Your Harvard Pilgrim Health Care Benefits and Rates are changing on April 1, 2018 January 2018 Dear SBSB Member: Important: There is no need for you to take any action now. This is for your information only. The April 1, 2018 group health insurance annual renewal and open enrollment period is rapidly approaching for members of the Small Business Service Bureau, Inc. (SBSB) enrolled in Harvard Pilgrim Health Care (HPHC). We are taking this opportunity to provide you with important information about your upcoming group health insurance renewal. Please take time to carefully review this information about your benefits. Harvard Pilgrim is making changes to most of its plans sold in the small group market in Massachusetts. As a result of these changes, your Harvard Pilgrim plan is being modified and will no longer be available in its current form as of April 1, 2018. However, Harvard Pilgrim has a number of plan options you can consider to meet your company s needs. Enclosed you will find two (2) important pieces of information. 1. A Harvard Pilgrim Product Name Comparison Chart that outlines the 2017 Product Name and the corresponding new 2018 Product Name. Additionally, a plan specific Harvard Pilgrim Benefit Comparison Chart is available online by logging into your account at www.sbsbhealth.com. Go to the Document Library; MA Health Plan; Harvard Pilgrim Health Care; Benefit Chart folder. Once there, select the chart with your current 2017 plan name. Here you will find a comprehensive outline of the specific 2018 benefit updates to your current (2017) plan. There is a Benefit Comparison Chart for each of Harvard Pilgrim s products. (Please note: If the product is no longer available for transferring groups it is noted as a closed plan.) 2. The Harvard Pilgrim Massachusetts Intermediary Benefit Design package that provides a description of the major benefits for each of the 2018 products. Please note the Key Changes for all Harvard Pilgrim plans listed on the cover page of the 2018 Benefit Design package. Highlights include: Flex Benefit: lower your out of pocket costs for general laboratory and day surgery when you use Flex facilities! (See the enclosed brochure for more information.) Family deductible: For plans with $2,000 individual deductible or less, the standard has changed for the family deductible from 2x the individual deductible to 2.5x individual deductible. All plans are Plan Year, except Affordable HMO 25- Flex which is calendar year.
What s next There is nothing you need to do now. There will be no changes to your plan until your April 2018 renewal date. By late February, SBSB will have information on your 2018 premium rate. YOU HAVE A CHOICE! As your trusted health care partner, we are committed to helping you navigate these changes with a minimum impact to you, your business and your employees. SBSB has a many health plan options you can consider during the 2018 open-enrollment. If you no longer want your current plan as modified for 2018, or decide it s time for a change, SBSB will assist you in transferring to the plan of your choice, hassle-free! Please call an SBSB Benefit Specialist Toll Free at 1-800-472-7199, or your SBSB credentialed broker if you have questions regarding your HPHC Plan renewal. We will work with you to review your current plan - and help you decide the best option for your 2018 coverage! Thank you for relying on SBSB for your health plan needs. We will continue to offer you and your employees plans that offer high quality and service, and look forward to serving you in the year ahead. Sincerely, Lisa M. Carroll President Small Business Service Bureau, Inc. Enclosures Summary of Benefits and Coverage (SBC) SBSB members can view Harvard Pilgrim Health Care 2018 SBCs by logging into their account at www.sbsbhealth.com. (Instructions for new member access are available on the homepage.) Once logged in, click on the Document Library link. Click on the 2018 SBC link and then on your health insurance carrier name to find your existing plan. 1x3564
