2018 HRA Core Plan Member Guide. Aetna, Anthem, Cigna, CVS Caremark

Transcription

1 2018 HRA Core Plan Member Guide Aetna, Anthem, Cigna, CVS Caremark

2 What s Inside 3 Your Medical and Prescription Drug ID Cards 4 Plan Features 6 Health Reimbursement Account 8 Your Non-Emergency Care Options 10 Prescription Drug Coverage 12 Healthcare Tools and Services 13 Your Medical Plan in Action 15 Contacts 2

3 Your Medical and Prescription Drug ID Cards Unless you changed your medical plan carrier for 2018, you can continue using your same medical ID card and CVS Caremark prescription ID card again this year. Be sure to take both with you whenever you visit your doctor or pharmacy. If you did choose a new HRA Core plan carrier, you can keep using your CVS Caremark card, but can expect to get a new medical ID card in the mail. How to Print a Temporary ID Card If you lose your medical or prescription drug ID card, or if you re waiting for both ID cards to come in the mail, you can print temporary ones. You need to register on your plan carrier s website before you can print your card. Aetna Go to and select View/Print an ID Card in the I want to menu on the main page. Anthem Log on to and select Customer Support, then click Request an ID Card or Print a temporary ID card. Electronic copies of ID cards are available using the Anthem Anywhere app. Cigna Log on to and select Profile in the upper right corner of the page. Then, select Print or Request an ID Card. CVS Caremark Go to select Plan and Benefits and choose Print Member ID Card. 3

4 Plan Features Taking care of your health is a lot easier when you know how your medical plan works. This guide can help you understand your plan s comprehensive medical and prescription drug coverage so you ll be ready to use it when you need to. Let s start with the basics. Prevention Is Key Your plan covers in-network preventive services at 100%, without you having to meet the annual deductible. Preventive care services covered at 100% include: Physical exams Health screenings Certain immunizations Visit your medical plan carrier s website to see all the preventive services that are covered at 100% (see p. 15). In-Network vs. Out-of-Network Which providers you see is up to you, but you usually pay less when you use an in-network provider. In-network providers have agreed with your medical plan carrier to provide services at a reduced rate. This means the provider can t bill you for more than the rate negotiated with your carrier. When you use out-of-network providers: Generally, your costs are higher than for in-network providers. You pay more in coinsurance (40% vs. 20%). Out-of-network providers may charge much more than the plan s Reasonable & Customary (R&C) charge. The R&C charge is the average fee charged by a healthcare provider in your area. It can t be more than 200% of the amount Medicare allows at the time of service. You re responsible for the difference. Prescription medications aren t covered. Qualified Status Change Your coverage is for all of 2018 unless you have a qualified status change, such as marriage, the birth of a child or your spouse/ domestic partner gets or loses medical coverage. If you have a qualified status change, you can update certain enrollment choices within 31 days of the change at UPoint > Life Changes. Visit UPoint to learn about Health Insurance Portability and Accountability Act (HIPAA) Special Enrollment Rights that let you enroll in coverage outside of Annual Enrollment. 4

5 HRA Core plan Health reimbursement account EE contribution McKesson contribution Deductible Coinsurance out-of-pocket maximum In-network Out-of-pocket maximum In-network** Out-ofnetwork Out-ofnetwork EE* $0 $750 $2,125 $2,500 $5,000 $4,625 $7,125 EE + SP/DP* or Child(ren) $0 $1,100 $3,175 $3,750 $7,500 $6,925 $10,675 EE + Family $0 $1,500 $4,250 $5,000 $10,000 $9,250 $14,250 *** EE = employee. SP/DP = spouse/domestic partner. *** If you re enrolled in EE + SP/DP, EE + Child(ren) or EE + Family coverage, your plan has an out-of-pocket maximum of $6,850 per individual. This means no one covered by your plan pays more than $6,850 a year for in-network services. Annual Deductible Coinsurance Out-of-Pocket Maximum STOP Your annual deductible is the amount you pay for office visits, prescription drugs and other covered services before your plan begins sharing the cost. Coinsurance kicks in after you meet your annual deductible. It s the percentage you and your plan each pay when you re sharing costs. The most you pay in a year for healthcare services is called the out-of-pocket maximum. After you reach the out-of-pocket maximum, the plan covers 100% of eligible services for the remainder of the plan year. If you have additional questions about what the HRA Core plan covers and costs, see your plan s Summary of Benefits and Coverage (SBC) at > Plan Documents. 5

6 Health Reimbursement Account McKesson credits your health reimbursement account to help you pay for eligible medical and prescription medication expenses. The credit is available immediately on the day your HRA Core coverage begins. The amount of the credit depends on who s covered by your plan: $750 Employee only coverage $1,100 Employee + Spouse/ Domestic Partner or Employee + Child(ren) $1,500 Employee + Family McKesson Owns the Account McKesson owns and credits the account, and your medical plan carrier is the administrator. Automatic Payments Your medical plan automatically pays your eligible medical and prescription medication expenses from your health reimbursement account. These payments count toward your deductible. Use It or Lose It Health reimbursement account credits don t carry over. Be sure to use your credits by December 31,

