A Comprehensive Benefits Solution offered exclusively to you by: Benefits provided through LBMC Employment Partners, LLC 2018
Benefits Information
Summary of Benefits Offered Group Health, Dental and Vision Provider: BlueCross BlueShield Health plans are High Deductible Health Plans (HDHP) 3 Health Plan Options available Health Savings Account (HSA) Provider: HealthEquity Life Insurance: Lincoln Financial Life Assistance Program Benefits: Work Life Balance Assistance Legal Assistance Identity Theft Worldwide Emergency Travel Assistance Will Preparation Assistance Access to Discounted Auto/Homeowners/Renters/Condo/Umbrella Rates: Liberty Mutual LBMC Benefit Advocacy Services: Third Party / HIPAA compliant Workers Compensation Benefits and Administration: Zurich Critical Illness and Accident Plan: Colonial
2018 HDHP Plan Option 1 Annual Deductible Individual Annual Deductible Family Out-of-Pocket Max Individual Out-of-Pocket Max Family In-Network (Your Cost) $1,900 $3,800 $4,000 $8,000 Out-of-Network (Your Cost) $7,500 $15,000 $15,000 $30,000 Co-Insurance 80% 50% Primary Care & Specialist Visits 20% after deductible 50% after deductible Preventive Services 0% - No deductible N/A Inpatient Services 20% after deductible 50% after deductible Outpatient Services 20% after deductible 50% after deductible Emergency Care Services 20% after deductible 20% after deductible Urgent Care Center 20% after deductible 50% after deductible Mental Health (In-Patient & Out-Patient) 20% after deductible 50% after deductible Prescription Drugs 40%/50%/60% after deductible (Individual pays 0% after plan out of pocket maximum has been met) N/A
2018 HDHP Plan Option 2 Annual Deductible Individual Annual Deductible Family Out-of-Pocket Max Individual Out-of-Pocket Max Family In-Network (Your Cost) $3,300 $6,600 $5,000 $10,000 Out-of-Network ( Your Cost) $7,500 $15,000 $15,000 $30,000 Co-Insurance 80% 50% Primary Care & Specialist Visits 20% after deductible 50% after deductible Preventive Services 0% - No deductible N/A Inpatient Services 20% after deductible 50% after deductible Outpatient Services 20% after deductible 50% after deductible Emergency Care Services 20% after deductible 20% after deductible Urgent Care Center 20% after deductible 50% after deductible Mental Health (In-Patient & Out-Patient) 20% after deductible 50% after deductible Prescription Drugs 40%/50%/60% after deductible (Individual pays 0% after plan out of pocket maximum has been met) N/A
2018 HDHP Plan Option 3 Annual Deductible Individual Annual Deductible Family Out-of-Pocket Max Individual Out-of-Pocket Max Family In-Network (Your Cost) $5,000 $10,000 $6,250 $12,500 Out-of-Network (Your Cost) $15,000 $30,000 $22,500 $45,000 Co-Insurance 80% 50% Primary Care & Specialist Visits 20% after deductible 50% after deductible Preventive Services 0% - No deductible N/A Inpatient Services 20% after deductible 50% after deductible Outpatient Services 20% after deductible 50% after deductible Emergency Care Services 20% after deductible 20% after deductible Urgent Care Center 20% after deductible 50% after deductible Mental Health (In-Patient & Out-Patient) 20% after deductible 50% after deductible Prescription Drugs 40%/50%/60% after deductible (Individual pays 0% after plan out of pocket maximum has been met) N/A
2018 Plan Rates CDHP National Plans BCBSTN Option 1 Option 2 Option 3 Annual Deductible Individual: Family: Out-of-Pocket Max Individual: Family: $1,900 $3,800 $4,000 $8,000 $3,300 $6,600 $5,000 $10,000 $5,000 $10,000 $6,250 $12,500 2018 Medical Rates Option 1 Option 2 Option 3 Individual Only $632.78 $532.42 $378.01 Individual + 1 $1,328.83 $1,118.09 $793.85 Family $1,771.77 $1,490.77 $1,058.44 Above rates are effective 1/1/2018
BCBS Network P and Blue Card Blue Network P Largest, most broad and utilized network. Popular flagship choice for negotiated discounts. Providers located nationwide for convenient, easy access to care. The BlueCard Program gives you access to doctors and hospitals almost everywhere, giving you the peace of mind that you ll be able to find the healthcare provider you need. Outside of the United States, you have access to doctors and hospitals in nearly 200 countries and territories around the world through the BlueCard Worldwide Program.
