Starmark HealthyEdge SM

Transcription

1 Simple pla desig. Tools to maage costs. Starmark HealthyEdge SM PPO Advatage Pla Desigs Self-Fuded Health Pla Desigs ad Stop-Loss Isurace Specifically for Busiesses With Te or More Employees

2 Starmark HealthyEdge SM The beefits you wat. The protectio you eed. Employers like you ofte struggle to fid healthcare beefits optios that give you the cotrol, flexibility ad value you eed util ow. With HealthyEdge, you get better cotrol over your health beefits, the flexibility to tailor your self-fuded pla to your specific eeds, ad the opportuity to receive a refud if your group s claims are lower tha previously expected ad fuded. To lear more about self-fudig ad how your fiacial risk is miimized with stop-loss isurace, refer to the separate brochure, Uderstadig how Starmark HealthyEdge fudig works for busiesses with 10 or more employees. Why Starmark? For more tha 25 years, Starmark has served thousads of employers with expertise i group healthcare beefits. Cotrol costs ad customize beefits through truly flexible mix-ad-match pla desigs. Achieve greater etwork access ad i-etwork discouts with atiowide access to atioal ad regioal PPO etworks, icludig Aeta Sigature Admiistrators (ASA) PPO Network, GWH-Ciga Network ad Private Healthcare Systems (PHCS), a MultiPla etwork. Experiece cost-effective pharmaceutical care through prescriptio drug maagemet programs that use a atiowide etwork of retail pharmacies as well as home delivery ad mail order pharmacy services. Alteratively, you may choose ot to offer outpatiet prescriptio drug coverage. More tha great beefits! Experiece Starmark s uparalleled persoal service. Choose from flexible pla desigs to create a pla to meet your eeds ad budget. Employers have trusted Starmark to serve the healthcare beefit eeds of their employees sice Starmark: Persoal. Flexible. Trusted. Ecourage your employees to get ad stay healthy with the CareChampio 24/7 health advocacy service, ad Healthy Foudatios health ad welless maagemet suite. Make erollmet easy with Express Coect, Starmark s paperless employee erollmet process. 2 Starmark is headquartered with the Trustmark Compaies i this prairie-style buildig i Lake Forest, Illiois.

3 Starmark HealthyEdge SM PPO Advatage Get the advatage of a familiar beefit offerig with the cost-savig feature of separate accruals; oe for i-etwork ad aother for out-of-etwork services. Customize Your Health Pla Desig Pla desig flexibility allows you to tailor your self-fuded pla desig to meet your eeds ad budget. Refer to the separate isert (MK85) for a compariso of state madates ad self-fuded beefits. Ask your broker for details. Idividual Deductible 1 (i-etwork/out-of-etwork) Caledar Year The 12-moth period from Jauary 1 to December 31 durig which covered expeses ca be applied to satisfy the deductible. The accumulatio period resets every Jauary 1. Pla Year The 12-moth period durig which covered expeses ca be applied to satisfy the deductible. The pla year begis with the group s effective date ad the accumulatio period resets 12 moths later, o the pla s aiversary. $ 0/$2,000 2 $ 750/$1,500 $ 2,000/$4,000 $ 4,000/$8,000 $ 250/$750 $1,000/$2,000 $ 2,500/$5,000 $ 5,000/$10,000 $ 500/$1,500 $1,500/$3,000 $3,000/$6,000 $ 10,000/$20,000 Coisurace (i-etwork/out-of-etwork) Coisurace Limit (i-etwork/out-of-etwork) Family Deductible 1 ad Out-of-Pocket Limit 1 Multiplier Lifetime Maximum Beefit 100/ /70 80/60 70/50 50/50 $5,000/$10,000 $10,000/$15,000 $15,000/$20,000 $20,000/$25,000 A multiple of the idividual deductible ad out-of-pocket limit. Oe time Two times Three times Ulimited for essetial health beefits (as defied by federal regulatio) Out-of-Pocket Limits 1 The percetage of covered charges the member must pay each year. The family out-of-pocket limit is oe, two or three times the idividual out-of-pocket limit, depedig o the family deductible ad out-of-pocket limit multiplier selected. The out-of-pocket limit does ot iclude the deductible. Refer to your proposal for the out-of-pocket limits applicable to your self-fuded pla desig. Example: Usig a 80/60 coisurace, the $5,000/$10,000 coisurace limit ad a family out-of-pocket limit of two times the idividual out-of-pocket limit, the out-of-pocket limits are calculated as follows: I-etwork Out-of-etwork Idividual Family 20% of $5,000 = $1,000 40% of $10,000 = $4,000 2 x $1,000 = $2,000 2 x $4,000 = $8,000 1 I- ad out-of-etwork deductibles ad out-of-pocket limits accrue separately. 2 Whe the $0/$2,000 deductible is selected with the 100/70 coisurace, the physicia/specialist office visit copay, ad the prescriptio drug card or o outpatiet prescriptio drug coverage must also be selected. 3

