CHOICES 2016 BENEFITS CHANGES

Transcription

1 CHOICES 2016 BENEFITS CHANGES

2 2016 BENEFITS CHANGES/ADDITIONS You do not have to re-enroll for the 2016 plan year unless you want to make changes to your current elections; 2015 elections will automatically roll over for the 2016 plan year. For those enrolling during 2016 plan year; you must enroll within 31 days of your hire date, change in status date or qualify event. WHAT S NEW Erlanger Health System is committed to providing the best health system employee benefit program in the Chattanooga area. To meet that goal, Erlanger has worked meticulously to make appropriate changes for the 2016 plan year. This brochure summarizes the changes for the 2016 plan year. You will receive more detailed information on changes during open enrollment, being held November 1st through November 20th, ENROLL Enrollers from Hodges & Mace will be available at all main campuses this year. We are introducing several new voluntary benefit products for the 2016 plan year. You are not required to meet with an enroller and can review and make the election yourself go to Applications & Links/Employee Direct Access/ once logged in go to Benefits Enrollment. If enrolling from home, please go to erlanger.org/forassociates/employeedirectaccess/ once logged in go to Benefits Enrollment. GROUP LEGAL Most legal issues are usually accompanied by other personal and/or financial issues. Knowing this, a voluntary benefit through Legal Club of America called the Family Protection Plan (FPP) is being offered for plan year The FPP, anchored by the Family Legal Plan, provides team members who elect the benefit access to a nationwide network of pre-qualified professionals in each of the following areas: Free and Discounted Legal Care Identity Theft Solutions Tax Preparation and Advice Financial Education and Credit Counseling LifeEvents Telephonic Counseling The cost for this program is $6.46 per pay period. The deduction will be taken post-tax each pay period. PET INSURANCE All Regular Full-time and Regular Part-time team members can enroll in this benefit. Get coverage and care for your pets with Veterinary Pet Insurance (VPI) through Nationwide. Plan options are listed in the column on the right. To enroll in this benefit, contact VPI at 877-PETS-VPI ( ). Let them know you are an Erlanger Health System employee and are interested in participating in their program. This will ensure you deductions are sent to us and are taken post-tax bi-weekly from your paycheck. EVERYDAY & COMPREHENSIVE CARE PET WELLNESS PLAN PLUS + MAJOR PLAN SERVICES Physical Exam: Two Exams Per Policy Term... $60 ($30 max per exam) Behavioral Exam and/or Treatment... $30 Vaccination or Titer... $75 Heartworm or FeLV/FIV Test... $35 Fecal Test... $25 Deworming... $25 Nail Trim... $20 Microchip... $40 Health Certificate... $40 Flea Control or Heartworm Prevention... $75 One Additional Test (One Test Per Policy Term):... $75 (1) Health Screen (Blood Test) or (2) Radiograph (X-rays) or (3) Electrocardiogram (EKG) MAXIMUM ANNUAL BENEFIT...$500 PET WELLNESS PLAN PLUS FOR EVERYDAY CARE No deductible Covers wellness exams, shots, tests and more Freedom to use any vet, anywhere Maximum annual benefit of $500 Includes 24/7 access to vethelpline MAJOR PLAN FOR COMPREHENSIVE CARE $250 annual deductible Covers accidents, illnesses, procedures, X-rays and more Chronic condition coverage included Freedom to use any vet, anywhere Limited hereditary coverage after first year Includes 24/7 access to vethelpline PET WELLNESS PLAN PLUS + MAJOR PLAN COMPREHENSIVE Includes all plan options listed above. Cost is based on the type of pet (dog or cat) and age of the pet.

