ISABELLA COUNTY 2018 OPEN ENROLLMENT 2018 Plan Year BCN Medical - PowerPoint PPT Presentation

ISABELLA COUNTY 2018 OPEN ENROLLMENT 2018 Plan Year

BCN Medical Coverage HRA Benefit Options – Effective 1/1/18 Purchased Plan HRA Option A HRA Option B HRA Option c BCBS Deductible $5,000/$10,000 $0/$0 $100/$200 $500/$1,000 Single/Family 20% 0% 10% - $500/$1,000 20% - $1,500/$3,000 Coinsurance % Out of Pocket Max **Includes deductible, $6,350/$12,700 N/A N/A N/A coinsurance and copayments Office/Specialist $30/$30 $30/$30 $30/$30 $30/$30 Visit $30/24 Visit Max $30/24 Visit Max $30/24 Visit Max $30/24 Visit Max Chiro Copay/ Max Urgent Care/ER $30/$150 $30/$150 $30/$150 $30/$150 Copay 10/40/80 Mail Order 2x Copay Prescription Copays

CLAIMS PROCESS 1. Present BCBS ID Card & 44North Subscriber HRA Card to the provider to explain the HRA process. 2. Provider will submit claim to Participating Provider BCBS. 3. After 44North receives your claim from the carrier, claims specialists will ensure the processing of your medical provider claim within 7 to 10 days. 4. You will then receive a 44North explanation of benefits (EOB), showing the medical provider’s bill has been processed. 5. DON’T FORGET TO PAY PROVIDER FOR ANY Participating Provider REMAINING CHARGES IF ANY (Copay, etc).

Claim Example The following are a few examples of medical procedures that are subject to deductible and coinsurance MRA $0 Deductible Surgery Option A 0% Diagnostic Test Coinsurance $5,000 $100 Deductible Hospital Stay Deductible Pathology Option B 10% - $500 Anesthesia Coinsurance 20% $500 Coinsurance Deductible Option C 20% - $1,500 Coinsurance

Where Should I Go For Care? Billions of dollars are wasted each year because patients visit the wrong health care centers during non-emergencies. Use the below as a quick reference to be a better consumer. Use T his: Sympto ms/ Co nditio ns: Adva nta g e s: Co st: Ave ra g e Whe re to find: T ime : • Sore throat • May have extended $ 60 minutes Visit your primary care doctor. If • Painful urination hours you do not have one you can Doctor’s • Low-grade fever • Ongoing relationship find a primary care physician at Office • Earache • Can generally be bcbsm.com “find a doctor” • Cold and flu reached after hours • Mild allergy symptoms by phone • Skin rash • Eye irritation or redness • Evening and weekend $$ 60-90 minutes Search using Urgent • Minor burns, cuts or scrapes hours http://www.findurgentcare.com • Sprains and strains Care • Walk-in appointments or http://www.bcbsm.com or • Minor asthma issues available ask your primary care doctor to • Convenient locations recommend a near by urgent care. • Life threatening conditions • 24/7 availability $$$ 2-4 hours Call 9-1-1 or visit your local • • Chest pain Suitable for hospital. Emergency • Possible broken bones emergency situations Room • Sudden blurred vision • Poisoning • Loss of consciousness **Need help finding a participating provider or urgent care center? 44North is available to help! Call 855-306-1099**

Prescription Coverage – Effective 1/1/18 Generic Preferred Brand Non-Preferred • $10 copay 30 day • $40 copay 30 day • $80 copay 30 day • $20 copay Mail Order • $80 copay Mail Order • $160 copay Mail Order

Prescription Coverage • Prior authorization - means that certain clinical criteria must be met before coverage is provided. You may be required to pay additional out-of-pocket costs or a higher copayment if you do not have prior authorization. Your pharmacist or physician can request prior authorization on your behalf by calling BCBS pharmacy help desk. • Step Therapy - Drugs that require step therapy may require previous treatment with one or more formulary agents prior to coverage. • Quantity Limits - BCBS has established Quantity Limits for certain medications based either on package size or to promote appropriate prescribing of drugs intended for one-a-day doses. Some medications, including specialty drugs, are limited to a 30 day supply and cannot be filled for a 90 day supply

How to Read Your EOBs 44North Reimbursed Plan EOB Blue Cross Blue Shield Purchased Plan EOB 1 2 10 3 1 2 3 8 9 5 6 7 10 4 11 3 4 5 6 7 1. Employer Info 8. HRA Deductible 2. Member Info 9. HRA Coinsurance 2 3. Provider Info 10. Reimbursed Amount Paid to Provider 4. Date of Service 11. Amount Employee Must Pay Provider 5. BCBS Approved Amount 6. Purchased Plan Deductible 7. BCBS Paid

