2019 EMPLOYER BENEFIT PROGRAM OVERVIEW 2019 Employee Benefit Review - - PowerPoint PPT Presentation

2019 EMPLOYER BENEFIT PROGRAM OVERVIEW

2019 Employee Benefit Review

• Terminology
• Moda Medical Provider Network
• Medical Plans – Moda Health
• Dental Plans– Standard Insurance
• Vision Plan- VSP
• Flexible Spending Account - PacificSource Administrators
• Rate Information
• Questions

TERMINOLOGY

Deductible- a fixed dollar amount an insured individual must pay before the insurance company will pay for a covered service Out of Pocket Max- maximum dollar amount an insured will pay on the plan. Once the maximum is reached the insurance company will pay 100% of covered expenses for the remainder of the year Coinsurance- the cost sharing percentage the insured must pay for covered services Copays- a fixed dollar amount that the insured is responsible for paying. For example for an office visit or prescription medication Network- health care providers contracted with the insurance company that have agreed to accept negotiated discounts

MODA HEALTH PLANS

• Expanded provider network
• 2 Plan Options

Ø Base Plan (Synergy Network) includes Adventist. Legacy, OHSU, Tuality in Portland Metro. Go to modahealth.com for complete list Ø Buy Up Plan (Connexus Network) is one of the largest Preferred Provider Networks in Oregon and includes Providence, Legacy, OHSU, Adventist, Tuality in Portland Metro. Go to modahealth.com for complete list

• Go to www.modahealth.com to search for contracted providers. Under Find Care you can search by
• Network. Select Synergy Network for the Base Plan and Connexus Network for the Buy Up Plan. If

you are enrolling in the Base (Synergy Plan) search for Medical Homes under the Synergy Network. You must elect a Medical Home on your enrollment form in order for your election to be processed.

MEDICAL PLAN COMPARISON

Plan Options $3000D Moda Synergy (Base Plan) $1500D Moda Connexus (Buy Up Plan) Deductible $3,000 Individual $6,000 Family $1,500 Individual $3,000 Family Coinsurance 20% In Network 40% Out of Network 20% In Network 40% Out of Network Out of Pocket Maximum $5,000 Individual $10,000 Family $5,000 Individual $10,000 Family Preventive Care Covered in Full Covered in Full Primary Care $20 per visit Medical Home PCP $40 per visit non Medical Home PCP $25 per visit Specialty Care $40 per visit $25 per visit Alternative Care $20 per visit/$1,500 maximum Out of Network 40% after Deductible $25 per visit/$1,500 maximum Out of Network 40% after Deductible Routine Lab and X-Ray 20% Coinsurance. Deductible waived 20% Coinsurance. Deductible waived

MEDICAL PLAN COMPARISON

Plan Options $3000D Moda Synergy (Base Plan) $1500D Moda Connexus (Buy Up Plan) High T ech Imaging (CT, MRI, PET) 20% Coinsurance after Deductible 20% Coinsurance after Deductible Emergency Room $200 Copay, Deductible waived. Physician, Lab and other: 20% after Deductible $200 Copay, Deductible waived. Physician, Lab and other: 20% after Deductible Urgent Care $20 per visit $25 per visit Inpatient Hospital 20% Coinsurance after Deductible 20% Coinsurance after Deductible Outpatient Hospital 20% Coinsurance after Deductible 20% Coinsurance after Deductible Maternity Services 20% Coinsurance after Deductible 20% Coinsurance after Deductible Outpatient Mental Health $20 per visit Out of Network 40% after Deductible $25 per visit Out of Network 40% after Deductible Inpatient Mental Health 20% Coinsurance after Deductible 20% Coinsurance after Deductible

MODA PHARMACY BENEFIT

Participating Retail Pharmacy 30 day supply: Value Medication - $2 Copay Select Medication- $15 Copay Preferred Medication- $45 Copay Brand Medication- $75 Copay Mail Order Pharmacy up to a 90 day supply: Value Medication - $6 Copay Select Medication- $45 Copay Preferred Medication- $135 Copay Brand Medication- $225 Copay Specialty Pharmacy up to a 30 day supply: Preferred Specialty- $225 Copay Specialty: 30% Coinsurance

