Benefits Preview Weber State University. Look inside for important information about how to use your PEHP benefits.

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1 Weber State University Benefits Preview Look inside for important information about how to use your PEHP benefits.

2 Weber State University » Contact Information Welcome to PEHP We want to make accessing and understanding your healthcare benefits simple. This Benefits Summary contains important information on how best to use PEHP s comprehensive benefits. Please contact the following PEHP departments or affiliates if you have questions. On the Web»myPEHP mypehp is your online source for personal health and plan benefit information. You can review your claims history, see a comprehensive list of your coverages, look up contracted providers, and more. Create a mypehp account to enroll in PEHP benefits electronically. Customer Service or Weekdays from 8 a.m. to 5 p.m. Have your PEHP ID or Social Security number on hand for faster service. Foreign language assistance available Pre-notification/pre-authorization»Inpatient hospital pre-notification or Mental Health/Substance Abuse pre-authorization»pehp Customer Service or Prescription drug benefits»pehp Customer Service or »Express Scripts Specialty pharmacy»accredo PEHP flex$/limited FLEX$»PEHP FLEX$ Department or health savings accounts (HSA)»Health Equity Prenatal program» PEHP WeeCare or wellness and disease management» PEHP Healthy Utah or PEHP Waist Aweigh or » PEHP Integrated Care or /weecare Value-Added Benefits program» PEHPplus.../plus»Blomquist Hale Online enrollment help line or Claims mailing address PEHP 560 East 200 South Salt Lake City, Utah PAGE 2

3 Weber State University » Benefit Changes & Reminders Benefit Changes & Reminders All Medical Plans» Healthcare Reform requires a Summary of Benefits and Coverage (SBC) to be distributed to all benefiteligible employees before open enrollment. This will be distributed through a WSU Special Campus Bulletin during the first week of April.» Effective Jan. 1, 2013, new preventive services for women have been added to the Affordable Care Act list. Please see the Master Policy for a complete list of preventive services.» Accupuncture services are no longer a covered benefit.» Medco, PEHP s pharmacy benefit manager, is now known as Express Scripts and can be found online at Members who made changes to their PEHP plans will receive a new ID card in the mail from Express Scripts. It will serve as your medical, pharmacy, and out-of-state network ID card. If you did not make changes, continue to use your current card(s).» Members can shop for value, compare prices, and save money using PEHP s new Cost & Quality Tools, accessible through their mypehp account.» Medicare Supplement plans PEHP offers three Medicare Supplement Medical plans and Medicare Part D approved Prescription Drug plans. PEHP also offers a value-added Discount Dental plan to individuals who enroll in one of the PEHP Medicare Medical Supplement options. Please contact PEHP Customer Service for more details and enrollment information. The STAR Plan» The STAR Plan will continue to be an option using the Advantage and Summit Care networks. The STAR Plan has two components: A High Deductible Health Plan HDHP) and a Health Savings Account (HSA). There is no employee cost share for this plan. Those enrolled in the STAR PLAN will receive semimonthly contributions to their HSA in the amount of $31.25 single / $62.50 double and family each pay day. FLEX$ Changes» Due to Federal Healthcare Reform, the medical Flexible Spending Account maximum has been reduced to $2,500. The dependent day care maximum will remain at $5,000.» Beginning April 1, 2013, PEHP FLEX$ card holders may be required to enter a Personal Identification Number (PIN) when making point-of-sale purchases. To view your PIN, you will need your PEHP member ID (last 6 digits) and FLEX$ card number. Log in to your mypehp account and, once on the FLEX$ page, click on Card Status. Follow the online steps to view your PIN, as well as PINs for other cardholders on your account. Questions? Please contact PEHP FLEX$ at PAGE 3

