2015 CHC Medical Plan

Transcription

1 2015 CHC Medical Plan ANNUAL DEDUCTIBLE All deductibles (except for Out of Network) cross accumulate Commonwealth Health Corporation Resident Full Time Deductible Applies CDH Plan YOU PAY Get Healthy Deductible $200 $200 PPO Plan CHC Hosp./Facility $500/$750/$1,000* $500/$750/$1,000* Enspire Network $1,250/$1,875/$2,500* $1,500/$2,750/$3,250* $1,250/$1,875/$2,500* $1,500/$2,750/$3,250* Out of Network $2,000/$3,250/$4,500* $2,250/$4,750/$6,000* OUT OF POCKET MAXIMUM CHC Facility $5,000/$7,000/$9,000* $5,000/$9,000/$10,000* HEALTHY OUTCOMES HEALTH REIMBURSEMENT ACCOUNT (HRA) (Max. annual deposits) Enspire Network $5,750/$8,125/$10,500* $6,000/$11,000/$12,250* $5,750/$8,125/$10,500* $6,000/$11,000/$12,250* Out of Network Unlimited Unlimited Achieve Healthy Outcomes Up to $200** Up to $200** Complete Know Your Numbers/Health Assessment $250*/$500*/$750* Not applicable LIFETIME MAXIMUM None None INPATIENT HOSPITAL SERVICES (applies to facility services only) OUTPATIENT HOSPITAL SURGERY PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY CHEMOTHERAPY/RADIATION THERAPY RADIOLOGY AND LAB SERVICES LAB SERVICES Physician Office Based CHC Hospital Yes $500 Co pay after deductible $500 Co pay after deductible Yes 25% 30% CHC Hosp./Facility Yes $300 Co pay after deductible $300 Co pay after deductible Yes 25% 30% CHC Hosp./Facility Combination of 45 Visits Enspire Network Combination of 30 Visits Combination of 30 Visits Out of Network Combination of 30 Visits Yes, CHC Hosp./Facility 25% 30% Yes 25% 30% Yes 35% 40% Yes 60% 70% Enspire Network Yes 25% 30% Yes 35% 40% Out of Network Yes 60% 70% CHC Facility No $25 copay per day for basic services; $75 per day for advanced radiology Enspire Network*** Yes 25% 30% (includes Urgentcare) Yes 35% 40% Enspire Network*** Yes 25% 30% (includes Urgentcare) Yes 35% 40% PREVENTIVE SERVICES All Network Providers No $0 $0 $25 copay per day for basic services; $75 per day for advanced radiology EE Only/EE + Child or Spouse/EE + Family Revised 04/13/15 ** Healthy Outcomes and/or Healthy Activities *** Center Care providers in the following specialty areas; Dermatology, Urology, Endocrinology, Rheumatology, and Psychologists will be paid as an Enspire Network Provider until the specialty becomes available in the Enspire Network.

