TAKING CARE OF. HEALTH CARE GHI FEHB Standard and High Option Plans for Federal Employees and Retirees

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1 TAKING CARE OF HEALTH CARE GHI FEHB Standard and High Option Plans for Federal Employees and Retirees 2018

2 As one of the nation s largest nonprofit health insurers, EmblemHealth offers quality, affordable health plans, convenient community resources and access to top doctors and hospitals across the New York tristate area. We re committed to creating healthier futures for our members and our community.

3 CHOOSING EMBLEMHEALTH When you choose a health care plan for 2018, consider one of our EmblemHealth plans. As a Federal employee, you can enroll in our GHI FEHB Standard or GHI FEHB High Option plans. If you have questions or need help choosing one of these plans, call (TTY: 711), 8 a.m. to 6 p.m., Monday to Friday. If you are already enrolled in either of these plans, you don t need to do anything. You will continue to be covered through the end of If you d like to enroll in either of these plans, please do so through your agency s standard enrollment procedure. Make sure to include the GHI plan enrollment codes shown inside this brochure. This year s open enrollment period takes place November 13, 2017 through December 11,

4 GHI FEHB STANDARD AND HIGH OPTIONS PLANS As a federal employee or retiree, you can choose from two GHI FEHB options: Standard Option Plan High Option Plan Both give you the freedom to get care from specialists without a referral. Standard Option Plan This is our in-network plan, which means you can get care from our large network of quality doctors, including specialists, without a referral. Simply choose one of our network doctors and make an appointment. In most cases, a copay will be your only out-of-pocket cost. A copay is the amount you pay for health services. High Option Plan With this plan, in addition to coverage for in-network care, you re also covered for out-of-network care. Please note that some of the costs for this plan are different from the Standard Option, which means your out-of-pocket costs will be higher. When you see an out-of-network doctor, you pay the doctor. Ask the doctor s office to fill out a claim form with the type of service you received, and then you send the form to us. We ll send you a check for the amount we cover. 2

5 Benefit Highlights for GHI FEHB Standard and High Option Plans The following is a side-by-side comparison of the benefits offered through the two options. Before making your selection, please review them and carefully consider which option best suits your needs, and those of your family. Rate information for both plans can be found on the next page. Plan Choices Medical Care Primary Care Physician (PCP) office-visit Specialist office visit Diagnostic lab/ X-ray Preventive care routine physical exam Standard Option In-network Copay $40/$10 (subscriber/ dependent) $40/$10 (subscriber/ dependent) Standard Option Out-of-network Copay High Option In-network Copay High Option Out-of-network Copay Not covered $20 50% of plan s fee Not covered $20 50% of plan s fee $40 Not covered $20 50% of plan s fee $0 Not covered $0 50% of plan s fee Well child care $0 Not covered $0 50% of plan s fee Women s wellness services $0 Not covered $0 50% of plan s fee Acupuncture $40 Not covered Not covered Not covered Other Services Outpatient mental health $0 Not covered $0 50% of plan s fee Urgent care $40 Not covered $20 50% of plan s fee Ambulance Prescription drugs Other Services You pay all charges after $100 $15 generic/$50 brand/$100 nonformulary 25% coinsurance up to $200 maximum per prescription for specialty drugs Inpatient care $250/$750 (subscriber/ dependent) maximum Emergency room Ambulatory surgery $175 copay (waived if admitted) Not covered Not covered You pay all charges after $100 $20 generic/$45 brand/$80 nonformulary 25% coinsurance up to $200 maximum per prescription for specialty drugs Not covered $200/$600 maximum $175 copay (waived if admitted) $175 copay (waived if admitted) You pay all charges after $100 Not covered 50% of plan s fee $175 copay (waived if admitted) $150 Not covered $150 50% of plan s fee * You must also pay a yearly deductible of $500 (the amount you pay before your plan starts to pay) before we pay the fee schedule amount. A fee schedule is the amount your plan has agreed to pay for these services. This is the most amount of money your plan will pay. For your detailed Summary of Benefits and Coverage (SBC), go to emblemhealth.com/federal. You can also request a free printed copy of the SBC by calling the number on the back of your member ID card, Monday to Friday, 8 a.m. to 6 p.m. (closed on weekends), (TTY: 711). Your SBC shows what your plan covers and what (if any) cost-sharing responsibilities you have. For complete details about the benefits available through these plans, please read the Federal RI