PHARMACY TIER DEFINITIONS

• Value Medications- commonly prescribed products used to treat chronic medical conditions
• Select Medications- generic medications that represent the most cost effective option from a

therapeutic category. It may include brand medication that has been identified as favorable

• Preferred Medications- have been found to be clinically effective at a favorable cost when

compared to other medications in the same therapeutic class and/or category (includes Preferred Specialty)

• Brand Medications- medications sold under a trademark and protected name
• Specialty Medications- used to treat complex chronic conditions such as Hepatitis C, Multiple

Sclerosis or Rheumatoid Arthritis

• Brand Substitution- Both generic and brand medication are covered. If a member requests, or the

treating physician prescribes, when a generic is available, the member will be responsible for the brand cost sharing plus the difference between the generic and brand

myModa

Get to know your benefits! myModa, your personalized member website, helps you manage your health plan and find ways to improve and maintain your health. modahealth.com

Your health. Your benefits. All at your fingertips.

Questions?

We’re here to help. Call us toll-free at 888-374-8907. TTY users, please call 711.

Discover more ways to better health

> Email a physician, psychologist, pharmacist, dentist, dietitian or fitness expert > Track healthy living habits using online tools > Click on Find Care to find a physician, dentist, pharmacist or clinic > Check drug prices before you buy > Complete health risk assessments > View the online medical library > Access exclusive member savings

Easily see and manage your benefits

> View your benefit eligibility and history > Receive and view electronic explanation

• f benefits (EOBs)

> Review your prescription history and check prices ahead of time > View account information, such as your contact information and dependents > Download your digital member ID card or

• rder a new one

> Check the status of pending claims, view your personal claims history and access claim forms

Log in to myModa 24/7

To sign in to myModa, visit modahealth.com. On the right-hand side of the home page, type in your username and password and click the Go! button. If you don’t have a myModa account, creating one is

• easy. You’ll love everything

you can do on myModa, like check your benefits, use interactive health tools, see your Member Handbook and more.

14298935 (6/16) SS-1103-MED Health plans in Oregon and Alaska provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon Dental Service, dba Delta Dental Plan of Oregon. Dental plans in Alaska provided by Delta Dental of Alaska.

Respiratory Care program

As a member of this program, our health coaches will work with you to identify your asthma triggers, set goals, track your progress and help provide the support you need to feel your best and breathe easier.

Women’s Health & Maternity Care program

As an expectant mother enrolled in this program, you’ll get the support and information you need both during and after your

• pregnancy. You can also talk
• ne-on-one with a health coach

about any women’s health topic, from breast self-exams to prenatal care, from breastfeeding to heart attack symptoms. Whether you are 19, 99 or somewhere in between, a Moda Health coach is available to talk with you.

Lifestyle coaching program

Explore your health and any lifestyle changes you are considering with a professional health coach, including: > Nutrition

• > Sleep

> Stress

• > Physical activity

Your health coach creates a partnership with you to discuss your goals and create a plan of action that feels good to you. Your coach will give advice or information when you ask for it, but you will be the one to decide what you want to work

• n and how you will achieve it.

Spine & joint care program

You will work with coaches in the areas of spine and joint disorders as well as acute and chronic pain to learn about spine and joint anatomy and informed decision

• making. You will also work with

your coach to create a plan of modified, joint-sparing activities and techniques to use at home

• r work. You will be supported

as you work with your provider

• n stretching and strengthening

exercises, relaxation techniques, diet and weight management, and medication management.