4 Beefit Optios Select a physicia/specialist office visit copay ad your self-fuded pla desig will iclude the correspodig urget care copay. If desired, a therapy, alterative medicie ad/or emergecy room copay ca be selected, with the amout depedet o the physicia/specialist office visit copay selected. Physicia/Specialist Office Visit Urget Care Therapies (optioal) Alterative Medicie (optioal) Emergecy Room (optioal) $25 copay $45 copay $25 copay $25 copay $250 copay $35 copay $65 copay $35 copay $35 copay $250 copay $45 copay $85 copay $45 copay $45 copay $250 copay Deductible ad coisurace Deductible ad coisurace Deductible ad coisurace Deductible ad coisurace $200 access fee (per occurrece, waived if admitted as ipatiet) Physicia/Specialist Office Visit Covered charges are paid i full after the i-etwork physicia/specialist office visit copay. This icludes charges for the visit, allergy ijectios ad certai o-surgical ijectios performed at the same office visit, ad billed by the attedig physicia. The physicia/specialist office visit copay does ot apply to prevetive care services or ay surgical procedure. Coverage for prevetive care services is described i the Self-Fuded Pla Desig Features sectio of this brochure. Surgical procedures, as well as services whe a copay is ot selected, are subject to the pla deductible ad coisurace. Urget Care Covered charges are paid i full after the i-etwork urget care copay. This icludes charges for x-ray, lab, pathology ad radiology services performed at the same visit ad billed by the urget care ceter. The urget care copay does ot apply to prevetive care services or ay surgical procedure. Coverage for prevetive care services is described i the Self-Fuded Pla Desig Features sectio of this brochure. Surgical procedures, as well as services whe a copay is ot selected, are subject to the pla deductible ad coisurace. Therapies Speech, occupatioal ad physical therapy The therapy copay applies to i-etwork speech, occupatioal ad physical therapies. Therapies provided at a physicia/specialist office visit may also be subject to the separate physicia/specialist office visit copay. Therapies received at a hospital are subject to the pla deductible ad coisurace, ad cout toward the maximum visit limit. Maipulative therapy The therapy copay applies to i-etwork maipulative therapy ad icludes procedures provided at the office visit, except diagostic x-rays. These are subject to the outpatiet diagostic x-ray ad lab beefit selected. If a copay is ot selected, covered services are subject to the pla deductible ad coisurace. Refer to the Covered Services sectio of this brochure for more iformatio. Alterative Medicie The alterative medicie copay applies to i-etwork services. If a copay is ot selected, covered services are subject to the pla deductible ad coisurace. For a list of covered alterative medicie services, refer to the Covered Services sectio of this brochure. Emergecy Room Copay: Covered charges are paid i full after the copay. The copay is ot waived if admitted as ipatiet. If a copay is ot selected, the separate $200 emergecy room access fee applies. Access Fee: After the additioal $200 emergecy room access fee is paid, covered charges are subject to the pla deductible ad coisurace. Charges for o-emergecy treatmet received i the emergecy room are subject to the pla deductible ad coisurace. Copays ad the emergecy room access fee do ot apply toward the pla deductible or out-of-pocket limit. For additioal iformatio o emergecy admissios, see page 10. 4