3 IMPROVEMENT/CHANGES TO PLANS 2016 PRESCRIPTION DRUG BENEFITS 5 TIERS The health plans will have 5 tiers of benefits: TIER 1 benefits apply to physicians and providers employed by Erlanger TIER 2 benefits apply to Independent physicians and providers not employed by other local area healthcare systems in BCBST Network S. Chattanooga area. TIER 3 benefits apply to services not available at Erlanger, but performed inside the State of Tennessee. Providers must be members of BCBST Network S TIER 4 benefits apply to services performed outside the State of Tennessee, considered Out-of-Area benefits. You and your covered dependents must access BCBS providers TIER 5 is Out-of-Network Benefits. There is no coverage unless a true medical emergency Medical premiums for employees will increase for the 2016 plan year; however, the rates will remain very competitive for the Chattanooga area. We have kept the four-rate tier structure for the medical, dental and vision plans and have made enhancements to the overall benefits package for the 2016 Plan Year. CHANGES TO PLANS FOR 2016 EHS will offer the same two deductible options for 2016, $750 or $1,250 Emergency Room Copayment will increase to $250 per visit Advanced Imaging will increase to $350 (includes PET Scan, CAT Scan, MRI and etc.). The copayment includes all views, contrast and the read. This copayment also applies to any Advanced Imaging completed in the Emergency Room. A Skilled Nursing Facility benefit has been added subject to applicable deductible and coinsurance with a limit of 60 days per year. Hospice Care has been added for all four tiers of benefits subject to applicable deductible and paid at 80% coinsurance. A Routine Outpatient Diagnostic Lab and X-ray benefit has been added. You must have services completed at an Erlanger system for Tier 1 and Tier 2 and a $75 Copayment will apply. If performed at the Tier 3 level the benefit will be subject to deductible and 70% coinsurance and if performed at Tier 4 the benefit will be subject to deductible and 30% coinsurance. Bariatric Surgery will be subject to the applicable deductible and paid at 90% coinsurance. Bariatric procedures can only be performed at Erlanger Health System by our Bariatric Center. Medication benefits will be added for Erectile Dysfunction for employees and/or their spouse over the age of 40. A list of medications and their applicable copayments will be available add on our 2016 Drug Formulary List. ERLANGER PHARMACIES (MOORE & KING) 30 DAY 90 DAY GENERIC...$5 Co-pay... $10 Co-pay DEDUCTIBLE (applies to Brand Name, Non-Preferred)...$ $125 BRAND NAME...$40 Co-pay... $80 Co-pay NON-PREFERRED BRAND NAME...$65 Co-pay... $130 Co-pay SPECIALTY...50% ($100 min... No Coverage to $200 max.) Smoking Cessation - Zyban, Wellbutrin...$0 Co-pay... $10 Co-pay and Chantix (first 3 months covered at $0 Copay; then $5 Generic Copay for 9 months) Nicorette Gum and NicoDerm CQ Patches...$0 Co-pay... Not Available (3 month coverage at 100%) OTHER PHARMACIES 30 DAY 90 DAY GENERIC...$15 Co-pay... No Coverage DEDUCTIBLE (applies to Brand Name, Non-Preferred)...$ No Coverage BRAND NAME...$55 Co-pay... No Coverage NON-PREFERRED BRAND NAME...$80 Co-pay...No Coverage SPECIALTY...50% ($175 min... No Coverage to $425 max.) PRESCRIPTION DRUG PLAN CHANGES For Brand Name and Preferred Brand Name Drugs a $125 deductible will apply before the drug will be copayment eligible We have eliminated the ability to fill a 90 day supply at any other retail pharmacy. All 90 day supplies will have to be filled at Erlanger Pharmacy (formerly Moore & King). Smoking Cessation Drugs, Zyban, Wellbutrin and Chantix, will be covered at a $0 Copayment for the first 3 months then will be subject to the Generic Copayment for 9 months only at Erlanger Pharmacies (formerly Moore & King) Nicorette Gum and NicoDerm CQ Patches will be covered for 3 months at 100% only at Erlanger Pharmacies (formerly Moore & King)

4 ACCIDENT ADVANTAGE PLUS INSURANCE OVERVIEW - AFLAC GROUP ACCIDENT ADVANTAGE PLUS INSURANCE OVERVIEW - AFLAC GROUP (continued) GROUP ACCIDENT ADVANTAGE PLUS INSURANCE (AFLAC) Benefits for Group Accident are payable regardless of any other insurance. Coverage is guaranteeissue, provided the applicant is eligible for coverage. The plan features both inpatient and outpatient treatment and covered accidents. Benefits are available for both spouse and/or dependent children. The plan is portable; please refer to the policy for complete details. Employees who currently have Group Accident coverage through UNUM may keep their UNUM policies; employees are not required to transition to AFLAC. COMPLETE FRACTURES (Closed Reduction Benefits) Range from $3,000 for Hip/Thigh down to $240 for Coccyx (tailbone)/rib/finger/toe COMPLETE DISLOCATIONS (Closed Reduction Benefits) Range from $2,000 for Hip down to $160 for Finger/Toe CHILD(REN) PARALYSIS Quadriplegia...