Care programs

Care coordination and case management

When you’re sick, need hospitalization or surgery, or are seriously injured, we’ll take some of the work off your plate — so you can focus on healing. Our nurse case managers and care coordinators will help you: > Navigate the healthcare system > Communicate and work with your providers to support your care plan > Understand your benefits > Arrange medically necessary, covered services

• rdered by your provider

> Connect with community resources

eDoc

Email a health professional about your nonurgent health concerns. eDoc keeps it private and customized to you. Connect with: > Board-certified physicians > Licensed psychologists > Pharmacists > Dentists > Dietitians > Fitness experts > eDocVoice — leave a message for a provider, and you’ll get a phone response within 24 hours

Nurse line

Need quick advice? The friendly nurses on our Registered Nurse Advice Line are available 24 hours a day. Just call 866-321-7580 for guidance on: > Basic health conditions and symptoms > Treatment for minor injuries and burns > Home cold and flu remedies > When to visit your doctor

Be Better tools

modahealth.com

Care programs

Want to feel your best? You’ve got a coach in your corner! Whether you have an ongoing health issue, like diabetes,

• r just want to eat better and exercise, we can help.

When you or your dependent enrolls in one of our care programs, we’ll deliver

• ne-on-one support from

a health coach. Choose the program with the right fit: > Cardiac Care > Dental Care > Depression Care > Diabetes Care > Lifestyle Coaching > Respiratory Care > Spine & Joint Care > Women’s Health & Maternity Care

Cardiac Care program

Heart disease is the leading cause of death in America. You can lower your risk with lifestyle changes, like exercise. As part

• f this program, you’ll take a

personal risk assessment. This will help you and your health coach make a plan just for you.

Dental Care program

Research shows that when your mouth is healthy, your body is healthier, too. Work with a coach to learn how to take better care of your teeth and

• mouth. Your coach will help you

start new, healthy habits and communicate with your dentist.

Depression Care program

If you struggle with depression, there’s help. As part of this program, your coach will help you understand and manage your

• symptoms. You’ll get support all

along your path to feeling better.

Diabetes Care program

What’s the best way to control your diabetes? Learn what you can do to lower your risk for complications. You’ll set goals and track your progress toward better health with expert guidance and support.

To enroll:

Call 877-277-7281 or email careprograms@ modahealth.com. TTY users, please call 711.

• ver

Take your health from good to great!

modahealth.com

9462800_ORAK (11/15) Health plans in Oregon and Alaska provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon Dental Service, dba Delta Dental Plan of Oregon. Dental plans in Alaska provided by Delta Dental of Alaska.

Respiratory Care program

As a member of this program, our health coaches will work with you to identify your asthma triggers, set goals, track your progress and help provide the support you need to feel your best and breathe easier.

Women’s Health & Maternity Care program

As an expectant mother enrolled in this program, you’ll get the support and information you need both during and after your

• pregnancy. You can also talk
• ne-on-one with a health coach

about any women’s health topic, from breast self-exams to prenatal care, from breastfeeding to heart attack symptoms. Whether you are 19, 99 or somewhere in between, a Moda Health coach is available to talk with you.

Lifestyle coaching program

Explore your health and any lifestyle changes you are considering with a professional health coach, including: > Nutrition

• > Sleep

> Stress

• > Physical activity

Your health coach creates a partnership with you to discuss your goals and create a plan of action that feels good to you. Your coach will give advice or information when you ask for it, but you will be the one to decide what you want to work

• n and how you will achieve it.

Spine & joint care program

You will work with coaches in the areas of spine and joint disorders as well as acute and chronic pain to learn about spine and joint anatomy and informed decision

• making. You will also work with

your coach to create a plan of modified, joint-sparing activities and techniques to use at home

• r work. You will be supported

as you work with your provider

• n stretching and strengthening

exercises, relaxation techniques, diet and weight management, and medication management.

Care programs

Lifestyle Coaching program

If you simply want to feel healthier, here’s your chance. Talk through any lifestyle changes you want to make with a personal health coach. Your coach can give you helpful tips for: > Nutrition > Sleep > Stress > Exercise

Respiratory Care program

How would you like to breathe easier? Identify your asthma triggers, set goals, track your progress and get the support you need to feel your best.

