Large Employer Health Insurance
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- Angelica Wilkins
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1 Large Employer Health Insurance Health Plans One team. Connected. Caring for you. HealthPlans.com Toll-Free:
2 Self-funded Health Plans is an experienced third-party administrator. Self-funded plans are suitable for large employers who wish to fund their own health insurance plan. Benefits to having a self-funded plan include greater flexibility. Self-funded plans allow employers a choice of what benefits they would like to offer the amount of risk they wish to take. The flexibility of a well-designed, selffunded plan can lead to significant cost savings. With a well thought out plan positive claim experience, an employer may see a great reduction in benefit costs. Call to learn more. Insurance for Large Employers (More than 50 Employees) Health Plans will help large employers comply with the Affordable Care Act employer mate by providing a wide range of benefit options. You now have access to innovative plan choices clear, consistent information to help empower decisionmaking about all coverage options so your business can purchase plans tailored to your needs. Innovative Health Insurance Plans When you choose Health Plans you receive quality plans that meet exceed the requirements of the Affordable Care Act. Our team works with you /or your agent to design costsaving strategies that meet the unique needs of your business. We provide an innovative program that allows you to identify health benefits that meet budget goals by choosing the right copays, deductibles benefits for your business employees. Unlimited plan options are available with our quoting tool, which allows the employer to set the co-pays, deductible other benefits to work with the company s budget. Health Plans is helping employers meet the employer mate by offering a minimum essential coverage (MEC) plan which provides affordable coverage to employees at most every employment level. Every employer will be assigned a dedicated Client Relationship Executive who will provide an additional layer of service by assisting with on boarding, transitional care, benefit design consultation health plan administration. Available services included with self-funded plans Claims payment utilizing the region s largest provider network Member ID card production medical, dental vision claims processing Benefit Plan design consultation document creation Established IRS claim-editing tool review process 1099 forms Coordination of benefits Administration Client Cost of medical claims for COBRA Relationship Executive management clinical reporting Health services (medical care utilization management) Complaint appeals coordinator Pharmacy benefits manager Additional services National regional provider networks Wellness On-site programs health screenings Employee Flexible assistance program spending health care reimbursement Accounts Dental, using a VISA debit card vision, disability life insurance
3 Self-funded Health Plans is an experienced third-party administrator. Self-funded plans are suitable for large employers who wish to fund their own health insurance plan. Benefits to having a self-funded plan include greater flexibility. Self-funded plans allow employers a choice of what benefits they would like to offer the amount of risk they wish to take. The flexibility of a well-designed, selffunded plan can lead to significant cost savings. With a well thought out plan positive claim experience, an employer may see a great reduction in benefit costs. Call to learn more. Insurance for Large Employers (More than 50 Employees) Health Plans will help large employers comply with the Affordable Care Act employer mate by providing a wide range of benefit options. You now have access to innovative plan choices clear, consistent information to help empower decisionmaking about all coverage options so your business can purchase plans tailored to your needs. Innovative Health Insurance Plans When you choose Health Plans you receive quality plans that meet exceed the requirements of the Affordable Care Act. Our team works with you /or your agent to design costsaving strategies that meet the unique needs of your business. We provide an innovative program that allows you to identify health benefits that meet budget goals by choosing the right copays, deductibles benefits for your business employees. Unlimited plan options are available with our quoting tool, which allows the employer to set the co-pays, deductible other benefits to work with the company s budget. Health Plans is helping employers meet the employer mate by offering a minimum essential coverage (MEC) plan which provides affordable coverage to employees at most every employment level. Every employer will be assigned a dedicated Client Relationship Executive who will provide an additional layer of service by assisting with on boarding, transitional care, benefit design consultation health plan administration. Available services included with self-funded plans Claims payment utilizing the region s largest provider network Member ID card production medical, dental vision claims processing Benefit Plan design consultation document creation Established IRS claim-editing tool review process 1099 forms Coordination of benefits Administration Client Cost of medical claims for COBRA Relationship Executive management clinical reporting Health services (medical care utilization management) Complaint appeals coordinator Pharmacy benefits manager Additional services National regional provider networks Wellness On-site programs health screenings Employee Flexible assistance program spending health care reimbursement Accounts Dental, using a VISA debit card vision, disability life insurance
4 Member Choice Consider Defined Contribution Plans Defined contribution can save time money for employers from the administrative time to the duties that go along with choosing managing your employees health plans. With rising health care costs, it offers more financial predictability because the amount contributed is decided up front. In addition to freeing up time relieving cost, defined contribution plan also can provide choices for employees by offering more transparency flexible, customizable health care instead of a one-sizefits-all option. Employers can take a step back shift some of the responsibility for health care benefit plan options to the employee through the use of the defined contribution plan. Our defined contribution plan allows employers to choose a set amount ($) or percentage (%) to contribute towards an employee s health care. Defined contribution allows employers to pick from six different plans. Employees will pick the plan that meets their budget health care needs.