4 Weber State University » PEHP Medical Networks PEHP Medical Networks PEHP Advantage Care The PEHP Advantage Care network of contracted providers consists of predominantly Intermountain Healthcare (IHC) providers and facilities. It includes 34 participating hospitals and more than 7,500 participating providers. PARTICIPATING HOSPITALS Beaver County Beaver Valley Hospital Milford Valley Memorial Hospital Box Elder County Bear River Valley Hospital Cache County Logan Regional Hospital Carbon County Castleview Hospital Davis County Davis Hospital Duchesne County Uintah Basin Medical Center Garfield County Garfield Memorial Hospital Grand County Moab Regional Hospital Iron County Valley View Medical Center Juab County Central Valley Medical Center Kane County Kane County Hospital Millard County Delta Community Medical Center Fillmore Community Hospital Salt Lake County Alta View Hospital Intermountain Medical Center PEHP Preferred Care Salt Lake County (cont.) The Orthopedic Specialty Hospital (TOSH) LDS Hospital Primary Children s Medical Center Riverton Hospital San Juan County Blue Mountain Hospital San Juan Hospital Sanpete County Gunnison Valley Hospital Sanpete Valley Hospital Sevier County Sevier Valley Medical Center Summit County Park City Medical Center Tooele County Mountain West Medical Center Uintah County Ashley Valley Medical Center Utah County American Fork Hospital Orem Community Hospital Utah Valley Regional Medical Center Wasatch County Heber Valley Medical Center Washington County Dixie Regional Medical Center Weber County McKay-Dee Hospital The PEHP Preferred Care network of contracted providers consists of providers and facilities in both the Advantage Care and Summit Care networks. It includes 46 participating hospitals and more than 12,000 participating providers. PEHP Summit Care The PEHP Summit Care network of contracted Providers consists of predominantly IASIS, MountainStar, and University of Utah hospitals & clinics providers and facilities. It includes 38 participating hospitals and more than 7,500 participating providers. PARTICIPATING HOSPITALS Beaver County Beaver Valley Hospital Milford Valley Memorial Hospital Box Elder County Bear River Valley Hospital Brigham City Community Hospital Cache County Logan Regional Hospital Carbon County Castleview Hospital Davis County Lakeview Hospital Davis Hospital Duchesne County Uintah Basin Medical Center Garfield County Garfield Memorial Hospital Grand County Moab Regional Hospital Iron County Valley View Medical Center Juab County Central Valley Medical Center Kane County Kane County Hospital Millard County Delta Community Medical Center Fillmore Community Hospital Salt Lake County Huntsman Cancer Hospital Jordan Valley Hospital Salt Lake County (cont.) Pioneer Valley Hospital Primary Children s Medical Center Riverton Children s Unit St. Marks Hospital Salt Lake Regional Medical Center University of Utah Hospital University Orthopaedic Center San Juan County Blue Mountain Hospital San Juan Hospital Sanpete County Gunnison Valley Hospital Sanpete Valley Hospital Sevier County Sevier Valley Medical Center Summit County Park City Medical Center Tooele County Mountain West Medical Center Uintah County Ashley Valley Medical Center Utah County Mountain View Hospital Timpanogos Regional Hospital Wasatch County Heber Valley Medical Center Washington County Dixie Regional Medical Center Weber County Ogden Regional Medical Center Find Participating Providers Go to to look up participating providers for each plan. PAGE 4

5 Weber State University » Understanding Your Benefit Grid Understanding Your Benefits Grid DeDuctibles, Plan MaxiMuMs, and limits Medical Plan year Deductible $250 per individual, $500 per family. Does not apply to Out-of-Pocket Maximum 1 Only applies for inpatient, outpatient hospital ch Pharmacy Deductible Does not apply to Out-of-Pocket Maximum Plan year Out-of-Pocket Maximum Maximum Lifetime Benefit Pre-existing Condition Waiting Period inpatient facility services al and Surgical Requires Pre-notification lity Non-custodial $100 per individual, $200 per family. $2,000 per individual, $4,000 per family None 9-month Waiting Period waived with evid 90% of MAF after Deductible 90% of MAF after Co Copayment A specific amount you pay directly to a provider when you receive covered services. This can be either a fixed dollar amount or a percentage of the PEHP Maximum Allowable Fee. Contracted Contracted benefits apply when you receive covered services from contracted providers. You are responsible to pay the applicable copayment. Non-Contracted If your plan allows the use of non-contracted providers, noncontracted benefits apply when you receive covered services. You are responsible to pay the applicable copayment, plus the difference between the billed amount and PEHP s Maximum Allowable Fee (see Page 12). Maximum Allowable Fee (MAF) A schedule of maximum allowable fees established by PEHP and accepted by contracted providers, along with any required member copayment as payment in full (see Page 12) medical Deductible The set dollar amount that you must pay for yourself and/or your family members before PEHP begins to pay for covered medical benefits. Pharmacy deductible The set dollar amount separate from the medical plan year deductible that you must pay for pharmacy for yourself and/or your family members before PEHP begins to pay for covered pharmacy benefits. Plan Year Out-of-Pocket Maximum The maximum dollar amount that you and/ or your family pays each year for covered medical services in the form of copayments and coinsurance (includes deductibles on The STAR Plan). Maximum LIFETIME BENEFIT The total amount the plan pays for each covered family member in his or her lifetime. Pre-Existing Condition Waiting Period A condition that is present six months before your plan enrollment date for which medical treatment, consultation, or diagnostic testing was received. This section tells you if you have a waiting period before coverage for a preexisting condition begins. PAGE 5