Spine & Joint Care program

Live with less pain. Learn about spine and joint disorders, as well as acute and chronic pain. By understanding your body, you can make better decisions about your treatment. Working with your coach, you’ll create a plan

• f activities that go easy on your
• joints. You’ll also learn about:

> Stretching and strengthening exercises > Relaxation techniques > Diet and weight > Medication management

Women’s Health & Maternity Care program

Are there women’s health issues that concern you? If so, talk with a health coach about matters like: > Breast cancer and self-exams > Heart attack symptoms > Changes related to menopause > And much more If you’re expecting, a health coach can give you information and support to help you have the best possible experience during and after your pregnancy.

Care programs

modahealth.com

Member ID cards

To use your benefits, just have your member ID card ready. It shows your member and group numbers, along with

• ther important details. Hand it to your provider whenever

you go in for care.

Online or in your wallet, your member ID card has you covered.

• ver

6235999 (8/14) MKT-1504 Health plans in Oregon provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon Dental Service.

Questions?

We’re happy to help. Just call our customer service team. Medical: 877-605-3229 Dental: 877-277-7280 Pharmacy: 888-361-1610

New member?

If you just joined us, welcome. We’re thrilled to partner with you along your health journey. We’ll mail you an ID card right

• away. We suggest you keep

it in your wallet or purse.

View your card online

It’s easy to access your ID card from a computer or smartphone, too. Here’s how: Find it at myModa Visit modahealth.com and log in to myModa. Choose “view/download/print ID card” from your member shortcuts and open the PDF. Don’t have a myModa account? Create one in seconds. With your member ID card handy, visit modahealth.com and follow the instructions to enter your information. You’ll love everything you can do at myModa — check your benefits, review claims, see your Member Handbook, find a health coach and more. Get the mobile ID app If you have a smartphone or mobile device, visit your app store and search for “Moda Health ecard.” Launch the app by entering your mobile PIN code and subscriber ID. You’ll find your PIN code on your PDF card at myModa. Easy! You can even email or fax your ID card to providers or family members. We hope these digital options make getting care a little better.

modahealth.com

Member ID cards

What does my ID card look like?

Each card is a little different. Your card includes your member ID number and plan provider network. If you have a group plan, the card might also have your employer’s logo. Most cards look something like this: Front Back

www.modahealth.com

This card does not certify or guarantee benefits.

ID number J01234567 Group number 10101010 Mobile PIN code 1234 Networks Name Name Subscriber/Dependent(s) (00) Mary J. Smith (01) John A. Smith (02) Kimberly N. Smith (03) Maxwell E. Smith

s a m p l e s a m p l e

ID ID ID num num num J012 12 ent(s) ent(s) ent(s) Smith Smith John A. Smith John A. Smith

s s

Kimberly N. Smith Kimberly N. Smith Maxwell E. Sm Maxwell E. Sm

PCN : XXX BIN : XXX

Moda Health Medical: 866-938-0356 Dental: 866-938-0356 Pharmacy: 866-938-0356 Send claims to: P.O. Box 40384, Portland OR 97240

s a m p l e s a m p l e

X XX

d OR OR 97240

modahealth.com

VOLUNTARY DENTAL PLAN OVERVIEW

Standard Insurance Plan 1 Deductible $50 Individual $150 Family Annual Maximum (maximum benefit available) $1,000 Allowance 90% Usual and Customary Class 1- (exams, cleanings, sealants, fluoride, space maintainers) Covered in Full Class 2 – (fillings, oral surgery, endodontics, periodontics and anesthesia) 20% Coinsurance after Deductible Class 3 – (restorative crowns, dentures) 50% Coinsurance after Deductible Implants 50% Coinsurance after Deductible Orthodontia Not Covered

VOLUNTARY DENTAL PLAN OVERVIEW

Standard Insurance Plan 2

Eligible Expenses (plan pays) Benefit Level 1: 0% of first $250 of eligible expenses Benefit Level 2: Plan pays 80% of remaining eligible expenses up to maximum Annual Maximum (maximum benefit available) $3,000 Allowance 80% Usual and Customary Routine Exam, Bitewing X-rays, Cleanings Limited to 2 per benefit period Full Mouth/Panoramic X-rays 1 in 3 years Crowns and Prosthodontics 1 in 5 years Flouride and Sealants Flouride under age 18: 1 per benefit period Sealants under age 16 See Summary for additional plan details

Boly:Welch Dental Plan Scenarios Standard Plan 1

Examples are not actual costs of services, this is for illustration purposes only.