2 2015 CHC Medical Plan PHYSICIAN SERVICES HOSPITAL Inpatient and Outpatient Commonwealth Health Corporation Resident Full Time CHC Facility Enspire Network*** CHC Facility Non CHC Facility Deductible Applies CDH Plan YOU PAY Yes 10% 10% Yes 25% 30% Yes 25% 30% PHYSICIAN OFFICE VISIT Enspire Network*** No $20 $20 OBSTETRIC PHYSICIAN OFFICE VISIT (Maternity) OTHER ELIGIBLE MEDICAL SERVICES (i.e., durable medical) (includes Urgentcare) No $40 $40 PPO Plan Enspire Network No $20/$200 max. $20/$200 max. No $40/$400 max. $40/$400 max. All Network Providers Yes 25% 30% EMERGENCY SERVICES CO PAY All Facilities No $300 $300 (if admitted, inpatient benefits apply; applies to facility services only) ALLERGY INJECTIONS All Facilities No $5.00 per injection $5.00 per injection ALLERGY TREATMENT Enspire Network Yes 25% 30% (includes Urgentcare) Yes 35% 40% PRESCRIPTION DRUG BENEFIT Annual Deductible $100/$200 (Single/Family) $100/$200 (Single/Family) Retail (30 Day Supply) Mail Order or Retail (90 Day Supply) Generic Riverside Yes $5 $5 Generic All Other Yes 25% (min. $15; max. $25) 25% (min. $15; max. $25) Formulary Brand Yes 25% (min. $25; max. $75) 25% (min. $25; max. $75) Non Formulary Brand Yes 50% (min. $50; max. $125) 50% (min. $50; max. $125) Generic Riverside Yes $10 $10 Generic All Other Yes 25% (min. $25; max. $63) 25% (min. $25; max. $63) Formulary Brand Yes 25% (min. $63; max. $188) 25% (min. $63; max. $188) Non Formulary Brand Yes 50% (min. $125; max. $313) 50% (min. $125; max. $313) Proton Pump Inhibitors Yes 50% 50% PAY PERIOD CONTRIBUTIONS (Rates reflect the Nicotine Free and Get Fit Club wellness incentives) Full Time Ee Only $44.39 $22.94 EE/Spouse $ $97.01 Ee/Child $97.43 $80.57 Family $ $ Part Time Ee Only $75.40 $64.15 EE/Spouse $ $ Ee/Child $ $ Family $ $ EE Only/EE + Child or Spouse/EE + Family Revised 04/13/15 ** Healthy Outcomes and/or Healthy Activities *** Center Care providers in the following specialty areas; Dermatology, Urology, Endocrinology, Rheumatology, and Psychologists will be paid as an Enspire Network Provider until the specialty becomes available in the Enspire Network.

3 BENEFITS Commonwealth Health Corporation EXPLANATION ELIGIBILITY REQUIREMENTS COST PER PAY PERIOD SERVICE NUMBER HEALTH REIMBURSEMENT ACCOUNT (HRA) CHC funded account that can be used to pay for eligible medical expenses. CDH: Earned on completion of Know Your Numbers/Health Assessment and Get Healthy Rewards. PPO: Earned on completion of Get Healthy Rewards. Enrolled in CHC Medical Plan. Eligible expenses include: Medical Services covered by the medical plan (excluding prescription Covered co pays, deductibles and coinsurance PRESCRIPTION PLAN (HealthSmartRx) Prescription Plan is provided in conjunction with the CHC Medical Plan Retail Pharmacy benefit Mail Order Mail at Retail Separate RX Deductible $100 single $200 family Add Copay description Enrolled in CHC Medical Plan. Included with the Medical Plan premium or HealthSmartRx MEDICATION THERAPY MANAGEMENT SERVICES (MTMS) Benefit Eligible Employee Status** enrolled in Medical Plan Spouse Eligibility Requirements Dependent Verification Available to for all CHC Medical Plan Members including dependents enrolled in the CHC Medical Plan. Services provided at Riverside Pharmacy for treatment of: Asthma Allergy Diabetes Hypertension High Cholesterol Congestive Heart Failure Generic: $0.00 Co pay for 30 or 90 day Preferred Brand: $20 copay for 30 day and $40 copay for 90 day (after deductible) Spouses who have access to an employer sponsored group medical plan are not eligible for coverage through the CHC Medical Plan. CHC partners with Aon Consulting to carry out the eligibility verification of covered dependents. Coverage begins the first day of the month following 60 day waiting period benefit eligible employees if enrolled in the Medical Plan. Your spouse is eligible for coverage under the following circumstances: * Spouses whose employer does not offer group medical coverage. * Spouses who do not qualify for their employer s group medical coverage. * Spouses who are selfemployed or not employed. * Spouses who are retired and/or covered by Medicare. * Spouses who are employed by CHC. You will be asked to provide documents that show your spouse or children are eligible for coverage. Examples include; marriage certificate, birth certificate, legal adoption papers, etc. Included with the Medical Plan premium Coverage included in the Medical Plan premium Riverside Pharmacy Amanda Walden You will receive Time Sensitive Information from Aon mailed to your Home. Your prompt reply is essential.

