COSE Health and Wellness Trust 1240 Huron Road, Suite 300 Cleveland, OH

Transcription

1 COSE Health ad Welless Trust 1240 Huro Road, Suite 300 Clevelad, OH Medical Mutual of Ohio Z8116-GHP R10/16

2 COSE Health ad Welless Trust A self-fuded beefit optio for small group employers I Partership with Medical Mutual

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4 For may small busiesses, the curret health isurace ladscape provides limited choice ad flexibility whe it comes to offerig you ad your employees healthcare coverage. The COSE Health ad Welless Trust was created based o the belief that beig a small busiess does t mea you ca t provide the beefits of a larger compay, such as competitive rates ad a broad variety of pla optios. To provide you with a more competitive set of solutios for your compay ad your employees, COSE has partered with Medical Mutual to offer the COSE Health ad Welless Trust, also kow as the COSE MEWA. This is a multiple employer welfare arragemet (MEWA) desiged as a self-fuded beefit optio for busiesses with 50 or fewer employees. Ad, busiess owers with o employees are also eligible to apply. What is the COSE MEWA? The COSE MEWA was developed by COSE to help small busiess members ad their employees maage the icreasig cost of healthcare beefits. The COSE MEWA offers 16 differet pla optios, icludig traditioal copay plas ad high deductible health plas with varyig deductibles ad coisurace. By usig factors such as medical history, geder, age ad locatio to set your rates, the COSE MEWA may be less expesive for your group tha similar plas offered uder the Affordable Care Act (ACA). The COSE MEWA is ot subject to some of the ACA-madated beefits ad taxes ad fees, so these savigs are passed alog to you. The COSE MEWA maitais stop-loss coverage to provide pla sposors with additioal protectio from large fiacial losses. The COSE MEWA selected Medical Mutual to admiister beefits for participatig employers, which meas all beefit optios are tied to the same Customer Care team, local assistace, ad etwork of doctors ad hospitals members have accessed for years. 1

5 Purchasig Coverage Oce you decide to offer coverage through the COSE MEWA, the ext step is to determie which pla is best for your busiess. You have a broad rage of pla desigs ad beefit optios from which to choose. Copay Plas w/rx 1,3 I-Network No-Network Deductible $250 Idividual/$500 Family $2,000 Idividual/$4,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $1,750 Idividual/$3,500 Family $5,000 Idividual/$10,000 Family Copay primary care $25 Coisurace after deductible Copay specialist $50 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $6,600 Idividual/$13,200 Family Ulimited w/rx 1,3 I-Network No-Network Deductible $500 Idividual/$1,000 Family $2,500 Idividual/$5,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $2,500 Idividual/$5,000 Family $7,000 Idividual/$14,000 Family Copay primary care $25 Coisurace after deductible Copay specialist $50 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $6,600 Idividual/$13,200 Family Ulimited w/rx 1,3 I-Network No-Network Deductible $1,000 Idividual/$2,000 Family $2,000 Idividual/$4,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $3,000 Idividual/$6,000 Family $5,000 Idividual/$10,000 Family Copay primary care $20 Coisurace after deductible Copay specialist $40 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $5,000 Idividual/$10,000 Family Ulimited w/rx 2,3 I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $1,000 Idividual/$2,000 Family $7,000 Idividual/$14,000 Family Copay primary care $25 Coisurace after deductible Copay specialist $50 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $5,000 Idividual/$10,000 Family Ulimited 2

6 Copay Plas (cotiued) w/rx 2,3 I-Network No-Network Deductible $1,500 Idividual/$3,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $3,500 Idividual/$7,000 Family $9,000 Idividual/$18,000 Family Copay primary care $30 Coisurace after deductible Copay specialist $60 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $6,600 Idividual/$13,200 Family Ulimited w/rx 2,3 I-Network No-Network Deductible $3,000 Idividual/$6,000 Family $4,000 Idividual/$8,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $3,600 Idividual/$7,200 Family $9,000 Idividual/$18,000 Family Copay primary care $30 Coisurace after deductible Copay specialist $60 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $6,600 Idividual/$13,200 Family Ulimited w/rx 2,3 I-Network No-Network Deductible $5,000 Idividual/$10,000 Family $10,000 Idividual/$20,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $5,000 Idividual/$10,000 Family Copay primary care $30 Coisurace after deductible Copay specialist $60 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $6,600 Idividual/$13,200 Family Ulimited 3