6 2018 GHI FEHB High Option Plan Enrollment Codes and Rates Non-Postal rates apply to most non-postal employees. Use the Guide to Federal Benefits to find out which special enrollment category you are in. Or, contact the agency that handles your health benefits enrollment. Postal Category 1 rates apply to career bargaining unit employees represented by: National Postal Mail Handlers Union (NPMHU). National Association of Letter Carriers (NALC). Postal Police bargaining units. American Postal Workers Union (APWU). Postal Category 2 rates apply to career bargaining unit employees represented by: Other non-apwu. Non-Postal Career Executive Service (PCES). Non-law enforcement Postal Service career employees, including management employees and employees covered by the National Rural Letter Carriers Association bargaining unit. Non-postal rates apply to all career non-bargaining unit Postal Service employees. Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable Guide to Federal Benefits. For further assistance, Postal Service employees should call the Human Resources Shared Service Center , option 5. (TTY: 711.) OPTIONS INCLUDE: GHI FEHB High Option plan, serving all of New York and Northern New Jersey. GHI FEHB Standard Option plan, serving New York City plus most New York counties, as well as Northern New Jersey. These plans are only available to individuals who live or work in certain counties. Please see federal brochure RI for the counties included in these plans service areas. Type of Enrollment GHI FEHB High Option Enrollment Code NON-POSTAL PREMIUM POSTAL PREMIUM Biweekly Monthly Biweekly Gov t Share Your Share Gov t Share Your Share Category 1 Your Share Category 2 Your Share Self Only 801 $ $ $ $ $ $ Self and Family 802 $ $ $1, $1, $ $ Self Plus One 803 $ $ $ $1, $ $ GHI FEHB Standard Option Self Only 804 $ $98.90 $ $ $92.53 $86.17 Self and Family 805 $ $ $1, $ $ $ Self Plus One 806 $ $ $1, $ $ $

7 Care Where You Live and Work This plan uses the National Network. A network is a group of health care professionals or facilities that contract with EmblemHealth. They provide covered products and services to members. You ll usually pay less when you use your network. This network includes quality doctors, hospitals, and urgent care centers located throughout the neighborhoods of all five New York City boroughs, plus in Nassau, Suffolk, Westchester, Rockland, and Orange counties. Plus covered access across all 50 states. With a GHI FEHB plan you have coverage at top-ranked area hospitals, including: Lenox Hill Hospital Memorial Sloan-Kettering Cancer Center Montefiore Medical Center Northwell Health NYU Hospital Center Staten Island University Hospital St. Barnabas Hospital Health Center Need to Find a Doctor? You can see a full listing of doctors in this plan through the Find a Doctor or Hospital search at emblemhealth.com/federal. AdvantageCare Physicians EmblemHealth partners with AdvantageCare Physicians, a leading New York medical group, to provide enhanced primary and specialty care to our members. With 36 medical offices across the New York metropolitan area, AdvantageCare Physicians takes a coordinated, team-based approach to care. For more information and a list of locations, visit acpny.com. Neighborhood Care With eight convenient locations across New York City, EmblemHealth Neighborhood Care provides in-person customer service and wellness support. Our customer care navigators help EmblemHealth members understand how to make the most of their benefits. From easy-to-understand enrollment seminars to assistance with translating complex medical documents, our team is here to help. As a community-based resource, EmblemHealth Neighborhood Care also partners with local organizations to support the surrounding communities. Visit emblemhealth.com/community for upcoming classes and programs at Neighborhood Care. 5

8 Telemedicine through Amwell With telemedicine through Amwell, you can get non-urgent medical care. Use your phone, computer, or mobile device. It s convenient, immediate, and available 24 hours a day, 365 days a year. Talk to doctors who practice primary care, family care, and more. Telemedicine doctors can prescribe certain medicines.* You can also talk to a registered dietician. Telemedicine is in-network care. That means you pay only your copay (the amount you pay for health services). Use telemedicine when: You feel sick and don t want to leave home. You don t have time to see your doctor in person. You re out of town and need a doctor s advice. Remember: Telemedicine does not replace the care of your regular doctor. * Only applicable in U.S. states where telemedicine prescriptions are allowed. New York State permits telemedicine prescriptions, but others may not. Members without computer access can take advantage of this benefit by using their phone or mobile device to speak with a doctor from the Amwell network. 6