5 How does defined contribution work? Employer: Determines the amount each month per employee identifies how many plan options will be available for employees Employee: Chooses from different plan options the employer selected. (Up to six plans available.) Plan 2 Plan 1 Plan 3 Chooses who can receive coverage employees only Plan 5 Plan 4 Plan 6 employee plus spouse employee plus family Employee pays the difference from what the employer provides the amount of the monthly premium through payroll deduction (Pretax) Get a quote Contact your agent HealthPlans.com/findanagent Visit HealthPlans.com/employers Call ask for a quote we will direct you to our sales team!
6 Defined Contribution Plan Options In-network benefits are provided in the chart below. For out-of-network benefits or more details, please refer to the Summary of Benefits Coverage found at HealthPlans.com. 1,000 1,500 2,500 3,500 HSA Compatible 4,000 6,350 Individual $1,000 $1,500 $2,500 $3,500 $4,000 $6,350 Family $2,000 $3,000 $5,000 $7,000 $8,000 $12,700 Coinsurance Out-of-Pocket Maximum 20% 20% 30% 0% 30% 0% Individual $2,000 $3,000 $5,000 $3,500 $6,000 $6,350 Family $4,000 $6,000 $10,000 $7,000 $12,000 $12,700 Medical Benefits Preventive Care Services Primary Care Physician Visit Co-pay $25 Co-pay $30 Co-pay $35 Co-pay $35 Specialist Visit Urgent Care Services Lab X-ray (Diagnostic Test) Co-pay $25 Co-pay $25 Co-pay $25 1 Co-pay $45 Co-pay $30 Co-pay $30 1 Co-pay $70 Co-pay $35 Co-pay $35 1 apply for all services. Co-pay $70 Co-pay $35 Co-pay $35 1 Hospital Services Outpatient Services Co-pay $25 Co-pay $30 Co-pay $35 Co-pay $35 Inpatient Services apply for all plans. Pharmacy Benefits Pharmacy - Individual - Family No cost to you. This includes preventive immunizations, screenings, exams.* apply for all plans. Emergency Services Co-pay $200 Co-pay $200 Co-pay $300 Maternity Services Mental Health Substance Use Disorder apply for all plans. $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 1 = $0 1 = $0 1 = $0 1 = $0 2 = $12 2 = $12 2 = $12 2 = $12 3 = $12 3 = $12 3 = $12 apply for all 3 = $12 4 = $50 4 = $50 4 = $50 services. 4 = $50 5 = $100 5 = $100 5 = $100 5 = $100 6 = $150 6 = $150 6 = $150 6 = $150 apply for all services. apply for all services. Plan Details: *Examples include gynecological exam, screening mammography, well-child care newborn care. Limitations do apply. For a detailed listing, visit HealthPlans.com. 1 Lab X-ray co-pays waived if services are performed during an office visit. Lab X-ray performed without an office visit are subject to a separate co-pay per date of service.
7 4Preferred 5Non-Preferred Your Trusted Partner When it comes to health insurance, Health Plans is here for you your business. We can help you identify the right plan for your employees. Our plans are available for businesses headquartered in South Dakota the following Iowa counties: Clay, Dickinson, Emmet, Lyon, O Brien, Osceola, Plymouth, Sioux Woodbury. If you have any questions, call our toll-free phone or Sales@HealthPlans.com a.m. to 5 p.m. CT, Monday through Friday How do I know what a health plan covers? Our Enrollment Guide explains which services are covered or not covered by Health Plans. Other topics in the Enrollment Guide include: practitioner provider availability utilization management procedures pharmaceutical management procedures policies practices for collecting, using protecting your personal health information how to use your benefit plan What Does it Mean to Have a 6- Pharmacy Plan? We offer a 6-tier pharmacy plan for all our defined contribution plans. This allows employees to optimize their dollars spent on medications by identifying those medications at lower costs that work as well as others that cost more. 1Preventive Medications 2Preferred Generics 3Non-Preferred Generics Brs The Enrollment Guide is available on our website, click Plans for Individuals Families. Brs 6Specialty Medications (Br Generic)
8 HealthPlans.com Toll-Free: AVHP AU1514
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
National Guardian Life Insurance Company Maine College of Art Student Health Insurance Plan Coverage Period: 09/01/2015-08/31/2016
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cirstudenthealth.com/udmercy or by calling 1-800-322-9901.
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Health Plans - How to Use a Deductible and Other Important Questions
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Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.boonchapman.com or by calling 1-800-252-9653. Important
Massachusetts. HPHC Insurance Company The Harvard Pilgrim Tiered Copayment PPO Summary of Benefits and Coverage: What this Plan Covers & What it Costs
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Companion Life Insurance Company: Saint Xavier University Student Health Insurance Plan Coverage Period: 08/11/2015-08/10/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.bannerbenefits.com by clicking on the Resources tab and then Plan
Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://knowyourbenefits.dfa.ms.gov or by calling 1-866-586-2781.