5 Outpatiet Diagostic X-Ray ad Lab Choices: 100% up to $250 per perso, per year 100% up to $500 per perso, per year 100% up to $1,000 per perso, per year Coisurace oly (deductible waived) 1 Deductible ad coisurace Coverage icludes i-etwork x-ray, lab, pathology ad radiology services. Covered charges exceedig the maximum or services received out-of-etwork, are subject to the pla deductible ad coisurace. Ipatiet Admissio ad Outpatiet Surgery Access Fees Optio Whe the optioal ipatiet admissio ad outpatiet surgery access fees are selected, a additioal $500 access fee applies to facility charges for each hospital admissio ad a additioal $500 access fee applies to facility charges for each outpatiet surgical visit. After these access fees are paid, covered charges are subject to the pla deductible ad coisurace. These access fees do ot apply toward the pla deductible or out-of-pocket limit. For iformatio o emergecy admissios, see page 10. Note: These access fees caot be selected idividually. Supplemetal Accidet Optio Choose supplemetal accidet beefits to help prepare your employees for a uexpected accidet or ijury by providig first-dollar coverage. The first $500 of covered charges per accidet is paid at 100 percet uder your self-fuded pla desig. Additioal covered charges are subject to the pla deductible ad coisurace. Coverage icludes medical charges resultig from accidetal ijury icurred withi 90 days of the accidet. Materity Optio Selectig the materity optio provides your employees with peace of mid whe plaig for pregacy ad delivery. Normal materity ad ursery care covered charges are subject to the pla deductible ad coisurace. CareChampio 24/7 Optio CareChampio 24/7 is a health advocacy service that supports members as they avigate through the healthcare system. Advisors are available aytime, day or ight, ad ca help members fid a doctor or hospital i-etwork, uderstad healthcare beefits ad claim paymets, idetify cost-savig opportuities, hadle eldercare issues ad more! YourCare Optio Choose the optioal YourCare health ad welless outreach program to help your employees protect their most importat asset their health. YourCare provides members with proactive, timely ad persoalized iformatio, icludig: Welless remiders to ecourage prevetive tests ad screeigs based o age ad geder Persoalized, detailed remiders to help members stay curret with recommeded guidelies for maagig a chroic coditio Outreach from registered urses to assist members who have oe or more serious health coditios Starmark HRA: Seamless. Iovative. Bottom-lie friedly. Save moey ad help your employees maage healthcare costs. Pair a higher-deductible health pla with the Starmark HRA (health reimbursemet arragemet) for lower health pla costs ad cash-flow cotrol with the added bous of: Seamless claims ad HRA itegratio, which meas o claims to file No prefudig; HRA expeses are fuded oly as icurred Easy fud maagemet for employees 1 The coisurace oly optio is ot available whe the 100/70 coisurace is selected. 5