Harvard Pilgrim Product Name Comparison Chart 2017 Plan Name 2018 Plan Name Affordable HMO 25 Affordable HMO 25 - Flex Affordable HMO 40 (discontinued) Best Buy HMO 500 - Flex Best Buy HMO 1000 Best Buy HMO 1000 - Flex Best Buy HMO 1000 with Coinsurance Best Buy HMO 1000 with Coinsurance - Flex Best Buy HMO 2000 Best Buy HMO 2000 - Flex Best Buy HMO 2000 with Coinsurance Best Buy HMO 2000 with Coinsurance - Flex Best Buy HMO 2000 with Copayment - Flex Best Buy HMO 3000 Best Buy HMO 3000 - Flex Core Coverage HMO 1750 (discontinued) Core Coverage HMO 1750 - Flex Core Coverage HMO 3000 (discontinued) Core Coverage HMO 3000 - Flex Best Buy HSA HMO 2000 Best Buy HSA HMO 2000 - Flex Best Buy HSA HMO 2000 with Coinsurance - Flex Best Buy HSA HMO 2000 with Cost Share - Flex Best Buy HSA HMO 3000 Best Buy HSA HMO 3000 - Flex Best Buy HSA HMO 3000 with Cost Share - Flex Best Buy HSA HMO 3100 Best Buy HSA HMO 3100 - Flex Standard Platinum Standard Platinum Standard Standard Standard Standard Standard Bronze Best Buy HSA PPO 3100 (closed plan) Best Buy HSA PPO 4500 (closed plan) Best Buy HSA PPO 3100 - Flex (closed plan) Best Buy HSA PPO 4500 - Flex (closed plan)
Massachusetts Intermediary Benefit Designs Second Quarter - 2018 The following are the Massachusetts Intermediary Benefit Designs (Group) for the Second Quarter of 2018. Key Changes: - Featured cost sharing for members who use Flex facilities for General Laboratory and services - Family Deductible: For plans with $2,000 individual deductible or less, the standard has changed for the family deductible from 2x the individual deductible to 2.5x individual deductible - Embedded Pediatric Dental: For Standard Connector plans, Core Coverage, and plans with a $3,000 individual deductible, the Out-of-imum for the Pediatric Dental benefit will be included in the medical OOPM. - All HSA plans will include preventative RX - All plans are Plan Year, except Affordable HMO 25 - Flex (Calendar Year) - Introduction of new plans, as noted on the grid. Affordable HMO 40 is no longer offered - For Core Coverage HMO 1750 and 3000, Emergency Room will fall under the deductible
Affordable HMO Plans Co-insurance ER Urgent Care Inpatient/ Acupuncture RX Cost Share (Value Affordable HMO 25 - Flex $25/$40 None/None $1,700/$3,400 None $125 Hosp: $40 IP: $1,000 $125 $25 $40 Retail: $5/$25/$40/$60/ Others: $40 Platinum $40 $12.50/$62.50/$100/$180/ MD0000004607 Conv: $25 $150 Others: $500 X-Rays: $40 $1,350/$2,700 RX0000001291 N/A Embedded DN0000010123 Co-insurance ER Urgent Care Inpatient/ Best Buy HMO 500 - Flex $25/$40 $500/$1,250 $5,750/$11,500 None $300 Hosp: $40 IP: (New Plan) $200 Best Buy HMO Plans $40 $200 then $40 $25 Acupuncture RX Cost Share (Value $40 Retail: $5/$30/$60/$90/ $12.50/$75/$150/$270/ MD0000004618 Conv: $25 $50 then $200 then $40 $1,350/$2,700 RX0000001600 Embedded Embedded DN0000010098 Best Buy HMO 1000 - Flex $25/$40 $1,000/$2,500 $5,750/$11,500 None $300 Hosp: $40 IP: $200 $40 MD0000004608 Conv: $25 $50 then $200 then $40 then $40 $200 $25 $40 Retail: $5/$30/$60/$90/ $12.50/$75/$150/$270/ $1,350/$2,700 RX0000001600 Embedded Embedded DN0000010098 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 2 of 9
Co-insurance ER Urgent Care Inpatient/ Best Buy HMO 1000 with $30/$50 $1,000/$2,500 $5,250/$10,500 $400 Hosp: $50 IP: Coinsurance - Flex $50 MD0000004609 Conv: $30 $150 then Others: then Acupuncture RX Cost Share (Value $50 Retail: $5/$30/$60/$90/ $12.50/$75/$150/$270/ $1,350/$2,700 RX0000001601 Embedded Embedded DN0000010098 Best Buy HMO 2000 - Flex $25/$40 $2,000/$5,000 $5,750/$11,500 None $300 Hosp: $40 IP: $250 $40 MD0000004610 Conv: $25 $75 then $200 Others: $40 then $40 $200 $25 $40 Retail: $5/$30/$60/$90/ $12.50/$75/$150/$270/ $1,350/$2,700 RX0000001600 Embedded Embedded DN0000010098 Best Buy HMO 2000 with Coinsurance - Flex $35/$65 $2,000/$5,000 $6,800/$13,600 $500 Hosp: $65 IP: $65 MD0000004611 Conv: $35 $150 then Others: then $50 Retail: $5/$30/$60/$90/ $12.50/$75/$150/$270/ $550/$1,100 RX0000001602 Embedded Embedded DN0000000329 Best Buy HMO 2000 with Copayment - Flex (New Plan) Best Buy HMO Plans $35/$55 $2,000/$5,000 $6,800/$13,600 None $1,000 Hosp: $55 IP: $1,000 $55 MD0000004619 Conv: $35 $250 then $1,000 Others: $55 then $55 $1,000 $35 $50 Retail: $5/$30/$80/$110/ $12.50/$75/$200/$330/ $550/$1,100 RX0000001609 Embedded Embedded DN0000000329 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 3 of 9
