2019 Retiree Benefits Open Enrollment Guide

Transcription

1 2019 Retiree Benefits Open Enrollment Guide Open Enrollment Period: November 28, 2018 to December 5, 2018 Election Forms due to Human Resources: December 5, 2018 Benefits Effective: January 1, 2019 Payment Coupons reflecting 2019 Changes: to be mailed by December 28

2 Page 2 TABLE OF CONTENTS INTRODUCTION... 3 CHANGES FOR DEPENDENT ELIGIBILITY... 3 ONLINE HEALTH CARE ACCESS... 4 MEDICAL/RX PLANS... 5 DENTAL BENEFITS... 6 VISION BENEFITS MEDICAL/DENTAL/VISION RATES... 7 BENEFIT PROVIDER CONTACT INFORMATION... 8

3 Page 3 INTRODUCTION Dear Retiree: It s open enrollment time. This is your annual opportunity to make changes to your benefit elections. We believe that it is important for you to understand the benefits offered to you. Please review this guide in its entirety. We urge you to keep this guide and refer to it throughout the year when you have questions regarding your benefits. Enrollment forms must be received by Human Resources by December 5, New Carriers for 2019! o Priority Health Medical some minor copay changes for medical and Rx with the PPO 80% plan o Delta Dental o EyeMed Vision What else do I need to know? Summary of Benefits and Coverage (SBC): The SBC is a requirement under health care reform and replaces the benefit-at-a-glance documents. It allows you to compare your Allegan County provided benefits to other employers, such as your spouse s plan or even Medicare options. We encourage you to use the SBC to determine which plan is right for you. DEPENDENT ELIGIBILITY You may enroll the following dependents in the medical, prescription, dental, and vision plans: Eligible SPOUSE: Your legally married spouse. Eligible CHILDREN: You or your spouse s natural child, stepchild, legally adopted child, a child placed with you for adoption, a child for whom you are required to provide health insurance by a Qualified Medical Child Support Order, or a child for whom you or your spouse have legal guardianship. The child is eligible for coverage through the end of the month in which they turn 26. You are responsible for notifying HR that your dependent is no longer eligible for coverage. Eligible DISABLED DEPENDENTS: A dependent 26 years of age or older who depends on you or your spouse for support as they are unable to support themselves due to a mental or physical condition. The child must depend on you or your spouse for financial support. The disability must have occurred before the end of the year in which the dependent turns 18. 3

4 Page 4 evisits* Have a headache, cough or back pain? Describe your symptoms using an online questionnaire and a doctor will diagnose and treat you within one day. How it works: Log in to your MyHealth account at priorityhealth.com. Select the MedNow tile, then select Click to Begin. You ll be asked a few health questions, including a brief questionnaire based on your current symptoms )only one condition can be treated at a time). A care provider will reach out within one day with your diagnosis and treatment plan. *evisits are available if you are an established Spectrum Health patient, or once you ve had a MedNow video visit.

5 Page 5 MEDICAL PLANS There are two plan options. Each utilizes the Priority Health network of providers. You can locate participating providers near you by visiting the Priority Health website at using the Find a Doctor feature. Although both plans give you the freedom to seek care outside of the Priority Health network, you will always have the highest level of coverage if you remain in-network. Please refer to your SBC or Benefit Summary for full details. PPO Plan 80% HDHP HSA 100% In-Network Out-of-Network In-Network Out-of-Network Annual Deductible $1,000/Individual $2,000/Family $2,000/Individual $4,000/Family $2,000/Individual $4,000/Family $4,000/Individual $8,000/Family Coinsurance Maximum $1,000/Individual $2,000/Family $2,000/Individual $4,000/Family N/A N/A TrOOP $7,350/Individual $14,700/Family $14,700/Individual $29,400/Family $3,000/Individual $6,000/Family $6,000/Individual $12,000/Family Coinsurance 80% after deductible 60% after deductible 100% after deductible 80% after deductible Hospital 80% after deductible 60% after deductible 100% after deductible 80% after deductible Emergency Room $100 copay Deductible waived 100% after in-network deductible Ambulance Urgent Care Center $60 copay Deductible waived $100 copay Deductible waived 100% after in-network deductible 60% after deductible 100% after deductible 80% after deductible Preventive Services Covered 100% Not covered Covered 100% Not covered Office Visits Specialist Office Visits Advanced Diagnostic Imaging (MRI, CT, etc.) Telemedicine MedNow Prescription $30 copay Deducible waived $45 copay Deductible waived $100 copay Deductible wavied MedNow $0 copay 60% after deductible 100% after deductible 80% after deductible 60% after deductible 100% after deductible 80% after deductible 60% after deductible 100% after deductible 80% after deductible MedNow Covered in full after deductible Generic $10 copay $10 copay after deductible Preferred Brand $50 copay $40 copay after deductible Non-Preferred Brand $50 copay $80 copay after deductible Preferred Specialty $50 copay $40 copay after deductible Non-Preferred Specialty $50 copay $80 copay after deductible

