I can choose my doctor

Transcription

1 This is an advertisement Federal Employees and Annuitants 2015 Rates and Benefits test results online excellent prenatal care I can choose my doctor a wide rane of specialists Not a member yet? Call toll free , Monday throuh Friday, 8 a.m. to 5 p.m. for more information. Statements above related to HealthSpan physicians and services only. healthspan.or/feds

2 A better choice for ood health With care and coverae workin seamlessly toether, HealthSpan is uniquely desined to ive you the information and support you need to live healthy. your choice of top doctors Our doctors are amon the best, and carin for people is their passion. Plus, you ve ot the power to chane doctors anytime. personalized care and attention* Your HealthSpan doctors, nurses, and specialists are connected to your electronic health record, so they can work toether to deliver reat care that s riht for you. everythin under one roof You can do more and drive less because all of our locations offer pharmacy and lab services. lots of healthy extras Stay at your best with healthy resources like online health prorams and local wellness classes, many of which are free. online access anytime, anywhere* Use your computer, smartphone, or mobile device to your doctor s office, schedule routine appointments, view lab test results, refill prescriptions, and more. a better experience We care about the whole you body, mind, and spirit. Our doctors, health plans, and medical facilities all work as one, so your experience is smoother and simpler. *These features are available when you receive care at HealthSpan medical offices.

3 Better Informed. Better Toether. In Ohio, over 75,000 people turn to us as their trusted partner for better-informed care and support for total health. Take a look, and you ll see why HealthSpan is your best choice. Federal Employees Health Benefits (FEHB) Options...2 HealthSpan Medicare Advantae for Federal Employees...3 Your dental and vision benefits...4 Additional benefit hihlihts...5 Your benefits summary for How to enroll...8 Our locations...9 Prefer to see this information online? Go to healthspan.or/feds. Already a member? If you re currently a member and have questions, please call , Monday throuh Thursday, 8:15 a.m. to 5 p.m., and Friday, 9 a.m. to 5 p.m. For TTY, please call

4 Federal Employees Health Benefits (FEHB) Options* As a Federal employee or annuitant, you can choose between two HealthSpan traditional HMO plan options. Both offer a wide rane of care and support to help you stay healthy and et the most out of life. They re desined to make it easy for you to know what to expect and et the riht care for your needs. HealthSpan FEHB Hih Option If you expect to receive care often, this option may be riht for you. You ll pay hiher premiums but lower copays for most health care services and prescription drus. HealthSpan FEHB Standard Option If you and your family are in ood overall health, this miht be the riht option for you. You ll pay lower premiums but hiher copays for most services and prescriptions. The easier, the better Most preventive care services at no chare. Copays for most covered services, includin office visits and prescriptions. No deductible. No referrals required to see certain specialists, like obstetriciansynecoloists,** optometrists (for routine eye refractions), and mental health or substance abuse providers. No paperwork to fill out or bills for the services you receive. Personalized care Choose your own HealthSpan doctor many of our physicians come from the top medical schools in the country. See hihly trained specialists ready to serve you. Dependin on the specialty, you may not need a referral. Our doctors aren t overburdened with insurance paperwork their focus is on deliverin the care you need. * This is a summary of the features of the HealthSpan health plan. Before makin a final decision, please read the Plan s Federal brochure (RI ). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. **Call Customer Relations to find out which ob-yn providers are affiliated with your primary care physician. 2

5 HealthSpan Medicare Advantae for Federal Employees If you re enrolled in Medicare Parts A and B, HealthSpan Medicare Advantae for Federal Employees may be riht for you. Your FEHB premiums stay the same when you enroll, but you ll have lower cost sharin for most services and better benefits. And you don t need to suspend your FEHB coverae to enroll in this option. Maximize your health plan With Medicare Advantae for Federal Employees, you ll enjoy all the benefits of Medicare, plus all the benefits of your FEHB proram, without any increase in your FEHB premiums. Review the benefits chart in this brochure for details about the lower cost sharin and the extra benefits you receive with this option.. Better benefits Reduced copays for most office visits, inpatient services, emerency services, and prescription drus. Additional coverae for hearin aids ($500 allowance per ear every 36 months). Membership in SilverSneakers Fitness Proram at no additional chare. Durable medical equipment (DME) covered at $0 copay. Give us a call For details about benefits, copays, limitations, and services, please call , 8 a.m. to 8 p.m., seven days a week. For TTY for the hearin/ speech impaired, call 711. One of our licensed sales specialists will be happy to help. NOTE: Any Federal Members currently in our Medicare Manaed Care Plan, known as HealthSpan Interated Care Medicare Plus for Federal Members (Medicare Cost), can maintain their current Plan, or they may choose to move to HealthSpan Interated Care Medicare Advantae. HealthSpan Interated Care Medicare Plus (Medicare Cost) is closed to any new membership. HealthSpan Medicare Advantae for Federal Members benefits are subject to Medicare rules and you may have to receive care from different plan providers than with your FEHB coverae. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premiums, and copayments/coinsurance may chane on January 1 of each year and at other times in accord with your roup s contract with us. To join a HealthSpan Medicare Health Plan, you must reside in the HealthSpan Medicare Advantae service area in which you enroll. You must pay the Medicare Part B premium to join a HealthSpan Medicare health plan. HealthSpan is an HMO plan with a Medicare contract. Enrollment in HealthSpan depends on contract renewal. SilverSneakers is a reistered mark of Healthways, Inc. 3