7 Health Savigs Accout (HSA) Plas HSA 2000 w/mmrx (Aggregate) I-Network No-Network Deductible $2,000 Idividual/$4,000 Family $5,000 Idividual/$10,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $5,000 Idividual/$10,000 Family Copay primary care Coisurace after deductible Coisurace after deductible Copay specialist Coisurace after deductible Coisurace after deductible Copay urget care Coisurace after deductible Coisurace after deductible Maximum out of pocket $2,000 Idividual/$4,000 Family $10,000 Idividual/$20,000 Family HSA 2750 w/mmrx 5 I-Network No-Network Deductible $2,750 Idividual/$5,500 Family $5,500 Idividual/$11,000 Family Coisurace (member cost) 20% 40% Coisurace maximum out of pocket (excludes deductible) $1,250 Idividual/$2,500 Family $2,500 Idividual/$5,000 Family Copay primary care Coisurace after deductible Coisurace after deductible Copay specialist Coisurace after deductible Coisurace after deductible Copay urget care Coisurace after deductible Coisurace after deductible Maximum out of pocket $4,000 Idividual/$8,000 Family $8,000 Idividual/$16,000 Family HSA 3000 w/mmrx I-Network No-Network Deductible $3,000 Idividual/$6,000 Family $6,000 Idividual/$12,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $5,000 Idividual/$10,000 Family Copay primary care Coisurace after deductible Coisurace after deductible Copay specialist Coisurace after deductible Coisurace after deductible Copay urget care Coisurace after deductible Coisurace after deductible Maximum out of pocket $3,000 Idividual/$6,000 Family $11,000 Idividual/$22,000 Family HSA 4000 w/mmrx I-Network No-Network Deductible $4,000 Idividual/$8,000 Family $8,000 Idividual/$16,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $5,000 Idividual/$10,000 Family Copay primary care Coisurace after deductible Coisurace after deductible Copay specialist Coisurace after deductible Coisurace after deductible Copay urget care Coisurace after deductible Coisurace after deductible Maximum out of pocket $4,000 Idividual/$8,000 Family $13,000 Idividual/$26,000 Family HSA 5000 w/pd Rx 2,3 I-Network No-Network Deductible $5,000 Idividual/$10,000 Family $10,000 Idividual/$20,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $5,000 Idividual/$10,000 Family Copay primary care Coisurace after deductible Coisurace after deductible Copay specialist Coisurace after deductible Coisurace after deductible Copay urget care Coisurace after deductible Coisurace after deductible Maximum out of pocket $6,450 Idividual/$12,900 Family $15,000 Idividual/$30,000 Family 4

8 Health Reimbursemet Accout (HRA) Plas HRA w/rx 2,4 I-Network No-Network Deductible $1,000 Idividual/$3,000 Family $2,000 Idividual/$6,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $4,000 Idividual/$8,000 Family Copay primary care $25 Coisurace after deductible Copay specialist $50 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $2,500 Idividual/$7,500 Family Ulimited HRA w/rx 2,4 I-Network No-Network Deductible $2,000 Idividual/$6,000 Family $4,000 Idividual/$12,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $8,000 Idividual/$16,000 Family Copay primary care $25 Coisurace after deductible Copay specialist $50 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $3,500 Idividual/$10,500 Family Ulimited HRA 2500 w/mmrx 4,6 I-Network No-Network Deductible $2,500 Idividual/$5,000 Family $5,000 Idividual/$10,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $5,000 Idividual/$10,000 Family Copay primary care Coisurace after deductible Coisurace after deductible Copay specialist Coisurace after deductible Coisurace after deductible Copay urget care Coisurace after deductible Coisurace after deductible Maximum out of pocket $2,500 Idividual/$5,000 Family $10,000 Idividual/$20,000 Family HRA w/rx 2,4 I-Network No-Network Deductible $3,000 Idividual/$9,000 Family $6,000 Idividual/$18,000 Family Coisurace (member cost) 0% 40% Coisurace maximum out of pocket (excludes deductible) N/A $12,000 Idividual/$24,000 Family Copay primary care $25 Coisurace after deductible Copay specialist $50 Coisurace after deductible Copay urget care $75 Coisurace after deductible Maximum out of pocket $4,500 Idividual/$13,500 Family Ulimited Drug Beefits 1. Rx Card: Retail: $10 geeric. $20 preferred brad, $40 o-preferred brad, $100 oral chemotherapy drugs, 50% up to $200 maximum specialty Mail Order: $30 geeric, $60 preferred brad, $120 o-preferred brad, $100 oral chemotherapy drugs, 50% up to $200 maximum specialty 2. Rx Card: Retail: $10 geeric. $30 preferred brad, $60 o-preferred brad, $100 oral chemotherapy drugs, 50% up to $200 maximum specialty Mail Order: $30 geeric, $90 preferred brad, $180 o-preferred brad, $100 oral chemotherapy drugs, 50% up to $200 maximum specialty 3. Home Delivery Icetive: O the fourth fill withi 180 days, member will pay double the applicable copay or coisurace. Geeric Icetive: If member or provider requests a brad-ame drug whe a geeric equivalet exists, the member pays the brad-ame copay PLUS the differece betwee the cost of the geeric drug ad the brad-ame drug 4. Health Reimbursemet Arragemet (HRA) cotributios are admiistered by Medical Mutual. 5. Home Delivery Icetive for major medical plas (Select Active Choice): For plas where the deductible does ot equal the maximum out of pocket, if the member declies to use the Home Delivery program ad after they have met their deductible, the member pays 100% coisurace o the fourth fill ad beyod. 6. For Major Medical Drug o a HRA pla, oce the member deductible is met, the member will cotiue to be charged at the poit of sale; member will be reimbursed through the employer-elected HRA fudig arragemet oce the claim has bee processed through the Medical Mutual system. 5

