Benefits. Open Enrollment Newsletter. Welcome to Your Checklist for Open Enrollment. What Happens if I Don t Elect My Medical Benefits?

Transcription

1 Your Main Line Health Benefits Welcome to Your 2015 Open Enrollment Newsletter Open Enrollment, which runs from November 2nd to 23rd, is your opportunity to select your benefits for the coming year; this year, it s more important than ever to become educated about the coverage options available to you and your family. Read ahead about the significant changes to our benefits programs, aimed at providing you with cost-effective, high-quality services. We want to help you make the best decisions for you and your family and remind you of cost-saving options, such as: Medical plan contribution discounts for not using nicotine or tobacco products Additional discounts rewarding exercise and work-life balance The introduction of our new MLH Select medical plan Adjustments to our prescription drug coverage We hope you ll take the time to visit Benefits Express and our new online 2015 Benefits Enrollment WebGuide for more details about the coverage plans and options. As always, our Benefits Counselors are happy to answer any questions you may have. Checklist for Open Enrollment Don t Forget! Open Enrollment Period November 2nd to November 16th Review/Correction Period November 17th to November 23rd (No additional changes will be accepted after November 23rd) During Open Enrollment, you must: Re-elect your medical plan Re-enroll your eligible dependents Review the new MLH Select medical plan Declare tobacco or nicotine use Take action to earn Health & Productivity rewards-based contributions for your medical plan What Happens if I Don t Elect My Medical Benefits? Important Note: Our medical plan options are changing for As a result, you must re-elect your medical benefits options during Open Enrollment. If you don t complete your enrollment by November 23rd, medical coverage will be waived for you and your dependents. All other elections, except Flexible Spending Accounts, will carry over. 1

2 Why Choose MLH Select? Save on Services with the MLH Select Medical Plan There s when you receive care referred by your primary-care physician (PCP). That s the benefit of relying on your doctor s expertise and staying in-network. There s no coinsurance when you get PCPreferred care. The plan covers your costs in full or after you make a copayment. You spend less out-of-pocket when you visit a physician in the new SelectPLUS or Keystone Health Plan East (KHPE) networks. (You ll pay more if you don t get referrals from your PCP.) Minimize Your Costs through the New SelectPLUS The MLH Select medical plan allows you to minimize your costs when you receive care from providers who participate in the SelectPLUS network, which was designed to give you and your eligible dependents broad access to high-quality health care services. You can minimize your costs by selecting a PCP within the network or by having your care referred to a SelectPLUS provider. Many JeffPlus providers are also in the MLH Select network. Participating Facilities Bryn Mawr Hospital Lankenau Medical Center Paoli Hospital Riddle Hospital Bryn Mawr Rehab Hospital Mirmont Treatment Center Thomas Jefferson University Hospitals (including the Methodist Hospital division) Magee Rehabilitation Holy Redeemer Nemours/Alfred I. dupont Hospital for Children Find Participating Providers Visit to search an online database of participating providers within the SelectPLUS network beginning in Since providers can join or stop participation within the SelectPLUS network at any time, be sure to confirm with your provider whether he or she participates. Participating Physicians MLH and Jefferson-employed physician practices All specialists currently participating in the JeffPLUS network All pediatricians currently participating in the JeffPLUS network Select, recently added primary-care physicians Please note: Not all JeffPLUS Adult PCPs participate in the SelectPLUS network. We encourage you to confirm your provider s participation before making an appointment. 2