7 Still Have Health Reimbursement Account Credits from Before 2016? The HRA Core plan won t be available for That means if you ve been carrying over pre-2016 health reimbursement account credits, this is your last chance to use them. You need to use all of your health reimbursement account credits by December 31, 2018, or you lose them. If you changed medical plan carriers for 2018, your pre-2016 balance will be transferred to your new carrier shortly after the first quarter of

8 Your Non-Emergency Care Options Nurse Advice Line Call the nurse advice line when you: Have a headache, sprain or other non-emergency symptom. Need help deciding whether to visit a doctor, urgent care clinic or emergency room. Find your nurse advice line s phone number on your medical ID card. You re not charged for using this service. Retail Clinics Visit a retail clinic when: Your doctor s office is closed. You need help with a sinus infection, non-severe burn or other common symptom and minor injury. Retail clinics are available at many local pharmacies, not just CVS. Find an in-network clinic through your medical plan carrier s website or by calling the phone number on your medical ID card. Urgent Care Clinics Visit an urgent care clinic when you need attention right away for symptoms that aren t life-threatening. Visit your medical plan carrier s website to find an in-network urgent care clinic near you. Telemedicine When you re having non-urgent symptoms but would rather not make the drive to your doctor s office, use your plan s telemedicine service.* Telemedicine allows you to talk to a doctor about non-urgent health concerns through video streaming on your laptop, tablet or mobile device. This means that you can make an appointment, speak to a doctor and get a treatment plan without leaving your bed. Aetna Teladoc Online: teladoc.com By phone: App: Teladoc** Anthem LiveHealth Online: livehealthonline.com App: LiveHealth Online Mobile** Cigna MDLIVE Online: MDLIVEforCigna.com By phone: App: MDLIVE for Cigna** Amwell Online: AmwellforCigna.com By phone: App: Amwell for Cigna** ** State laws regarding telemedicine vary. ** Available on the App Store, Google Play TM and Windows Store. Teladoc is available on the App Store and Google Play only. 8

9 What to Do in an Emergency If you have an emergency, get medical help right away.* You pay for emergency care like any other eligible expense. If coinsurance applies, the plan pays 80% of the cost whether you get care from an in-network or out-of-network provider. However, you may have higher out-of-pocket costs if you use an out-of-network provider. * An emergency is a severe medical condition (including severe pain, unexpected symptoms during an illness or after a serious accident) that would cause a reasonable person to expect that the absence of immediate medical attention will result in placing the health or survival of the individual in serious jeopardy, seriously impair bodily functions or cause serious dysfunction to a bodily organ or part. 9

10 Prescription Drug Coverage CVS Caremark administers prescription drug coverage. You can use your prescription medication benefits at CVS stores and hundreds of other retail and specialty pharmacies in the CVS Caremark network, such as Health Mart. Prescription Coverage Before Meeting Your Deductible You pay prescription medications like any other eligible healthcare expense. This means you pay the full cost of your medications until you meet your deductible. Prescription Coverage After Meeting Your Deductible After meeting your medical plan s annual deductible, coinsurance kicks in. This means you and the plan begin sharing the costs of your eligible medical expenses, including your prescription medication costs. Medication Discounts Chronic Condition Medication Discount Program If you or your covered family member take prescription medicines for asthma, diabetes, heart disease, high blood pressure or high cholesterol, you may be eligible to receive discounts for those medications by periodically working with a condition support manager over the phone (see the table below). The manager can help you better understand your condition, answer questions and assist you in following your doctor s treatment plan. If you qualify for medication discounts under the Chronic Condition Medication Discount Program, your deductible is waived and: You pay nothing for generic medications. You pay 10% for preferred brand name medications (instead of 20%). You pay 20% for non-preferred brand name medications (instead of 40%). Medical Plan Carrier Condition Support Manager Phone Number Aetna Aetna In Touch Care Anthem Condition Care Cigna Personal Health Team You re eligible for the Chronic Condition Medication Discount Program as soon as you re eligible for McKesson benefits. Once you re eligible to participate, the condition support manager determines whether your condition is appropriate for the program. 10

11 CVS Caremark Online Register on the CVS Caremark website to find in-network pharmacies, estimate average costs of a medication and find details about mail order and specialty pharmacies. Go to > Sign Up Now and follow the prompts. Your covered family members can set up their own secure accounts (children must be age 19 or older). Download the CVS Caremark App Use the CVS Caremark app to access many of the same features found on Download the free app at (Standard mobile phone carrier and data usage charges apply.) CVS Mail Order Program You can fill your prescriptions up to a 90-day supply at CVS Caremark s mail order pharmacy or at any retail pharmacy in CVS Caremark s network. Visit to order your prescription medications online. 11

