ASSURE. Level-Funded Plans. Enjoy the best of both worlds the security of a fully insured plan with the advantages of a self-funded plan

Transcription

1 ASSURE Level-Fnded Plans Enjoy the best of both worlds the secrity of a flly insred plan with the advantages of a self-fnded plan Available to employers with enrolled employees

2 Providing a comprehensive health plan for yor employees at a cost-effective rate can be a challenge. Network Health is making it easier for employers by offering a new hybrid prodct that combines the best featres of a flly insred and self-fnded plan. Or Assre level-fnded prodct incldes all the featres of or flly insred plans, like health management, a wellness program, network disconts and online tools. By self-fnding the plan, we are able to offer benefit designs comparable to yor crrent plan while avoiding many costly mandates of an ACA plan. In this book yo will find... What is level-fnding?...2 How does Assre work?...2 What companies qalify to prchase Assre?...3 What are the advantages of Assre?...3 Who s who?...4 Why choose Network Health?...5 Practical example...6 What s the provider network for Assre?...8 Pharmacy benefits and online tools...8 Health management services...9 Empower wellness program Network Health s Nrse Line Assre plan benefit designs Looking for more? Contact yor agent, broker or consltant to see if the Assre plan is right for yor bsiness and to get a qote. Visit networkhealth.com/assre for more details or yo can call or sales team at

3 WHAT IS LEVEL-FUNDING? Level-fnding is a cost-effective health plan fnding soltion that allows companies to benefit from predictable, set monthly rates similar to a flly insred plan. WHAT COMPANIES QUALIFY TO PURCHASE ASSURE? Instead of monthly premims, yor company will be responsible for a specified level of claim liability. This means, each month yo will fnd this maximm claim liability, thereby eliminating the normal volatility of self-fnding. If yor company s claims are less than the amont yo ve fnded at the end of the year, yo get 50 percent of the fnding srpls. Payments are calclated after the 24-month claim liability period has expired (12 months after the end of the policy year). Assre is an excellent choice for employers looking for an alternative to ACA-compliant health plans. If yor claims go over the fnded amont, yor company is protected by stop-loss coverage. This limits the risk yor company is exposed to and protects yo from catastrophic claims. An advance fnding featre allows the payment of claims, even when yor fnding level is less than claim payments. This featre ensres that yo ll never pay more than yor maximm claim fnding amont for any month of the year. HOW DOES ASSURE WORK? Yor company fnds the accont for yor Assre plan, while Network Health Administrative Services, LLC, administers the plan. Yor monthly fnding will consist of the following. Administrative fee Stop-loss premim Claims fnding This fnding amont will only vary based pon the nmber of employees and/or dependents covered by the plan. Assre is a bndled prodct that incldes the featres of a flly insred health plan bt with the opportnity to get some money back. FULLY INSURED TRADITIONAL SELF-FUNDED To qalify to prchase or Assre prodct, yor company mst have enrolled employees with at least 80 percent of employees located in Network Health s service area. WHAT ARE THE ADVANTAGES OF ASSURE? Enjoy the opportnity to earn back 50 percent of srpls claim fnds at the end of yor policy year Yor employees can earn rewards for healthy choices with or Empower wellness program employees can earn p to $225 in rewards Eliminate the financial risk and fnding flctations that yo may see in a traditional self-fnded plan Save on health care costs and pt more resorces back into yor bsiness Experience a bndled prodct like a flly insred plan, while enjoying the financial advantages of a self-fnded plan Expected claims and administrative fee Claims? fnding Administrative fee Stop-loss Claims fnding is variable and it can change? based on the health care needs of the grop. Potential to get 50 percent of nsed claims fnds back Claims fnding Stop-loss ACA-compliant health plans ACA-compliant health plans are individal or small grop plans that inclde the reqired Essential Health Benefits and are labeled by metal level (Bronze, Silver, Gold and Platinm). Stop-loss This is protection for claims that exceed the agreed pon claims fnding. 2 networkhealth.com/assre Administrative fee LEVEL-FUNDED networkhealth.com/assre 3