3 How Does the MLH Select Medical Plan Compare to the PPO Core Medical Plan? The MLH Select medical plan allows you to choose your own doctors and hospitals, but if you visit a primarycare physician (PCP) within the SelectPLUS network, all office visits are covered 100 percent with no copay. Your out-of-pocket costs may be minimized by having care referred by your PCP (see the chart below). MLH Select PPO Core Calendar Year Deductible SelectPLUS KPHE Referred JeffPLUS $0 $0 $0 Personal Choice $500/individual $1,500/family Coinsurance Paid by You $0 $0 0% unless otherwise noted 20% after Out-of-Pocket Maximum $3,000/individual $5,000/family $3,000/individual $5,000/family Primary Care Doctor Office Visits $0 copay $20 copay $20 copay $40 copay, Specialty Care Doctor Office Visits $10 copay $30 copay $25 copay For a more detailed comparison, please see the full comparison chart on the next page. $45 copay, Frequently Asked Questions about the MLH Select Medical Plan What if I need to see a specialist? How does the referral process work? Your PCP can provide a referral before you see a specialist. All referrals are done electronically. You may be able to get a referral simply by calling your PCP s office. Your PCP will decide if he or she needs to see you before providing a referral. If you have any questions about the status of a referral, call Member Services at ASK-BLUE or visit the Independence Blue Cross benefits portal at What if I need care for an emergency or life-threatening situation? If you need emergency care (for example, treatment for onset of sudden, severe and persistent pain or uncontrolled bleeding), go to the nearest emergency room (ER) or urgent care center. Notify your PCP as soon as possible when care is provided by a physician other than your PCP. You are responsible for any copays due for services rendered (ER copays are waived if you are admitted to the hospital). Why do I pay more if I don t get a referral? When you work with your PCP to coordinate all of your care, you re getting help from an expert to ensure you get the quality of care you need. When you don t get referrals from your PCP, you re not taking advantage of the efficiencies available through the MLH SelectPLUS, so you are responsible for additional out-of-pocket expenses. What if I need laboratory or routine/complex radiology? All laboratory services in either the SelectPLUS or Keystone Health Plan East network are covered at 100 percent ($0 copay). For routine and complex radiology, your PCP will assign you to a designated facility (sometimes called capitation). Your expenses will depend on the designated facility s network participation. For more information on your facility assignment, please call your physician s office or Member Services at ASK-BLUE. What if I need emergency care while outside the service area on vacation? Go to the nearest hospital to receive the appropriate care. If you are treated in the ER, you will be responsible for the plan s ER copay. If you are admitted to the hospital through the ER, you will be covered at the Home Hospital level of benefit. If you have any questions about your coverage, call Member Services at ASK-BLUE. My child attends college out of state. How will he/she be covered by the plan? Your child can enroll in a Guest Membership through the MLH Select plan and receive comprehensive medical benefits, including routine and preventive services, while away from home. A Guest Member remains a member of his/her home plan, but is enrolled to receive benefits of the host plan. To enroll, call Member Services at least 30 days prior to leaving the service area. 3

4 2015 Medical Benefits Comparison Chart Benefits MLH Select PPO Core SelectPLUS Keystone Referred All-Self Referred Care Out-of- In JeffPLUS Personal Choice Out-of- Calendar Year Deductible $0 $0 Coinsurance Paid by You $500/individual $1,500/family $1,000/individual $3,000/family $0 $0 20% after $0 0% unless otherwise noted $500/individual $1,500/family $1,000/individual $3,000/family 20% after Out-of-Pocket Maximum $5,000/individual $10,000/family $3,000/individual $5,000/family $3,000/individual $5,000/family $5,000/individual $10,000/family Primary Care Doctor Office Visits Specialty Care Doctor Office Visits Preventive Care for Adults & Children $0 copay $20 copay $10 copay $30 copay $35 copay, $40 copay, $20 copay $25 copay $40 copay, $45 copay, $0 $0 $0 $0 $0 Routine Mammograms $0 $0 $0 $0 $0 Routine Gynecological Exam/PAP Hospital - Inpatient Services (also applies to mental health and substance abuse care) Emergency Room $0 $0 $0 $0 $0 $0 (waived if admitted) admission (waived if admitted) Urgent Care Center $50 copay $70 copay admission $70 copay, $70 copay, $0 home facilities/ $350 copay per admission (waived at home facilities) $70 copay, admission, then 20% after $70 copay, Outpatient Routine Radiology $15 copay $30 copay 30% after $20 ($15 at home facilities) $50 copay, then 30% after Outpatient Specialty Radiology (e.g., MRI, PET) $15 copay $30 copay 30% after $50 ($15 at home facilities) Outpatient Laboratory $0 $0 $0 $0 Outpatient Surgery (facility) $0 $300 copay per occurrence $300 per occurrence, then 20% after $100 copay per occurrence ($0 at home facilities) $75 copay, then 30% after $20 copay per occurrence, no $300 copay per occurrence, then 20% after Outpatient Surgery (physician/surgeon) $0 $0 20% after $0 20% after Maternity Care (pre- and post-natal visits) Maternity Care (hospital) $0 Therapy Services: Physical, Speech, Cardiac, Pulmonary, Occupational, Respiratory, Orthoptic $0 $20 copay $20 copay $15 copay, initial visit $20 copay, initial visit admission $15 copay $30 copay admission $30 copay, no $0 home facility ($350 per admission at non-home JeffPLUS facility) $30 copay admission, then 20% after $40 copay, Durable Medical Equipment Spinal Manipulations (chiropractic care) N/A 10%, 20%, N/A $30 copay $40 copay, no plan pays 80%, no plan pays 80% N/A $40 copay per visit 4 Disclaimer: This information is for illustration purposes only. Any discrepancies between this exhibit and the contract will be governed by the contract and its related schedule of benefits.