6 Your dental and vision benefits Whichever option you choose, your HealthSpan health plan comes with dental and vision benefits.* Dental benefits Vision benefits Whether you choose the Hih Option or the Standard Option, you ll have benefits for annual exams and cleanins throuh Delta Dental. To locate a Delta Dental dentist, please visit or call For more information about your dental benefits, see the benefit chart on paes 6 and 7, or return the reply card in the back of this brochure. Details about your dental benefits are included in the Federal Employees Health Benefits brochure (RI ). EyeMed Vision Care is our provider network for routine eye exams (eye refractions)* To locate a provider, call EyeMed at or visit Once you ve found an optometrist, simply call that doctor to make an appointment. Let them know you have EyeMed and provide your HealthSpan medical record number (MRN) located on your ID Card. For more information about your benefits, see the benefit chart on paes 6 and 7, or return the reply card in the back of this brochure. Details about your vision benefits are included in the Federal Employees Health Benefits brochure (RI ). * This is a summary of the features of the HealthSpan health plan. Before makin a final decision, please read the Plan s Federal brochure (RI ). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. 4

7 Additional benefit hihlihts Emerency services Benefit chanes in 2015 Wherever you o, we ve ot you covered As a HealthSpan Federal Employees Health Benefits (FEHB) member, your benefits include emerency care nationwide at emerency departments and urent care centers. Enjoy peace of mind when you travel, knowin that you re covered for emerency care anywhere in the country. Our FEHB brochures explain how to et care, what you pay, what kind of care is covered, and what to do if you have an emerency and need to be hospitalized at a non HealthSpan facility. What to know before you o Harness the power of prevention and take time before you leave town to prepare for a healthy trip. Here s a convenient checklist to help you et ready: Catch up on vaccinations. Your doctor can consult with you and help you et any vaccinations you need. Call the appointment and advice line ( ) for more information or to make an appointment. Be sure to call well in advance of your trip. Stock up on prescriptions. Make sure you pack enouh medication to last you throuh your trip. Carry your HealthSpan ID card with you at all times. A few benefits will be chanin in the new plan year, includin those hihlihted below. For a complete list of benefit chanes, see the FEHB brochure (RI ). HealthSpan Wellness Specialty Care Referral Requirements Expanded Service Area Note: Worldwide coverae services do not apply to Medicare Advantae members. This is a summary of the features of the HealthSpan health plan. Before makin a final decision, please read the Federal Employees Health Benefits (FEHB) brochure, RI All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB brochure. 5

8 Your benefits summary for 2015 Deductible Office visits Outpatient surery Urent care Emerency Services 1 Hospitalization Preventive adult primary care exam Preventive well child primary care exam Primary care visit Specialty care visit Vision exams throuh EyeMed providers Most lab and X-rays, such as blood tests and ultrasounds Office visit Provided at a plan or non-plan facility. Inpatient services Generic drus Picked up from Plan pharmacy Most prescription drus 2 (up to 30-day supply) or delivered by Plan mail-order service (up to Brand name drus 90-day supply) Most durable medical equipment (DME) Hearin aids Fitness Eyewear 3 Throuh EyeMed providers Dental 3,4 Throuh Delta Dental providers This is a summary of the features of the HealthSpan health plan, includin HealthSpan Medicare Advantae for Federal Members. Before makin a final decision, please read the Federal Employees Health Benefits (FEHB) brochure, RI , and the HealthSpan Medicare Advantae for Federal Members. Evidence of Coverae (EOC). All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB brochure and the HealthSpan Medicare Advantae for Federal Members EOC. 1 The emerency copay is waived if admitted directly to the hospital as an inpatient. 2 If you request a brand-name dru in place of a eneric dru prescribed by your doctor, you may be required to pay full chares. 6