4 WHO S WHO? WHY CHOOSE NETWORK HEALTH? We live and work in Wisconsin, which means no one from across the contry answers calls or tells s how to manage or plans. We do it all in Wisconsin, from handling claims, billing and enrollment to working one-on-one with cstomers like yo. Plan Sponsor - Employer and stop-loss policy holder Plan Participant - Employee Stop-Loss Insrance Carrier - Network Health Insrance Corporation (NHIC) Third Party Administrator (TPA) - Network Health Administrative Services, LLC (NHAS) We keep things rnning smoothly We deliver qick and accrate plan administration and or cstomer service rates higher than Wisconsin and national averages in several areas. NHAS administers everything for yor plan on yor behalf, inclding the following. We speak in plain langage Paying claims and maintaining proper fnds on deposit for claims payment Preparing claims reports or other data necessary for the plan and/or the stop-loss insrer (NHIC) Providing plan information for filing government reqired reports Billing and collecting administrative fees and stop-loss premim for the plan Handling appeals NHAS prepares the plan docment on behalf of the plan sponsor/employer NHAS will secre stop-loss coverage throgh NHIC. There is an integrated approach between NHAS, the administrator and NHIC (the stop-loss carrier). COBRA Administration services provided by Employee Benefits Corporation We know health insrance can be confsing and intimidating. That s why we ve made a pledge to end the health insrance jargon. We give yo straight answers that are easy to nderstand. We nderstand the importance of qality health care Co-owned by Froedtert Health and Ministry Health Care, a part of Ascension, we re able to offer access to a large network of high-qality providers. Across 23 Wisconsin conties, we ve negotiated deep disconts for the benefit of or cstomers. Focsed on the individal Or Assre plan gives employees access to nrse care managers to manage health conditions. We believe in partnering with individals for better health. 4 networkhealth.com/assre networkhealth.com/assre 5

5 Let s take a look at how the Network Health Assre plan works and why it s a perfect fit for Tony and his employees. 6 networkhealth.com/assre Annal claims fnding... $33, Annal medical claims total... $20, Annal claims difference...$13,190 Pie in the Sky Pizzeria s 50 percent refnd... $6,595 Network Health Administrative Services (TPA) isses the refnd. Annal claims fnding... $33, Annal medical claims total... $42, Annal claims difference... -$8,810 Stop-loss insrance covers the claims difference. Pie in the Sky Pizzeria does not have to pay the difference PIE IN THE SKY PIZZERIA EMPLOYEE BREAKDOWN Pie in the Sky Pizzeria has a total of 20 fll-time employees and 25 dependents participating in the health plan. All of the employees live in Winnebago, Otagamie and Wapaca conties. BEST CASE Pie in the Sky Pizzeria is a family-owned and operated pizza restarant with mltiple locations in northeast Wisconsin and has become a favorite among locals and torists. Since the company s opening in 2011, Pie in the Sky Pizzeria has grown from ten to 30 fll-time employees. Tony, the owner, is crrently offering a health plan to his employees that s compliant with the Affordable Care Act. Becase the costs are really ctting into his bottom line, he decided to start searching for an alternative health plan. WORST CASE PIE IN THE SKY PIZZERIA GROUP BREAKDOWN PRACTICAL EXAMPLE Joseph is an employee at Pie in the Sky Pizzeria and is a participant of the Assre plan. This year he incrred $13,000 in claims de to his cardiac disease. The graphic below shows how this affects Pie in the Sky Pizzeria s annal claims fnding. $3,000 balance covered by stop-loss $10,000 specific dedctible per employee $13,000 claims for cardiac disease networkhealth.com/assre 7