9 YOUR HEALTH AND WELLNESS ARE IMPORTANT TO US Take advantage of the many free programs and support services you get with this plan. Health and Wellness Programs that Help You Stay Healthy In addition to your doctor s care, below are some programs you can join to help you and your enrolled family members stay healthy. To see the full list, visit emblemhealth.com/stayhealthy. Heart disease support. Diabetes support. Preventive cancer screenings. Domestic violence victim support and resources. Pregnancy management and support after giving birth. Help to stop smoking. Chronic obstructive pulmonary disorder (COPD) support. Free checkups and immunizations for children and adults. Get Healthy Discounts Your GHI FEHB High Option plan includes Healthy Discounts,* which can help you save money on: Weight loss services Save on Jenny Craig and Nutrisystem. Health club memberships Join selected clubs at lower costs. Jazzercise Enroll in a Jazzercise class, receive one week free, and save 15 percent of the monthly fee. Registered dietitians Save 25 percent on nutrition counseling. Massage therapy Save up to 25 percent on therapeutic massage. Acupuncture therapy Save up to 25 percent on acupuncture therapy. Hearing care Save on hearing aid purchases and get other discounts through HearX, HearUSA and Amplifon centers. At Amplifon centers, you also get a low-price guarantee on hearing aids, free batteries, follow-up care and screenings, and a 60-day trial period with a 100% money-back guarantee. Vision affinity discount program Get discounts of up to 20 percent at participating EyeMed with CPS Vision Care centers. Laser vision care Save up to 25 percent on laser vision correction. Health care services and products Pay up to half of the cost of over-the-counter drugs, dental care, home nursing care and more. For details, visit emblemhealth.com/goodhealth. * Please note: Services included in the Healthy Discounts program are available only through participating vendors. These discount programs are not health care benefits and we do not insure them. For more about these services, please visit emblemhealth.com/goodhealth. 7

10 myemblemhealth: YOUR SECURE HEALTH SERVICES WEBSITE Having convenient and easy access to the right tools and information is a big part of staying healthy. That s why we want you to take advantage of myemblemhealth. myemblemhealth keeps your personal health care information in one convenient and secure place. To register for myemblemhealth, go to emblemhealth.com. Once you re registered, you can check: The status of a claim, approval, or the amount you have paid toward your deductible. A deductible is the amount you pay before your plan starts to pay. Descriptions of your health benefits. Messages in your secure Message Center. You can also send secure messages to us. A list of your covered drugs. You can also order ID cards, download forms, and update your address. 8

11 Go Paperless and Get Rid of Clutter The Green Way! When you register for myemblemhealth, you can choose to get your documents online. They will be stored in your secure Message Center on myemblemhealth. You can choose to get the following: Explanations of benefits. Alerts about when your claims are processed. Personalized information about your health. Your plan newsletter. Updated information about your coverage and benefits. Manage Your Health Online myemblemhealth has lots of tools to help you take care of your health and meet your personal wellness goals. Health Assessment Gives you an overall picture of your health and has steps you can take to make healthy lifestyle changes. You can also fill out a Health Assessment for your covered dependents. Health Journeys This personalized program helps you make healthy choices and manage your health conditions. Each Journey is based on your personal choices to help you change things like sleep and nutrition habits or improve your blood pressure and cholesterol. They can last anywhere from a few days to a few weeks, depending on your unique path. Treatment cost calculator A tool that helps you figure out how much health care services could cost. On the Go! myemblemhealth Mobile App With the myemblemhealth mobile app, you have useful benefit and plan information at your fingertips. Sign in to manage your health benefits whenever and wherever you want. The myemblemhealth app is available for download from the App Store or from Google play. 9

12 55 Water Street, New York, New York emblemhealth.com This brochure is intended to provide general information about the GHI health insurance program for FEHB members and is superseded by Federal Brochure RI All benefits are subject to the definitions, limitations and exclusions set forth in that Federal brochure. Refer to GHI policy form PLD-1032E. EmblemHealth insurance plans are underwritten by Group Health Incorporated (GHI), HIP Health Plan of New York (HIP) and HIP Insurance Company of New York K1 10/17