9 Prescriptio Drug Beefits Prescriptio drug beefits are icluded with every COSE MEWA pla. Medical Mutual parters with Express Scripts to offer your employees access to more tha 70,000 pharmacies. We make sure your employees receive the care ad attetio they deserve while maagig pharmacy costs by: Ecouragig the use of formulary drugs (a formulary is a list of preferred brad-ame ad geeric medicatios for which members pay a lower out-of-pocket charge) Makig sure high-cost specialty drugs are maaged cosistetly, regardless of whether they are admiistered as part of medical services or through a prescriptio Acillary Beefits I additio to the self-fuded beefits of the COSE MEWA, you ll also have the optio of addig the followig fully isured employee beefits, edorsed by COSE ad admiistered by Medical Mutual. Additioal premiums will apply. Detal With DeteMax, a extesive, atioal detal etwork, your employees have access to geeral practitioers, periodotists, prosthodotists, orthodotists ad oral surgeos. Visio With coverage from VSP, a atioal leader i visio ad eye care beefits, you ca offer your employees comprehesive, hasslefree visio beefits. Employees will have coverage that icludes beefits for eye exams, eyeglass leses, frames ad cotact leses through a expasive etwork of participatig VSP provider locatios. Life Isurace Your employees ad their loved oes ca be protected from fiacial hardship i the evet of a death. With group term life isurace plas, you ca offer coverage based o salary or a flat beefit amout. These beefits are offered through Cosumers Life Isurace Compay, a subsidiary of Medical Mutual. 6

10 Spedig Accouts Health Savigs Accout A health savigs accout (HSA) allows your employees to save for healthcare costs i a tax-advataged accout. Whe used i cojuctio with a Medical Mutual qualified high deductible health pla: Cotributios are made tax free The HSA balace ears iterest tax free Qualified medical expese paymets from the accout are tax free, icludig paymets made for IRS-eligible depedets Medical Mutual s HSA has o mothly accout admiistrative fees for your employees ad allows them to maage their COSE MEWA ad Medical Mutual beefits ad HSA together through My Health Pla, Medical Mutual s secure member website. Oce a employee erolls i the HSA ad registers for My Health Pla, he/she will be able to: Track HSA ad ivestmet balaces Pay for qualified medical expeses Ivest i mutual fud optios (a miimum balace may be required) Report ad reissue a lost or stole debit card Access tax forms Use all the health beefits resources o My Health Pla Use a Medical Mutual debit card to pay for qualified medical expeses, icludig doctor visits, prescriptios ad more A employee ca use his/her Medical Mutual debit card to pay for qualified medical expeses, icludig doctor s visits, prescriptios ad more. As a pla sposor, the Medical Mutual HSA provides you full admiistrative access to your employees HSA plas. You ll be able to: Maage employee erollmet ad verify employee participatio Chage employer/employee cotributios Maage all reportig 7

