Kentucky Anthem Health Marketplace product families Get to know our product families with this easy-to-use guide. Effective January 1, 2016 32552KYEENABS Rev. 10/15 Please note: The charts on the following pages describe benefits in general terms and represent per member, in-network costs.
What is the Anthem Health Marketplace? Anthem Health Marketplace is our online private exchange. It offers a wide range of health plans grouped together as benefit families for you to choose from for your employees. We re all about making it clear and easy! Manage your health benefits Control your health costs Offer a benefits solution on a single, flexible platform This guide is a great first step. Look it over to get a better understanding of our benefit families. Remember, we re here every step of the way -- from helping you make the best product selections to guiding your employees to a plan that works for them.
Here are some of the high-level guidelines we followed in our approach to the benefit families: } Each family is composed of eight plans. The objective is to offer a benefit option to meet each employee s unique needs. } Instead of selecting a plan, you select a family of benefit options for your employees. } The families are presented from richest to leanest in relation to cost. } All benefit options within the product families are also available outside of the Anthem Health Marketplace platform. } Enhance your product family selection by offering dental, vision, life and disability along with your health plan. Choose from six dental and 12 vision plans, as well as life and short- and long-term disability, to offer your employees a well-rounded benefits package. } For 1,000+ eligible employee business, you may: Build a family by selecting up to eight standard products within the current portfolio, subject to Underwriting review. Build a custom dental plan to meet your needs. Select vision benefits to build a custom vision plan. Defined Contribution is a funding solution that lets you control and predict health care costs for your employees. It lets you: } Determine the amount you want to spend on health care coverage. } Deposit those pretax dollars into a defined contribution account. } Offer your employees the option to use allocated dollars to choose their health, dental, and vision benefits. How it works If you defined your contribution as $5,500 per employee, here is what that allocation may look like for one of your employees. Annual defined contribution amount $5,500 Benefit options: Health plan #1 annual premium $2,822 Health plan #2 annual premium $3,257 Dental annual premium $1,784 Vision annual premium $936 Account balance: - $42 Employee annual payroll deduction $ 42 If your employee selects health plan number one, $2,822 will be deducted from the $5,500 allocation amount leaving $2,678 to put toward a dental and vision plan. If the employee also chooses a dental plan, $1,784 would be deducted, leaving $894 to use toward a vision plan. The yearly premium for the vision plan is $936, more than the allocation amount would cover. Therefore, $42 would be taken out from the employee s annual payroll to cover the cost. 1
100-500 eligible employees Family name Family 6A 100+ Family 6B 100+ Family 6C 100+ Plan name for Health Savings Account (HSA) PPO Option 22, Rx AE 01 2016 Option 3, Rx AE 01 2016 Option 37, Rx AE 01 2016 Option 9, Rx AE 01 2016 Option E5, Rx AO 01 2016 Option 22, Rx AE 01 2016 Option 37, Rx AE 01 2016 Option L2, Rx AQ 01 2016 Option E5, Rx AO 01 2016 Option E6, Rx AO 01 2016 Option 37, Rx AE 01 2016 * Preventive care covered at 100% in-network. Deductible individual Coinsurance percentage in network Out-of-pocket max amount in network Office visit Covered service pharmacy (Rx) Emergency room $1,500 90% $3,000 10% primary care physician (PCP); 10% specialist In-network member pays 10%; out-of-network $2,500 80% $6,600 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% to a $200 maximum copay; $200 prescription ; OOP combined with medical $750 80% $3,000 $20 PCP; $20 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; member to a $200 maximum copay; $750 80% $5,500 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; to / 10% ; plan pays 90% 20% ; plans pays 