Best Buy HMO Plans Co-insurance ER Urgent Care Inpatient/ Best Buy HMO 3000 - Flex $40/$60 $3,000/$6,000 $7,350/$14,700 None $450 Hosp: $60 IP: $1,000 $350 Others: $60 $40 Acupuncture RX Cost Share (Value $50 Retail: $5/$30/$80/$110/ $60 $12.50/$75/$200/$330/ MD0000004620 Conv: $40 $200 then $500 then $60 RX0000001608 Embedded Embedded DN0000000316 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 4 of 9
Co-insurance ER Core Coverage HMO 1750 - Flex $35 Copay $1,750/$3,500 $7,350/$14,700 for the first $250 3 mem (6 per fam). All other visits Ded then Core Coverage Plans Urgent Care Inpatient/ Hosp: $35 IP: Copay for the first 3 mem (6 per fam). All other visits Others: $35 Copay for the first 3 mem (6 per fam). All other visits Ded then Acupuncture $35 Copay for the first 3 visits per mem (6 per fam). All other visits RX Cost Share (Value Retail: $5/$30/$60/$90/ $35 Copay for the first 3 mem (6 per fam). All other visits MD0000004616 Conv: $35 Copay for the first 3 mem (6 per fam). All other visits $150 then then $12.50/$75/$150/$270/ RX0000001607 Embedded Embedded DN0000000316 Core Coverage HMO 3000 - Flex $35 Copay for the first 3 mem (6 per fam). All other visits Ded then $3,000/$6,000 $7,350/$14,700 $250 Hosp: $35 Copay for the first 3 mem (6 per fam). All other visits $35 Copay for the first 3 mem (6 per fam). All other visits MD0000004617 Conv: $35 Copay for the first 3 mem (6 per fam). All other visits IP: $150 then Others: then $35 Copay for the first 3 mem (6 per fam). All other visits Ded then $35 Copay for the first 3 visits per mem (6 per fam). All other visits Retail: $5/$30/$80/$110/ $12.50/$75/$200/$330/ RX0000001608 Embedded Embedded DN0000000316 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 5 of 9
Co-insurance ER Best Buy HSA HMO 2000 - Flex $2,000/$5,000 $5,250/$10,500 None Best Buy HSA HMO Plans Urgent Care Inpatient/ Hosp: Ded IP: then then $10 Acupuncture RX Cost Share (Value Retail: $5/$30/$60/$90/ $12.50/$75/$150/$270/ MD0000004612 then Ded then then then $10 RX0000001603 Non-Embedded Embedded Preventive RX to Retail & Mail Best Buy HSA HMO 2000 with $2,000/$5,000 $6,250/$12,500 Hosp: Ded IP: Coinsurance - Flex (New Plan) $30/$45 $400 then $45 MD0000004613 $45 then $30 Ded then then then then Retail: $5/$30/$80/$110/ $12.50/$75/$200/$330/ RX0000001604 Non-Embedded Embedded Preventive RX to Retail & Mail Best Buy HSA HMO 2000 with $2,000/$5,000 $6,000/$12,000 None Hosp: Ded IP: $50 Cost Share - Flex (New Plan) $35/$55 $400 then $55 $500 $200 $35 MD0000004621 $55 then $35 Ded then then $250 then $55 then $55 Retail: $5/$30/$80/$110/ $12.50/$75/$200/$330/ RX0000001610 Non-Embedded Embedded Preventive RX to Retail & Mail $1,300/$2,600 DN0000000167 $400/$800 DN0000000330 $650/$1,300 DN0000000331 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 6 of 9
Co-insurance ER Best Buy HSA HMO 3000 - Flex $3,000/$6,000 $6,000/$12,000 None Best Buy HSA HMO Plans Urgent Care Inpatient/ Hosp: Ded IP: then then $20 Acupuncture RX Cost Share (Value Retail: $5/$30/$80/$110/ $12.50/$75/$200/$330/ MD0000004614 then Ded then then then $20 RX0000001605 Non-Embedded Embedded Preventive RX to Retail & Mail Best Buy HSA HMO 3000 with $3,000/$6,000 $6,000/$12,000 None Hosp: Ded IP: $50 Cost Share - Flex (New Plan) $35/$55 $400 then $55 $500 $200 $35 $55 then $55 Retail: $5/$30/$80/$110/ $12.50/$75/$200/$330/ $650/$1,300 DN0000000331 MD0000004622 then $35 Ded then then $250 then $55 RX0000001605 Non-Embedded Embedded Preventive RX to Retail & Mail Best Buy HSA HMO 3100 - Flex $3,100/$6,200 $6,400/$12,800 None Hosp: Ded IP: $50 $40/$65 $750 then $65 $750 $40 Bronze MD0000004615 $65 then $40 Ded then $250 then $1,000 then $65 then $65 Retail: $5/$30/50%/50%/50% (T3 $125/script max, T4 $250/script max, T5 $500/script max) $12.50/$75/50%/50%/50% (T3 $312.50/script max, T4 $750/script max, T5 $1,500/script max) RX0000001606 Non-Embedded Embedded Preventive RX to Retail & Mail $650/$1,300 DN0000000331 $250/$500 DN0000000332 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 7 of 9
