wegovy® when prescribed for non-diabetes conditions.

Where can I find the list of covered prescription medications?

Go to prescription drugs for various lists of covered medications (e.g., Advanced Control Specialty Formulary, HDHP/HSA Preventive Therapy Drug List, Performance Drug List).

Are medical premiums changing, and where can I find plan costs?

Yes. 2027 medical premiums depend on the plan you choose and who you cover. Review healthcare premiums for details. During Open Enrollment, you can view your personalized costs in Workday based on your coverage elections.

What is the spousal or domestic partner surcharge?

Beginning January 1, 2027, a $50-per-pay-period surcharge will apply if you enroll your working spouse or domestic partner in an M&T medical plan when they have access to other employer-sponsored medical coverage. You will be asked to complete an attestation in Workday when you enroll for 2027 benefits.

This change helps keep overall costs down and support the long-term sustainability of our benefits program, while also providing coverage for spouses/domestic partners who don’t work or don’t have access to another employer’s health insurance plan.

If you and your spouse or domestic partner both work for M&T Bank, the surcharge will not apply.

What if my spouse does not work/does not have access to employer coverage?

If your spouse or domestic partner does not have access to employer-sponsored medical coverage, the surcharge does not apply.
Note: The spousal surcharge would not apply to those covered by Medicaid or Medicare as their only medical coverage.

Does the surcharge apply if I cover my spouse or domestic partner only under dental or vision?

No.

Does the surcharge apply to children?

No.

What if my spouse or domestic partner has Medicare or Medicaid?

Medicare or Medicaid coverage is not considered employer-sponsored medical coverage.

What if my spouse or domestic partner also works for M&T Bank?

The surcharge is not applicable when both individuals work for M&T.

Will I need to provide proof of my spouse or domestic partner's coverage?

During Open Enrollment, you'll complete an attestation confirming your spouse's or domestic partner's coverage status. Similar to the Tobacco Surcharge attestation process, M&T may conduct audits and request documentation to verify the information provided. If covering a domestic partner, you may be required to submit documentation verifying the authenticity and duration of the partnership. Review the dependent verification documentation for a list of acceptable documents.

Is the surcharge deducted pre-tax or post-tax?

The surcharge is deducted pre-tax.

Can I contribute to a Health Savings Account (HSA) in 2027?

You may contribute to an HSA if you enroll in an M&T high-deductible health plan (HDHP) and meet all other HSA eligibility requirements.

Why can’t I contribute to an HSA with the PPO?

The Premier PPO is not a Health Savings Account (HSA)-eligible high-deductible health plan (HDHP). However, if you are enrolled in the Premier PPO, you can contribute to a Medical Reimbursement Account (MRA). The MRA allows you to set aside money for copays and medical expenses on a pre-tax basis. Unlike HSA money, MRA funds are “use it or lose it,” and cannot be rolled over from year to year.

What if I enroll in the PPO but had money in my HSA?

The money is always yours. You can use your account balance to continue to pay for qualified medical expenses.

What spending account is available with the Premier PPO?

Employees enrolled in the Premier PPO may contribute to the Medical Reimbursement Account (MRA).

Who is eligible for an M&T HSA contribution?

Full-time employees enrolled in an M&T HDHP will receive an HSA contribution when frozen earnings are under $100,000. Part-time employees in an HDHP, earning less than $40,000 and working between 10–29 hours per week will receive a $500 HSA contribution, regardless of coverage level elected.

Can I enroll in dental and/or vision coverage without M&T medical coverage, including dependent-only coverage?

You do not need to be enrolled in M&T medical to elect any benefits other than the HSA or LPFSA. We like to think of our benefits as a-la-carte. You do need to enroll yourself to enroll a dependent in the coverage.

Are any benefits changing for 2027?

Two existing services are being replaced: Teladoc is being replaced by CVS Virtual Care, and Ovia Health is being replaced by Progyny. Additional benefit offerings are also available for 2027 including Cylinder and Hello Heart.

Will Progyny still be available in 2027?

Yes. With expanded offerings for pregnancy, postpartum and menopause.

Can each person enrolled in Critical Illness receive the $50 screening credit?

The Critical Illness Plan pays you $50 when you and your covered family members get a health screening. The benefit is paid one time for each family member per plan year. If you enroll a family of four, you can get $200 each plan year.

How do I access an attorney through the MetLife Legal Plan?

Start by calling the MetLife Legal Plans Client Service Center at 1-800-821-6400. A representative will confirm your eligibility and coverage and connect you with a participating attorney or help schedule an appointment. Identify yourself as a MetLife Legal Plan member and provide your plan name and the type of legal matter you need assistance with. You can also choose to use an out-of-network attorney.

Where can I find the 2027 Open Enrollment Guide?

Go to forms/docs for helpful forms, documents and legal notices, including the 2027 Open Enrollment Guide.

Where can I find office hours, dates, registration details and the webinar recording?

Go to the MTBWell home page to register for office hours and to access the on demand webinars.