Your 2017 GE Medical Plan

Transcription

1 Take time to understand How to use your plan Important health information Resources available to you Your 2017 GE Medical Plan A guide to help you make the most of your health care benefits

2 Take an active role in your health care. Work closely with your doctor Follow evidence-based medical guidelines Ask questions and get involved in treatment decisions Manage your spending and use your resources wisely

3 Your plan options When enrolling, choose to pay more in payroll contributions and less when seeking care, or less in payroll contributions and more when seeking care. Also, choose which type of savings accounts you would like to help you save and pay for eligible medical expenses. With a few exceptions, such as some prescriptions and specialty medical services for Option 1 & 2, your insurance benefits start after you meet your deductible. Once you satisfy your deductible, in-network services are covered at 80% of eligible expenses; 100% after you meet your out-of-pocket maximum. For out-of-network care, services are covered at 60% of eligible expenses after you meet your deductible.* Option 1 Option 2** Option 3 MEDICAL CONTRIBUTIONS Highest MEDICAL CONTRIBUTIONS Lower MEDICAL CONTRIBUTIONS Lowest DEDUCTIBLES & CO-INSURANCE MAX Lowest SAVINGS ACCOUNT GE-credited HRA Employee-funded FSA*** ATTRIBUTES You pay the most in medical contributions, but you have the lowest deductible. DEDUCTIBLES & CO-INSURANCE MAX Higher SAVINGS ACCOUNT GE-credited HRA Employee-funded FSA*** ATTRIBUTES You pay less in medical contributions than in Option 1, but your deductible is slightly higher. DEDUCTIBLES & CO-INSURANCE MAX Highest SAVINGS ACCOUNT Employee-funded HSA Employee-funded Limited Purpose FSA (LPFSA) (dental and vision only) ATTRIBUTES You pay the least in medical contributions, but you have the highest deductible. HRA - Health Reimbursement Account FSA - Flexible Spending Account HSA - Health Savings Account *Additional out-of-network provider billed charges may apply. **Option 2 Select (Kaiser/UPMC) replaces Option 2 in Erie County, PA and California. ***Employees have the choice of either a Health Care FSA or LPFSA. 3

4 Quick tips to maximize your benefits Make healthy lifestyle choices. Get all your recommended preventive screenings. The following are covered 100% in-network, as recommended by the U.S. Preventive Services Task Force, and not subject to the deductible: Cervical, breast, prostate and colon cancer Annual adult physicals Osteoporosis Depression Pediatric prevention, including well-child care visits and screenings A variety of blood, urine and other lab tests Immunizations for influenza, hepatitis, tetanus and many more Annual lung cancer screening: age with 30-year tobacco history Women s preventive screenings include: Annual routine gynecological care Prenatal office care visits Counseling for generic contraceptives and devices When medically appropriate, Breast Cancer Susceptibility Gene (BRCA) genetic testing and counseling Get more details by visiting ge.com/healthahead/healthcaredecisions or Your Benefits Handbook. Age, condition and frequency restrictions may apply. If you re not sure whether a specific service is covered for you or a family member, please contact your health plan administrator. 4

5 Be an active health care consumer. Avoid out-of-network care and services whenever possible. When you use doctors or hospitals out-of-network, you pay more. Network providers have met quality standards and have agreed to provide services to GE members at a discount. Even when being treated at an in-network hospital, be sure to verify that the treating providers are in-network. Avoid emergency room visits for non-emergencies. For minor issues, visit an in-network convenience clinic, urgent care center or your doctor s office. If it s more serious and your doctor is not available, consider an urgent care facility. These options cost far less than emergency rooms. Know the cost before you get the care. Not all providers charge the same price for services. Ask questions and tell your doctor you have a consumer-directed health plan with a deductible. Discuss the best treatment options, and make sure your concerns are covered and you have a clear understanding of next steps and potential costs. Treatment Cost Calculator (TCC)* Find physicians, hospitals and clinics in your area; compare those providers by quality, cost and location; locate urgent care facilities and more. To add the TCC to your mobile device... Search for GE TCC in the app store. *Not available for Option 2 Select (Kaiser/UPMC). 5