6 Page 6 DENTAL AND VISION BENEFITS Dental Benefits Delta Dental PPO & Delta Dental Premier Delta Dental PPO (Point-of-Service) is Delta Dental s preferred provider organization plan that offers quality dental benefits at great savings. Plus, this plan gives you access to two of the nation s largest networks of participating dentists our Delta Dental PPO network and our Delta Dental Premier network. You can visit any licensed dentist, but you will save the most money if you see a dentist who participates in either our PPO or Delta Dental Premier Networks. To find a participating dentist, use the Find a Dentist tool on our website or call our customer service team at Delta Dental s Automated Service Inquiry (DASI) system is available 24/7, or representatives may assist you Monday through Friday, 8:30 a.m. to 8 p.m. Dental Services Annual Deductible applies to Preventive, Basic and Major Services Annual Maximum Benefit applies to Preventive, Basic and Major Services Preventive Services Coverage $0 $1,000 per person Routine Cleanings 100% Basic Services Minor Restorative 75% Simple Extractions 75% Endodontics 75% Periodontics 75% Major Services Crowns and Bridges 50% Dentures 50% Vision Benefits EyeMed Vision Benefits are provided by EyeMed. To locate a participating vision provider in your area, please visit or call your vision provider and ask if they participate in the EyeMed network. Vision Services Frequency In-Network Coverage Vision Exam Once every 12 months $0 copay Frames Once every 24 months $0 copay; $130 allowance, 20% off Balance over $130 Standard Plastic Lenses Once every 12 months $10 copay Contact Lenses Once every 12 months $130 allowance, or paid in full if medically necessary

7 Page RETIREE HEALTH INSURANCE RATES Option 1 PPO Plan 80% Rx $10/$50/$50 Ded. $1,000/$2,000 Medical/Dental/Vision Rates Effective 1/1/2019 Med/Den/Vision Monthly Rate (12) Medical Only Monthly Rate (12) Single: $ $ Double: $1, $1, Co-Insurance 80% after deductible Option 2 HDHP HSA 100% Rx $10/$40/$80 after ded. Ded. $2,000/$4,000 Co-Insurance 100% after deductible deductible applies to all services Family: $2, $2, Single: $ $ Double: $1, $1, Family: $1, $1, Please refer to Benefits Summary for plan details. Preventive Care is covered at 100% on both plans with no co-pay, deductible or co-insurance.

8 Page 8 BENEFIT PROVIDER CONTACT INFORMATION Important Contact Information Medical/Prescription Priority Health Customer Service Mental & Substance Abuse MedNow / Mobile App Dental Delta Dental Customer Service Mobile smartphone app Delta Dental Vision EyeMed Customer Service EYEMED ( ) EyeMed Members App The contents of this guide are intended for use as an easy to read summary. It does not constitute a contract. Additional limitations and exclusions are detailed in the official plan documents. For an official description of benefits, please refer to each carrier s certificate/benefit guide. More information is available by contacting the Human Resources Department.