Teva 2013 Open Enrollment Your Choices and Options
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1 2013 COBRA Guide
2 Open Enrollment Your Choices and Options 2 HEALTHCARE 2 Medical (includes vision) 5 Prescription Drug 6 Dental Enroll November 5 16 More information will be provided by our vendor, Conexis. For help and support, please call Conexis Customer Service Center at (877)
3 Now s Your Chance! Open Enrollment is a once-a-year opportunity to enroll in your Teva benefits. Plan options and rates are changing. Be an informed benefits shopper by taking a few steps to prepare Learn more about your 2013 benefits by reviewing this guide and the 2013 Benefits Guide at What s Changing in 2013? 2013 Medical Plan Options Teva is pleased to offer three medical plans from which to choose. Teva s use of out-ofpocket maximums on each plan ensures that you can budget your family s health expenses for the year. Out-of-pocket maximums and s vary by plan; be sure to review plan details so that you can select the best option for you and your family. The Aetna Select Plan (HMO) and Aetna Low Dental plans will no longer be available. Your 2013 medical plan options include: Aetna Core Plan a new option Aetna Premier Plan a new name for the POS II program Aetna Value Plan with Health Savings Account Enroll by November 5 16 To enroll, log on to If you need help, please call Conexis at (877)
4 Healthcare Medical Teva offers three options for medical coverage: Aetna Core Plan Aetna Premier Plan Aetna Value Plan with Health Savings Account (HSA) You can find more information, including plan costs, at Aetna Core Plan This is a plan you should consider if you want the flexibility of in- and out-of-network care with the peace of mind to know that you will have lower out-of-pocket expenses for your care. If you have a medical condition or need frequent care, this plan will protect you from paying higher out-of-pocket costs than the Value Plan; however, this plan does have a higher annual and copay than the Premier Plan. Aetna Premier Plan You will pay more for this plan, but it gives you maximum protection by limiting the amount you pay out of your pocket for healthcare expenses. This plan is ideal for those with chronic illnesses or large families who expect to make multiple doctor and specialist visits throughout the year. This plan also allows you to use in- and out-of-network providers. Find an Aetna Network Provider You can see if your doctor participates in any of the Aetna networks for our three medical plans. Simply go to and click Find a Doctor. To search the network Teva uses for our medical plans, choose Aetna Choice POS II (Open Access). 2
5 Aetna Value Plan with Health Savings Account (HSA) Not only is this plan a low-cost option, but it also gives you the opportunity to save and invest money in an HSA tax-free to pay for future healthcare expenses. The Aetna Value Plan has a higher than the other Teva plans: $2,000 if you cover yourself only $4,000 if you cover eligible dependents This plan allows you to use in- and out-of-network providers. And, you don t need a referral to see a specialist. Routine physicals and other preventive care services are free when you go to in-network doctors, regardless of whether you ve met the. For other services, such as doctor or specialist office visits for an illness, lab tests, emergency room visits or X-rays you ll pay the full cost until the has been met. Save Money with In-Network Care Although all plans offer the flexibility of in- and out-of-network care, you can maximize your benefits and reduce your healthcare costs by using in-network providers. Use the provider search tool on to see if your doctors, specialists and hospitals are in or out of the network. To search the network Teva uses for our medical plans, click Find a Doctor, and choose Aetna Choice POS II (Open Access). If you plan to go out-of-network, consider using a pre-tax Health Care FSA to save money on your medical expenses. 3