6 Weber State University » Medical Benefits Grid» Advantage, Summit & Preferred Care Traditional (Non-HSA) Summit care Advantage care Preferred care * Services received by a non-contracted provider will be paid at a percentage of PEHP s Maximum Allowable Fee (MAF). You will be responsible for your assigned coinsurance and deductible (if applicable). You will also be responsible for any amounts billed by a noncontracted provider in excess of PEHP s Maximum Allowable Fee. There is no Out-of-Pocket Maximum for services received from a non-contracted provider. Contracted Provider Non-Contracted Provider Deductibles, Plan Maximums, and Limits Plan Year Deductible In and Out of Network Deductibles are combined $250 per individual, $500 per family Same as using a contracted provider *See Above for Additional Information **See Below for Additional Information Pharmacy Deductible $100 per individual, $200 per family Not applicable Plan year Out-of-Pocket Maximum Pharmacy Out-of-Pocket Maximum Does not apply to non-preferred drugs Specialty Drug Out-of-Pocket Maximum, office/outpatient Separate yearly out-of-pocket maximum $2,500 per individual $5,000 per double $7,500 per family $2,000 per individual Not applicable No Out-of-Pocket Maximum *See Above for Additional Information **See Below for Additional Information $3,600 per individual No Out-of-Pocket Maximum Maximum Lifetime Benefit None None Pre-existing Condition Waiting Period Does not apply to any individuals up to age 19 9-month Waiting Period waived or reduced with evidence of prior Creditable Coverage 9-month Waiting Period waived or reduced with evidence of prior Creditable Coverage **Applicable deductibles and coinsurance for services provided by a non-contracted provider will apply to your in-network plan year deductible and Out-of- Pocket Maximum. However, once your in-network deductible and Out-of-Pocket Maximum are met, coinsurance amounts for noncontracted providers will still apply. Inpatient facility services Medical and Surgical Requires pre-notification Skilled Nursing Facility Non-custodial Up to 60 days per plan year. Requires pre-authorization through Medical Case Management Hospice Up to 6 months in a 3-year period. Requires pre-authorization through Medical Case Management Rehabilitation Requires pre-authorization through Medical Case Management Mental Health and Substance Abuse Requires pre-authorization MAF = Maximum Allowable Fee Non-contracted providers may charge more than the MAF unless they have an agreement with you not to. Any amount above the MAF will be billed to you and will not count toward your deductible or out-of-pocket maximum. PAGE 6