$5,000...$10,000 Paraplegia...$2,500...$5,000 LACERATIONS Up to 2 long...$75 2 to 6 long...$300 More than 6 long...$600 Lacerations not requiring stitches...$38 INJURIES REQUIRING SURGERY Eye Injuries (Treatment and surgery within 90 days)...$300 Tendons/Ligaments* - Single...$400 - Multiple...$600 (Treatment for tendons/ligaments within 60 days, surgical repair within 90 days.) If the insured fractures a bone or dislocates a joint, and tears, severs, or ruptures a tendon or ligament in the same accident, AFLAC will pay one benefit. AFLAC will pay the largest of the scheduled benefit amounts for fractures, dislocations, or tendons and ligaments. RUPTURED DISC (Treatment within 60 days, surgical repair within 1 year) Injury occurs during first certificate year...$100 Injury occurs after first certificate year...$400 TORN KNEE CARTILAGE (Treatment within 60 days, surgical repair within 1 year) Injury occurs during first certificate year...$125 Injury occurs after first certificate year...$500 CONCUSSION A concussion or Mild Traumatic Brain Injury (MTBI) defined as a disruption of brain function resulting from a traumatic blow to the head. The concussion must be diagnosed by a physician...$150 BURNS (Treatment within 72 hours, first degree not covered) Second Degree Less than 10% of body surface covered...$100 At least 10%, but not more than 25% of body surface covered...$200 At least 25%, but not more than 35% of body surface covered...$500 More than 35% of body surface covered...$1,000 Third Degree Less than 10% of body surface covered...$1,000 At least 10%, but not more than 25% of body surface covered...$5,000 At least 25%, but not more than 35% of body surface covered...$10,000 More than 35% of body surface covered...$20,000 INTERNAL INJURIES Results in open abdominal or thoracic surgery...$1,000 EXPLORATORY SURGERY Without repair, i.e. arthroscopy...$250 EMERGENCY DENTAL WORK Repaired with crown...$300 Resulting in extraction...$100 SPOUSE OR CHILD(REN)E COMA State of profound unconsciousness lasting 30 days or more...$2,500...$5,000 Medical Fees... No Coverage...$75 Emergency Room Treatment ((benefit payable once every 24-hour period and only once per accident)... No Coverage...$150 Emergency Room Observation Benefits... No Coverage...$100 Major Diagnostic Testing... No Coverage...$200 Accident Follow-up Treatment... No Coverage...$30 Physical Therapy (6 treatments one per day per covered accident)... No Coverage...$30 Air Ambulance... No Coverage...$1,500 Ambulance... No Coverage...$400

5 ACCIDENT ADVANTAGE PLUS INSURANCE OVERVIEW - AFLAC GROUP (continued) TRANSPORTATION (Within 90 days of accident) Train or Plane...$300 Bus...$150 OTHER SERVICES Blood/Plasma...$400 Prosthesis...$750 Appliance...$100 Family Lodging Benefit (per night)...$150 Wellness Benefit (payable after premiums paid for 12 months; pay once each 12 month period for each covered person for certain wellness exams)... $50 Hospital Admission...$500 Hospital Confinement (per day)...$100 Hospital Intensive Care (per day)...$200 Rehabilitation Unit Benefit (per day)...$75 CHILD(REN) SPOUSE ACCIDENTAL DEATH (Within 90 days of accident) Accidental Death... $5,000...$20,000...$40,000 Accidental Common Carrier Death... $10,000...$40,000...$80,000 DISMEMBERMENT (Within 90 days of accident) Single Dismemberment... $2,500...$5,000...$10,000 Double Dismemberment... $5,000...$10,000...$20,000 Loss of One or More Fingers or Toes... $250...$500...$1,000 Partial Amputation of Finger(s) or Toe(s) including at least one joint)s... $80...$80...$80 BI-WEEKLY RATES - AFLAC GROUP ACCIDENT ADVANTAGE PLUS INSURANCE Employee...$6.12 Employee + Spouse...$9.37 Employee + Dependent Children...$11.00 GROUP HOSPITAL INDEMNITY INSURANCE - AFLAC GROUP Hospital Confinement (per day)...$250 Hospital Admission (per confinement)...$1,000 Hospital Intensive Care (per day)...$250 Surgical Benefit (per procedure)... up to $2,500 Anesthesia Benefits... up to $625 Hospital Emergency Room/Physician Benefit (maximum per visit)...$50 Out-of-Hospital Prescription Drug Benefit (per prescription)...$20 Well Baby Care (per visit)...$50 BI-WEEKLY RATES - AFLAC GROUP HOSPITAL INDEMNITY INSURANCE Employee...$26.97 Employee + Spouse...$53.58 Employee + Dependent Children...$40.43 Family...$67.04 It s not possible for this synopsis of benefits to include every detail or circumstance that may apply; the AFLAC Group Hospital Indemnity Insurance policy supersedes this overview. Family...$14.25 It s not possible for this synopsis of benefits to include every detail or circumstance that may apply; the AFLAC Group Accident Advantage Plus Insurance policy supersedes this overview.