12 Healthcare Tools and Services Comparison Shop for Healthcare Using Castlight Castlight is your online personal healthcare assistant. Use the website to compare prescription medication costs, read reviews of physicians in your area and see how your medical plan and your Total Rewards work together. To learn more about Castlight, go to > Medical Plans and Programs > Castlight Program. Use Best Doctors for Expert Second Opinions and Medical Advice When you have questions about a medical treatment or medication side effects, need an in-depth review of your current treatment plan or help finding a local specialist, contact Best Doctors. Learn more at totalrewardslibrary > Medical Plans and Programs > Best Doctors Program. Get a New Hip or Knee Without Paying an Arm and a Leg You (or a covered family member) may be able to participate in the Centers of Excellence (COE) program to get a hip or knee replacement at little or no cost to you. The program gives you access to world-class hospitals and surgeons so you can get the best care and lower your risk of complications. Find out more at totalrewardslibrary > Medical Plans and Programs > Hip and Knee Program. 12

13 Your Medical Plan in Action Let s take a closer look at how the HRA Core plan works with in-network and out-of-network providers. You may need to tell your doctor s office about the plan claim process. Your medical ID card has contact information for your providers to use if they have questions. Meet Luke After hiking with friends, Luke develops a bad rash. Let s compare how his medical plan works at in-network and out-of-network providers. In-Network Claims Luke s medical plan carrier processes each claim and sends him an explanation of benefits (EOB) listing the total cost of services, amounts paid by the plan and the amount Luke is responsible for paying. Luke s provider sends him a bill for the amount that he owes. Luke can compare the amount on the bill with the EOB and call his carrier if he has questions before paying the bill. Let s see how the claim process works for Luke s doctor visit. 1. Luke shows his medical ID card at his doctor s office. 2. After Luke s visit, his doctor submits a claim to Luke s medical plan carrier. 3. Luke s medical plan carrier processes the claim and automatically uses available health reimbursement account credits to pay eligible costs that are Luke s responsibility. 4. Luke s medical plan carrier sends him an EOB. 5. If there s a balance due, Luke s doctor bills Luke directly. Luke has to pay the full amount until he meets his annual deductible. Out-of-Network Claims If Luke uses out-of-network providers, he normally pays for services at the time of his visit and files a claim for reimbursement. Claim forms are available on the medical plan carrier s website contact your carrier to make sure you use the correct form. Luke follows the instructions on the form to file the claim. Let s see how Luke s claim process works when he visits an out-of-network doctor. 1. Luke shows his medical ID card at the doctor s office. 2. Luke may need to pay at the time of his visit. If his doctor says he/she will submit a claim form for Luke, Luke skips to step If Luke s doctor doesn t submit a claim for him and he pays out of pocket, Luke will download a claim form from his medical plan carrier s website, complete the form and submit it to his carrier. 4. Luke s medical plan carrier processes his claim. If he has credits in his health reimbursement account, they re automatically applied toward the cost of his office visit if the costs are eligible. Luke s medical plan carrier sends him an EOB. 5. Luke s doctor sends him a bill if there isn t enough credit in his health reimbursement account to cover the costs of his visit. 13

14 Explanation of Benefits Your medical plan carrier processes your claims and sends you an explanation of benefits (EOB) that shows how much the plan paid, how much you paid and what you may still need to pay out of pocket. An EOB isn t a bill, it s simply a summary of your claim. Review your EOB carefully before paying your provider and call your medical plan carrier if you have questions. If you want to review your claims activity more frequently or need additional information, visit your medical plan carrier s website. 14

15 Contacts Medical Plan Carrier Information If you still have questions about how your plan works, contact your carrier. Be sure to register on both your medical plan carrier s and CVS Caremark s websites to access online tools and learn how you can use your medical and prescription drug dollars more effectively. Aetna Available in all states except Hawaii. Cigna Available in all states except Hawaii. Anthem Available in California, Florida, Michigan and Pennsylvania. CVS Caremark Manage Your Plan on the Go with Carrier Apps Stay on top of your healthcare anytime from anywhere. Download your medical plan carrier s app and CVS Caremark s to track claims, see details of your coverage, search for in-network providers, access healthcare tools and more. Carrier apps are available on your carrier s website, the App Store or Google Play. 15

16 UPoint Review and manage your Total Rewards. Total Rewards Library Find information about health and wellness programs from any device connected to the internet. HR Support Center 855.GO.MCKHR ( ) Press 1 for the McKesson Benefits Center for Health, Vitality and Pension questions. Benefit experts are available 7 a.m. - 6 p.m. Central time, M-F. Oprime 1 para asistencia en español a través del McKesson Benefits Center. February 2018