7 Weber State University » Medical Benefits Grid» Advantage, Summit & Preferred Care Contracted Provider Non-Contracted Provider OUTPATIENT facility services Outpatient Facility and Ambulatory Surgery Ambulance (ground or air) 80% of MAF after deductible 80% of MAF after deductible Medical emergencies only, as determined by PEHP Emergency Room 80% of MAF, minimum $150 copayment per visit 80% of MAF, minimum $150 copayment per visit Medical emergencies only, as determined by PEHP. If admitted, inpatient facitlity benefit will be applied Urgent Care Facility 100% of MAF after $45 copayment per visit 60% of MAF after deductible University of Utah Medical Group Urgent Care Facility Preferred Care only Diagnostic Tests, X-rays, Minor For each test allowing $350 or less Diagnostic Tests, X-rays, Major For each test allowing more than $ % of MAF after $50 copayment per visit Not applicable Chemotherapy, Radiation, and Dialysis Dialysis with non-contracted providers requires pre-authorization Physical and Occupational Therapy Requires pre-authorization after 8 visits per plan year 100% of MAF after applicable office copayment per visit 60% of MAF after deductible professional services Inpatient Physician Visits 100% of MAF after applicable office copayment 60% of MAF after deductible per visit Surgery and Anesthesia Primary Care Office Visits and Office Surgeries 100% of MAF after $25 copayment per visit 60% of MAF after deductible Specialist Office Visits and Office Surgeries 100% of MAF after $35 copayment per visit 60% of MAF after deductible University of Utah Medical Group 100% of MAF after $50 copayment per visit Not applicable Preferred Care only Emergency Room Specialist 100% of MAF after $35 copayment per visit 100% of MAF after $35 copayment per visit Diagnostic Tests, X-rays, Minor For each test allowing $350 or less Diagnostic Tests, X-rays, Major For each test allowing more than $350 Mental Health and Substance Abuse No pre-authorization required for outpatient services. Inpatient services require pre-authorization Outpatient: 100% of MAF after $35 copayment per visit Inpatient: 80% of MAF after deductible Outpatient: 60% of MAF after deductible Inpatient: 60% of MAF after deductible MAF = Maximum Allowable Fee Non-contracted providers may charge more than the MAF unless they have an agreement with you not to. Any amount above the MAF will be billed to you and will not count toward your deductible or out-of-pocket maximum. PAGE 7

8 Weber State University » Medical Benefits Grid» Advantage, Summit & Preferred Care Contracted Provider Non-Contracted Provider prescription drugs Retail Pharmacy Up to 30-day supply Mail-Order 90-day supply Specialty Medications, retail pharmacy Up to 30-day supply Specialty Medications, office/outpatient Up to 30-day supply Specialty Medications, through specialty vendor Accredo Up to 30-day supply MISCELLANEOUS services Adoption See limitations Preferred generic: $10 copayment after deductible Preferred brand name: 75% of discounted cost after deductible. $25 minimum, no maximum copayment Non-preferred: 50% of discounted cost after deductible. $50 minimum, no maximum copayment Preferred generic: $20 copayment after deductible Preferred brand name: 75% of discounted cost after deductible. $50 minimum, no maximum copayment Non-preferred: 50% of discounted cost after deductible. $100 minimum, no maximum copayment Tier A: 80% of MAF after deductible. No maximum copayment Tier B: 70% of MAF after deductible. No maximum copayment Tier A: 80% of MAF after deductible. No maximum copayment Tier B: 70% of MAF after deductible. No maximum copayment Tier A: 80% of MAF after deductible. $150 maximum copayment Tier B: 70% of MAF after deductible. $225 maximum copayment 100% after deductible, up to $4,000 per adoption Plan pays up to the discounted cost, minus the applicable copayment. Member pays any balance Plan pays up to the discounted cost, minus the applicable copayment. Member pays any balance Plan pays up to the discounted cost, minus the preferred copayment. Member pays any balance 60% of MAF after deductible Not covered 100% after deductible, up to $4,000 per adoption Affordable Care Act Preventive Services 100% of MAF 60% of MAF after deductible See Master Policy for complete list Allergy Serum Chiropractic Care Up to 10 visits per plan year 100% of MAF after applicable office copayment 60% of MAF after deductible per visit Durable Medical Equipment, DME Except for oxygen and sleep disorder equipment, DME over $750, rentals that exceed 60 days, or as indicated in Appendix A of the Master Policy require pre-authorization. Maximum limits apply on many items. See the Master Policy for benefit limits Medical Supplies Home Health/Skilled Nursing Up to 60 visits per plan year. Requires pre-authorization and Medical Case Management Infertility Services Select services only. See the Master Policy 50% of MAF after deductible 30% of MAF after deductible Injections Requires pre-authorization if over $750 Temporomandibular Joint Dysfunction 50% of MAF after deductible 30% of MAF after deductible Up to $1,000 lifetime maximum **Some services on your plan are payable at a reduced benefit of 50% of Maximum Allowable Fee or 30% of Maximum Allowable Fee. These services do not apply to any Outof-Pocket Maximum. Deductible may apply. Refer to the Master Policy for specific criteria for the benefits listed above, as well as information on limitations and exclusions. MAF = Maximum Allowable Fee Non-contracted providers may charge more than the MAF unless they have an agreement with you not to. Any amount above the MAF will be billed to you and will not count toward your deductible or out-of-pocket maximum. PAGE 8