4 BENEFITS Commonwealth Health Corporation EXPLANATION ELIGIBILITY REQUIREMENTS COST PER PAY PERIOD SERVICE NUMBER OPT OUT PHARMACY DISCOUNTS The Opt Out is available to employees who are eligible for medical coverage but choose to waive coverage. The Opt Out credit is $35 per pay period ($910 annually). CHC will fund up to $500 to your Health Care Flexible Spending Account if you elect to opt out of coverage as long as you contribute the same amount into the account. The remaining balance of the $910 annual optout amount will be paid to you as regular pay on a pay period basis and will be subject to taxes. (OR) You can elect to receive $35 as regular pay ($910 annually) each pay period which will be subject to payroll taxes. Riverside Pharmacy: Over the counter products and Smoking Cessation Products sold AT COST. Eligible but not enrolled in the CHC Medical Plan. Must provide proof of other medical coverage. No cost to you Riverside Pharmacy EMPLOYEE HEALTH MEDICAL CLINIC Medical services provided by Nurse Practitioners. CHC Employee Health Medical Clinic 720 Second Street, Suite 207 Bowling Green, Kentucky (270) Fax (270) CHC EMPLOYEE HEALTH SERVICES Dr. Jayashree Seshadri Primary care physician services provided to CHC employees, spouses, and children age 18 and over covered in the CHC Medical Plan CHC employees, spouses and children age 18 and over covered in the CHC Medical Plan CHC Employee Health Services 720 Second Street, Suite 307 Bowling Green, Kentucky (270) Fax (270) GET FIT CLUB Get Fit Club is a wellness program that promotes and rewards employees for adopting healthier lifestyles and making better health care choices.. Employees enrolled in the CHC Medical Plan can earn rewards for completing wellness activities. No cost to you Employee Wellness chcgetfit.biova. healthfitness.com

5 Commonwealth Health Corporation BENEFITS EXPLANATION ELIGIBILITY REQUIREMENTS COST PER PAY PERIOD SERVICE NUMBER DENTAL PLAN (HRI) Dental coverage for you and your dependents. This plan utilizes the Health Resources, Inc. (HRI) Dental Network. No Deductible Maximum Benefit is $1,200 per person per plan year. Preventative & 100% Diagnostic Basic 80/20 Major 50/50 Orthodontics 50/50 Maximum Orthodontics Benefit is $1,000 lifetime benefit per person. Full Time or Part time (regularly scheduled to work 15 hours per week minimum). On line enrollment must be completed within 31 days of hire. Coverage begins the first day of the month following the 60 day waiting period. Plan premiums are deducted on a pre tax basis. Full time You Only $2.31 Spouse $9.89 Child(ren) $9.89 Family $9.89 Part time You Only $5.34 Spouse $12.91 Child(ren) $12.91 Family $12.91 or For claims questions: Health Resource, Inc VISION PLAN (Humana Vision) Vision Plan for you and your dependents utilizing the Humana Vision network On line enrollment must be completed within 31 days. Coverage begins the first day of the month following the 60 day waiting period. Plan premiums are deducted on a pre tax basis. You Only $3.31 Spouse $5.63 Child(ren) $5.96 Family $8.94 Insurance Specialist, LLC Bryne Wiseman GROUP LIFE INSURANCE (Cigna) 1.5 times base Annual Salary, rounded to the next highest multiple of $1,000 Maximum of $300,000 Includes Accidental Death and Dismemberment Benefit Coverage automatically begins after 31 days continuous FLEXIBLE SPENDING ACCOUNT Pre tax contributions Health Care and Dependent Care Accounts Deductions begin the first day of the month following the 60 day waiting period. On Line enrollment must be completed within 31 days. Cost varies based on individual elections. CHC Medical Plan CoreSource CHCMedicalPlan.net Pre tax deductions for Child/Dependent Care Expenses You may contribute on a pay period basis up to $5,000 per plan year. Pre tax deductions for Health Care Expenses You may contribute on a pay period basis up to $2,550 per plan year. Cost varies by individual elections. Cost varies by individual elections.