6 Get the most out of your prescription drug benefits * OptumRx is GE s Prescription Drug Plan administrator. Your network includes select independent pharmacies, plus CVS, Target, Walgreen s, Duane Reade, Rite Aid, Walmart and Sam s Club. Remember these tips: Use generic drugs whenever possible. Generic drugs may cost less than brand names. If no generic equivalent is available, ask your doctor about similar lower-cost drugs that may be equally effective. If you fill your prescription at a local pharmacy, show your GE Pharmacy Card (Options 1 & 2) or OptumRx ID card (Option 3), to confirm your eligibility and receive plan benefits. Prescription Drug Program RxBIN: RxPCN: 9999 RxGRP: Company Name and Program Issuer (80840): ID: Name: John Q Sample Use your GE Pharmacy Card (Options 1 & 2) to access available funds in your HRA or HCFSA (Health Care FSA) to pay for prescription drug expenses. Note: If you have both an HCFSA and HRA, funds will always draw from your HCFSA first, then your HRA. Printed 01/11/99 9 You can now get a 90-day supply for eligible medications at mail order pricing in person at Walgreen s and Duane Reade or by home delivery through OptumRx. To learn more, search for additional network pharmacies, or if you wish to start home delivery, please visit optumrx.com or call

7 Pilot programs: Save when receiving convenience care, urgent care, flu shots and other immunizations. Receive care at a negotiated rate of $50 per visit at select CVS and Walgreen s pharmacies that have a participating convenience care clinic within their location. Convenience care clinics provide many basic health care services such as vaccines, screenings, treatment for minor injuries, skin conditions and other nonemergent care. Make appointments online to avoid long waits. You can also receive urgent care services for $100 per visit at MedExpress locations. Urgent care is for those who need attention quickly for illnesses and injuries, but do not require an emergency room visit. Search for participating locations near you at optumrx.com. No payment will be required at the time of service if you present your GE Pharmacy Card or OptumRx ID card. Immunizations: Pharmacies offer flu shots and other immunizations at negotiated rates. If no clinic is within the pharmacy, be aware that pharmacists are licensed to provide most immunizations. *Not available for Option 2 Select (Kaiser only). 7

8 Make sure you understand how your savings accounts work * A look at your savings account options Using your savings accounts correctly is the key to maximizing your plan. If you are in Option 1 or 2, GE credits an HRA, which you can use to pay for most medical and prescription drug expenses. You can also have an FSA. To manage your HRA/FSA accounts visit your online portal at wageworks.com/ ge, or call WageWorks directly at For more information, go to the Savings Accounts section of ge.com/ healthahead/ healthcaredecisions If you are in Option 3, consider opening an HSA to pay for current and future health care expenses on a pre-tax basis (certain IRS restrictions apply). To open an HSA or make changes to your contributions, go to OneHR.ge.com. All employees eligible for health care can open an LPFSA, which can be used for dental and vision expenses only. A DCFSA allows you to pay for qualified day care expenses with pre-tax dollars. You can fund a DCFSA and an HCFSA or LPFSA. You cannot fund both an HCFSA and LPFSA you must choose one or the other. WageWorks EZ Receipts Mobile App For those enrolled in Option 1 or 2 or for those who have an HCFSA, LPFSA and/or DCFSA, manage your savings accounts on the go. To add EZ Receipts to your mobile device... Search for EZ Receipts in your app store. 8

9 Change the way you manage claims You may change your reimbursement preference at any time. You can choose between Pick & Process or Auto-Reimbursement at any time. Review each claim received from your health plan and choose how to process them. Note, any change in preference will become effective for future claims not previously reimbursed, after your change is processed. Visit your online portal at wageworks.com/ge, or call WageWorks directly at to learn more. Auto-Reimbursement for your medical claims and the GE Pharmacy Card for your purchases combine to eliminate most steps in the process for Options 1 & 2. When you go to the doctor, dentist or eye doctor: 1. Your doctor, dentist or eye doctor submits your claim. 2. You receive an explanation of benefits from your insurance administrator and the bill from your doctor. 3. The amount you need to pay your doctor is automatically reimbursed by direct deposit or check from any balance in your HCFSA/LPFSA or HRA. When you fill a prescription: 1. Show your card and swipe. 2. Your GE Pharmacy Card works as both your Prescription Plan ID and your account debit card. 3. Expenses covered by your prescription drug plan will be verified automatically and paid directly from your HCFSA first, then your HRA. 4. Once you get your funds, you pay your doctor. *Not available for Option 2 Select (Kaiser only). 9

10 Use your resources Health Care Hub Free, easy and available when you need it! Make smart, costeffective health care choices and access all the tools and resources you need for your medical, behavioral health, vision, dental and savings accounts benefits, quickly and easily! Link directly to OneHR, HealthAhead, the GE Benefits Center, Health Coach from GE, and more! Download the Health Care Hub from your mobile app store by searching for GE Health Care Hub. 10