80% 80% 80% 70% 80% $15 copay; 100% $1,500 90% $3,000 10% PCP; 10% specialist In-network member pays 10%; out-of-network $5,000 100% $5,950 0% PCP; 0% specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay ; medical applies before copayments/; prescription OOP accumulates to overall medical plan OOP with 100% coverage thereafter $2,500 80% $6,600 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% to a $200 maximum copay; $200 prescription ; OOP combined with medical member to a $200 maximum copay; to / $5,000 80% $6,600 $35 PCP or specialist to / 10% ; plan pays 90% 20% ; plans pays 80% 0% ; plan pays 100% 80% 70% $15 copay; 100% $15 copay; 100% $5,000 100% $5,950 0% PCP; 0% specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay ; medical applies before copayments/; prescription OOP accumulates to overall medical plan OOP with 100% coverage thereafter $6,350 100% $6,450 0% PCP; 0% specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/; prescription OOP accumulates to overall medical plan OOP with 100% coverage thereafter member to a $200 maximum copay; 20% ; plans pays 80% 0% ; plan pays 100% 0% member ; plan pays 100% 70% Covered service hospitalization Plan pays 90% after Plan pays 90% after after after after 2
100-500 eligible employees Family name Plan name Deductible individual Coinsurance percentage in network Out-of-pocket max amount in network Office visit Covered service pharmacy (Rx) Emergency room Covered service hospitalization Option 19, Rx AE 01 2016 $2,000 70% $5,500 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; 70% after Option 25, Rx AE 01 2016 $2,500 80% $5,800 20% PCP; 20% specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; 80% after Family 6L 100+ Lumenos HSA Lumenos HSA Option E2 01 2016 $2,600 80% $5,000 20% PCP; 20% specialist 20% member in network; 40% member out of network $3,000 80% $5,000 20% PCP; 20% specialist In-network member pays 20%; out-of-network 20% member ; plan pays 80% 20% ; plan pays 80% Lumenos HSA (copays) - Option E2, Rx AO 01 2016 $3,000 100% $4,000 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ 100% Lumenos HSA (copays) Option E3, Rx AO 01 2016 $5,000 100% $6,450 $30 PCP; $60 specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ 100% $2,500 80.00% $6,600 $35 PCP or specialist to / $15 copay; 100% Option 25, prescription AE 01 2016 $2,500 80% $5,800 20% PCP; 20% specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; 80% Family 6M 100+ Lumenos HSA Option 3 01 2016 Lumenos HSA Option E2 01 2016 $6,450 0% $6,450 0% PCP; 0% specialist 0% member in network; 50% member out of network $3,000 80% $5,000 20% PCP; 20% specialist In-network member pays 20%; out-of-network 0% member ; plan pays 100% 20% ; plan pays 80% Lumenos HSA (copays) Option E2 Rx AO 01 2016 $3,000 100% $4,000 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ 100% Lumenos HSA (copays) Option E3 prescription AO 01 2016 $5,000 100% $6,450 $30 PCP; $60 specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ 100% to / $15 copay; 100% $1,500 90% $3,000 10% PCP; 10% specialist In-network member pays 10%; out-of-network 10% ; plan pays 90% Plan pays 90% 20% ; plans pays 80% Family 8A 100+ Option E5, Rx AO 01 2016 Option 22, Rx AE 01 2016 $5,000 100% $5,950 0% PCP; 0% specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay ; medical applies before copayments/; prescription OOP accumulates to overall medical plan OOP with 100% coverage thereafter $2,500 80% $6,600 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% to a $200 maximum copay; $200 prescription ; OOP combined with medical 0% ; plan pays 100% 80% Option 3, Rx AE 01 2016 $750 80% $3,000 $20 PCP; $20 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; 80% Option 37, Rx AE 01 2016 member to a $200 maximum copay; 70% Option 9, Rx AE 01 2016 $750 80% $5,500 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; 80% 3
