Brevard Public Schools Medical Plan Options & Resources

Transcription

1 Brevard Public Schools Medical Plan Options & Resources Plan Year: 1/1/ /31/ a 04/14 Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.

2 Cigna Pre- Enrollment Line A Cigna Pre-Enrollment hotline will be available to all enrolling BPS employees and dependents Enrollees can call and speak with a knowledgeable Enrollment Specialist for: Information on their specific plan options Help finding participating doctors and other health care professionals. Help to get comparisons of all Cigna products and resources available to them The specialists can provide contracted rates for services and prescriptions The hotline is staffed 24 / 7 / 365 It will remain open throughout the year for new hires Phone Number:

3 BPS Health Plan 2018 Employee payroll deductions for medical coverage remain the same Changes for telehealth services Copay will be reduced to just $10! An additional provider Amwell will join MDLive to offer telehealth services

4 Wellness Incentive Activities 1. Biometric Screenings What are they? Cholesterol / HDL /Weight / Height /Body Mass Index (BMI) / Blood Pressure / Waist Measurement Where and When Do They Take Place? Beginning in September at Schools and Work sites Year-round at Labs/ Physician offices /BPS Well- Care Centers 2. Health Risk Assessments What is it? A Health Questionnaire How do I do it? Log on to mycigna.com 4

5 Wellness Incentive Reward IF both the Biometric Screening and Health Risk Assessment are completed, the In-network BPS Health plan deductible will be: $500 / Individual $1,000 / Two or more If both activities are not completed, the In-network BPS Health plan deductible will be: $1,500 / Individual $3,000 / Two or more e 04/14 Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.

6 BPS Incentive Rewards Program January 2018 Activity Milestone Award Points Health Assessment Biometric Screening (onsite or PCP) Required for reduced medical plan In-network deductible Required for reduced medical plan In-network deductible Required for reduced medical plan deductible. Annual Physical Get an annual physical 100 points BMI Blood Pressure Waist Circumference Dental Cleaning (Self-Reported) Achieve/Maintain a healthy Body Mass Index of less than 30 Achieve/Maintain a healthy blood pressure of less than or equal to139/89 Achieve/Maintain a healthy waist circumference of less than 35 for women and 40 for men Dental Preventive Exams up to 2 per year 75 points 75 points 75 points 2 x 50 points for each cleaning = 100 points Telephonic Coaching Make progress towards personal health goal 75 points Online Coaching Program Complete one online health coachingprogram 50 points Flu Shot Get a flu shot 25 points Earn 450 points and your name will be put in a drawing to earn a prize (ex: Gift Card)* *PPACA alternatives available

7 2018 BPS Health Plan BPS Health Plan w/ Wellness BPS Health Plan Wellness Incentive (Received if an ACTIVE EE and both activities are completed) Your Costs In-Network Deductible: $500 EE / $1,000 Two or more Your Costs Not Applicable Network National OAP Network National OAP Network Individual Deductible $500 $1,500 Family Deductible $1,000 $3,000 Deductible Application Medical Medical Coinsurance (Plan/Member) Plan 80% / You 20% Plan 80% / You 20% Individual In-network Out of Pocket Maximum (includes deductible) Non-collective Family Innetwork Out-of-Pocket Maximum (includes deductible) $4,000 $4,000 $8,000 $8,000 7

8 2018 BPS Health Plan BPS Health Plan w/ Wellness Your Costs BPS Health Plan Your Costs Preventive Services 100% covered 100% covered Primary Care Physician $30 copay $30 copay Specialist $50 copay $50 copay Preferred Health Centers $15 copay $15 copay Urgent Care $45 copay (waived if admitted) $45 copay (waived if admitted) Emergency Room 20%^ + $250 copay (waived if admitted) 20%^ + $250 copay (waived if admitted) Inpatient Hospital $600 copay per admit + 20%^ coinsurance $600 copay per admit + 20%^ coinsurance Outpatient Services 20%^ 20%^ ^Cost share after deductible is met 8