11 Flexible Spedig Accouts A flexible spedig accout (FSA) is a tax-free accout a employee fuds ad uses to pay for out-of-pocket healthcare costs. The employee s pretax cotributio to the FSA lowers the employer s FICA tax liability ad may help save o other taxes. Depedig o the FSA, employees ca be reimbursed for expeses related to healthcare, visio ad detal expeses; work-related trasportatio; ad depedet daycare. Medical Mutual offers several FSA optios to meet the eeds of your employees: Medical FSAs For expeses related to certai out-of-pocket healthcare costs, icludig deductibles, copays, prescriptio medicatios ad medical equipmet Limited purpose FSA For detal ad visio expeses oly ad ca be paired with a HSA Child daycare, elder care ad adult daycare accout optios To pay for the care of depedet childre uder age 13 or depedet adults who caot care for themselves Commuter beefit accouts For parkig or public trasportatio expeses related to commutig to ad from work. The IRS limits the amout employees ca cotribute to medical FSAs for 2016 ad 2017 to $2,550, subject to cost-of-livig adjustmets. You decide whether your employees have to forfeit the fuds or ca carry over up to $500 ito the ext pla year. Employees who have a HSA are prohibited from keepig fuds i a medical FSA, but ca combie fuds with a limited-purpose FSA. Health Reimbursemet Accouts A health reimbursemet accout (HRA) is a IRS-approved, employer-fuded, tax-advataged employer health beefit pla that reimburses employees for out-of-pocket medical expeses. HRAs cover medical expeses that are subject to the deductible icurred by your employees, their eligible spouses ad depedets. A HRA from Medical Mutual: Allows you to custom build a HRA pla to meet the size ad budget of your busiess Provides employees quick ad efficiet claims processig by Medical Mutual without claim submissio Tracks HRA activity for the employee o their Explaatio of Beefits (EOB) ad olie through the My Health Pla member website 8

12 Tools ad Resources The COSE MEWA, i partership with Medical Mutual, offers coveiet olie tools for both you ad your employees to maage all aspects of your health isurace plas. EmployerLik With EmployerLik, you ca quickly take care of your day-to-day maagemet duties: Add/cacel employees Chage persoal ad depedet iformatio Order ID cards Pay your mothly bill View certificate books Olie Tools Medical Mutual offers olie tools to provide all erolled employees with 24/7 access to their accouts o their smart phoes, tablets or computers usig My Health Pla or the MedMutual Mobile App: Access your ID card aytime you eed it Fid a doctor, hospital or urget care facility ear you View pla beefits ad claims iformatio Compare provider ad treatmet costs usig the My Care Compare tool Opt-i for paperless commuicatios Idetity Theft Services As a value-added beefit of the COSE MEWA, you ad your employees will have access to idetity theft resolutio services at o additioal cost. Services are provided through ID Resolutio, a leader i idetity maagemet services. Your employees will have ulimited access to fraud specialists who facilitate the resolutio of virtually ay idetity-related problem. 9

13 Focus o Health ad Welless Through Medical Mutual, the COSE MEWA offers a comprehesive suite of programs desiged to promote healthy lifestyle behaviors. These welless programs start with a health assessmet to provide a baselie to help your employees better uderstad their health ad idetify risk factors for disease. Additioal programs are available so your employees ca make positive chages to improve their well-beig. Health Resource Ceter By accessig the Health Resource Ceter o My Health Pla, your employees ca watch videos desiged to teach them how to eat healthier, be more active ad maage ay coditios they may have. They ca also access iteractive tools ad quizzes, a searchable health ecyclopedia ad a symptom checker tool. Fitess Discouts Your employees ca save moey o memberships to local ad atioal fitess clubs through Medical Mutual s Fitess Discouts Program. QuitLie Program Medical Mutual s QuitLie is available to help tobacco users give up the habit for good by providig oe-o-oe coachig, a persoalized quit pla ad educatioal materials. I additio, icotie replacemet therapy is available to maximize their chaces of quittig. Weight Watchers Reimbursemet To help employees reach their health ad weight goals, Medical Mutual offers a special reimbursemet for completig a Weight Watchers meetig series. Your employees ad their depedets ages 10 ad older ca participate i Olie, At Work or Local (Commuity) Meetigs ad ca be reimbursed up to $150 of their registratio fees per caledar year based o attedace. For more iformatio or to get a quote, please cotact your broker or call (440) You ca also questios to COSEbeefits@medmutual.com. Weight Watchers is a registered trademark of Weight Watchers Iteratioal. 10

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