6 2016 PLAN HIGHLIGHTS $750 TIER 1 TIER 2 TIER 3 TIER 4 TIER 5 ERLANGER NETWORK S NETWORK S OUT-OF-AREA OUT-OF- HEALTH Excludes local Services not Service performed NETWORK NETWORK healthcare systems & available at EHS, outside the state Erlanger Employed their employed but inside the of Tennessee Providers providers inside the state of TN BCBST BCBS Network Chattanooga area. Network S. $1,250 TIER 1 TIER 2 TIER 3 TIER 4 TIER 5 ERLANGER NETWORK S NETWORK S OUT-OF-AREA OUT-OF- HEALTH Excludes local Services not Service performed NETWORK NETWORK healthcare systems & available at EHS, outside the state Erlanger Employed their employed but inside the of Tennessee Providers providers inside the state of TN BCBST BCBS Network Chattanooga area. Network S. ANNUAL DEDUCTIBLE Individual...$ $750...$1, $5,000...No Coverage Family... $2,250...$2,250...$4, $15,000...No Coverage ANNUAL OUT-OF-POCKET MAXIMUMS Individual... $5,000...$5,000...$7, $15,000...No Coverage Family... $10,000...$10,000...$15, $30,000...No Coverage s and Out-of-Pocket Maximums accrue for TIER 1, 2, and 3. s and Outof-Pocket Maximums apply only to TIER 4 No Coverage LIFETIME MAXIMUM...Unlimited... Unlimited... Unlimited...Unlimited... Not Applicable PHYSICIAN OFFICE SERVICES Primary Care Physician...$10... $30... $30...$50...No Coverage Specialty...$25... $50... $50...$75...No Coverage Behavioral Health Office Visit...$10... $25... $25...$25...No Coverage Chiropractic/Manipulative Therapy...$20... $20... $20...$20...No Coverage (limit 30 visits per calendar year) Provider-Administered Specialty Drugs...$ Subject to deductible...subject to deductible.. Subject to deductible...no Coverage Copay and out-of-pocket and out-of-pocket and out-of-pocket Physical Therapy...80%... No Coverage...70%...30%...No Coverage PREVENTATIVE HEALTH CARE SERVICES Mammography...100%... No Coverage... No Coverage...No Coverage...No Coverage (Routine and diagnostic) Colonoscopy...100%... No Coverage... No Coverage...No Coverage...No Coverage (Preventive and diagnostic) Smoking Cessation... Workforce... No Coverage... No Coverage...No Coverage...No Coverage Intervention/Counseling (limit 12 visits per calendar year) EMERGENCY ROOM SERVICES Emergency Care Services...$250 Co-pay...$250 Co-pay...$250 Co-pay...$250 Co-pay...$250 Co-pay (Waived if admitted) If Admitted through the ER...80%...80%... 80%...80%...80% (If admitted to hospital through ER for a true medical emergency; stay covered at Tier 1 Level; but subject to applicable Tier and Out-of-Pocket Maximums) *Emergency Care Physicians...100%...100% %...*100%...*100% *Out-of-Area and Out-of-Network physician claims associated with an ER visit will only be paid at 100% of the maximum allowable charges. Member is subject to balance billing. High-Tech Imaging (performed in ER)..$350 Co-pay...$350 Co-pay...$350 Co-pay...$350 Co-pay...$350 Co-pay Ambulance Service (ground/air)... $75/$300...$75/$300...$75/$ $75/$ $75/$300 FACILITY SERVICES Inpatient Services...80%... No Coverage... 70%...30%...No Coverage Outpatient Services...80%... No Coverage... 70%...30%...No Coverage Physical Therapy...80%... No Coverage... 70%...30%...No Coverage High Tech Imaging...$350 Co-pay... No Coverage... 70%...30%...No Coverage Provider-Administered...$250 Co-pay... Subject to deductible...subject to deductible.. Subject to deductible...no Coverage Specialty Drugs and out-of-pocket and out-of-pocket and out-of-pocket OUTPATIENT SERVICES Diagnostic Lab & X-ray...$75 Co-pay...Erlanger Only... 70%...30%...No Coverage ANNUAL DEDUCTIBLE Individual... $1,250...