9 Your benefits summary for 2015 HealthSpan HealthSpan Medicare Advantae for Federal Members Hih Option Standard Option Hih Option Standard Option $0 $0 $0 $0 $0 copay $0 copay $0 copay $0 copay $0 copay $0 copay $0 copay $0 copay $20 copay $30 copay $5 copay $15 copay $20 copay $40 copay $5 copay $15 copay $20 copay $40 copay $5 copay $15 copay $0 copay $0 copay $0 copay $0 copay $50 per surery $250 per surery $5 per surery $250 per surery $35 per visit $45 per visit $5 per visit $35 per visit $100 per visit $150 per visit $50 per visit $65 per visit $250 per admission $500 per admission $200 per benefit period $250 per benefit period $10 copay $15 copay $5 copay $10 copay $30 copay $40 copay $10 copay $20 copay 20% 20% $0 copay $0 copay Covered only for children throuh ae 17. Member pays all chares in excess of $1,000 for each hearin impaired ear every 36 months. For children throuh ae 17: Member pays all chares in excess of $1,000 for each hearin impaired ear every 36 months. For all other members: Member pays all chares in excess of $500 for each hearin impaired ear every 36 months. Not a covered benefit SilverSneakers Fitness Proram Member pays all chares in excess of $100 every 24 months towards the purchase of eyelass lenses, frames, or contact lenses. Member pays 30% for Class I Benefits (dianostic and preventive services, emerency palliative treatment, and X-rays) and 50% for Class II Benefits (oral surery services for simple extractions, includin preoperative and postoperative care, and minor restorative services) up to $750 per person total per benefit year. Oral examinations are payable twice per calendar year; bitewin X-rays are payable once per calendar year. 3 These benefits are neither offered nor uaranteed under contract with the FEHB Proram, but are made available to all enrollees and family members who become members of HealthSpan. 4 This Summary of Dental Plan Benefits should be read in conjunction with your Dental Care Certificate. Your Dental Care Certificate will provide you with additional information about your Delta Dental plan, includin information about plan exclusions and limitations. In the event that you seek treatment from a dentist that does not participate in any of Delta Dental s prorams, you may be responsible for more than the percentae indicated. SilverSneakers is a reistered mark of Healthways, Inc. 7

10 How to enroll Becomin a member is easy. Just follow the three simple steps below. The information in this booklet can help you pick the riht plan that meets your needs. 1. Choose an option Select HealthSpan s Hih Option or Standard Option. Brief descriptions of these options are on pae 2. You will find more detail about benefits on paes Select the type of enrollment you want Select Self Only or Self and Family. Self and Family enrollment provides benefits for you and your eliible family members. Then look at the Your rates for 2015 chart below and note your enrollment code. 3. Enroll in HealthSpan 1 Most employees and annuitants can enroll online. Visit opm.ov or contact your employin aency or retirement office for FEHB enrollment procedures and other information. Annuitants may call the Retirement Information Center at (for TTY, call ) or retire@opm.ov. If you re eliible for Medicare, or will be soon, you may be able to pay a lower share of the cost for most services and et better benefits by enrollin in HealthSpan Medicare Advantae for Federal Members. See details on pae 3. Your rates for Non-Postal Premium Postal Premium Biweekly Share Monthly Share Biweekly Share Enrollment Code Gov t You Gov t You Cateory 1 Your Share Cateory 2 Your Share Hih Option Standard Option Self Only 641 $ $ $ $ $ $ Self + Family 642 $ $ $ $ $ $ Self Only 644 $ $62.45 $ $ $49.34 $62.45 Self + Family 645 $ $ $ $ $ $ These are hihlihts of the FEHB enrollment process. Please refer directly to opm.ov and your employin aency or retirement office for FEHB coverae effective dates, enrollment procedures and deadlines, and other information. To add an eliible family member to your HealthSpan Self and Family enrollment, complete and return an Enrollment Chane Form to us. These forms can be obtained by callin Member Services. 2 These rates do not apply to all enrollees. If you are in a special enrollment cateory, please refer to your special FEHB Guide or contact the aency that maintains your health benefits enrollment. 8

11 Service Area In 2015, our FEHB plans will be offered in 32 counties. Cincinnati: Adams, Brown, Butler, Clermont, Clinton, Hamilton and Hihland counties Cleveland: Cuyahoa, Geaua, Lake, Lorain, Medina, Portae, Stark, Summit and Wayne counties Lima: Allen, Aulaize, Mercer and Van Wert counties Sprinfield: Champain, Clark, Preble and Shelby counties Toledo: Fulton, Henry, Lucas, Ottawa, Putnam and Wood counties Younstown: Mahonin and Trumbull counties 9

12 HealthSpan Interated Care 1001 Lakeside Ave, Ste 1200 Cleveland, OH Notice of Summary of Benefits and Coverae (SBC): Availability of Summary Health Information The FEHB Proram offers numerous health benefits plans and coverae options. Choosin a health plan and coverae option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverae (SBC) about each of its health coverae options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. This plan s SBC is available, free of chare, by returnin the reply card in the back of this brochure, or by callin toll free or TTY. To find out more information about plans available under the FEHB Proram, includin SBCs for other FEHB plans, please visit opm.ov. healthspan.or/feds Please recycle. This material was produced from eco-responsible resources _ 10/14