6 WHAT S THE PROVIDER NETWORK FOR ASSURE? HEALTH MANAGEMENT SERVICES To search for specific providers in each network, se or Find a Doctor search at networkhealth.com. Under Choose a Plan, select 2018 HMO/POS/EPO (I get coverage throgh my employer). PHARMACY BENEFITS AND ONLINE TOOLS Throgh or partnership with CVS/caremark, yo ll have access to an extensive pharmacy network, so yor employees will have the convenience of a pharmacy near their home or work. CVS/caremark works to provide innovative and accessible prescription benefits while keeping costs low. The pharmacy network for Assre incldes the following pharmacies. Complex Case Management We offer case management services to help people with high-risk conditions. We re able to identify candidates throgh claims, health assessment data and doctor and self-referrals. Or experienced nrse case managers work with people to develop cstomized care plans and help them navigate the health care world. Case managers can help with the following. Coordinate care with providers Explain medical instrctions Provide gidance on care and how to avoid problems Make follow-p calls so cstomers know exactly what to do, who to see and where to go to get the treatment they need Assist with access to care Inform people abot signs indicating their condition is worsening, so they know when to call the doctor Condition Management CVS Network Health s condition management programs empower people with health conditions to take charge of their health and better manage symptoms. Or team of registered nrses provide health coaching, edcation and other resorces to help. Here is what they do. Help identify health goals and find tools to achieve them Find edcational self-management workshops and commnity events to teach skills needed to manage a condition Promote healthy lifestyle behaviors sch as exercise and eating right Provide resorces on how to manage symptoms Spport commnication with doctors Costco Shopko Walmart Other independent pharmacies and clinical locations are also available, along with a prescription drg mail-order program. We offer condition management programs for these conditions. CVS/caremark s cstomer service center is also open 24 hors a day, seven days a week to answer qestions abot prescription drg coverage. Chronic obstrctive plmonary disease (COPD) Asthma Diabetes Heart failre Heart disease Or nrses are even known to go as far as to visit cstomers in the hospital. It s that kind of personal attention that sets Network Health apart. 8 networkhealth.com/assre networkhealth.com/assre I love feeling like I m actally making a difference. Here are some of the online tools that are inclded. Mobile app to check on or refill prescriptions on-the-go Search tool to get directions and maps to pharmacies Ask-a-pharmacist messaging to get confidential and reliable answers to prescription drg qestions Yvonne Morrow, RN, oncology care manager at Network Health 9

7 EMPOWER WELLNESS PROGRAM Empower is an innovative program that encorages participants and their covered sposes to make healthy decisions. Empower rewards participants for meeting health and fitness goals, and gives them access to the tools they need to spport their goals. Participants earn points with cash vale p to $225 redeemable toward a variety of rewards. Another perk of the Empower program is that participants also receive a free Fitbit pedometer to help monitor activity. Everyone who registers online in My Accont can reqest a FREE pedometer (a $59 vale). Go to My Accont and register. Select Empower, click on Order Pedometer & Allow Access. Participants can also pgrade to a different Fitbit device. (One pedometer per lifetime.) NETWORK HEALTH S NURSE LINE The Network Health Nrse Line is available 24 hors a day, seven days a week, 365 days a year. It s there for those need-it-right-now sitations and it s a great resorce for any of the following. Symptoms like a sore throat, mscle pain or fever Help figring ot where to go for care if it s not an emergency Advice or additional information on general health isses Qestions, information or instrctions for crrent medications or newly prescribed ones ASSURE PLAN BENEFIT DESIGNS To access the Network Health Nrse Line call Empower A GREAT INCENTIVE FOR HEALTHY LIVING 10 networkhealth.com/assre networkhealth.com/assre 11

