Health Benefits Simplified

Transcription

1 Health Benefits Simplified What you need to do: What s inside: Review this benefit overview Benefit Highlights Turn in all completed paper forms to your Human Resources Department. Complete the HealthEZpay application or sign up online at CGBBenefits.com Manage your benefits by visiting CGBBenefits.com Wellness Program Medical Management HealthEZpay Managing Your Benefits Online Features Medical Benefit Overview Effective 1-Jan Dec-2011

2 Welcome HealthEZ is a benefit administrator that specializes in helping companies like yours provide affordable, custom benefit plans. We are here to simplify your healthcare experience. We can be reached by phone or online Customer service # & 24/7 nurseline Your company benefit website What you need to do: What s inside: Review this benefit overview Turn in all completed paper forms to your Human Resources Department 3. Manage your benefits by visiting www. xyzcompanybenefits.com or calling customer service at Medical Plan Network of Doctors Medical Management Pharmacy Online Tools HealthEZpay Summary of Medical Benefits

3 Medical Plan Effective 1-JAN-2011 Your medical plan will remain the same. New ID Cards You will receive new benefit ID card(s). It is important to use your new ID card at the doctor s office and pharmacy. Precertification The medical system is increasingly pushing patients into expensive and unnecessary procedures. To make sure you receive the best treatment possible, we are requiring your doctor notify us before MRI and CT scans as well as inpatient treatment. Network of Doctors Is my doctor in the network? To find an in-network physician or facility go to and click on Find a Doctor or call customer service at If you can t find your doctor in the network, contact HealthEZ. HealthEZ may be able to work with your doctor directly. Medical Management and Nurseline You have 24/7 access to HealthEZ s medical management staff. They have extensive experience helping employees navigate the medical maze. These services are available to everyone whether you have a chronic condition like asthma or diabetes, or a more complex condition such as cancer or heart disease. If you have questions about what kind of care to seek or where to seek it (do I really need to go to the ER for this?), if you ve just found out you re pregnant, or if you have any nagging questions, nurses are there to help you. Just call , 24/7. Pharmacy Caremark Your pharmacy benefit manager is Caremark. Caremark is one of the largest pharmacy management companies in the country and can offer additional discounts - especially on higher cost drugs. Your pharmacy claims will also appear on your new HealthEZ statement. Although CVS and Caremark are part of the same company, you do not have to go to CVS for prescriptions. Saving on Pharmacy Costs Here are a few ways to save on pharmacy costs: Ask your doctor to start you on the lowest cost alternative Check out the $4 prescriptions at places like Wal-Mart and Target 3. Price shop your prescriptions at Sam s Club and Costco; you don t have to be a member to access their pharmacy 4. Ask your pharmacist about pill splitting; it can lower your cost

4 Online Tools Visit your one-stop benefit website for benefit information, forms, account balances, processed claims, previous statements and much more. An online account allows you to fully manage your benefits. To sign up for online access, follow these steps: Go to and click LOGIN. Click Need to set up your online access? 3. Enter your Member ID - found on your ID card - your Social Security number, and your date of birth. Pick a Username and Password. Be sure to make your Password at least 8 characters long, any combination of letters or numbers is acceptable. Click Proceed to my Account and you re registered! Call customer service with any questions. The EZ way to pay medical bills Pay your medical bills the easy and accurate way. HealthEZpay consolidates your medical bills and allows you to review online, then simply approve or decline payment for each. You save money and time by securely paying online. Use your HSA account or credit/ debit card. Call for more information or go to and click on My Benefits then HealthEZ Payment Service.