9 2018 BPS Health Plan Place of Service: Your Plan Pays Based on Where You Receive Services Note: Services where plan deductible applies are noted with a caret (^). These Benefits apply to both the BPS Plan With & Without Wellness The only difference is the amount of the deductible ($500 / $1,000) ($1,500 / $3,000) Benefit Physician s Office (Your Cost) Independent Lab (Your Cost) Emergency Room & Urgent Care Facility (Your Cost) Outpatient Facility (Your Cost) In- Network Out-of- Network In- Network Out-of- Network In- Network Out-of- Network In- Network Out-of- Network Lab $0 40%^ $0 40%^ ER: 20%^ UC: $0 $0 40%^ X-ray 20%^ 40%^ N/A 40%^ ER: 20%^ UC: $0 20%^ 40%^ Advanced Radiology Imaging N/A 40%^ N/A N/A ER: 20%^ UC: 20%^ 20%^ 40%^ Advanced Radiology Imaging (ARI) includes MRI, MRA, CAT Scan, PET Scan etc. Note: All lab and x-ray services including ARI provided at Inpatient Hospital are covered under Inpatient Hospital Benefit. Note: X-Rays will be covered 100% only if completed at Urgent Care Facility. 9

10 2018 Pharmacy Benefits BPS Plan w/ Wellness BPS Plan In-Network Only Retail (30-day supply) Home Delivery (90-day supply) Retail 90 (90 days from a Retail Pharmacy)* Retail (30-day supply) Home Delivery (90-day supply) Retail 90 (90 days from a Retail Pharmacy)* Preventive Medications CopaysApply Copays Apply Copays Apply Copays apply Copays apply Copays Apply Generic You pay $20 You pay $40 You pay $60 You pay $20 You pay $40 You pay $60 Cigna- Preferred Brand You pay $50 You pay $100 You pay $150 You pay $50 You pay $100 You pay $150 Specialty Rx Cigna Home Delivery is Exclusive Provider You pay $125 You pay $250 You pay $375 You pay $125 You pay $250 You pay $375 Prescription Drug List: Standard Rx Program subject to Refill-too-soon and Prior Authorization, Step Therapy, Quantity Limits etc. See Certificate of Coverage for details. *Retail 90 available at select Pharmacies. 10

11 GETTING THE MOST OUT OF THE CIGNA PHARMACY BENEFITS PLAN: Learn what drugs are covered Compare prices Use Cigna Home Delivery Pharmacy Talk to a pharmacist any time Use mycigna.com or mycigna MobileApp Review the covered drug list on Cigna.com, mycigna.com or the mycigna Mobile App to know which drugs are generic or preferred and cost less Prescription Drug Quote Tool on mycigna.com and the mycigna Mobile App shows what drugs cost, or compare prices at over 62,000 retail pharmacies and Cigna Home Delivery Pharmacy Medications delivered right to your door at no additional cost there may even be a cost savings TheraCare provides education and support for customers who have complex conditions and may use injectable medications 24/7/365 access to claim history, benefit details, drug and pharmacy comparison tools and a pharmacist to answer your questions 11

12 Open Access Plus Network National Network 699,600 doctors and specialists 5,800 hospitals and facilities No referrals needed No designated PCP needed Same network as last year National Labs LabCorp and Quest: With national labs Quest Diagnostics or Laboratory Corporation of America (LabCorp), members can save up to 84%. There are hundreds of locations nationwide, so Quest Diagnostics and LabCorp make it easy to get lab services at a lower cost. Other labs are part of the Cigna network, (for example those associated with a doctor s office or on site at a hospital), but customers will likely get even bigger savings when they go to Quest Diagnostics or LabCorp. 12

13 Finding In-Network Doctors & Facilities During Open Enrollment: Current non-cigna members can log onto Cigna.com to find in-network providers and facilities ~ be sure you are in the OAP Network 13