8 EPO NON-HSA PLANS PLAN # AE5 AE6 AE7 AE8 AE9 AE10 AE11 Dedctible Coinsrance Ot-of-Pocket Maximm Office Visit Copayment PLAN NAME Single Family What Participants Pay Single Family PCP Specialist LF_E1000 CO- CHOICE_20 $1,000 $2,000 20% $3,000 $6,000 LF_E1500 CO- CHOICE_20 $1,500 $3,000 20% $3,500 $7,000 LF_E2000 CO- CHOICE_20 $2,000 $4,000 20% $4,000 $8,000 LF_E2500 CO- CHOICE_20 $2,500 $5,000 20% $4,500 $9,000 LF_E3000 CO- CHOICE_20 $3,000 $6,000 20% $5,000 $10,000 LF_E4000 CO- CHOICE_20 $4,000 $8,000 20% $6,000 $12,000 LF_E5000 CO- CHOICE_20 $5,000 $10,000 20% $6,850 $13,700 D = Dedctible Only D/C = Dedctible and Coinsrance Emergency Room Urgent Care MDLIVE Virtal Visits $30 per visit $60 per visit $250 per visit $150 per visit $10 per visit These smmaries are only intended to highlight and give a general description of some of the benefits available. For a complete description of benefits, limitations and exclsions, please refer to the Smmary of Participant Responsibility Tables. Standard Pharmacy Benefits Generics Retail Preferred brand drgs 30-day Non-preferred prescription drgs spply Preferred specialty drgs Non-preferred specialty drgs Generics Preferred brand drgs 90-day Non-preferred prescription drgs spply Preferred specialty drgs Non-preferred specialty drgs Retail 30-day spply 90-day spply By-Up Pharmacy Benefits Generics Preferred brand drgs Non-preferred prescription drgs Preferred specialty drgs Non-preferred specialty drgs Generics Preferred brand drgs Non-preferred prescription drgs Preferred specialty drgs Non-preferred specialty drgs All plans with 20% coinsrance $20 per prescription or refill $40 per prescription or refill $60 per prescription or refill 25% after dedctible 40% after dedctible $55 per prescription or refill mail order $105 per prescription or refill mail order $180 per prescription or refill mail order No mail order No mail order All plans with 20% coinsrance $10 per prescription or refill $25 per prescription or refill $50 per prescription or refill 25% after dedctible 40% after dedctible $25 per prescription or refill mail order $60 per prescription or refill mail order $150 per prescription or refill mail order No mail order No mail order EPO NON-HSA PHARMACY 9 networkhealth.com/assre networkhealth.com/assre 12 13

9 EPO HSA PLANS D = Dedctible Only D/C = Dedctible and Coinsrance Ot-of-Pocket Maximm Dedctible Coinsrance Office Visit Emergency PLAN # PLAN NAME Single Family What Participants Pay Single Family PCP Specialist Room Urgent Care AEH1 LF_HSAE1500_0 $1,500 $3,000 0% $1,500 $3,000 D D D D D AEH2 LF_HSAE1500_20 $1,500 $3,000 20% $2,000 $4,000 D/C D/C D/C D/C D/C AEH3 LF_HSAE2000_0 $2,000 $4,000 0% $2,000 $4,000 D D D D D AEH4 LF_HSAE2000_20 $2,000 $4,000 20% $2,500 $5,000 D/C D/C D/C D/C D/C AEH5 LF_HSAE2500_0 $2,500 $5,000 0% $2,500 $5,000 D D D D D AEH6 LF_HSAE2500_20 $2,500 $5,000 20% $3,000 $6,000 D/C D/C D/C D/C D/C AEH7 LF_HSAE3000_0 $3,000 $6,000 0% $3,000 $6,000 D D D D D AEH8 LF_HSAE3000_20 $3,000 $6,000 20% $5,000 $10,000 D/C D/C D/C D/C D/C AEH9 LF_HSAE3500_0 $3,500 $7,000 0% $3,500 $7,000 D D D D D AEH10 LF_HSAE3500_20 $3,500 $7,000 20% $5,500 $11,000 D/C D/C D/C D/C D/C AEH11 LF_HSAE4000_0 $4,000 $8,000 0% $4,000 $8,000 D D D D D AEH12 LF_HSAE4000_20 $4,000 $8,000 20% $6,000 $12,000 D/C D/C D/C D/C D/C AEH13 LF_HSAE5000_0 $5,000 $10,000 0% $5,000 $10,000 D D D D D AEH14 LF_HSAE5000_20 $5,000 $10,000 20% $6,550 $13,100 D/C D/C D/C D/C D/C AEH15 LF_HSAE6500_0 $6,500 $13,000 0% $6,500 $13,000 D D D D D These smmaries are only intended to highlight and give a general description of some of the benefits available. For a complete description of benefits, limitations and exclsions, please refer to the Smmary of Participant Responsibility Tables. Virtal Visits Standard Pharmacy Benefits All plans with 0% coinsrance All plans with 20% coinsrance Generics Dedctible $20 per prescription or refill after dedctible Retail Preferred brand drgs Dedctible $40 per prescription or refill after dedctible 30-day Non-preferred prescription drgs Dedctible $60 per prescription or refill after dedctible spply Preferred specialty drgs Dedctible 25% after dedctible Non-preferred specialty drgs Dedctible 40% after dedctible Generics Dedctible $55 prescription or refill mail order after dedctible Preferred brand drgs Dedctible $105 prescription or refill mail order after dedctible 90-day Non-preferred prescription drgs Dedctible $180 prescription or refill mail order after dedctible spply Preferred specialty drgs No mail order No mail order Non-preferred specialty drgs No mail order No mail order Retail 30-day spply 90-day spply By-Up Pharmacy Benefits All plans with 0% coinsrance All plans with 20% coinsrance Generics Dedctible $10 per prescription or refill after dedctible Preferred brand drgs Dedctible $25 per prescription or refill after dedctible Non-preferred prescription drgs Dedctible $50 per prescription or refill after dedctible Preferred specialty drgs Dedctible 25% after dedctible Non-preferred specialty drgs Dedctible 40% after dedctible Generics Dedctible $25 per prescription or refill mail order after dedctible Preferred brand drgs Dedctible $60 per prescription or refill mail order after dedctible Non-preferred prescription drgs Dedctible $150 per prescription or refill mail order after dedctible Preferred specialty drgs No mail order No mail order Non-preferred specialty drgs No mail order No mail order EPO HSA PHARMACY 9 networkhealth.com/assre networkhealth.com/assre 14 15