6 Outpatiet Prescriptio Drug Beefit Choices Offer Flexibility Starmark HealthyEdge SM self-fuded pla desigs offer 3 prescriptio drug beefit optios to meet your group s eeds: a prescriptio drug card, the Price Assurace Program or o outpatiet prescriptio drug coverage. 1 Prescriptio Drug Card 2 Price Assurace Program Prescriptio Deductible Must be met i full every year by each member before the copay applies. The prescriptio deductible does ot apply to geerics. $0 per perso $250 per perso $500 per perso Retail Copay (up to a 30-day supply) Geeric Preferred Nopreferred Brad Brad $ 0 $30 $ 50 $ 0 $45 $ 75 $15 $30 $ 60 $15 $45 $ 75 $20 $60 $100 Mail Service Copay (up to a 90-day supply) Geeric Preferred Nopreferred Brad Brad $ 0 $ 75 $150 $ 0 $110 $225 $30 $ 75 $180 $30 $110 $225 $40 $150 $300 The $0 geeric prescriptio drug copays ca be selected oly with the $0 prescriptio deductible. The prescriptio copay ad deductible do ot apply toward the idividual or family deductibles, or toward out-of-pocket limits. Credit from prior pla drug card deductibles ad carry-over provisios do ot apply to the prescriptio deductible. OR This program provides prescriptio drug savigs at participatig pharmacies atiowide. Whe members preset their medical ID card at a participatig pharmacy, they receive: The lowest price available i that store, o that day Geeric drug savigs Drug utilizatio review The Price Assurace Program icludes most drugs that, by federal law, require a prescriptio. Covered prescriptio drugs are subject to the i-etwork pla deductible ad coisurace whe the prescriptio is filled at a participatig pharmacy. If a prescriptio drug is excluded from coverage uder your self-fuded pla desig, members may still receive a discout o their prescriptio through this program. Prescriptio Safeguards To ecourage the safe ad appropriate use of prescriptio drugs, Starmark pla desigs utilize quatity limits ad prior authorizatio for certai drug classes covered by the prescriptio beefit. These limits ad prior authorizatios are iteded to esure proper prescriptio utilizatio ad cliically appropriate quatities. Additioally, Specialty Guidelie Maagemet, provided by Starmark s cotracted pharmacy beefit maager, helps to esure members receive the most appropriate specialty medicatio for maagig their complex medical coditios. Refer to the separate brochure, Safety, Savigs ad Coveiece, for more iformatio. To lear more about the prescriptio drug beefit, specialty pharmacy services ad ways to save o prescriptios, refer to the separate brochure, Makig the Most of Your Prescriptio Beefit. Visit a Participatig Pharmacy to Maximize Beefits Participatig pharmacies have cotracted with Starmark s cotracted pharmacy beefit maager to charge a fixed amout for prescriptio drugs. Noparticipatig pharmacies may charge a price sigificatly above this amout, which may mea higher prescriptio expeses for members. Whe a oparticipatig pharmacy is used, the member pays the full price of the prescriptio drug at the time of purchase. OR 3 No Outpatiet Prescriptio Drug Coverage You may choose to waive coverage for outpatiet prescriptio drugs. Members do ot receive a discout ad pay the full price for prescriptios filled at a retail, mail service or specialty pharmacy. Prescriptio drugs received ipatiet or admiistered i a physicia s office are covered uder your self-fuded pla desig, subject to the pla deductible ad coisurace. 6

7 Self-Fuded Pla Desig Features Prevetive Care Services Covered prevetive care services received i-etwork will be paid uder your self-fuded pla desig at 100 percet. 1 Covered prevetive care services iclude, but are ot limited to: Physicia office visits for prevetive care services Adult physicals Routie ob/gy visits Well-child visits Routie mammograms PSA (prostate-specific atige) Colorectal cacer screeig Adult ad child immuizatios (icludig flu ad peumoia shots) Age ad frequecy schedules apply. For a complete list of prevetive care services, visit regulatios/prevetio/recommedatios.html. I o evet will beefits for prevetive care services be less tha that which is required by state or federal law, as applicable. Reasoable medical maagemet techiques may be used to determie appropriate frequecy, method or settig for a prevetive care service to the extet such service is ot specified i the guidelies or recommedatios. Lab Card Program All HealthyEdge PPO Advatage pla desigs iclude the Lab Card Program. This volutary program offers 100 percet coverage for covered outpatiet laboratory testig whe testig is directed to a participatig Quest Diagostics laboratory as part of the Lab Card Program. Provider collectio ad hadlig fees may apply ad are subject to health beefit pla provisios. For more iformatio, visit Note: The Lab Card Program is ot available whe the GWH-Ciga Network is selected. Quest Diagostics Icorporated is a provider of laboratory testig, iformatio ad services, ad is ot affiliated with Trustmark or Starmark. Physicia/Hospital PPO Network Selectio Offerig employees a choice of PPO etworks ecourages i-etwork utilizatio while maitaiig freedom of choice i provider care. You may select two etworks per busiess locatio up to a maximum of five etworks. By usig i-etwork providers, your employees ca take advatage of egotiated discouts. If a out-of-etwork provider is used, the member is resposible for ay amout exceedig the Reasoable ad Customary Fee 2. Receive Network Access While Outside the Primary PPO Service Area Whe members ad their eligible depedets ecouter a uexpected illess or eed medical treatmet while outside their primary PPO etwork s coverage area, they ca take advatage of i-etwork beefit levels, subject to the terms of your pla, ad PHCS-egotiated discouts by usig PHCS Healthy Directios. Members ca visit a PHCS Healthy Directios provider whe: Travelig for busiess or vacatio Attedig a out-of-area educatioal istitutio Residig outside their primary PPO etwork s coverage area Members who have the Aeta Sigature Admiistrators (ASA) PPO Network, GWH-Ciga Network or Private Healthcare Systems (PHCS) as their etwork maitai provider access through these etworks whe outside the primary PPO service area. For more iformatio about PHCS Healthy Directios, refer to the separate flyer (MK60b). 1 Prevetive care beefits are i accordace with guidelies from the U.S. Prevetive Services Task Force, Health Resources ad Services Admiistratio, ad the Advisory Committee o Immuizatio Practices of the Ceters for Disease Cotrol ad Prevetio. 2 Reasoable ad Customary Fee is the lesser of the provider s actual charge, or a percetage of the Medicare reimbursemet rate i effect at the time services are provided. 7