5 2015 Changes for PPO Core Effective January 1, 2015, the Personal Choice provider copay, coinsurance and s will change. The Out-of- coinsurance you pay will also change from 30 percent to 40 percent for all services. See the chart below for a side-by-side summary of these changes PPO Core Personal Choice Changes Benefit Service Doctor s Office Visit: Primary Care Provider (PCP) Specialist Personal Choice 2014 $35 $40 Personal Choice 2015 $40 $45 Deductible: Family $1,000 $1,500 Outpatient Diagnostic Services: Routine Radiology $50 copay plus 20% coinsurance $50 copay plus 30% coinsurance MRI/CAT/PET/MRA $75 copay plus 20% coinsurance $75 copay plus 30% coinsurance Emergency Room $100 $125 (all networks) Therapy Services (Physical, Occupational, Speech, etc.) $30 $40 Benefit Service JeffPLUS 2014 Personal Choice 2014 JeffPLUS 2015 Personal Choice 2015 Out-of-Pocket Maximum: Individual Family $2,500 $4,500 $2,500 $4,500 $3,000 $5,000 $3,000 $5,000 Additional information is available in the Independence Blue Cross PPO Core Plan Summary Your Prescription Drug Benefit Copay and Coinsurance Supply 30-Day Supply 60-Day Supply 90-Day Supply Employee Pharmacy Generic: $10 Brand: $18 Specialty: $30 Generic: $20 Brand: $36 Specialty: $60 Generic: $30 Brand: $54 Specialty: $90 Retail (30-Day Only) Generic: $15 Brand Formulary: 20% with $30 min/$50 max Brand Non-Formulary: 40% with $50 min/$100 max Specialty: 40% with $50 min/$100 max Not available Not available 5