In Network Example Plan 1: Network Example Plan 1 $1200.00 Dental Bill $1100.00 is 90% UCR for Crown in Portland $100.00 is the balance. Provider writes off, due to contract must accept UCR Crown is covered under category 3 under Plan 1, which is paid at 50% $1100.00 remaining on bill, after write off $550.00, 50% of allowed amount paid by Standard $550.00 ,50% member responsibility Standard pays: $550.00, Member pays: $550.00, Provider writes off: $100.00 Out of Network Example Plan 1 $1200.00 Dental Bill $1100.00 is 90% UCR for Crown in Portland $100.00 is the balance, which is above UCR. The balance is the member responsibility because the provider is not contracted and is not required to write it off. Crown is covered under Category 3 under Plan 1, which is paid at 50% $1100.00 remaining on bill (above UCR) $550.00 50% of allowed amount paid by Standard $550.00 50% member responsibility $100 above UCR is also the member responsibility Member pays: $650.00, Standard pays $550.00

Boly:Welch Dental Plan Scenarios Standard Plan 2

Examples are not actual costs of services, this is for illustration purposes only.

In Network Example Plan 2: Network Example Plan 1 $1200.00 Dental Bill $1000.00 is 80% UCR for Crown in Portland $200.00 is the balance. Provider writes off, due to contract must accept UCR $1000.00 remaining on bill, after write off $250.00 is the member responsibility before Standard pays. Member pays 1st $250. $750.00 remaining after member pays deductible or Category 1 Standard pays remainder at 80% per plan Category 2= $600 Member pays 20%= $150.00 Standard pays: $600.00, Member pays: $400.00, Provider writes off: $200.00 Out of Network Example Plan 2 $1200.00 Dental Bill $1000.00 is 80% UCR for Crown in Portland $200.00 is the balance. Member is responsible because it is above UCR $1000.00 remaining on bill (above UCR) $250.00 member responsibility per plan. Category 1 or Deductible $750.00 Remaining on bill Standard pays remainder at 80% per plan Category 2= $600 Member pays 20%=$150 Standard pays $600.00, Member pays: $600.00,

VOLUNTARY VISION– VISION SERVICE PLAN (VSP)

VSP Benefit Description Copay Frequency Well Vision Exam Refractory eye exam $10 Copay Every 12 months Frame $130 retail allowance for a wide selection of frames $150 retail allowance for featured frame brands 20% savings on the amount over your allowance $25 Copay for Materials (Glasses or Contacts) Every 12 months Lenses Single vision, lined bifocal and lined trifocal lenses Polycarbonate lenses for dependent children Covered in Full (after exam copay) Every 12 months Lens Enhancements Includes: Tints, Dyes, UV Protection, Scratch Resistant Coating, Polycarbonate Lenses (covered in full for dependent children), Anti Reflective Coating, Photochromic Lenses See Benefit Summary for copays Every 12 months Contacts (in lieu of glasses) $130 allowance for elective contacts, after copay Contact lens exam included (fitting and evaluation) $25 Copay for Materials Every 12 months Extra Savings 20% savings on additional glasses and sunglasses within 12 months of

• exam. Laser Vision correction discounts and Retinal screening discounts.