9 Weber State University » Medical Benefits Grid» Advantage & Summit STAR The PEHP STAR Plan (HSA-Qualified) Summit care* Advantage care* Refer to the applicable Master Policy for specific criteria for the benefits listed below, as well as information on limitations and Exclusions. * Services received by a non-contracted provider will be paid at a percentage of PEHP s Maximum Allowable Fee (MAF). You will be responsible for your assigned coinsurance and deductible (if applicable). You will also be responsible for any amounts billed by a non-contracted provider in excess of PEHP s Maximum Allowable Fee. There is no Out-of-Pocket Maximum for services received from a noncontracted provider. Deductibles, Plan Maximums, and Limits Plan Year Deductible $1,500 single plan $3,000 double or family plan Plan Year Out-of-Pocket Maximum Includes amounts applied to deductible and prescription drugs $2,500 single plan $5,000 double plan $7,500 family plan Maximum Lifetime Benefit None None Pre-existing Condition Waiting Period Does not apply to any individuals up to age 19 INPATIENT FACILITY SERVICES 9-month Waiting Period waived or reduced with evidence of prior Creditable Coverage Same as using a contracted provider *See Above for Additional Information No Out of Network Out-of-Pocket Maximum *See Above for Additional Information 9-month Waiting Period waived or reduced with evidence of prior Creditable Coverage Medical and Surgical Requires pre-authorization Skilled Nursing Facility Non-custodial Up to 60 days per plan year. Requires pre-authorization through Medical Case Management Hospice Up to 6 months in a 3-year period. Requires pre-authorization through Medical Case Management Rehabilitation Requires pre-authorization through Medical Case Management Mental Health and Substance Abuse Requires pre-authorization Contracted Provider Non-Contracted Provider 80% of MAF after deductible 80% of MAF after deductible MAF = Maximum Allowable Fee Non-contracted providers may charge more than the MAF unless they have an agreement with you not to. Any amount above the MAF will be billed to you and will not count toward your deductible or out-of-pocket maximum. PAGE 9

10 Weber State University » Medical Benefits Grid» Advantage & Summit STAR OUTPATIENT facility services Outpatient Facility and Ambulatory Surgery Ambulance (ground or air) 80% of MAF after deductible 80% of MAF after deductible Medical emergencies only, as determined by PEHP Emergency Room 80% of MAF after deductible 80% of MAF after deductible Medical emergencies only, as determined by PEHP Urgent Care Facility Diagnostic Tests, X-rays, Minor For each test allowing $350 or less Diagnostic Tests, X-rays, Major For each test allowing more than $350 Chemotherapy, Radiation, and Dialysis Dialysis with non-contracted providers requires pre-authorization Physical and Occupational Therapy Requires pre-authorization after 8 visits Contracted Provider Non-Contracted Provider professional services Inpatient Physician Visits Surgery and Anesthesia Primary Care Office Visits and Office Surgeries Specialist Office Visits and Office Surgeries Emergency Room Specialist 80% of MAF after deductible 80% of MAF after deductible Diagnostic Tests, X-rays, Minor For each test allowing $350 or less Diagnostic Tests, X-rays, Major For each test allowing more than $350 Immunizations 100% of MAF 60% of MAF after deductible Mental Health and Substance Abuse Up to 30 visits per plan year for outpatient services. No pre-authorization required for outpatient services. Inpatient services require pre-authorization Outpatient: 50% of MAF after deductible Inpatient: 80% of MAF after deductible Outpatient: 30% of MAF after deductible Inpatient: 60% of MAF after deductible MAF = Maximum Allowable Fee Non-contracted providers may charge more than the MAF unless they have an agreement with you not to. Any amount above the MAF will be billed to you and will not count toward your deductible or out-of-pocket maximum. PAGE 10