8 Covered Services Whe medically ecessary, eligible charges for the followig services are payable uder your self-fuded pla desig subject to the pla deductible, coisurace ad, for out-of-etwork providers, Reasoable ad Customary Fee 1. Hospital ad Provider Services Semiprivate hospital room, board ad geeral ipatiet ursig care Itesive care uit Miscellaeous services ad supplies provided by a hospital o a ipatiet basis Miscellaeous services ad supplies provided by a hospital or free-stadig surgical ceter ad related to outpatiet surgery or outpatiet treatmet of ijury Aesthetics ad their admiistratio Physicia s fees except as otherwise oted Prevetive care services 2 Other Services ad Supplies Prescriptio drugs (See page 6 for details o outpatiet prescriptio drug beefits.) Blood ad blood plasma, oxyge ad retal of equipmet for its admiistratio Local licesed ambulace service to or from a hospital X-rays (ot detal x-rays) performed for diagosis ad treatmet Laboratory tests performed for diagosis ad treatmet X-ray, radium, cobalt ad radioactive isotope therapy Artificial limbs ad eyes Casts, splits, trusses, crutches ad odetal braces Retal of a wheelchair, hospital-type bed or other durable medical equipmet Complicatios of pregacy Outpatiet pre-admissios testig Hospice care Maximum of 6 moths per lifetime Home healthcare Maximum of 100 days per year Skilled ursig care Maximum of 81 days per year RN ad LPN fees for private-duty ursig recommeded by a physicia Nodetal treatmet of temporomadibular joit dysfuctio (TMJ) Chroic pai treatmet programs Maximum of 10 visits per year Therapies Speech, occupatioal ad physical therapist s fees, whe prescribed by a physicia 60-visit limit per therapy per year Maipulative therapy 20-visit limit per year Alterative Medicie Acupucture, massage therapy, aturopathic services 12-visit limit per therapy, per year Maximum of $250 per therapy, per visit Nutritioal couselig 3 3-visit limit per lifetime, except for diabetic couselig 1 Reasoable ad Customary Fee is the lesser of the provider s actual charge, or a percetage of the Medicare reimbursemet rate i effect at the time services are provided. 2 Coverage for prevetive care services is described i the Self-Fuded Pla Desig Features sectio of this brochure. 3 Nutritioal couselig may be covered uder prevetive care services. 8