Facts You Need to Know & Remember Changes can only be made with proof of a Qualifying Event and within 30 days of the event (i.e., marriage, divorce, new baby, loss of other coverage). If you want to cancel coverage, you must let us know by the 15 th of that month. There are no mid-month cancellations. If notified timely, all plans will be cancelled at the end of the month. This is a qualified HDHP; therefore, you cannot be covered as a dependent on someone else s PPO plan. When electing Individual + One or Family Coverage you are responsible for the Family deductible. If you elect Medical coverage and want to take advantage of the Health Savings Account with Health Equity, please request information to do so during the enrollment process Remember to use In-Network Providers to receive maximum benefit.
Facts You Need to Know & Remember Preventive care is covered at 100% in-network. Once you meet the deductible in a plan year, the plan coinsurance coverage takes effect (Preventive care does not apply to deductible.) Your out-of-pocket maximum equals your deductible plus your coinsurance amount. Step Therapy: For specified drugs, BCBST may require that members first try the generic or a lower cost brand drug before the requested drug is dispensed. Pre-authorization requirements: Certain procedures and drugs may require preauthorization.
HSA Contribution Limits and Catch-Up Provisions The IRS/US Treasury Department has released the 2018 HSA Contribution Limits as follows: 2017 2018 Change Individual Coverage $3,400 $3,450 + $50 Family Coverage $6,750 $6,900 + $150 Over 55 catch-up provision: Additional $1,000 Members entitled to and enrolled in Medicare A, B or D cannot contribute to a health savings account When enrolled on a HDHP plan, you cannot participate as a dependent on any type of PPO health plan
Health Savings Account (HSA) Information The funds in your health savings account are yours you own them. Your tax free dollars can earn interest. After your balance reaches $2,000 you will have the option to invest funds. Your contributions can be made in a lump sum payment or at your discretion throughout the year. You can choose to use your funds to offset your deductible, or you can continue to let your balance grow. Your year-end balance remains and rolls over to the next year. Unused funds continue to earn interest. All funds are yours and balances can be saved to use during retirement for qualified medical expenses.
2018 BCBS Dental PPO Benefit Deductible Calendar Year Applies to Coverage B, C and D only Individual $50 Family $150 Benefit Maximum Applies to Coverage A, B, & C (per individual, per calendar year) $1,000 Coverage D (per individual, per lifetime) $1,500 Percentages Benefit Coverage A Preventive & Diagnostic 100% Exams, X-rays, Cleanings, Fluoride Sealants, Space Maintainers Coverage B Basic Restorative Care 80% Basic Restorative Services, Basic Oral Surgery, Basic Endodontics, Basic Periodontics Coverage C Major Restorative Care 50% Major Restorative & Prosthodontics, (12 Month Waiting Period) Major Periodontics, Major Endodontics, Major Oral Surgery Coverage D Orthodontics 50% Dependent Child to Age 18 (Per Individual) (12 Month Waiting Period) Preferred Option* Network Dentists paid at PPO fee schedule Non-Network Dentists paid 30% less than PPO fee schedule *Members may see any dentist. Dentists in the BCBST network have agreed to limit their charges to a fee schedule. Since BCBST is not contracted with non-network Dentists, members may be responsible for any billed charges that exceed BCBST Maximum Allowable Charge.