11 Weber State University » Medical Benefits Grid» Advantage & Summit STAR prescription drugs Retail Pharmacy Up to 30-day supply Mail-Order 90-day supply Specialty Medications, retail pharmacy Up to 30-day supply Contracted Provider Preferred generic: $10 copayment after deductible Preferred brand name: 75% of discounted cost after deductible. $25 minimum, no maximum copayment Non-preferred: 50% of discounted cost after deductible. $50 minimum, no maximum copayment Preferred generic: $20 copayment after deductible Preferred brand name: 75% of discounted cost after deductible. $50 minimum, no maximum copayment Non-preferred: 50% of discounted cost after deductible. $100 minimum, no maximum copayment Tier A: 80% of MAF after deductible. No maximum copayment. Tier B: 70% of MAF after deductible. No maximum copayment. Non-Contracted Provider Plan pays up to the discounted cost after deductible, minus the applicable copayment. Member pays any balance Plan pays up to the discounted cost after deductible, minus the applicable copayment. Member pays any balance Plan pays up to the discounted cost after deductible, minus the applicable copayment. Member pays any balance Specialty Medications, office/outpatient Up to 30-day supply Specialty Medications, through specialty vendor Accredo Up to 30-day supply MISCELLANEOUS services Adoption See limitations Tier A: 80% of MAF after deductible. No maximum copayment. Tier B: 70% of MAF after deductible. No maximum copayment. Tier A: 80% of MAF after deductible. $150 maximum copayment. Tier B: 70% of MAF after deductible. $225 maximum copayment. 100% after deductible, up to $4,000 per adoption 60% of MAF after deductible Not covered 100% after deductible, up to $4,000 per adoption Affordable Care Act Preventive Services 100% of MAF 60% of MAF after deductible See Master Policy for complete list Allergy Serum Chiropractic Care Up to 10 visits per plan year Durable Medical Equipment, DME Except for oxygen and sleep disorder equipment, DME over $750, rentals that exceed 60 days, or as indicated in Appendix A of the Master Policy require pre-authorization. Maximum limits apply on many items. See the Master Policy for benefit limits Medical Supplies Home Health/Skilled Nursing Up to 60 visits per plan year. Requires pre-authorization and Medical Case Management Infertility Services Select services only. See the Master Policy for details 50% of MAF after deductible 30% of MAF after deductible Injections Requires pre-authorization if over $750 Temporomandibular Joint Dysfunction Up to $1,000 lifetime maximum 50% of MAF after deductible 30% of MAF after deductible MAF = Maximum Allowable Fee Non-contracted providers may charge more than the MAF unless they have an agreement with you not to. Any amount above the MAF will be billed to you and will not count toward your deductible or out-of-pocket maximum. PAGE 11

12 Weber State University » Weber State Benefits Preview» Supplemental Pharmacy Supplemental Pharmacy Weber State University has established a supplemental plan with PEHP to cover members whose individual out-of-pocket pharmacy costs exceed $2,000 during the plan year. While the State pharmacy out-of-pocket maximum is $3,000, Weber State s supplemental coverage will cap your qualified out-of-pocket pharmacy expenses at $2,000 per individual per plan year. Out-of-pocket costs that apply to this supplemental coverage include preferred generic drugs, preferred brand name drugs, and preferred specialty medications obtained through the pharmacy benefit. Out-of-pocket costs that are not eligible for supplemental coverage include non-preferred drugs, the cost difference between generic drug and brand name drugs when a substitute is available, and specialty medications obtained through the medical benefit. Meeting your deductible» It is PEHP s discounted cost of an eligible medication that is applied toward the deductible.» Once the deductible is met, you are responsible to pay the applicable copayment or coinsurance. Meeting your pharmacy out-of-pocket Maximum» Your Pharmacy deductible does apply to the pharmacy out-of-pocket maximum.» If your pharmacy deductible is applied to the purchase of a non-preferred medication, it does not apply to the out-of-pocket maximum because non-preferred medications do not apply to the pharmacy out-ofpocket maximum.» Once your pharmacy deductible is met, your pharmacy copayments or coinsurances are applied to your pharmacy out-of-pocket maximum.