5 Summary of Medical Benefits Plan Year Deductible Plan Year Out-of-Pocket Maximum In-Network $1,500 / Single $3,000 / Family $3,000 / Single $6,000 / Family Annual Maximum $1,500,000 Out-Of-Network $1,500 / Single $3,000 / Family $3,000 / Single $6,000 / Family Preventative Health Care No Deductible No Deductible Routine Physical Exams 100% 60% Immunizations, Well Child Care, Cancer Screenings 100% 60% Routine Diagnostic Tests, Lab and X-rays 100% 60% Routine Mammograms and Breast Exams (Maximum 1 exam per calendar year) 100% 60% Routine Pelvic Exams and Pap Test (Maximum 1 exam per calendar year) 100% 60% Routine PSA Test and Prostate Exams (Maximum 1 exam per calendar year) 100% 60% Routine Colonoscopy and Sigmoidoscopy 100% 60% Routine Hearing Exams 100% 60% Routine Eye Exam and Glaucoma Testing 100% 60% Office Visits Deductible does apply Deductible does apply Illness or Injury 80% 60% Chiropractic Care- limited providers only (Medical necessity verified after 15 visits) 80% 60% Physical, Occupational and Speech Therapy (Maximum 20 visits per calendar year) 80% 60% Mental Health and Substance Abuse 80% 60% Inpatient Hospital Services (precertification required) Deductible does apply Deductible does apply Facility (Subject to the payment of a semi-private room rate or negotiated room rate) 80% 60% Physician 80% 60% Mental Health and Substance Abuse 80% 60% Mental Health and Substance Abuse--Partial Hospitalization 80% 60% Outpatient Hospital Services Deductible does apply Deductible does apply Physician and Facility 80% 60% Mental Health and Substance Abuse 80% 60% Testing and Imaging Deductible does apply Deductible does apply Lab, Pathology and X-Ray 80% 60% CT, MRI and PET (precertification required) 80% 60% Urgent or Emergency Care Deductible does apply Deductible does apply Urgent Care Center 80% 80% Hospital Emergency Room 80% 80% Emergency Ambulance 80% 80% Durable Medical Equipment and Prosthetics (Maximum $4,000 benefit per calendar year) Deductible does apply 80% Deductible does apply 60% Prescription Drugs Deductible does apply Deductible does apply Up to a 31-day supply on prescriptions Generic Products 80% Preferred Brand 80% Non-Formulary Brand 80% Specialty 80% Up front payment required* NOTES: This serves as a summary of your benefit plan only. Please refer to your Summary Plan Description for actual coverage, limitation and exclusion provisions. Deductibles and coinsurance apply toward the out-of-pocket maximums. Precertification requirements will be outlined in your Summary Plan Document. 3. Out-of-Network services deemed to be true emergencies by the Plan Administrator will be paid at In-Network benefit level.

6 BASIC PERSONAL INFORMATION - REQUIRED TITLE (MR., MRS., MS., DR., ETC.) FIRST NAME LAST NAME SUFFIX (JR., SR., ETC.) - - SOCIAL SECURITY NUMBER - - PREFERRED PHONE - - OTHER PHONE M M - D D Y Y DATE OF BIRTH Mail this form to: HealthEZ Inc West 78th Street Bloomington, MN or fax it: PAYMENT OPTIONS AND ACCOUNT INFORMATION HealthEZ can use a variety of account types to automatically fund your healthcare expenses. Please check the type of account you wish to use and fill in the appropriate account information. If you choose HSA, use the debit card information for that account. Primary Account (The first source to use for payment) HSA Visa Mastercard American Express Discover CREDIT or DEBIT CARD NUMBER M M Y Y SECURITY CODE** EXPIRATION DATE BILLING ADDRESS (If different from your home address) CITY - STATE ZIP CODE Secondary Account (Used as backup for primary account) HSA Visa Mastercard American Express Discover 3. NOTIFICATIONS - REQUIRED Take Full Advantage of our Online Services: By subscribing with your you can receive notifications when your statements are available online and when a medical bill (over a specified amount) is ready to be paid by your credit card. ADDRESS Be sure to set up a username and password at com CREDIT or DEBIT CARD NUMBER M M Y Y SECURITY CODE** EXPIRATION DATE BILLING ADDRESS (If different from your home address) CITY - STATE ZIP CODE Other Account (Used as backup for secondary account) HSA Visa Mastercard American Express Discover CREDIT or DEBIT CARD NUMBER M M Y Y SECURITY CODE** EXPIRATION DATE BILLING ADDRESS (If different from your home address) 4. AUTHORIZATION I authorize HealthEZ, Inc. to use the information provided on this application to pay my healthcare providers directly. HealthEZ may not use any such information for any other purposes (such as payment of any fees to HealthEZ or for any marketing purposes) and may not disclose such information to any third party. I understand that I am liable for any charges under the terms and conditions with my credit card/debit card company. I also understand that I am entitled to fraud protection under the same terms and conditions. SIGNATURE M M - D D Y Y DATE CITY STATE ZIP CODE - IMPORTANT NOTE: The HealthEZ Medical Payment Service cannot be utilized with coordination of benefits Privacy and Security Policy HealthEZ works diligently to protect the privacy and security of your sensitive financial and healthcare information. HealthEZ is committed to using every physical and technological method available to ensure the information you record on this application is used only for HealthEZ Medical Payment Service. If you do not wish to write your card number on this form, we will be happy to accept this information over the phone.