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Annual Enrollment for 2023 Benefits is October 26 – November 15, 2022

2022 BENEFITS
2022 BENEFITS

HSA Medical Plan

The HSA Medical Plan offers 100% coverage for in-network preventive care. For other health care services and prescription drugs, you must meet an annual deductible before benefits begin

When you enroll in the HSA Medical Plan, a Health Savings Account (HSA) is automatically opened in your name with HealthEquity. Tenneco will make a contribution to your account, and you can elect to make your own pre-tax contributions as well, up to IRS limits.

In-Network vs. Out-of-Network Care

In-network providers have negotiated service rates with BCBS. An out-of-network provider may charge more than BCBS is willing to pay. Because of this, the out-of-network deductible is higher than the in-network deductible. Before receiving treatment, check with BCBS to ensure a doctor, lab, hospital, specialist or other provider is in-network:

  • Clean Air & Powertrain team members: Go to BCBSAL
  • Motorparts & Performance Solutions team members: Go to BCBSIL

If you’re not sure which division you’re aligned with contact your local HR team.

HSA Medical Plan: Key Features

The chart below summarizes how medical services are covered under the HSA Medical Plan.

Plan Feature In-Network Out-of-Network

Annual Deductible (aggregate)1

Individual: $1,500
Family: $3,000

Individual: $3,000
Family: $6,000

Annual Out-of-Pocket Maximum (aggregate)1

Individual: $3,750
Family: $7,500

Individual: $7,500
Family: $15,000

Preventive Care2

Plan pays 100% of plan-eligible preventive care; no deductible applies

After you meet the deductible: Plan pays 60%

Coinsurance3

  • Doctor visits, hospitalization, outpatient care
  • Inpatient/outpatient mental health and substance abuse
  • Home health care, rehab, durable medical equipment, skilled nursing care, hospice
  • Urgent care

After you meet the deductible:
Plan pays: 80%
You pay: 20%

After you meet the deductible:
Plan pays: 60%
You pay: 40%

Hospital Emergency Room Care

After you meet the deductible:
Plan pays: 80%
You pay: 20%

If claim is submitted with a nonemergency diagnosis, additional $200 penalty will apply

After you meet the deductible:
Plan pays: 80%
You pay: 20%

If claim is submitted with a nonemergency diagnosis, you’ll pay 40%

  • Clean Air & Powertrain: If claim is submitted by your provider with a non-emergency diagnosis, an additional $200 penalty will apply.
  • Motorparts & Performance Solutions: Additional $200 copay applies (waived if admitted).
  1. “Aggregate” means the deductible or out-of-pocket maximum must be met at the full family level for any coverage tier other than individual coverage.
  2. For specific preventive services and immunization lists covered under your plan, contact your claims administrator (BCBSAL or BCBSIL).
  3. Visit limitations and/or precertificatoin may apply to some services.

IMPORTANT NOTE: Until further notice, anyone enrolled in a Tenneco medical plan will not be subject to copayments and deductibles related to the diagnostic testing and treatment for Coronavirus (COVID-19), nor will they be required to get prior authorization for treatment. For additional information, contact Blue Cross Blue Shield of Alabama (BCBSAL) or Blue Cross Blue Shield of Illinois (BCBSIL).

For additional information about Coronavirus and your Tenneco benefits, click here.

Tools at Your Fingertips

Your carrier offers tools and resources available 24/7. Find valuable information, check your coverages, look for network providers, review your Explanation of Benefits (EOB) and much more.

Team members aligned to Clean Air & Powertrain

  • Visit alabamablue.com or call 877-733-4375.
  • Download the BCBSAL app, available in the iTunes App Store or Google Play.

Team members aligned to Motorparts & Performance Solutions

  • Visit bcbsil.com/member or call 800-677-1973.
  • Download the BCBSIL app. Text BCBSILAPP to 33633* or search for BCBSIL in the iTunes App Store or Google Play.

Contacts

Medical

Clean Air & Powertrain
BCBSAL

Motorparts & Performance Solutions
BCBSIL

Prescription Drugs

CVS Caremark

Finding in-network care

In-network providers typically charge lower rates for services, saving money for you and Tenneco. Plus, your in-network deductible is lower than if you use out-of-network providers. Before receiving treatment, use your carrier’s Find a Doctor tool to ensure a doctor, lab, hospital, specialist or other provider is in-network.