6 Medical, Vision and Hearing Benefit Details Aetna Core Plan Aetna Premier Plan Aetna Value Plan with HSA Coinsurance Annual Deductible Copay Annual Out-of-Pocket Maximum* Annual Lifetime Maximum PCP Office Visit Specialty Care Emergency Room Inpatient Hospital Outpatient Surgery In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network 80% after $600 single $1,200 Employee + 1 $20 PCP/$30 Specialist $2,000 single $4,000 Employee + 1 $20 copay $1,200 single $2,400 Employee + 1 $4,000 single $8,000 Employee + 1 $30 copay 50% covered for non-emergency 90% after $300 single $600 Employee + 1 $20 PCP/$30 Specialist $1,000 single $2,000 Employee + 1 $20 copay Unlimited $600 single $1,200 Employee + 1 $2,000 single $4,000 Employee + 1 $30 copay 90% covered 50% covered for non-emergency 90% covered after 90% covered 80% after 80% after $2,000 single $4,000 Employee + 1 $4,000 single $8,000 Employee % covered for non-emergency after after Diagnostic Labs/X-rays 90% covered after Hearing Evaluation (one test per calendar year) 80% of R&C covered 80% of R&C covered Hearing Aids,, for bilateral aids every five years; max. of $5,000,, for bilateral aids every five years; max.of $5,000,, for bilateral aids every five years; max. of $5,000 Routine Eye 80% of R&C covered *Out-of-pocket maximum includes in all options. Exam 80% of R&C covered 80% of R&C covered Lenses and Frames $200/year max. for lenses, frames and/or contacts combined 4
7 Preventive Care For all of Teva s medical plan options, in-network preventive care is covered at 100%. Routine Physical Exams Routine OB/GYN Well-Child Visits Aetna Core Plan Aetna Premier Plan Aetna Value Plan with HSA In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network 80% of R&C covered, 80% of R&C covered, 80% of R&C covered, CVS Caremark Prescription Drug Coverage When you elect Teva medical coverage, you ll automatically have prescription drug coverage with CVS Caremark. You ll receive materials from CVS Caremark with information about all of the tools and resources available to you as a CVS Caremark member. Retail (up to a 30-day supply) Aetna Core Plan Aetna Premier Plan Aetna Value Plan with HSA Teva Generic & Brand $0 $0 $0 * Generic $5 $5 $5 * Brand Preferred** $25 $25 $25 * Brand Non-preferred** $40 $40 $40 * Mail and Retail Maintenance Program (up to a 90-day supply) Teva Generic & Brand $0 $0 $0 * Generic $10 $10 $10 * Brand Preferred** $62.50 $62.50 $62.50 * Brand Non-preferred** $100 $100 $100 * * Deductible waived for preventive Rx and prenatal vitamins. Go to or contact Caremark at (877) for a list of preventive prescriptions. **Go to to see which brand-name prescriptions are preferred; new hires can go to Keep in mind If you re filling your prescription through the mail order service, just write Please fill with a Teva drug on your prescription. 5
8 Dental Teva provides dental coverage through Aetna: Dental PPO Dental PPO Annual Deductible Annual Maximum for Classes I, II, III Class I: Preventive Oral exams, routine cleanings, fluoride treatments, sealants, full-mouth X-rays, bitewing X-rays, space maintainers Class II: Basic Restorative Fillings, root canal therapy, stainless steel crowns, gingivectomy, simple extractions, scaling and root planing, full and partial bony impacts Class III: Major Restorative Crowns, dentures, bridges, inlays, onlays, osseous surgery, repairs to crowns and inlays Class IV: Orthodontia Lifetime Maximum for Orthodontia In-Network Out-of-Network Employee Only: $50 Employee + 1: $100 Employee + Family: $150 $2,000 per covered member 100% covered 60% covered 100% of R&C covered, 80% of R&C covered 50% of R&C covered Children and adults: 50% covered, $2,000 per covered member Keep in mind... To see if your dentist participates in the Aetna network, go to and click Find a Doctor. The plan is in the Dental PPO/PDN/EEP/HealthFund with PPO PDN network. You can go to any dental care provider you choose. You don t need to select a Primary Care Dentist (PCD), nor do you need a referral to see a specialist. If you use an out-of-network dentist, you will be responsible for the annual, coinsurance and any amounts above the reasonable and customary (R&C) charges for your area. 6
9 Compliance Notices To view annual compliance notices, please visit Here you can access the following Compliance Notices Benefits Guide (starting on page 28) n HIPPA Privacy Notice n General Notice of COBRA Continuation Coverage Rights Under COBRA n Important Notice from Teva Pharmaceuticals USA, Inc. About Your Prescription Drug Coverage and Medicare n The Women s Health and Cancer Rights Act n Special Note on Maternity and Newborn Infant Coverage For an overview of each of your plans, you can also access Teva s Summaries of Benefits and Coverage (SBCs) and Summary Plan Descriptions (SPDs). 7
10 Providers/Benefits Contact Information Conexis Customer Service Center: (877) Conexis Website: Benefit Provider Name Phone Number Dental Aetna Dental ; (control number: ) Medical Aetna Value Plan with HSA Aetna Core Plan Aetna Premier Plan Aetna ; (control number: ) Vision Aetna Vision One ; (control number: ) 8
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