2018 BCBS Vision Benefit In-Network Out-of-Network Exams (1 exam and 1 contact lens fitting/follow-up within a 12 month period) Comprehensive Eye Exam $10 Copay Up to $35 Contact Lens Fitting and Follow-up Standard $55 Copay Not Covered Contact Lens Fitting and Follow- up- Premium 10% off retail Not Covered Materials Standard Plastic Lenses (Limited to one set of standard Plastic lenses within a 12 month period) Single $10 Copay Up to $30 Bifocal $10 Copay Up to $45 Trifocal $10 Copay Up to $60 Frames (limited to one pair of frames within a 24 month period) $0 Copay up to Up to $50 $100 allowance Contacts (limit one set of lenses within a 12 month period) Conventional $100 allowance Up to $80 Disposable $100 allowance Up to $80 Therapeutic Covered 100% Up to $200
2018 Rates - Dental and Vision Dental Rates BCBS Vision Rates - BCBS Individual $24.84 $7.36 Individual + 1 $48.56 $14.11 Family $99.87 $22.08
Federal Benefits Management - A Federal Benefits Coordinator will provide: Help understanding & navigating Social Security & Medicare Benefits Programs Support for making the transition from full-time employment into retirement Assistance in moving off of your Group Health Plan to Medicare Help in all phases of disability filing procedures
PhysicianNow powered by MDLIVE is a convenient, cost-effective alternative to the emergency room, urgent care facility or in-office doctor s appointment for most nonemergency conditions. Member Benefits: Quick, convenient access to locally-licensed and board-certified doctors 24/7 via phone or video Employer Benefits: Save on claims costs by routing members to a telehealth solution when appropriate. Average savings: ER visit: $908 PCP visit: $41 Urgent Care visit: $9 When to use PhysicianNow: When it s not an emergency When it s not easy to schedule with your doctor When you re traveling When you re too busy to go to your doctor s office 97% patient satisfaction rating across its book of business 90% of patients issues are resolved The average call-back time is 9 min 93% of patients say they would use the service again 93% of patients say they would recommend this service to family and friends Using telehealth services saves an average of $140 per visit Source: MDLIVE book of business reports
Identity Protection: New Free Service to Eligible Members Enrollment Members must enroll with Experian, no auto-enrollment Members receive 12 months of services, regardless of the status of their medical coverage going forward Once enrolled, members who continue to have eligible medical coverage will be automatically renewed each year An additional 12 months of services Enroll via the web through BlueAccess Link on the homepage in the Tools & Information section Enroll via the phone toll free number plus engagement codes Members will be asked for their BCBST Subscriber ID Other personal information may be requested to enable certain account features, at the member s discretion
Benefits Available at Additional Cost Accident o Benefits for covered person who receives injuries as a result of a covered accident. Critical Illness o Benefits for covered person with specified critical illness, such as heart attack or stroke.
Liberty Mutual offers LBMC members preferred rates on auto insurance, home or renter s insurance through the Group Savings Plus program.* More money in your pocket Your premium is locked in for a full 12 months PLUS many value added benefits, such as: 24/7, highly-rated claims service Convenient payment options including electronic funds transfer (EFT) or direct billing at home Start Saving Today! Nashville: Call Anthony Trepka at 800-668-0593 ext. 55532 Nationwide: Call 800-835-0894 *Discounts and credits are available where state laws and regulations allow, and may very by state. Certain discounts apply to specific coverages only. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. Coverage provided and underwritten by Liberty Mutual Insurance Company and its affiliates, 175 Berkeley Street, Boston, MA. A consumer report from a consumer reporting agency and/or motor vehicle report, on all drivers listed on your policy, may be obtained where state laws and regulations allow. 2008 Liberty Mutual Insurance Company. All Rights Reserved.
Services included In Monthly Administrative Fee Term Life Insurance Lincoln Financial Group o Life and AD&D equivalent to 1 times annual capital contribution (IC = $30,000) Life Assistance Program Benefits o Work-Life Balance Assistance o Worldwide Emergency Travel Assistance o Will Preparation Assistance o Legal Assistance o Identity Theft PEO Administrative Fees o Back-end administration of all benefits, access to HR Account Manager and communication Benefits Advocacy Service o Assists with claims/billing issues for any providers enrolled Physician Solutions Management Fee o K-1 details provided annually for individual tax returns for each IC Workers Comp Benefit o With the exception of those located in Washington state (per law, unable to be included in group policy) o Benefits are based on the annual capital contribution amount of $30K PEO administrative fee is $90 per month unless located in Wyoming or Washington state where fee will be $80 per month In case of claim from independent contractor, please report immediately to Kathy Waggoner at kwaggoner@lbmc.com or (615) 309-2431
If you have any questions. Visit: www.physiciansolutionslp.com E-mail: info@physiciansolutionslp.com Call: 1-866-328-5050 Please notify us with questions or for information on how to enroll. Often due to a high volume of calls, it may be easier to use email. Simply let us know the easiest way to reach you and a preferred time.