Buy-Up 500 Core 1000 HDHP Services In-Network 1 In-Network 1 In-Network 1 Calendar Year Deductible - Individual - Family $500 $1,500 $1,000 $3,

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1 Coverage Effective November 1, 2015 Buy-Up 500 Core 1000 HDHP Employee $65.00 $29.50 $18.63 Employee + Spouse $ $79.22 $54.21 Employee + Child/ren $ $60.10 $40.52 Family $ $ $ Employees who enroll in the HDHP 1300 Plan may be eligible to open a COSTS PER PAY Health Savings Account (HSA). This year, Ave Maria University will make a one-time deposit into the employee s Health Savings Account (HSA) once they provide their HSA Account and Routing Numbers to Payroll. Coverage Employer HSA Contribution Employee $500 Employee + Spouse $1,000 Employee + Child/ren $1,000 Family $1,000 6

2 Buy-Up 500 Core 1000 HDHP Services In-Network 1 In-Network 1 In-Network 1 Calendar Year Deductible - Individual - Family $500 $1,500 $1,000 $3,000 $1,300 $2,600 Coinsurance 20% 20% 20% Out-of-Pocket Max - Individual - Family $2,500 $5,000 Deductible, Coinsurance & Copays $3,500 $7,000 Deductible, Coinsurance & Copays $5,000 $5,000 Deductible, Coinsurance & Copays Office Visits - Primary Care - Specialists $20 Copay $40 Copay $25 Copay $45 Copay Preventive Care Covered at 100% Covered at 100% Covered at 100% Urgent Care Facility $45 Copay Emergency Room - Facility - Physician Ambulatory Surgical Center - Facility - Physician $150 Copay $45 Copay Independent Lab Services Covered at 100% Covered at 100% Diagnostic Testing Facility - X-ray - Advanced Imaging Services $150 Copay 1 Non-Network benefits are subject to a separate and higher Deductible, Coinsurance and Maximum. 2 HDHP 1300 has a Family Deductible that applies to anyone covering dependents. The Family Deductible applies to the entire family; whether one member of the family meets the Family Deductible or a combination of family members contribute to the Deductible. The 80/20% Coinsurance does not apply to any family member until the Family Deductible has been met. 7

3 Buy-Up 500 Core 1000 HDHP Services In-Network 1 In-Network 1 In-Network 1 Outpatient Hospital Facility - Facility - Physician Option 1: Option 2: $300 Copay Inpatient Hospital Facility - Facility - Physician Option 1: $600 Copay Option 2: $1,000 Copay Prescription Drugs Retail / Mail Order - Generic - Preferred - Non-Preferred $10 Copay $80 Copay $10 Copay $80 Copay Deductible, then: $10 Copay $80 Copay Prescription Drugs Retail / Mail Order - Generic - Preferred - Non-Preferred $25 Copay $125 Copay $25 Copay $125 Copay Deductible, then: $25 Copay $125 Copay 1 Non-Network benefits are subject to a separate and higher Deductible, Coinsurance and Maximum. 2 HDHP 1300 has a Family Deductible that applies to anyone covering dependents. The Family Deductible applies to the entire family; whether one member of the family meets the Family Deductible or a combination of family members contribute to the Deductible. The 80/20% Coinsurance does not apply to any family member until the Family Deductible has been met. 8

4 Do your homework. Look at past claims; consider future claims. Which plan makes the most sense for your family. Make an informed decision by comparing your costs under each plan. Light Usage Example Comparison of Costs for a Family of 3 Service Allowed Amount Buy-Up 500 Core 1000 HDHP Mammogram Preventive Exams PCP Visits Specialist Visits Service Costs $1, $ $ $ Annual Family Premiums 5, , , Service Costs & Annual Family Premiums 5, , , Initial Year HSA Contribution , Total Out-of-Pocket Costs $5, $3, $1,

5 Do your homework. Look at past claims; consider future claims. Which plan makes the most sense for your family. Make an informed decision by comparing your costs under each plan. Medium Usage Example Comparison of Costs for a Family of 7 Service Allowed Amount Buy-Up 500 Core 1000 HDHP Mammogram Preventive Exams 1, PCP Visits Specialist Visits 1, , PB Maintenance Rx 9, , , , Service Costs $12, $2, $2, $4, Annual Family Premiums 5, , , Service Costs & Annual Family Premiums 7, , , Initial Year HSA Contribution , Total Out-of-Pocket Costs $7, $5, $5,

