Employee Benefit Plan Effective April 1, 2014

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1 Employee Benefit Plan Effective April 1, 2014 Presented by: AND

2 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 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 2

3 April 2014 Open Enrollment NEW BENEFITS AVAILABLE THIS YEAR! Voluntary Hospital Indemnity Voluntary Accident NES/Colonial representative will introduce these products. 3

4 TYPE OF SERVICE DEDUCTIBLE: Single/Family COINSURANCE PERCENTAGE OUT OF POCKET MAXIMUM Single/Family Medical Plan Options Low Plan IN-NETWORK ONLY $3,000 / $6,000 IN-NETWORK $2,000 / $4,000 Basic Plan OUT-OF- NETWORK $6,000 / $18,000 IN-NETWORK Premium Plan OUT-OF- NETWORK $1,000 / $2,250 $4,000 / $12,000 50% 70% 50% 80% 60% $6,350 / $12,700 $6,350 / $12,700 OFFICE VISITS $35 copay SPECIALISTS OFFICE VISITS $50 copay PREVENTIVE CARE Paid at 100% Paid at 100% $12,700 / $38,100 $3,000 / $6,000 $12,000 / $36,000 $25 copay $40 copay Paid at 100% EMERGENCY ROOM VISIT $250 copay $250 copay $250 copay $250 copay URGENT CARE CENTER VISIT $50 copay $40 Copay IN-PATIENT HOSPITAL CONFINEMENT OUT-PATIENT HOSPITAL VISIT 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 4

5 Aetna Dental Plan 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 Prompt 1 (Dental Plan Member) 5

6 Empire Vision Plan There are no benefit changes for 2013 How to find a Blue View Vision provider: 1. Go to empireblue.com 2. Select Blue View Vision 3. Enter 6

7 Senior Med Employee Page 7

8 PPO Network Magnacare PPO Over 80,000 providers in New York & New Jersey 500,000 providers throughout the U.S. Easy-to-use provider search tool Name Practice type/specialty Location Language 8

9 Utilization Review Hines & Associates URAC Accredited Streamlined Precertification process Pre-cert requirements can be found in Summary Plan Description 9

10 Emergency or Urgent Care? Know The Difference! Urgent Care 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 Example: Sprained ankle Emergency 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: 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 10

11 Prescription Drug Discount Programs 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 Target CVS Rite Aide Costco Walgreens ShopRite In addition, the below web site is the ultimate pharmacy search engine for discounted generic drug programs available at pharmacies throughout the U.S. 11

12 Maximize Your Benefits! Network doctors - Use network providers for lower out of pocket expenses When possible, go to an Urgent Care Center instead of an Emergency Room. Utilize the Mail order prescription drug benefit to reduce copayments Use generic medications when possible Utilize Prescription Drug Discount Programs 12

13 Voluntary Plans Accident Insurance Hospital Indemnity You DO NOT have to participate in the Health Plan to enroll in a Voluntary plan. 13

14 Accident Insurance 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 others Employee, employee/spouse, one parent family and two parent family coverage available Coverage is portable

15 Hospital Indemnity Insurance 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 outpatient surgery and $250 for diagnostic procedure benefit Employee, employee/spouse, one parent family and two parent family coverage available

16 What we need you to do Medical, Dental and Vision Complete the Employee Election Form. If you want to add or remove dependents, please complete an Enrollment From for the appropriate carrier. CHP Medical Empire Vision Aetna - Dental Please return the complete forms to your Administrator by March 21st. Voluntary Hospital and Accident Meet with a Representative. One-on-one meetings will be held on 3/17 at Crown and 3/18 and 3/19 at Lakeview and Oak Hollow. 16

17 Questions? Thank you!