14 Current Cigna Customers: mycigna.com Find A Doctor or Service 14

15 Cost Savings Opportunities 1.List is not all-inclusive. 2. America's Emergency Care Environment, A State-by-State Report Card ", American College of Emergency Physicians (ACEP) The information provided here is for informational purposes only. You should consult your doctor for medical advice or services, including seeking advice prior to receiving care. During a medical emergency, go to the nearest hospital or call

16 Now just $10.00 per session! Get health related services via telephone, smartphone and computer. Provides condition appropriate care at alternative network locations. Secure, virtual Skype-like consultations. 16

17 Conditions Treated By MDLIVE Doctors General Health Acne Allergies Bronchitis Cold & flu Fever Gout Headache Infections Joint aches & pains Nausea & vomiting Pink eye Rashes Sinus infection Sore throat Sunburn Urinary tract infection Pediatric Care Cold & flu Constipation Ear infection Fever Nausea & vomiting Pink eye 17

18 A Doctor Is Always In MDLIVE provides immediate, on-demand 24/7/365 access to affordable, quality non-urgent care through a national network of licensed, board-certified U.S.-based doctors, including pediatricians. Online video consultations Phone consultations communication, post consultation Prescription services (sent directly to a pharmacy) Health care services are delivered by MDLIVE participating doctors and not by Cigna. 18

19 Registration Look for the MD Live link on your mycigna home page. Link to come from vendor Register Right Away! Register BEFORE you need to use MDLIVE and it will be ready for you when you DO need it! 19

20 What s available on mycigna for members? mycigna.com Print forms or print/order ID cards Check your coverage and explanation of benefits Track claims, payments and deductibles Sign up for online coaching programs Keep track of your health history and records with an online personal health record Find in-network doctors, specialists, hospitals and labs Learn about common health problems and treatment options Compare treatment and procedure costs Find cost and quality ratings for doctors and hospitals Switch a prescription to Cigna Home Delivery Pharmacy with one easy phone call, and have your medications delivered to your door Talk with a health specialist when you can t reach your doctor day or night No claim forms needed in-network 20

21 Cigna is OPEN 24/7/365 By phone Cigna24 Call us anytime day or night live, 24/7 customer service, 365 days a year Ask for a Spanish-speaking representative or speak with us in your preferred language interpreter service is available in over 150 languages Online and on the go mycigna.com and mycigna Mobile App Award-winning* directory of doctors, hospitals, facilities with cost and quality ratings Coverage details (copays, deductibles, out-of-pocket maximums, etc.) Claim activity and history Temporary ID cards or info on how to order new ones (mycigna.com only) A wealth of health information and resources (mycigna.com only) Compare drug prices with our Prescription Drug Price Quote tool You could save money when you order through Cigna Home Delivery Pharmacy (mycigna.com only) *. mycigna.com health care cost and quality capabilities named one of the top ten innovations of 2012 by Information Week. 21

22 Questions? If you still have questions about your benefits and Cigna Resources, please call Cigna-24 ( ) or see your Benefits Department for additional information. Rates will vary by plan design including the amount of plan deductibles, coinsurance, and out-of-pocket and lifetime maximums. All health insurance policies and health benefit plans have exclusions and limitations. For costs and details of coverage, see your enrollment materials. The information in this presentation summarizes the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see your employer s group insurance certificate, summary plan description or group service agreement the official plan documents. If there are any differences between the information in this presentation and the plan documents, the information in the plan documents takes precedence. Cigna, the Tree of Life logo, GO YOU, TheraCare and Healthy Rewards are registered service marks, and Cigna Home Delivery Pharmacy is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Tel- Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., Cigna Onsite Health, LLC, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc. (IL & IN), Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc. (MO, KS & IL), Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (TN & MS), and Cigna HealthCare of Texas, Inc. Cigna Home Delivery Pharmacy refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. In Texas, Open Access Plus and LocalPlus plans are considered Preferred Provider plans with certain managed care features and Open Access Plus IN and LocalPlus IN plans are considered Exclusive Provider plans with certain managed care features. All models are used for illustrative purposes only a 04/ Cigna. Some content provided underlicense.