11 Health Coach from GE For the answers you need and support you can trust. Health Coaches are specially trained nurses, backed by a team of doctors who can assess your situation, answer your questions and connect you to a broad range of resources at no cost to you and your covered dependents. Five reasons to call Health Coach from GE: 1. Find high-quality, cost-effective doctors and hospitals 2. Understand your diagnosis and treatment options 3. Access lifestyle coaching to get advice on making healthy choices like eating better, exercising or quitting tobacco 4. Understand your after-hours care options or get help with urgent medical care situations 5. Health Coach specializes in resolving medical claims Understand your plan, financial responsibilities and coverage Resolve claim issues, whether simple or complex Single point of contact between your medical carrier and provider Call Health Coach from GE at Behavioral Health services and Employee Assistance Program (EAP) Access confidential mental health resources, get help with outpatient behavioral health services, arrange inpatient services and more. EAP assists employees and their families coping with a wide variety of concerns, such as stress, marital and family conflicts, substance abuse and depression. To Access Behavioral Health or EAP services, call Health Coach from GE. 11

12 YOUR GE MEDICAL PLAN 2017 JUST INTRODUCED! Health4Me Simple, health care plan info on-the-go! For all GE enrolled members* Your confidential, convenient resource to help save time managing pharmacy benefits through OptumRx. Access member ID cards, refill prescriptions, track claims, complete price compares, and much more! UHC members will see additional medical related benefit information and can check account balances (Option 3 only) All in one app! Download from your mobile device s app store and register for your secure HealthSafe ID TM to begin. Questions? Contact Health Coach from GE at *Not available for Option 2 Select (Kaiser only). NowClinic No appointment needed. Just $40 per visit! Connect with a doctor by computer or phone and get help with minor illnesses such as cough, cold, flu, fever, nausea, sore throat, sinus infection and more. Available 24/7, licensed doctors can diagnose and prescribe most drugs.* Exclusively for GE Health Benefits and GE Health Choice members in all states except Texas and Arkansas.** For more information or to get started, go to mynowclinic.com/ge. NowClinic is mobile... search for NowClinic in your app store. Confirm availability in your state at learnmore.nowclinic.com * No controlled substances may be prescribed. Other prescriptions may be available where clinically appropriate and permitted by law and can be transmitted to an OptumRx participating pharmacy of your choice. **Not available for Option 2 Select (Kaiser and UPMC). 12

13 Baby Portal This portal is a one-stop shop to help you learn about your GE medical and absence benefits. This makes it easy to access programs, tools and resources that may help you prepare for your baby. Learn more at ge-healthahead.com/baby Expert Medical Opinion Program Get a second opinion from a Cleveland Clinic specialist, online and at no cost to you. Understand your condition and make more informed care decisions. Learn more at eclevelandclinic.org/ge Tobacco Cessation Programs GE offers services and resources to help you stop using tobacco and get healthier. With determination, a positive attitude and the proper support, you can do it! Go to ge.com/healthahead/healthcaredecisions 13

14 YOUR GE MEDICAL PLAN 2017 National Hip and Knee Replacement Centers of Excellence GE Health Benefits and Health Choice participants are eligible to go to one of our hip and knee replacement Centers of Excellence (COE): 100% coverage for Option 1 & 2 members; not subject to deductible and coinsurance, and 100% coverage, after meeting deductible, for Option 3 members* Providers and facilities in this program are nationally recognized for excellence in orthopedic care: Hospital for Special Surgery; New York, NY Carolina s Medical Center Mercy; Charlotte, NC The Christ Hospital; Cincinnati, Ohio Northwestern Memorial Hospital; Chicago, IL Two University Hospital locations in Ohio Cleveland Medical Center in Cleveland Conneaut Medical Center in Conneaut New England Baptist Hospital in Boston, MA Holy Cross Hospital in Fort Lauderdale, FL To learn more about this program and other COE programs, contact Health Coach from GE at Depending on the how far you live from the COE, a travel benefit may also be available. GE also has COEs for organ transplant, maternity (for GE Health Choice members only), bariatric surgery and certain types of cancer care. *Not available for Option 2 Select (Kaiser and UPMC). 14

15 Important Phone Numbers Health Plan Providers Health Choice Health Benefits Aetna CDPHP BCBS of Alabama UnitedHealthcare UPMC Kaiser Health Savings Accounts PayFlex Aetna Optum Bank UnitedHealthcare BenefitWallet BCBS of Alabama BenefitWallet CDPHP If you will not be able to work because of illness or injury for more than 7 days, you must report your absence to the GE Disability Benefits and Leave Center: , option 1 or online at OneHR > Life Insurance & Disability > File/View Disability Benefit Claim 15

16 Need assistance or want to learn more about everything in this guide? Visit ge.com/healthahead/healthcaredecisions Add Health Care Hub to your mobile device This guide provides highlights of GE s Health plans. If there are any conflicts between this document and the official Plan documents, the Plan documents prevail. Please note that some employees may be ineligible to participate in GE benefits. The General Electric Company reserves the right to terminate, amend, suspend, replace or modify the plans, at any time and for any reason. No individual has a vested right to any benefit under the Plan.