9 Metal Illess, Nervous Disorders, Substace Abuse ad Alcohol Abuse Groups with up to 50 employees Outpatiet expeses 40-visit limit per year; 120 visits per lifetime Covered charges are paid at 60 percet for a i-etwork provider; 50 percet for a out-of-etwork provider. Ipatiet expeses 20 days per year; 40 days per lifetime. These limits do ot apply to ipatiet alcohol abuse treatmet. Covered charges are paid accordig to the i- ad out-of-etwork coisurace selected. Groups with 51 or more employees Outpatiet ad ipatiet expeses Covered charges are paid the same as ay other covered service. Orga Trasplats Desigated trasplat facility Covered charges for approved trasplat services, icludig orga procuremet or acquisitio, are paid at 100 percet. Coverage is provided for trasportatio, lodgig ad meals for a compaio, subject to the followig limits: a. Trasportatio beefit: maximum of $1,000 per approved trasplat procedure b. Lodgig ad meals beefit: maximum of $250 per day; $10,000 per lifetime Nodesigated trasplat facility Covered charges for approved trasplat services at a out-of-etwork facility, icludig orga procuremet or acquisitio, are paid at 70 percet. No coverage is provided for trasportatio, lodgig or meals for a compaio. Healthy Foudatios Helps Members Get ad Stay Healthy Healthy Foudatios provides a comprehesive suite of health ad welless maagemet tools to help maximize the health potetial of every member. Healthy Foudatios icludes MyNurse 24/7, MateraLik materity welless program, olie support tools ad the Healthy Foudatios welless e-ewsletter. Plus, you ca elect to add the optioal YourCare health ad welless outreach program to help employees protect their most importat asset their health. To lear more, visit 9

10 Precertificatio Precertificatio is required for all hospital, rehabilitatio or skilled ursig admissios, behavioral health residetial treatmet, hospice, home healthcare or trasplat-related services, ad high-tech outpatiet radiology services, icludig CT, MRI ad PET scas. To precertify, the member must call the toll-free umber listed o the medical idetificatio card. Failure to precertify will result i a $300 pealty per occurrece. This pealty will ot cout toward the pla deductible, or toward the out-of-pocket limit. Precertificatio does ot guaratee self-fuded pla beefits are payable. The perso must be eligible at the time of service. Emergecy Admissios I the case of a emergecy admissio, the member must call the toll-free umber listed o the medical idetificatio card withi 48 hours after the admissio or o the ext regular busiess day after the start of treatmet, if later. Failure to call will result i a $300 pealty per occurrece. This pealty will ot cout toward the pla deductible, or toward the out-of-pocket limit. Note: If selected, the ipatiet admissio fee also applies. Pre-existig Coditios A pre-existig coditio is a coditio for which medical advice, diagosis, care, or treatmet was recommeded or received durig a six-moth period immediately precedig the effective date of coverage. For persos ages 19 ad older, beefits will ot be paid for a pre-existig coditio durig the first 12 moths of coverage uder the self-fuded pla desig (18 moths for late erollees). If a perso had creditable coverage with o more tha a 63-day gap i coverage, time covered uder the prior pla will be credited toward satisfyig the 12- or 18-moth pre-existig coditio limitatio period. Deductible Credit for New Groups A member cotiuously covered uder a prior idividual or group health pla with a caleder-year deductible will be credited for ay portio of the deductible satisfied uder the prior pla durig the same caledar year. Deductible credit will ot be give if movig to or from a health pla with a pla-year deductible. Credit is ot provided for out-of-pocket amouts or for employees added to a self-fuded pla after the group s iitial effective date. Erollee Defiitios Timely Erollees Timely erollees are eligible employees who complete ad sig a Employee Eligibility Statemet for themselves ad/or their depedets durig the employer s waitig period or prior to the ed of the iitial erollmet period. The iitial erollmet period is the 31 days followig the waitig period. Special Erollees Special erollees are employees or depedets who previously waived self-fuded coverage, but may ow be eligible because they have ivolutarily lost their other coverage, had a beefit/coverage chage or had a life-chagig evet. The erollmet period for a special erollee is the 31 days followig the special erollmet evet (60 days for special erollees who have lost their Medicaid or State Childre s Health Isurace Program coverage). Late Erollees Late erollees are eligible employees or depedets who request erollmet followig the iitial erollmet period. The iitial erollmet period is the 31 days followig the employer s waitig period or special erollmet evet. Special guidelies apply for special erollees ad late erollees. For more details, refer to the Importat Notice for Pre-existig Coditio Limitatios ad Special Erollmet Rights (UW105 SF) or ask your broker. Limited Occupatioal/ 24-Hour Coverage Work-related ijuries ad illesses are covered uder your self-fuded pla desig whe the member is ot covered by workers compesatio or similar coverage ad is ot eligible for such coverage. Hospital Bill Reward Program If a member detects ad resolves a error whe reviewig hospital bills, he or she will be rewarded 50 percet of the savigs, up to $1,000, uder your self-fuded pla desig. 10