Co-insurance ER Urgent Care Inpatient/ Acupuncture RX Cost Share (Value Standard Platinum $20/$40 None/None $3,000/$6,000 None $150 Hosp: $40 IP: $500 $150 $40 $40 Retail: $10/$25/$50 Platinum $20/$50/$150 $40 MD0000004598 Conv: $20 Day: $250 RX0000001592 N/A Embedded DN0000000247 Standard $30/$45 $1,000/$2,000 $5,000/$10,000 None $150 Hosp: $45 IP: $500 $45 MD0000004599 Conv: $30 Day: $250 $20 $200 $45 $45 Retail: $20/$30/$50 $40/$60/$150 RX0000001300 Embedded Embedded DN0000000248 Standard $30/$50 $2,000/$4,000 $7,350/$14,700 None $700 Hosp: $50 IP: $1,000 $50 MD0000004600 Conv: $30 Day: $750 $25 $500 $50 $50 Retail: $20/$60/$90 (Ded to T3) $40/$120/$270 (Ded to T3) RX0000001593 Embedded Embedded DN0000000316 Standard Bronze (New Plan) Bronze MD0000004601 $30/$50 $2,500/$5,000 $7,350/$14,700 None $700 Standard Connector (3-Tier Pharmacy) Plans Hosp: Ded then $50 then $30 IP: $1,000 Day: $750 $25 $500 $50 $50 Retail: $20/$60/$90 (Ded to T2 and T3) $40/$120/$270 (Ded to T2 and T3) RX0000001594 Embedded Embedded DN0000000316 of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 8 of 9
HPHC must receive complete applications including all required new business documents at least 10 days prior to the requested coverage effective date Business Rules Minimum Number of Participating Subscribers: 75% of those employees who are eligible for health benefits must participate in a group health plan sponsored by the employer (not necessarily those provided by HPHC). At least 51% of FTEs in the account must work within Massachusetts. Standard Connector (3 Tier Value Business Rules: These plans may only be offered alongside any other Standard Connector plan for groups with 6 or more Full Time Equivalents (FTEs). Minimum Enrollment Requirements (excluding waivers due to spousal or dependent coverage): Group Size Eligibility Requirements 1-5 FTEs: 100% of FTEs HSA Business Rule: Embedded OOPM: On a family contract each member has to only satisfy the individual OOPM and not the family OOPM. 6-100 FTEs (HMO): Renewals: 50% of FTEs 75% for side by side options Prospects: 75% of FTEs Embedded Deductible: On a family contract each member has to only satisfy the individual deductible and not the family deductible. All our HSA plans have embedded OOPM and non-embedded deductible. Massachusetts Minimum Creditable Coverage (MCC) standards: All Plans Meet Massachusetts Minimum Creditable Coverage Medicare Creditable Coverage (MCC) standards: All Plans Meet Medicare Minimum Creditable Coverage Notes: Please note that this document provides an overview of small group benefit designs only. Complete plan designs are defined in the applicable Evidence of Coverage (EOC). If there are discrepancies between this document and EOC, the terms of the EOC apply. For any questions on the application of these rules to a specific account, please call your HPHC representative. of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. Page 9 of 9
Pay less for day surgery and lab tests with the Flex benefit Costs for the same in-network medical service can vary widely depending on the type of location of the facility performing the service, with no significant difference in quality. So why pay more if you don t have to? That s where HMO-Flex and PPO-Flex come in. Harvard Pilgrim plans with the Flex benefit feature savings for members who use Flex facilities for general laboratory and day surgery services. There are many different opportunities for savings with Flex. It could be for general lab work recommended by your doctor during a routine visit, or arthroscopic surgery to treat a knee injury. Receiving services at a Flex facility could save you hundreds, or possibly thousands of dollars in out-of-pocket costs! Total average cost (facility) Member cost range at non-flex facility Member cost at a Flex facility Talk to your doctor about Flex let your doctor know that you have the Flex benefit and that you re interested in lowering your out-of-pocket costs by using a Flex facility. General lab work Day surgery (e.g. knee arthroscopy) *Deductible for HSA plans $10-$125 $40 copay deductible and $65 copay $6,770-$7,117 $500 copay deductible and coinsurance $0* $50-$250 copay* To find Flex facilities, see the provider directory at www.harvardpilgrim.org. Then choose HMO-Flex or PPO-Flex under Standard Plans. Facilities that are eligible for lower cost-sharing show the Flex name. For plans with Health Saving Accounts, the Flex benefit after the deductible is met. Harvard Pilgrim Health Care includes Harvard Pilgrim Health Care, Harvard Pilgrim Health Care of Connecticut, Harvard Pilgrim Health Care of New England and HPHC Insurance Company. cc6759 9_17