10 POS NON-HSA PLANS PLAN # AP5 AP6 AP7 AP8 AP9 AP10 AP11 PLAN NAME LF_P1000 LF_P1500 LF_P2000 LF_P2500 LF_P3000 LF_P4000 LF_P5000 D = Dedctible Only D/C = Dedctible and Coinsrance These smmaries are only intended to highlight and give a general description of some of the benefits available. For a complete description of benefits, limitations and exclsions, please refer to the Smmary of Participant Responsibility Tables. Emergency/Urgent Care In-Network Ot-of-Network Emergency Room $250 per visit $250 per visit Urgent Care $150 per visit 40% after dedctible Dedctible Coinsrance Ot-of-Pocket Maximm Office Visit In-Network Ot-of-Network In-Network Ot-of- Network In-Network Ot-of-Network In-Network MDLIVE Virtal Visits $10 per visit for all POS Non-HSA Plan. Benefits only available throgh the Network Health virtal visit provider network. Ot-of- Network In-Network Single Family Single Family What Participants Pay Single Family Single Family PCP Specialist $1,000 $2,000 $2,000 $4,000 20% 40% $3,000 $6,000 $6,000 $12,000 $1,500 $3,000 $3,000 $6,000 20% 40% $3,500 $7,000 $7,000 $14,000 D/C D/C $2,000 $4,000 $4,000 $8,000 20% 40% $4,000 $8,000 $8,000 $16,000 D/C D/C $30 per $2,500 $5,000 $5,000 $10,000 20% 40% $4,500 $9,000 $9,000 $18,000 D/C $60 per D/C visit visit $3,000 $6,000 $6,000 $12,000 20% 40% $5,000 $10,000 $10,000 $20,000 D/C D/C $4,000 $8,000 $8,000 $16,000 20% 40% $6,000 $12,000 $12,000 $24,000 D/C D/C $5,000 $10,000 $10,000 $20,000 20% 40% $6,850 $13,700 $13,700 $27,400 D/C D/C D/C Ot-of- Network D/C All plans with 20% coinsrance Standard Pharmacy Benefits In-Network Ot-of-Network Generics $20 per prescription or refill Not Covered Retail Preferred brand drgs $40 per prescription or refill Not Covered 30-day Non-preferred prescription drgs $60 per prescription or refill Not Covered spply Preferred specialty drgs 25% after dedctible Not Covered Non-preferred specialty drgs 40% after dedctible Not Covered Generics $55 per prescription or refill mail order Not Covered Preferred brand drgs $105 per prescription or refill mail order Not Covered 90-day Non-preferred drgs $180 per prescription or refill mail order Not Covered spply Preferred specialty drgs No mail order Not Covered Non-preferred specialty drgs No mail order Not Covered Retail 30-day spply 90-day spply By-Up All plans with 20% coinsrance Pharmacy Benefits In-Network Ot-of-Network Generics $10 per prescription or refill Not Covered Preferred brand drgs $25 per prescription or refill Not Covered Non-preferred prescription drgs $50 per prescription or refill Not Covered Preferred specialty drgs 25% after dedctible Not Covered Non-preferred specialty drgs 40% after dedctible Not Covered Generics $25 per prescription or refill mail order Not Covered Preferred brand drgs $60 per prescription or refill mail order Not Covered Non-preferred prescription drgs $150 per prescription or refill mail order Not Covered Preferred specialty drgs No mail order Not Covered Non-preferred specialty drgs No mail order Not Covered POS NON-HSA PHARMACY 916 networkhealth.com/assre networkhealth.com/assre 17