Register as a first time User at www.BCBSM.com BCBS will send you a PIN by mail in order to activate. • View EOBs (exception - OV) • Deductible Balances Inquiry • Monitor Claim Status • Update COB Information

MRA/FSA Online Portal Access your claim information 24/7 with our online claims portal. 1. Go to www.44n.com 2. Click on “ Client/Member Portal ” 3. Click on “ HRA and FSA Claims Portal ” 4. Sign in using your last name & last four digits of your social security number as your Username. Your password is your last name along with your birth date. Usernames and Passwords are CASE SENSITIVE Trouble logging in? Please call 855-306-1099

DENTAL & VISION – NO CHANGE! BCBS VISON COVERAGE • $10 Exam Copay - 12 month • $150 Frame Allowance – 12 month • $25 Glasses Copay • $150 Contact Lens Allowance • Contacts and Lenses - 12 month BCBS DENTAL COVERAGE • 100%/75%/50% • $1,200 Annual Maximum Benefit

Bi-Weekly Employee Cost Share Coverage Level: Opt ption n A Opt ption B n B Opt ption C n C Single $10. $10.95 $7. $7.41 $0. $0.00 Two-person $26. $26.28 $17. $17.79 $0. $0.00 Family $32. $32.85 $22. $22.24 $0. $0.00

Voluntary Term Life  Gives you the opportunity to choose a life insurance benefit that fits you at a price you can afford.  Accessible for Employee, Spouse and Dependents  Benefits are Portable and Convertible  Rates are based on the Employee’s current age for both Employee and Spouse

Guarantee Issue Amount – Newly Eligible  Full Time Employee: $200,000  Spouse: $30,000  May not exceed 50% of Employee elected amount  Dependent Children: $10,000  Age 14 days – 25 years (if a full-time student)  70 years or older, maximum benefit is $50,000

Eligible Increments of Increase  Employee: $10,000  Spouse: $5,000  You and your spouse may increase your coverage 1 increment during open enrollment up to the Maximum Benefit Level  Employee: $300,000 Maximum  Spouse: $150,000

SECTION 125 FSA • Pre-tax medical reimbursement • Can elect up to $2650 annually • $500 Rollover to Next Plan Year • Eligible Expenses Include: • Deductible/Coinsurance • Copays (Rx, ER, etc) • Dental/Vision DEPENDENT CARE • Pre-Tax Dependent Care • Can elect up to $5000 annually

Benny “Smart” Card The Smart Card works for: • Prescriptions: In store, mail order, or online • Patient balances due on medical statements. • Please make sure BCBS has processed the claim before you make a payment. • Office Visit Copays • Out of pocket expenses for vision, dental, and orthodontic claims • For more uses, contact 44North at 855.306.1099 **Plea ease se onl nly u use S e Smart C Card t d to p pay for e eligible e e expen penses w ses within t the he cur urrent pl plan y year . Any claims in the 90-day run out period will need to be submitted manually. Additional documentation may be requested by 44North for transactions that the IRS does not allow auto-substantiation (Ex: deductible/coinsurance items, dental, vision, or when card is used at non-IIAS merchant.)

Documentation For Reimbursement Documentation in regards to HRA/FSA fund distribution is important! The IRS requires the following for claims to be reimbursed: • Date of Service • Name of person receiving service • Name of provider • Type of service provided • Amount charged for each service and/or the amount reimbursed by the insurance • Approved charge vs. not approved (cosmetic for example) • Amount applied towards the deductible/coinsurance/co-pay Your EOBs contain all of this information! Example Receipts:

PRICING TRANSPARENCY W HY DO WE KNOW THE COST OF APPLIANCES , FURNITURE , AND GROCERIES , BUT NOT MEDICATIONS , MEDICAL TESTS , AND PROCEDURES ? O UR 44N ORT P YOU : H SHOPPE RS WI L L HE L S AVE ON M E CAL P ROCE DI DURE S S AVE ON P RE SCRI PT I ONS F ND F RAL G RANT S AND C O - PAY A SSI ANCE P ROGRAMS I E DE ST

PRICING TRANSPARENCY Common non-emergent procedures eligible for comparisons: • MRIs • Ultrasounds • CT Scans • Mammograms • Colonoscopies Contact a 44North Shopper to see if yours can be quoted!

PRICING TRANSPARENCY $20 GIFT CARD FOR CALLING 25% OF THE SAVINGS S O HOW DOES IT WORK ? MRI Without Contrast See how it works: FACILITY LOCATION COST Referred Facility A McLaren $2,319 B Open MRI $1,057 44North Shopper Facility C Mid-Michigan-Midland $1,762 D Mid-Michigan-Clare $1,966 $2,319 at the referred facility -$1,057 at the 44North Shopper facility $1,262 potential savings 25% of the potential savings = $315.50! Contact a 44North representative today to price your next procedure. 855-306-1099 x 1075 | SHOPPER@44N.COM