6 Do your homework. Look at past claims; consider future claims. Which plan makes the most sense for your family. Make an informed decision by comparing your costs under each plan. High Usage Example Comparison of Costs for a Family of 7 Service Allowed Amount Buy-Up 500 Core 1000 HDHP Mammogram Preventive Exams 1, PCP Visits Specialist Visits 1, , PB Maintenance Rx 9, , , , CT Scan OP Hospital Visit 6, , IP Hospital Stay 16, , , Service Costs $36, $4, $6, $5, Annual Family Premiums 5, , , Service Costs & Annual Family Premiums 9, , , Initial Year HSA Contribution , Total Out-of-Pocket Costs $9, $9, $6,

7 1. Stay In-Network! Prior to every service, verify the provider that is treating you is In-Network. Your Medical network is Cigna PPO. It is your responsibility to verify your providers participate in your network even when your physician refers you to a specialist or lab. Ask the provider if they participate in your network; do not ask if they accept your insurance. You can search for participating providers online at during Open Enrollment and at once your coverage is active. 2. Coverage Outside of Florida! Your Cigna coverage works outside of Florida. As long as the out-ofstate provider participates in their state s Cigna PPO network, your In-Network benefits apply. Out-ofstate hospitals that are in the Cigna PPO network are considered an Option 2 Facility. Search for National providers online at during Open Enrollment, and at once your coverage is active. 3. Option 1 vs. Option 2 Facilities! There is a cost differential on Buy-Up 500 for certain hospitals. Most participating hospitals are considered an Option 1 Facility in Florida. An example of an Option 2 Facility is a teaching hospital, like Shands Hospital in Gainesville, or the University of Miami Hospital. Outside of Florida, all Cigna PPO participating hospitals are considered an Option 2 Facility. 4. Urgent Care vs Emergency Room (ER) Emergency Room Visits are more expensive and take more time than a visit to an Urgent Care Center. Save the ER visits for a true medical emergency. Plan ahead and verify the location and hours of operation of the participating Urgent Care Center near your home or office. 5. Prior Authorization! HealthSmart requires prior authorization on Advanced Imaging Services (AIS): MRI, CAT, PET. Your physician is responsible for obtaining the authorization. If the AIS is denied, the radiology group will provide an alternate method of treatment. If your physician feels strongly that you need the AIS, have your physician call and request a peer-to-peer review. The number your physician should call is Disease Management! Once you are identified as having a chronic condition, you are automatically enrolled into the Disease Management Program. You will receive an introduction letter and a follow-up telephone call from a registered nurse. For more information on the Disease Management Program, call HealthSmart at ext Pricing Tool! Healthcare Bluebook is an online tool that enables you to find the best prices for healthcare services. Compare providers on both cost and quality. Download the Healthcare Bluebook app on your iphone or Android once you are enrolled, for easy access on the go. 12

8 8. Preventive Care! Wellness services are covered at 100% In-Network. Mammograms are covered at 100% whether routine or diagnostic, In-Network or Out-of-Network. A routine colonoscopy is covered at 100% for individuals age 50 and older once every 10 years, In-Network or Out-of-Network. 9. Monthly EOBs! Don t pay a provider bill without first matching it to your HealthSmart Explanation of Benefits (EOB). HealthSmart will mail your EOB to your home once a month. You can also view your EOBs online at Customer Service! If you have a claim or benefit question, contact HealthSmart at If you are not satisfied with the results after speaking with HealthSmart, please contact your Brown & Brown Insurance Agent, Britney Lamb, at or blamb@bbnaples.com. 11. Fill Generic! When prescribed a new medication, ask your provider for samples. If the new medication works, ask for the Generic. When a prescription is filled with a Brand name medications when a Generic is avaliable, you will pay the Brand copay, plus the difference in cost between the Brand and Generic. If you haven t met your deductible, you will pay the Brand cost and receive credit for the Generic cost toward the deductible. If you cannot take Generic, have your physician write Medically Necessary on your Brand prescription to avoid unnecessary costs. 12. Prescription Savings! Take advantage of the discounts local pharmacies are making available. Publix provides several medications for free, including antibiotics, Amlodipine, Metformin and Lisinopril. Many Generic medications are available for $4 at Target, Walmart and Winn Dixie. Walgreens and Costco have a prescription savings club where members can get a 90-day supply of many Generics for $10. For brand names drugs you may find manufacturer assistance at and visit to learn which drug store items are eligible for purchase with your FSA or HSA funds; verify which products require a prescription for purchase with FSA or HSA funds. 13. Pharmacy Programs! Cigna has programs in place to help control costs. When filling a prescription with Cigna for the first time, refer to the Medication Guide to see if your medication requires prior authorization, has a quantity limitation, requires you try an alternate medication first (step-therapy), or is a specialty pharmacy medicine that is only covered when filled through the Cigna Specialty Pharmacy. You can view the Formulary List online at during Open Enrollment. If you have questions regarding your Rx coverage, you can call the Cigna Pharmacy Benefit Manager 24/7 at