11 POS HSA PLANS PLAN # PLAN NAME Single Family Single Family What Participants Pay Single Family Single Family PCP Specialist PCP Specialist AHP1 LF_HSAP1500_0 $1,500 $3,000 $2,500 $5,000 0% 20% $1,500 $3,000 $4,000 $8,000 D D D/C D/C AHP2 LF_HSAP1500_20 $1,500 $3,000 $3,000 $6,000 20% 40% $2,000 $4,000 $6,000 $12,000 D/C D/C D/C D/C AHP3 LF_HSAP2000_0 $2,000 $4,000 $3,000 $6,000 0% 20% $2,000 $4,000 $5,000 $10,000 D D D/C D/C AHP4 LF_HSAP2000_20 $2,000 $4,000 $4,000 $8,000 20% 40% $2,500 $5,000 $7,000 $14,000 D/C D/C D/C D/C AHP5 LF_HSAP2500_0 $2,500 $5,000 $3,500 $7,000 0% 20% $2,500 $5,000 $6,000 $12,000 D D D/C D/C AHP6 LF_HSAP2500_20 $2,500 $5,000 $5,000 $10,000 20% 40% $3,000 $6,000 $8,000 $16,000 D/C D/C D/C D/C AHP7 LF_HSAP3000_0 $3,000 $6,000 $4,000 $8,000 0% 20% $3,000 $6,000 $8,000 $16,000 D D D/C D/C AHP8 LF_HSAP3000_20 $3,000 $6,000 $6,000 $12,000 20% 40% $5,000 $10,000 $9,000 $18,000 D/C D/C D/C D/C AHP9 LF_HSAP3500_0 $3,500 $7,000 $4,500 $9,000 0% 20% $3,500 $7,000 $9,000 $18,000 D D D/C D/C AHP10 LF_HSAP3500_20 $3,500 $7,000 $7,000 $14,000 20% 40% $5,500 $11,000 $11,000 $22,000 D/C D/C D/C D/C AHP11 LF_HSAP4000_0 $4,000 $8,000 $5,000 $10,000 0% 20% $4,000 $8,000 $10,000 $20,000 D D D/C D/C AHP12 LF_HSAP4000_20 $4,000 $8,000 $8,000 $16,000 20% 40% $6,000 $12,000 $12,000 $24,000 D/C D/C D/C D/C AHP13 LF_HSAP5000_0 $5,000 $10,000 $6,000 $12,000 0% 20% $5,000 $10,000 $13,100 $26,200 D D D/C D/C AHP14 LF_HSAP5000_20 $5,000 $10,000 $9,000 $18,000 20% 40% $6,550 $13,100 $13,000 $26,000 D/C D/C D/C D/C AHP15 LF_HSAP6500_0 $6,500 $13,000 $7,500 $15,000 0% 20% $6,500 $13,000 $14,000 $28,000 D D D/C D/C D = Dedctible Only D/C = Dedctible and Coinsrance These smmaries are only intended to highlight and give a general description of some of the benefits available. For a complete description of benefits, limitations and exclsions, please refer to the Smmary of Participant Responsibility Tables. Emergency/Urgent Care Dedctible Coinsrance Ot-of-Pocket Maximm Office Visit In-Network Ot-of-Network In-Network Ot-of-Network In-Network Ot-of-Network In-Network Ot-of-Network 0% Coinsrance 20% Coinsrance In-Network Ot-of-Network In-Network Ot-of-Network Emergency Room Dedctible Dedctible/Coinsrance Urgent Care D D/C D/C D/C MDLIVE Virtal Visits Sbject to dedctible and coinsrance (Example: Se has an online visit with an MDLIVE doctor. The cost is $40. She has already met her dedctible. The $40 is now sbject to the coinsrance of her plan. If Se had not yet met her dedctible, she wold pay $40 for the virtal visit and it wold be applied toward her dedctible.) All plans with 0% coinsrance All plans with 20% coinsrance Standard Pharmacy Benefits In-Network Ot-of-Network In-Network Ot-of-Network Generics Dedctible Not Covered $20 per prescription or refill after dedctible Not Covered Preferred brand drgs Dedctible Not Covered $40 per prescription or refill after dedctible Not Covered Retail Non-preferred prescription drgs Dedctible Not Covered $60 per prescription or refill after dedctible Not Covered 30-day spply Preferred specialty drgs Dedctible Not Covered 25% after dedctible Not Covered Non-preferred specialty drgs Dedctible Not Covered 40% after dedctible Not Covered Generics Dedctible Not Covered $55 per prescription or refill mail order after dedctible Not Covered Preferred brand drgs Dedctible Not Covered $105 per prescription or refill mail order after dedctible Not Covered Non-preferred prescription drgs Dedctible Not Covered $180 per prescription or refill mail order after dedctible Not Covered 90-day spply Preferred specialty drgs No mail order Not Covered No mail order Not Covered Non-preferred specialty drgs No mail order Not Covered No mail order Not Covered Retail 30-day spply 90-day spply By-Up All plans with 0% coinsrance All plans with 20% coinsrance Pharmacy Benefits In-Network Ot-of-Network In-Network Ot-of-Network Generics Dedctible Not Covered $10 per prescription or refill after dedctible Not Covered Preferred brand drgs Dedctible Not Covered $25 per prescription or refill after dedctible Not Covered Non-preferred prescription drgs Dedctible Not Covered $50 per prescription or refill after dedctible Not Covered Preferred specialty drgs Dedctible Not Covered 25% after dedctible Not Covered Non-preferred specialty drgs Dedctible Not Covered 40% after dedctible Not Covered Generics Dedctible Not Covered $25 per prescription or refill mail order after dedctible Not Covered Preferred brand drgs Dedctible Not Covered $60 per prescription or refill mail order after dedctible Not Covered Non-preferred prescription drgs Dedctible Not Covered $150 per prescription or refill mail order after dedctible Not Covered Preferred specialty drgs No mail order Not Covered No mail order Not Covered Non-preferred specialty drgs No mail order Not Covered No mail order Not Covered POS HSA PHARMACY 9 networkhealth.com/assre networkhealth.com/assre 19

12 Looking for more? Contact yor agent, broker or consltant to see if the Assre plan is right for yor bsiness and to get a qote. Visit networkhealth.com/assre for more details or yo can also reach or sales team at

13 1570 Midway Pl. Menasha, WI networkhealth.com/assre Self-insred plans administered by Network Health Administrative Services, LLC. c-sls-assrepbro-1017 SAL