Employee Health Insurance

Transcription

1 Employee Health Insurance Health insurance is available for any regular full time or part-time employee (30+ hours/week) and their dependents through CareFirst. Employees have three options for health insurance plans: HMO, POS Open Access, and PPO. The HMO plan is available at no cost to the employee. If employees wish to participate in the CareFirst POS or PPO plan, they may upgrade to that plan by paying the difference in cost. Please see the charts on pp. 3-4 of this packet to compare plan costs. Additionally, Bread for the City provides a dental discount plan through Dominion USA. Healthy Blue HMO Bread for the City pays 100% of the premium for health care coverage for employees selecting the CareFirst HMO. Bread for the City employees pay 10% of the coverage costs for any dependents on the HMO. Bread for the City pays the remaining 90% of the coverage cost for dependents. The employee contribution is a pre-tax contribution. The HMO plan requires employees to select a primary care physician (PCP); however you will not need a referral from the PCP to see another doctor in network. Employees must stay in network for benefits to be paid. Each person in a family can have a different PCP. A list of PCPs in network is available at under Find a Doctor. When selecting a plan, select Healthy Blue HMO. This year there is a $300 single 0 family deductible that must be met for certain services. Healthy Blue HMO benefits: Primary Care Physician office visit copays are $0 Specialist Physician office visit copays are $30 Preventive Care copays are $0 due to health care reform Prescription Drug Copays are for generic, for tier 2, and for tier 3 prescriptions Inpatient hospitalization requires a $300 copay, after meeting the deductible POS Option Open Access Employee Health Insurance (last revised 7/1/2016) 1

2 The POS Open Access Plan is available to employees for a monthly charge. Although employees have to select a primary care physician for their enrollment application, employees are not required to get a referral before seeing a specialist. Employees may also choose to go out of network to see a doctor. However, when employees self-refer outside the Blue Choice network, benefits are paid at 80% of allowable charges. Employees would pay the 20% plus any amount above the allowable charge. A list of participating primary care doctors and specialists can be accessed under the Blue Choice Opt Out Open Access Network at POS Open Access benefits: Primary Care Physician office visit copays are $30. Specialist Physician office visit copays are $40 Preventive Care copays are $0 due to the health care reform Out of network services are paid at 60% of the allowable charge Blue Preferred PPO The PPO plan is available to employees for a monthly charge. This plan offers flexibility in provider selection by allowing employees to self-refer to any participating provider in the BluePreferred PPO network, subject to a co-pay. A list of participating providers can be accessed at Most other benefits are covered at 100% subject to applicable co-pay as long as employees utilize a participating provider. The PPO provides a national network of providers located throughout the U.S. The PPO also allows employees to utilize non-participating providers (out of network services). When employees use non-participating providers, benefits are subject to a deductible. Benefits are reimbursed 80% of the allowable charge after the annual deductible is met. Please see the benefit summary attached. Blue Preferred PPO benefits: Office visit copays are $20 Preventive Care copay is $0 due to the health care reform Most services are covered at 100% after applicable copay Hospitalizations at an in network facility are covered at 100%. Preauthorization is required. Prescription drug copays are for generic (Tier 1), for Tier 2 and for Tier 3 Out of network deductible is $500 single $1000 family Employee Health Insurance (last revised 7/1/2016) 2

3 Health Insurance Plan Comparison (2016) Services Healthy Blue HMO POS Blue Choice Opt out Open Access Physician Services Deductible (In/out of Network) - Individual) - Family Hospitalization (In Network) $0 PCP $30 Specialist In Network Only $300 0 Deductible, then $300/admit $30 PCP $40 Specialist $0/$0 $0/$0 $0 $0 Blue Preferred PPO $20 PCP $20 Specialist $0/$500 $0/$1000 Emergency Room $200 per visit $50 per visit $50 per visit Diagnostic, X-ray, Lab $0 Work Out of Pocket Max - Individual: - Parent/Children: - Ind/Adult: - Family: Prescriptions: - Generic: - Tier 2: - Tier 3: $0 PCP $30 Specialist No charge for x-ray and lab $4500 $30 PCP $40 Specialist No charge for x-ray and lab $1300 In/Out Network 00/$3000 $3000/00 $3000/00 $3000/00 Employee Health Insurance (last revised 7/1/2016) 3

4 HMO Employee s Medical Costs (2016) Total Employee $ $ $0 Employee + Child(ren) $ $ $76.50 Employee + Spouse/Partner $ $ $95.36 Employee + Family $ $ $ POS Total Employee $ $ $ Employee + Child(ren) $ $ $ Employee + Spouse/Partner $ $ $ Employee + Family $ $ PPO Total Employee $ $ $ Employee + Child(ren) $ $ $ Employee + Spouse/Partner $ $ Employee + Family $ $ $ Dental Bread for the City provides a dental discount plan through Dominion, USA. The Access eppo plan is available at no cost to employees. If employees wish to select the Choice plan, they can upgrade for a monthly charge. Access eppo Schedule C Bread for the City pays 100% of the monthly premium for employees selecting the Access eppo plan. Preventative care is covered at 100%. There are approximately 2,200 providers in the local area that participate in this plan, and each family member may choose their own dentist. A list of participating dentists is available at Employee Health Insurance (last revised 7/1/2016) 4

5 The Access eppo plan does not provide ortho coverage. An ortho policy is available for an additional monthly cost of around $20, which would be entirely employee-paid. The Access eppo plan has a $2,000 annual maximum, meaning that after employees have used $2,000 worth of coverage they will have to pay the full cost of the procedure. Access eppo Plan Costs: Total Monthly Bread For the City Pays Individual $21.21 $21.21 $0.00 Employee + Spouse/Partner $40.12 $40.12 $0.00 Employee + 1 child $40.12 $40.12 $0.00 Family $51.58 $51.58 $0.00 Choice Under the Choice plan, employees can see any dentist within a network of 3,200 dentists. Employees can also see any dentist outside the network, and employees do not have to pick a general dentist. Dominion, USA will pay 100% preventative care in network, 80% for basic services and 50% for major services in network. In order to tell what your cost will be, the dentist will call Dominion, USA with the ADA codes and Dominion, USA will let them know how much your total cost will be. You will also be able to see dentists not participating with the network. Your out of pocket expenses will be higher. For dentists outside the network, Dominion, USA will pay 80% for preventive services, 65% for basic services and 40% for major services. There is a $50 individual/ 0 family deductible for both in and out of network benefits for the basic and major services. As with the Access plan, the Choice plan does not provide ortho coverage, but an ortho policy can be purchased for an additional monthly cost of around $20. The Choice plan has a 00 annual maximum. Choice Plan Costs: Total Monthly Bread For City Pays Individual $46.86 $21.21 $25.65 Employee + Spouse/Partner $92.52 $40.12 $52.40 Employee + 1 child $92.52 $40.12 $52.40 Family $ $51.58 $90.36 Employee Health Insurance (last revised 7/1/2016) 5