6 New! What s New This Year? Discounted Non-Tobacco/Nicotine Use Rates: If you certify that you don t use tobacco and nicotine products, you will earn a $20 per-pay-period discount on your medical plan contributions. PPO Plus HRA: To keep your costs low, we re looking to the future of health care. As part of this shift, enrollment in the PPO Plus HRA will not be offered to participants currently enrolled in the PPO Core or HMO plan. We are contemplating eliminating the PPO Plus HRA in the future. HMO Plan: The plan will be eliminated in If you re currently enrolled in the HMO plan, you will need to elect a new plan: MLH Select or PPO Core. Employee Pharmacy Copay for Brand-Name Drugs: There will be a $30 copay for a 30-day supply and a $90 copay for a 90-day supply when the employee or physician requests a brand prescription medicine when the generic equivalent is available. Specialty Drug Prescriptions: Specialty drugs are often prescribed for chronic and complex illnesses such as multiple sclerosis or rheumatoid arthritis. Because they are very expensive and often require special handling, monitoring and administration, most prescriptions for specialty New Medical Plan ID Cards Coming for Everyone in 2015 All medical plan members will get new medical ID cards in the coming year. Please take note that the new MLH Select medical plan ID card will look slightly different. New pharmacy ID cards will only be distributed to new enrollees. If you need a duplicate or replacement pharmacy card, please contact OptumRx at Be sure to provide an updated copy of your ID card to physicians, pharmacists and any other providers you might use. drugs must be filled through the employee pharmacy and can no longer be filled at a retail pharmacy. Contact OptumRx at for more information on specialty drug coverage. Health & Productivity Rewards This year, we are pleased to announce an expansion of the Health & Productivity Rewards Program. If you are actively committed to improving your health and are enrolled in an MLH medical plan, you may have the opportunity to lower your 2015 medical plan contributions: Certify you are not using any tobacco or nicotine products Earn the reward under the Health & Productivity Program by achieving 100 points for the steps you take to manage your health How Can I Sign Up? Detailed instructions on registering and using the WebMD portal for the Health & Productivity Rewards Program are available on the 2015 Benefits Enrollment WebGuide. You must log your activities on the WebMD portal by December 10, 2014, to receive the medical plan contribution discount, and you will not be able to receive the reward until you have fulfilled the required activities and achieved 100 reward points. Note: Tobacco/nicotine users can earn the 2014 reward points but will not receive the discounted medical plan contribution in 2015 if they are still using tobacco or nicotine products. 6

7 2015 Benefits Enrollment WebGuide This year, our new, online Benefits Enrollment WebGuide can help you make the best decisions for you and your family. Visit to understand your available benefits options and choose the plans that make the most sense for you and your family. We will not mail a hard-copy benefits guide this year. Our Benefits Counselors can help you find and print out any specific information you may need. Understanding Your Pay-Based Medical Plan Contributions Each employee s medical plan contributions will be determined by his or her annual salary as of September 1, 2014, standard schedule hours, family coverage option (e.g., single, employee + one dependent or family) and the type of medical plan selected. Beginning in 2015, the steps you take to manage your health better will also help to determine your medical plan contributions. My MLH Medical Plan Rates Here s how to access a summary of your 2015 medical plan contribution options: 1. Log in to MLH Employee Self Service 2. To the left of the panel on the home page, click on My MLH Medical Plan Rates 3. Review the instructions, which will explain how to interpret your medical contribution options 4. Click View Report to review your medical plan contribution options Receive Your 2014 W-2 Online! Go green, and don t waste time at the mailbox waiting for your 2014 W-2 form to do your taxes. MLH can deliver your W-2 form to you electronically. Be assured that your electronic W-2 is safe and secure on the MLH Employee Self Service site. You only need to sign up once. If you have previously signed up, there is no need to sign up again. You will automatically be notified when your W-2 is ready! How do you give consent? Simply log in to MLH Employee Self Service during Open Enrollment, click on the link for Payroll/Compensation, click on W-2/W-2c Consent, click Check Box and press Consent. 7

8 indicia Main Line Health Human Resources 240 Radnor Chester Road Suite 200 Radnor, PA Have a Question? Need Help Choosing Your Medical Plan? Human Resources Benefits Counselors Name Telephone Number Facilities Covered Maryann Blob BlobM@mlhs.org Lankenau Medical Center LIMR Main Line Health Laboratories Main Line Services (including 240 RCR, 950, 306, 259 RCR and data center offices) Sue Neilsen NeilsenS@mlhs.org Bryn Mawr Hospital Riddle Hospital Mirmont Treatment Center Paoli Hospital Karen Wenzel WenzelK@mlhs.org Main Line Affiliates Bryn Mawr Rehab Hospital Main Line Health Care Main Line Health HomeCare & Hospice