100-500 eligible employees Family name Plan name Deductible individual Coinsurance percentage in network Out-of-pocket max amount in network Office visit Covered service pharmacy (Rx) Emergency room Covered service hospitalization to / $15 copay; 100% Option L2, Rx AQ 01 2016 $5,000 80% $6,600 $35 PCP or specialist to / $15 copay; 100% $1,500 90% $3,000 10% PCP; 10% specialist In-network member pays 10%; out-of-network 10% ; plan pays 90% Plan pays 90% 20% ; plans pays 80% Family 8B 100+ Option E5, Rx AO 01 2016 $5,000 100% $5,950 0% PCP; 0% specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay ; medical applies before copayments/; prescription OOP accumulates to overall medical plan OOP with 100% coverage thereafter 0% ; plan pays 100% Option E6, Rx AO 01 2016 $6,350 100% $6,450 0% PCP; 0% specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ ; prescription OOP accumulates to overall medical plan OOP with 100% coverage thereafter 0% member ; plan pays 100% Option 22, Rx AE 01 2016 $2,500 80% $6,600 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% to a $200 maximum copay; $200 prescription ; OOP combined with medical 80% Option 37, Rx AE 01 2016 member to a $200 maximum copay; 70% to / $15 copay; 100% Option 19, Rx AE 01 2016 $2,000 70% $5,500 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; 70% after Family 8L 100+ Option 25, Rx AE 01 2016 Lumenos HSA Option E6 2016 $2,500 80% $5,800 20% PCP; 20% specialist Tier 1 $10; tier 2 $30; tier 3 $60; tier 4 25% member to a $200 maximum copay; $6,450 0% $6,450 0% PCP; 0% specialist 0% member in network; 50% member out of network 80% 0% member ; plan pays 100% Lumenos HSA - Option E2 01 2016 $3,000 80% $5,000 20% PCP; 20% specialist In-network member pays 20%; out-of-network 20% ; plan pays 80% Lumenos HSA (copays) - Option E2, Rx AO 01 2016 $3,000 100% $4,000 $25 PCP; $50 specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ 100% Lumenos HSA (copays) - Option E3, Rx AO 01 2016 $5,000 100% $6,450 $30 PCP; $60 specialist Tier 1 $10; tier 2 $30; tier 3 $50; tier 4 25% member to a $200 maximum copay; medical applies before copayments/ 100% 4
Life and disability products available on the Anthem Health Marketplace Life and disability Short-term disability Long-term disability Basic: } Flat amounts or multiples (up to five times) of your salary $20,000 to $500,000 } Accidental death and dismemberment (AD&D) matches life* } Includes conversion Basic: } 40%, 50%, 60% or 67% of salary } $500 up to $2,500 weekly maximum } Standard duration of either 13 or 26 weeks (other options available) } Elimination period options: 0/7, 7/7, 14/14 or 30/30 Basic: } 40%, 50% or 60% of salary } $1,000 up to $15,000 monthly maximum } Five-year or Social Security Normal Retirement Age (SSNRA) duration } Either two-year or SSNRA own occupation definition Voluntary: } Available in multiples of salary or increments of $10,000 } $10,000 to $500,000 } AD&D matches life } Includes conversion and portability Voluntary: } 50% or 60% of salary } $500 up to $2,000 weekly maximum } Standard duration of either 13 or 26 weeks (other options available) } Includes premium waiver } 3/12 pre-existing condition limitation Voluntary: } 50% or 60% of salary } $1,000 up to $10,000 monthly maximum } Five-year or SSNRA duration } Either two-year or SSNRA own occupation definition Both include: } Premium waiver } Accelerated death benefit } Travel assistance } Resource Advisor program AD&D riders: } Repatriation } Airbag and seat belt } Coma } Common carrier } Child education Both include: } Work retention assistance } Partial disability with residual } Integration with Anthem medical } Newborn and parenting resources } Resource Advisor program Both include: } Work retention assistance } Partial disability with residual } Resource Advisor program } 12-month work incentive } Workplace modification benefit } Elimination period of either 90 or 180 days } Premium waiver } 3/12 pre-existing condition limitation } Rehabilitation incentive } Survivor benefit Voluntary dependent: } Only available with voluntary employee life } Spouse coverage: $5,000 to $250,000, in increments of $5,000 } Children are eligible for $5,000, $10,000 or $15,000 } Can t be more than 50% of employee s voluntary life amount } AD&D not included } Includes conversion and portability } All amounts are guaranteed issue * Employers have the option of purchasing Life without AD&D. 5
Benefits management and cost control for employers. The right plan choices for employees. Making life easier for everyone. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.