11 Exclusios ad Limitatios Major Medical No beefits are payable uder your self-fuded pla desig for the followig expeses: Services ad supplies ot prescribed by a physicia or required to treat a covered coditio, or i excess of the Reasoable ad Customary Fee, or ot medically ecessary Detal care ad treatmet; hearig aids, eyeglasses ad cotact leses; eye or hearig exams 1 ; some foot treatmet, icludig orthotics Cosmetic surgery; hair prosthesis ad trasplats; treatmet for abormal male breast elargemet Charges the member is ot legally required to pay; charges for missed appoitmets; surcharges for weeked oemergecy office visits ad home visits by a physicia; treatmet redered by a member of the member s family; work-hardeig programs; occupatioal sickess ad ijury, except for members who are ot covered by workers compesatio or similar coverage ad are ot eligible for such coverage Normal pregacy, elective abortios ad routie ursery care, uless materity beefits are selected; surrogate paretig; reversal of sterilizatio; some assisted coceptio Weight reductio 1 ; smokig deterret medicatios 1 ; sex trasformatio or its reversal; restoratio or ehacemet of sexual activity Sesory itegratio therapy, cetral auditory processig disorder; most treatmet for sorig; excessive sweatig; phoophoresis; surface electromyogram; therapeutic cold devices; x-rays or tests ot related to diagosis or treatmet of sickess or ijury, uless otherwise specified Maiteace speech, occupatioal ad physical therapy; speech therapy for psychosocial speech delay, behavioral problems (icludig impulsive behavior ad impulsivity sydrome), attetio disorder, coceptual hadicap or metal retardatio Most dietary supplemets 1 ; experimetal/ivestigatioal drugs or treatmet; items for comfort or coveiece; expeses at a health spa; family or marriage couselig, aversio therapy, omedical self-care or self-help programs; home tractio devices; custodial care Suicide, attempted suicide or itetioal self-iflicted ijury, if ot the result of a medical coditio; ijury resultig from oe s ow egliget or illegal use of alcohol, drugs or over-the-couter medicatios Acts of war; participatio i a riot; commissio of or attempt to commit a feloy; egagig i a illegal occupatio 1 No beefits are payable uder your self-fuded pla desig for these expeses, except as required uder federal guidelies for prevetive care. Starmark Provides Uparalleled Persoal Service Starmark calls each ew group to welcome them ad follows up to esure satisfactio cotiues throughout the year. Represetatives assist to make reewal easy. Starmark s website provides iformatio ad resources to help members better maage their healthcare. Members have quick access to beefit iformatio at ad ca quickly access claim status usig their telephoe keypad

12 Trustmark, a employee beefits compay for early 100 years, is dedicated to providig fiacial security, improvig health ad well-beig, ad helpig people avigate the healthcare system. Servig more tha 2 millio covered lives or pla participats, Trustmark is rated A- (Excellet) by A.M. Best. Self-fuded plas are admiistered by Starmark, ad stop-loss isurace is provided by Trustmark Life Isurace Compay. Starmark is a distiguished leader i group healthcare beefits offerig self-fuded ad fully isured pla desigs. With paperless employee erollmet, health ad welless programs, atiowide etwork access ad seamless HRA admiistratio, Starmark is the choice i employer healthcare beefits. The iformatio cotaied i this product brochure is a geeral descriptio of features, beefits, requiremets ad restrictios of the beefit pla desig. More details are provided i the self-fuded pla documet, which is the prevailig documet ad the basis for beefit paymet. Pla desigs are subject to chage to comply with federal healthcare reform, as ecessary. Pla desig availability ad/or stop-loss coverage may vary by state. If the stop-loss isurace cotract is termiated before the ed of the cotract period, the aual aggregate attachmet poit will be deemed ot satisfied ad the employer remais resposible for fudig eligible claims icurred durig the time the self-fuded pla was i force. Subchapter S corporatios should cosult their tax advisor as beefits from a self-fuded pla may be taxable. 400 Field Drive Lake Forest, IL Star Marketig ad Admiistratio, Ic. MK122 (7-12)