Benefit Coverage Information

Transcription

1 Benefit Coverage Information The County provides multiple benefit plans to allow you to make the best decision for you and your family members. For medical coverage, you have the choice of: MetroHealth Select United Healthcare Medical Mutual of Ohio SuperMed The ancillary plans include: CVS Caremark Guardian Dental Guardian (Life Insurance) o Non-AFSCME employees receive $6,000 term-life insurance o Additional coverage may be purchased for a fee VSP Vision Care Union Eye Care The County is mandated by the Patient Protection & Affordable Care Act (PPACA) to provide medical and prescription options for your year old dependent whom you wish to cover. The plan does not provide dental or vision past the age of 23. If you wish to provide vision and dental coverage, you must do so with an additional charge through COBRA. Your dependent can be married or unmarried. The dependent is not restricted to be a full-time student. There will be no change to family coverage costs. The Benefits staff is willing to meet with you face-to-face and over the phone to assist with any benefits questions. To make an appointment please send an to benefits@cuyahogacounty.us.

2 MetroHealth Select (Metro) Only Coinsurance Coinsurance Maximum Maximum Out of Pocket None 100% paid None Coverage is limited to MetroHealth hospital, satellite facilities, and physicians with no out-ofnetwork component, meaning if you use non-network hospitals and doctors you must pay in full No network outside of Ohio; i.e., a dependent away at college will not have medical coverage if you choose this plan Two-option pharmacy network. Note that mail order must be done through MetroHealth o Option 1 MetroHealth pharmacy (lowest copay level) o Option 2 CVS network (low copays, not as low as option 1) Page 2

3 United Healthcare (UHC) Plan Name United Healthcare $250 United Healthcare $500 80%/60% Plan $250 Single $500 Family $500 Single $1,000 Family Coinsurance 90% paid 80% paid Coinsurance Maximum Maximum Out of Pocket $1,500 Single $3,000 Family $2,500 Single $5,000 Family Provides access to the Cleveland Clinic and University Hospitals networks Prescription drug (Rx) coverage is through CVS Caremark Has a well-established network throughout the country Only plan with an out-of-network feature. If you go out-of-network, there are higher deductibles/coinsurances/copays, as the rates shown in this document reflect in-network rates only Page 3

4 Medical Mutual of Ohio SuperMed (MMO) Plan Name SuperMed Bronze Plan (healthcare reform required offering) $250 Single $500 Family + 30% $4,000 Single $8,000 Family Coinsurance 90% paid 70% paid Coinsurance Maximum Maximum Out of Pocket $1,500 Single $3,000 Family Provides access to Cleveland Clinic Prescription drug (Rx) coverage is through CVS Caremark No out-of-network component, meaning if you use non-network hospitals and doctors you must pay in full Limited out-of-network panel outside of Ohio As a provision of the federal healthcare reform, we are required to offer a minimum value plan, for which the Bronze plan fulfills this requirement Page 4

5 Guardian Dental One plan (unless you are in AFSCME) Open PPO (meaning most dentists are in the plan at variable coverage levels) Preventive care covered at 100% Basic services covered at 80% Major services covered at 50% Orthodontic services covered at 50% (for children) under age 19 Plan Name Maximum Benefit Guardian Dental $0 $50 Out-of-Network* No maximum for preventative, basic, major services $1,000 lifetime maximum/person for TMJ treatment *deductible is waived for preventative services Page 5

6 VSP Vision Care - Employee-paid vision plan Benefit Description Copay Frequency Well Vision exam Focuses on your eyes and overall wellness $10 in network Every plan year Prescription Glasses $25 See Frame and Lenses Frame $140 allowance for a wide selection of frames $190 allowance for featured frame brands 20% savings on the amount over your allowance Included in prescription glasses Every plan year Lenses Single vision, lined bifocal, lined trifocal lenses, standard progressive lenses, base tints and scratch coating Polycarbonate lenses for dependent children Lens Enhancements Standard progressive lenses Premium progressive lenses Included in prescription glasses $0 $95 - $105 Every plan year Every plan year Contacts (instead of glasses) $140 allowance for contacts and contact lens exam (fitting and evaluation) $0 Every plan year 15% savings on a contact lens exam (fitting and evaluation) Diabetic Eyecare Plus Program Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD) $20 As needed Retinal screening for eligible members with diabetes Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details Page 6

7 Union Eye Care (UEC) Limited to Union Eye Care facilities for maximum reimbursement Low reimbursement levels for both network and non-network Benefit Non-Network Examination Exam with Dilation by Optometrist Exam with Dilation by Ophthalmologist $30 Co-payment Contact Lens Exam $35 Allowance One exam per calendar year One exam per calendar year Lenses Per Pair (two lenses) Single vision Bi-focal $40 Allowance Tri-focal $50 Allowance Lenticular $80 Allowance One pair per calendar year One pair per calendar year Frame Frame for prescription lenses $55 Allowance One per calendar year One per calendar year Contacts (instead of eyeglasses) Lenses $70 Allowance $50 Allowance Once per calendar year One per calendar year Page 7