$1,250...$2, $5,000...No Coverage Family... $3,750...$3,750...$7, $15,000...No Coverage ANNUAL OUT-OF-POCKET MAXIMUMS Individual... $4,000...$4,000...$7, $15,000...No Coverage Family... $8,000...$8,000...$15, $30,000...No Coverage s and Out-of-Pocket Maximums accrue for TIER 1, 2, and 3. s and Outof-Pocket Maximums apply only to TIER 4 No Coverage LIFETIME MAXIMUM...Unlimited... Unlimited... Unlimited...Unlimited... Not Applicable PHYSICIAN OFFICE SERVICES Primary Care Physician...$10... $30... $30...$50...No Coverage Specialty...$25... $50... $50...$75...No Coverage Behavioral Health Office Visit...$10... $25... $25...$25...No Coverage Chiropractic/Manipulative Therapy...$20... $20... $20...$20...No Coverage (limit 30 visits per calendar year) Provider-Administered Specialty Drugs...$ Subject to deductible... Subject to deductible... Subject to deductible...no Coverage Copay and out-of-pocket and out-of-pocket and out-of-pocket Physical Therapy...80%... No Coverage...70%...30%...No Coverage PREVENTATIVE HEALTH CARE SERVICES Mammography...100%... No Coverage... No Coverage...No Coverage...No Coverage (Routine and diagnostic) Colonoscopy...100%... No Coverage... No Coverage...No Coverage...No Coverage (Preventive and diagnostic) Smoking Cessation... Workforce... No Coverage... No Coverage...No Coverage...No Coverage Intervention/Counseling (limit 12 visits per calendar year) EMERGENCY ROOM SERVICES Emergency Care Services...$250 Co-pay...$250 Co-pay...$250 Co-pay...$250 Co-pay...$250 Co-pay (Waived if admitted) If Admitted through the ER...80%...80%... 80%...80%...80% (If admitted to hospital through ER for a true medical emergency; stay covered at Tier 1 Level; but subject to applicable Tier and Out-of-Pocket Maximums) *Emergency Care Physicians...100%...100% %...*100%...*100% *Out-of-Area and Out-of-Network physician claims associated with an ER visit will only be paid at 100% of the maximum allowable charges. Member is subject to balance billing. High-Tech Imaging (performed in ER)..$350 Co-pay...$350 Co-pay...$350 Co-pay...$350 Co-pay...$350 Co-pay Ambulance Service (ground/air)... $75/$300...$75/$300...$75/$ $75/$ $75/$300 FACILITY SERVICES Inpatient Services...80%... No Coverage... 70%...30%...No Coverage Outpatient Services...80%... No Coverage... 70%...30%...No Coverage Physical Therapy...80%... No Coverage... 70%...30%...No Coverage High Tech Imaging...$350 Co-pay... No Coverage... 70%...30%...No Coverage Provider-Administered...$250 Co-pay... Subject to deductible... Subject to deductible... Subject to deductible...no Coverage Specialty Drugs and out-of-pocket and out-of-pocket and out-of-pocket OUTPATIENT SERVICES Diagnostic Lab & X-ray...$75 Co-pay...Erlanger Only... 70%...30%...No Coverage

7 2016 PREMIUMS $750 $750 NON-NICOTINE USER + + FAMILY Full-time ( FTE)... $ $ $ $ Part-time ( FTE)... $ $ $ $ LOA (Monthly)... $ $ $ $ COBRA (Monthly)... $ $ $ $1, NICOTINE USER + + FAMILY Full-time ( FTE)... $ $ $ $ Part-time ( FTE)... $ $ $ $ $1,250 $1,250 NON-NICOTINE USER + + FAMILY Full-time ( FTE)... $ $ $ $ Part-time ( FTE)... $ $ $ $ LOA (Monthly)... $ $ $ $ COBRA (Monthly)... $ $ $ $1, NICOTINE USER + + FAMILY Full-time ( FTE)... $ $ $ $ Part-time ( FTE)... $ $ $ $ VISION + + FAMILY Regular Full-time & Part-time... $ $ $ $10.08 COBRA (Monthly)... $ $ $ $22.28 PRN... Not Eligible... Not Eligible... Not Eligible... Not Eligible DENTAL + + FAMILY Regular Full-time & Part-time... $ $ $ $25.00 COBRA (Monthly)... $ $ $ $81.56 PRN... Not Eligible... Not Eligible... Not Eligible... Not Eligible AB042 10/15