See summary for details Out of Network

• Included. See summary for details

FLEXIBLE SPENDING ACCOUNT 2019

Healthcare Flexible Spending Account Contribute up to $2700 in healthcare flexible spending account for qualified medical expenses. See IRS Code 213d for list of qualified expenses. Can roll over up to $500 of unused funds to the next plan

• year. Unused funds over $500

will be forfeited at end of year. Dependent Care Flexible Spending Account Allocate up to $5000 for Dependent Care expenses For detailed description of what qualifies for dependent care go to the member section at www.benefithelpsolutions.com Benny MasterCard Debit card available that can be used to pay for qualified expenses at the point of sale Other Reimbursement options

Submit a claim through MyFlex or send request via mail or fax

FSA Administrator

https://psa.pacificsource.com/Flex/

(541) 485-7488 or (800) 422-7038

Pacificsource Administrators

Save your receipt in the event that you have to substantiate your claim.

IMPORTANT STEPS

• 1. If this is your initial enrollment period, this is your only opportunity to elect coverage

until the next Open Enrollment period, unless you experience a qualifying event.

• 2. Make your enrollment election and submit it to Boly:Welch.

Please submit a waiver if you do not wish to elect coverage at this time.

• 3. Indicate your plan selection on the enrollment form. If you are enrolling in the medical

plan, you will need to select the Base plan (Moda Synergy) or the Buy Up plan (Moda Connexus). If you are enrolling in the Voluntary Dental plan you will need to either select Plan 1 or Plan 2 with Standard Insurance.

EMPLOYEE ADVOCACY

Resources to assist employees with: claim issues, benefit questions and clarifications Jennifer Young Insurance Broker Jennifer Direct Line: 503.887.1756 Jennifer Email: Jennifer@nwbenpartners.com Rebecca Basile Account Manager Rebecca Direct Line: 503.706.6511 Rebecca Email: Rebecca@nwbenpartners.com NWBP Fax: 503.914.1444

Prepared by NWBP, LLC

Monthly Rate Boly:Welch Contribution Employee Cost Employee Only $439.06 $283.06 $156.00 Employee + Spouse/Domestic Partner $1,009.86 $283.06 $726.80 Employee + Family $1,405.01 $283.06 $1,121.95 Employee + Child(ren) $834.22 $283.06 $551.16 Monthly Rate Boly:Welch Contribution Employee Cost Employee Only $514.54 $283.06 $231.48 Employee + Spouse/Domestic Partner $1,183.47 $283.06 $900.41 Employee + Family $1,646.56 $283.06 $1,363.50 Employee + Child(ren) $977.66 $283.06 $694.60 Monthly Rate Boly:Welch Contribution Employee Cost Employee Only $39.16 $0.00 $39.16 Employee + Spouse/Domestic Partner $77.08 $0.00 $77.08 Employee + Family $131.88 $0.00 $131.88 Employee + Child(ren) $93.96 $0.00 $93.96 Monthly Rate Boly:Welch Contribution Employee Cost Employee Only $37.20 $0.00 $37.20 Employee + Spouse/Domestic Partner $72.96 $0.00 $72.96 Employee + Family $100.36 $0.00 $100.36 Employee + Child(ren) $64.60 $0.00 $64.60 Monthly Rate Boly:Welch Contribution Employee Cost Employee Only $12.08 $0.00 $12.08 Employee + 1 $19.32 $0.00 $19.32 Employee + Family $31.80 $0.00 $31.80 Employee + Child(ren) $19.72 $0.00 $19.72

Voluntary Vision - Vision Service Plan (VSP) Voluntary Dental - Standard Insurance Plan 1 Voluntary Dental - Standard Insurance Plan 2 Medical, RX and Alternative Care- Moda Connexus $1,500 Deductible Plan (Buy Up Plan)

Boly:Welch

Employee Benefits

January 1, 2019 through December 31, 2019

Enclosed are the new health insurance rates which will become effective January 1, 2019 . The month of December is Open Enrollment. If you are currently enrolled and would like to make changes to your existing elections, or would like to enroll in the insurance plans for the first time, this is your opportunity to do so. If you waive your opportunity to enroll during Open Enrollment you will not be able to enroll during the year, unless you experience a qualifying event.

Medical, RX and Alternative Care- Moda Synergy $3,000 Deductible Plan (Base Plan)