6 Commonwealth Health Corporation BENEFITS EXPLANATION ELIGIBILITY REQUIREMENTS COST PER PAY PERIOD RETIREMENT PLAN LONG TERM DISABILITY PLAN (Cigna) VOLUNTARY TERM LIFE (Cigna) CANCER INSURANCE (Voluntary) through Allstate CHC 403b is a defined contribution plan. You may contribute a percentage of your annual compensation on a pretax basis to the 403b Plan up to the IRS annual maximum contribution amount. Provides a portion of your salary for total disability. 180 day Elimination Period. Pays up to 60% of your salary Insurance protection up to $150,000 for you and your eligible dependents. Proof of insurability not required when initially eligible for the benefit. Includes Accidental Death and Dismemberment Benefit. Employee coverage amounts are available in increments of $10,000 to $150,000. Spouse coverage up to $50,000 and Child coverage $10,000 contingent upon employee electing benefits for self. Provides coverage for expenses due to cancer. Pays regardless of any other insurance you may have Pays directly to you. Pays a Cancer Screening benefit when you have certain wellness screenings such as pap smear, mammogram, chest x ray, colonoscopy. Cancer Screening benefit is $25 each covered person for basic plan and $100 each covered person for enhanced plan. You will automatically be enrolled at a 3% contribution effective the first of the month after 90 days of service in an eligible status Coverage begins the first day of the month following the 30 day waiting period. Coverage begins the first day of the month following the 60 day waiting period. On Line enrollment must be completed within 31 days and must be approved by the insurance company. Coverage begins the first day of the month following the 60 day waiting period. On Line enrollment must be completed within 31 days and must be approved by the insurance company You will be automatically enrolled in the 403b Plan at a 3% contribution. You may change your contribution rate to a percentage of your annual compensation ranging from 1% to 100% up to the IRS maximum contribution amount. In calendar year 2015, the IRS maximum contribution limit is $18,000. If you are fifty (50) years of age or older, you may defer an additional $ The premium is paid 100% by CHC. You will be taxed on the premium amount paid by CHC and the benefit, when paid, is tax free. Coverage is paid in full by you and varies from person to person. The monthly cost per $1,000 is based upon the employee s age as of the date your benefit goes into effect. Premiums are deducted on a pretax basis. Pay Period rates Plan Ee Family Only Basic Enhanced SERVICE NUMBER Insurance Specialist, LLC Bryne Wiseman

7 Commonwealth Health Corporation BENEFITS EXPLANATION ELIGIBILITY REQUIREMENTS BEREAVEMENT You may be granted up to three scheduled working days off, with pay, for the death of an immediate family member. (See handbook for definition of immediate family member.) COST PER PAY PERIOD SERVICE NUMBER EMPLOYEE ASSISTANCE PROGRAM AT&T EMPLOYEE DISCOUNT HARTLAND MASSAGE Available to you and your dependents. Provides confidential, professional counseling services. Save up to 25% discount on qualified monthly service changes. 20% discount off of the regular price of a massage. Gift certificates are also available. No cost to you for the first (6) six sessions of each incident LifeServices EAP AT&T Bowling Green 1770 Campbell Ln. Phone: Provide Member Code: # Hartland Massage com DELL EMPLOYEE PURCHASE PROGRAM Employee discounts for purchase of Dell computers and equipment. Obtain EPP flyer through Citrix HOTEL DISCOUNTS Several local hotels offer discounts to CHC employees. For a complete listing of hotels and their associated discounts, please visit the section in Citrix Obtain flyer through Citrix

8 Commonwealth Health Corporation ADDITIONAL RESIDENT BENEFITS BENEFITS EXPLANATION ELIGIBILITY REQUIREMENTS COST PER PAY PERIOD SERVICE NUMBER VACATION 20 days per contract year Education MEDICAL EDUCATION STIPEND $1,500 per contract year Education RELOCATION EXPENSE REIMBURSEMENT One time relocation expense reimbursement offered up to a maximum of $1,000. Reimbursement provided by CHC Education MALPRACTICE INSURANCE Provided Premium is paid by CHC Education ONLINE REFERENCE MATERIAL Up to Date Subscription Premium is paid by CHC Education LAB COATS 2 coats provided per year if needed. For more detailed information on any of the above topics, please visit the icon located in Citrix.