13 Weber State University » Benefits Preview» Understanding Your EOBs 9 8 Understanding Your EOB (Explanation of Benefits) We send an EOB each time we process a claim for you or someone on your plan. Go paperless and view EOBs at your mypehp account at. AMOUNT CHARGED The medical provider s (e.g., doctor, hosptial, or clinic) bill for your service. AMOUNT INELIGIBLE The part of the bill that includes services not covered by your plan. This is between you and the provider. AMOUNT ELIGIBLE This is PEHP s maximum allowable fee (MAF). This is the most we allow contracted providers to charge for this service. However, non-contracted providers may charge more than the MAF. Avoid paying more by using only contracted providers (find them at ). DEDUCTIBLE The set amount you pay for eligible charges in a plan year before cost sharing takes place COINSURANCE The percentage of the cost you must pay under your plan. You may already have paid this amount when you received services. If so, the provider s bill may be lower than what s shown on the EOB. COPAY The fixed dollar amount you must pay under your plan. You may already have paid this amount when you received services. If so, the provider s bill may be lower than what s shown on the EOB. AMOUNT PAID The part of the bill PEHP paid. CLAIM NUMBER Keep this number as reference if you call PEHP about your claim. YOUR TOTAL RESPONSIBILITY The amount of the bill the provider expects you to pay. This is between you and the provider. See your applicable benefits summary and master policy for complete terms of your plan. 3/26/12

14 Weber State University » Benefits Preview» mypehp How to Set Up Your mypehp Account during open enrollment, You can access online enrollment. You can also access your claims history, explanation of benefits (EOB) and coverage levels online at my PEHP. You can enroll, access claims history, download explanation of benefits (EOB), check coverage levels, and much more by logging on to mypehp. Step 4: Enter your Social Security number, date of birth, and PEHP subscriber ID number to verify your identity. The 16-digit subscriber ID number can be found on your Medco/PEHP insurance card. If you do not have the number, call PEHP or fill out the online request to receive your ID number in the mail. Then, you will be asked to select a user name and password for future access. Here s how to set up your personal account: Step 1: Go to Step 2: Locate the mypehp Login on the right side of the page. The first time you log in, you must create an account. Once you have successfully set up your profile, enter your user ID and password into the boxes to access your information. Once you have successfully logged in, you are ready to enroll during open enrollment. You will also see a summary of all the plans you have enrolled in, a detailed list of all claims submitted to PEHP, and PDF files of your EOBs. You may also update your mailing address. However, if you wish to make any other changes outside of annual enrollment to your existing plans, you must submit a signed Change Form to PEHP. StepS FOR ONLINE ENROLLMENT: See next page. Step 3: To set up an account, click on Create my PEHP account. You must agree to the conditions detailed in the document on the next page to proceed. Once you have read and agreed to the terms, click I Agree to continue creating your personal profile. Graphical website depictions may vary from actual website.

15 Weber State University » Benefits Preview» Online Enrollment How to Enroll Online During open enrollment, if you re not adding or deleting dependents or changing benefit plans, you don t need to re-enroll. You must reenroll in FLEX$ every year. During open enrollment, online enrollment is available to active employees who have PEHP medical coverage. Early retirees, COBRA, and LTD enrollees must complete a paper enrollment form to make any plan changes. During open enrollment, online enrollment for FLEX$ is available only if you have been previously enrolled in medical and FLEX$. Otherwise, you must complete a paper enrollment form. New employees must complete enrollment forms for all plans. STEP 1: Log in to your mypehp account. See instructions on the previous page about how to create yours. STEP 5: Select among plans. STEP 2: If you re a returning user, you ll be directed to the mypehp main page. During open enrollment, you will have access to online enrollment through a link on the menu at left. STEP 3: You ll go straight to the online enrollment main page. It shows the PEHP benefits available to you. STEP 6: Add dependents by clicking New Dependent. STEP 7: If you, your spouse, or any dependents are covered by another health plan, supply the information. STEP 4: Click Enroll beneath the desired benefit to begin. For assistance with online enrollment, call or Graphical website depictions may vary from actual website. STEP 8: When you are finished adding dependents and other coverage information, you will have the opportunity to carefully review your information. Click the box after you have read the terms and conditions and signify you agree to them by typing your name. Once you click Confirm you will not be able to make additional changes to your medical plan. STEP 9: You will receive an enrollment confirmation. Click Print for a print-formatted PDF. This confirmation is for your personal records. When you return, the main page will show the benefits in which you have enrolled. NOTE: You can change your FLEX$ amount at anytime through May 15.

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