Luzerne County Head Start

Transcription

1 Luzerne County Head Start Howell Benefit Services, Inc. Linda Antosh, Product Specialist

2 Luzerne County Head Start Effective July 1, 2012 Geisinger Health Plan PPO Health Reimbursement Arrangement (HRA) No changes Met Life Dental Plan No changes to dental plan benefits

3 Health Reimbursement Arrangement (HRA) What Is It and How Does It Work? An HRA is not insurance. It is a vehicle to help employees pay part of the annual deductible and is funded by Luzerne County Head Start. Health plan has an annual deductible of $1,000 per individual and $3,000 per family. Deductible is based on Plan Year (July- June) Employee pays first $250 of expenses applied to deductible. HRA will automatically process and pay providers the remaining $750 through Connect Your Care (Third Party Administrator).

4 HRA Model Deductible: $1,000 Individual $3,000 Family Employee pays first $250 applied to the Individual Deductible Maximum of 3 deductibles per family LCHS pays remaining $750 of Individual Deductible Maximum of 3 deductibles per family

5 Dental Plan

6 Met Life Dental Plan In-Network Out-of-Network Annual Deductible None None Calendar Year Max $1,250 per person $1,250 per person

7 Met Life Dental Plan In-Network Out-of-Network Type A Preventive 100% 100% Oral Exams Full Mouth X-rays Periapical X-rays Other X-rays Bitewing X-rays Cleanings Fluoride Treatments Sealants Emergency Palliative Treatment

8 Met Life Dental Plan In-Network Out-of-Network Type B Basic 100% 100% Labs & Other Tests Space Maintainers Fillings Repairs Pulp Capping Endodontics Root Canal/ Pulpotomy Pulp Therapy Periodontics Non-Surgical Periodontal Maintenance

9 Met Life Dental Plan In-Network Out-of-Network Type C - Major 30% 20% Crowns Crown Build-ups/ Post & Core Rebases/Relines Oral Surgery Inlays/Crowns Prefab Stainless Steel and Resin Crowns Periodontal Surgery Surgical Extractions General Anesthesia Recementations Dentures Fixed Bridges Consultations

10 REMEMBER. Each plan year anniversary you are given the option to change your health insurance status You may also change your health insurance status during the plan year if any of the following occur: -marriage -birth or adoption of a child -divorce -termination of spouse s employment -death of a spouse or child -change in status full/part time of employee or spouse -change in health coverage due to spouse s employment

11 Action Needed Discuss options with spouse (if applicable) - Medical - Dental Complete enrollment/change forms if enrolling new or changing dependent status

12 Luzerne County Head Start Please return all enrollment forms to Human Resources by Monday, May 14th DON T FORGET TO SIGN YOUR FORMS! Thank You

13 Geisinger Health Plan 2012 Open Enrollment Luzerne County Head Start Barb Wilson Account Executive 13

14 Your Health Plan #6 in the nation and the top-ranked commercial health plan in PA* Excellent Accreditation from NCQA Maintained the highest level of accreditation since 1994 Extensive Network of providers PPO Medical Benefits PPO Prescription Benefits Accessories/Discount Programs Important Dates/Phone Numbers 14

15 With providers that are close to home Expansive network of providers 90 hospitals 28,000 physicians Access to leading advanced care facilities including Johns Hopkins, Geisinger Medical Center, West Penn Allegheny Health System, University of Maryland Health System, Temple University, University of Pennsylvania 15

16 16 Find a provider at

17 Benefit Changes effective July 1, 2012 Diabetic eye examinations will now be covered with no cost sharing required Pulmonary function tests will now be covered with no cost sharing required Coverage for durable medical equipment will increase from $2,500 to $5,000 per benefit period The following therapies are excluded from coverage: ayureda, craniosacral therapy, guided imagery, hippotherapy, homeopathy, massage therapy, naturopathy, reiki, therapeutic touch and yoga 17

18 Benefit Changes effective July 1, 2012 Breast reductions for females are covered when medically necessary. Prior authorization is required. Cost sharing for covered injectible drugs will increase from $75 to $100. Out of pocket maximum will increase from $1,200 to $1,500 per benefit period Deductible and co-inisurance will apply for inpatient skilled nursing facility services 18

19 Medical Benefit Options PPO Geisinger Choice No referral $15 PCP copay $25 Specialist copay No copay for well visits for children up to age 21 $100 ER copay $1,000/$3,000 deductible Out of Network Benefits Available 19

20 Screenings & Immunizations Mammograms Pap smears Chlamydia screening for females Dexa scan Fecal occult blood testing Cholesterol screening Diabetes care for ages including HbA1c testing, LDL-C screening and nephropathy screening Lipid Panel Newborn screening: one hematocrit and hemoglobin screening for infants under 24 months Colorectal Cancer screening: ages 50 and over 20

21 Other Services Lab Services: 100% after deductible Radiology: 100% after deductible Inpatient Hospital: 100% after deductible Outpatient Surgery: 100% after deductible Durable Medical Equipment: ($5,000 max per benefit year) Physical, Speech and Occupational Therapy (up to 45 visits): $25 copay Chiropractic Care (15 visits): $15 copay Eye Exams: $0 copay Impacted Wisdom Teeth Extraction: $0 copay 21

22 Prescription Benefits Retail (34 day supply) Mail order (90 Day Supply) Tier 1 $10 copay Tier 1 $20 copay Tier 2 $20 copay Tier 2 $40 copay Tier 3 $35 copay Tier 3 $70 copay 22

23 Urgent Care for urgent needs Stiches, sprains, flu, or minor pains. If you or your children need medical care now, but your doctor isn t in, turn to a Geisinger urgent care or afterhours center. Our professionals will treat injuries or illness that require immediate treatment but may not be serious enough to warrant an emergency room visit. Even better, or centers welcome both Geisinger patients and those who have never visited us before. For care when you need it most, turn to Geisinger for peace of mind. 23

24 Urgent Care Locations Geisinger Wyoming Valley Medical Center (Use Pearsall Heart Hospital entrance) 1000 E. Mountain Blvd, Wilkes-Barre Mon-Fri: 6pm to 11pm, Sat-Sun: 3pm to 11pm Walk-ins and appointments welcome Geisinger South Wilkes-Barre 25 Church St, Wilkes-Barre Mon-Fri: 9am to 9pm, Sat Sun: 9am to 4:30pm Walk-ins and appointments welcome Careworks After-Hours-Mountain Top 229 South Mountain Blvd, Mountain Top Mon-Fri: 5pm to 11pm, Sat Sun: 9am to 9pm No appointments necessary Careworks After-Hours-Dallas 114 Lt. Michael Cleary Drive, Dallas, PA Mon-Fri: 5pm to 11pm, Sat Sun: 9am to 9pm No appointments necessary For a complete listing of participating Urgent Care Centers visit 24

25 Urgent Care Additional Locations Concentra Urgent Care 268 Highland Park Blvd, Wilkes-Barre US Urgent Care LLC 3 West Olive St, Scranton Medical Express Care 1208 O Neill Highway, Dunmore For a complete listing of participating Urgent Care Centers visit 25

26 Member programs to suit every need Accessories program Fitness center discounts, eyeglasses and contact lenses, chiropractic services, acupuncture and massage therapy Phone reminders Immunizations, breast and cervical cancer screenings, and new mother checkups Tel-a-Nurse Free, 24-hour medical assistance hotline ID Cards 26

27 Important Contact Numbers For additional information: Customer Service: Pharmacy: Website: 27

28 28 QUESTIONS??