Employee Benefit Plan Effective April 1, 2014 Presented by: AND - - PowerPoint PPT Presentation
Employee Benefit Plan Effective April 1, 2014 Presented by: AND April 2014 Open Enrollment What to expect for April 2014 Open Enrollment Medical Remaining with CHP Adding a new Low Cost Plan Option 3 Plans Dental Slight increase to
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Medical Remaining with CHP Adding a new Low Cost Plan Option – 3 Plans Dental Slight increase to the current rates due to Health Care Reform Same plan design No provider disruption Vision No increase to the current rates Same plan design No provider disruption
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NES/Colonial representative will introduce these products.
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4 TYPE OF SERVICE Low Plan Basic Plan Premium Plan IN-NETWORK ONLY IN-NETWORK OUT-OF- NETWORK IN-NETWORK OUT-OF- NETWORK DEDUCTIBLE: Single/Family $3,000 / $6,000 $2,000 / $4,000 $6,000 / $18,000 $1,000 / $2,250 $4,000 / $12,000 COINSURANCE PERCENTAGE 50% 70% 50% 80% 60% OUT OF POCKET MAXIMUM Single/Family $6,350 / $12,700 $6,350 / $12,700 $12,700 / $38,100 $3,000 / $6,000 $12,000 / $36,000 OFFICE VISITS Deductible & Coinsurance $35 copay Deductible & Coinsurance $25 copay Deductible & Coinsurance SPECIALISTS OFFICE VISITS Deductible & Coinsurance $50 copay Deductible & Coinsurance $40 copay Deductible & Coinsurance PREVENTIVE CARE Paid at 100% Paid at 100% Deductible & Coinsurance Paid at 100% Deductible & Coinsurance EMERGENCY ROOM VISIT Deductible & Coinsurance $250 copay $250 copay $250 copay $250 copay URGENT CARE CENTER VISIT Deductible & Coinsurance $50 copay Deductible & Coinsurance $40 Copay Deductible & Coinsurance IN-PATIENT HOSPITAL CONFINEMENT Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance OUT-PATIENT HOSPITAL VISIT Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance PRESCRIPTION DRUG COPAYMENTS $25/$45/50% 90 Day Mail Order – 2 times copay MANDATORY MAIL ORDER $25/$45/50% 90 Day Mail Order – 2 times copay MANDATORY MAIL ORDER $25/$45/50% 90 Day Mail Order – 2 times copay MANDATORY MAIL ORDER
Dual Option Plan
Can switch between the DMO and the PPO plans during open enrollment.
DMO is an In-Network only plan
PPO provides both In-Network and Out-of-Network benefits.
There are no benefit changes for 2014
Aetna Navigator™ – easy-to-use member self-service website where you can check claims status, obtain claim forms, locate a participating dentist…
Or call Aetna Member Services at 1-877-238-6200 Prompt 1 (Dental Plan Member)
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There are no benefit changes for 2013
How to find a Blue View Vision provider:
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Over 80,000 providers in New York &
500,000 providers throughout the U.S.
www.magnacare.com
Easy-to-use provider search tool
Name
Practice type/Specialty
Location
Language
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URAC Accredited Streamlined Precertification process
Pre-cert requirements can be found in
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Urgent Care Emergency
Explanation: Medical care for a condition that needs immediate attention to minimize severity and prevent complications but is not a medical emergency. Average provider cost: $250 Explanation: a sudden, serious illness or accidental injury that is either life threatening or would result in severe physical damage if not treated immediately (for example, appendicitis) Average ER Facility cost: $800 Example: Sprained ankle Example: Appendicitis
Premium Plan - $40 copay Basic Plan - $50 copay Low Plan – Contracted Fee Premium Plan - $250 copay Basic Plan - $250 copay Low Plan - Much higher
Contracted fee
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You can find the listings of discounted drugs on the vendor’s web sites. Please note that these lists are updated periodically and are subject to change at anytime,
Walmart http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf Target http://sites.target.com/site/en/health/generic_drugs.jsp?sort=alph CVS http://www.cvs.com/CVSApp/promoContent/promoLandingTemplate.jsp?promoLandingId=1046 Rite Aide http://www.riteaid.com/pharmacy/rx_savings.jsf Costco http://www.envisionrx.com/pdfs/CMPPDrugList.pdf Walgreens http://www.walgreens.com/images/psc/pdf/11PM0109_30_90day_4_15.pdf ShopRite http://www.shoprite.com/cnt/Pharmacy.html
In addition, the below web site is the ultimate pharmacy search engine for discounted generic drug programs available at pharmacies throughout the U.S. http://www.medtipster.com
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Network doctors - Use network providers for lower out of
When possible, go to an Urgent Care Center instead of an
Utilize the Mail order prescription drug benefit to reduce
Use generic medications when possible Utilize Prescription Drug Discount Programs
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Plan pays lump sum dollar amount to you in the event of accidental injury, reimburses for emergency room visits, hospitalization, ambulance services, fractures, dislocations, and many other accident related benefits
24 hour coverage
Benefit pays $50 annually, per covered insured, for specific preventative health screening tests. Tests include: mammogram, pap smear, colonoscopy, chest X-ray and several
Employee, employee/spouse, one parent family and two parent family coverage available
Coverage is portable
Plan pays insured directly, $1,000 or $2,000, depending on
level coverage chosen, upon hospital admission
Pays $165/day to the insured for each day you are hospitalized
up to 60 days per confinement
Pays $150 for Emergency Room admission Plan pays up to $1,000, depending on level of coverage, for
Employee, employee/spouse, one parent family and two parent
family coverage available
Medical, Dental and Vision
Enrollment From for the appropriate carrier. CHP – Medical Empire – Vision Aetna - Dental
Voluntary Hospital and Accident
at Crown and 3/18 and 3/19 at Lakeview and Oak Hollow.
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