Frequently Asked Questions about the Anthem Lumenos Health Reimbursement Account (HRA) Plan 2016

Transcription

1 Frequently Asked Questions about the Anthem Lumenos Health Reimbursement Account (HRA) Plan 2016 You can learn more about the Anthem Lumenos HRA Plan enhancements for 2016 by logging in to our online educational health site. To access Anthem s online educational health site, go to and enter the password fujitsu. (After January 1, 2016, please visit enrollment.anthem.com/fujitsu.) Anthem Lumenos HRA Plan Overview Q: What is the Anthem Lumenos HRA Plan? A: The Anthem Lumenos HRA Plan is one plan in the family of consumer-driven health plans offered by Anthem Blue Cross. Consumer-driven plans are designed to educate you about health care options and empower you to take control of your health. Fujitsu makes health care dollars available to you in a Health Reimbursement Account (HRA) for you to spend the way you want on covered health care services. If your expenses exceed your annual HRA allocation, the plan also includes a Traditional Health Coverage component to further protect you. In addition, the Anthem Lumenos HRA plan provides the health and financial tools to help you manage your medical dollars and decisions wisely. Here's how it works. Fujitsu makes an annual allocation for you and your family in a Health Reimbursement Account (HRA). You first use the funds in your HRA to pay for the expense of covered health care services and prescription drugs. If you have money remaining in your HRA at the end of a plan year and many people do it stays in your HRA for as long as you're enrolled in the plan, to help pay for future health care needs. Also, you have an additional benefit that covers 100% of the cost of preventive services such as immunizations and health screenings without any additional out-of-pocket expense or deductions from your HRA. If you experience a major illness or injury, or if your medical expenses exceed your annual HRA allocation, Traditional Health Coverage will further protect you once you have satisfied an out-of-pocket responsibility. Q: What is the deductible amount? A: Your deductible is the annual amount you pay using your HRA and paying an out-of-pocket responsibility before the traditional health coverage portion of the plan begins. To see what the deductible amount is for your HRA plan, see Anthem Lumenos HRA Plan Summary. Q: What if I get seriously ill and spend all of my HRA money? A: Don't worry - you're still protected. Your Anthem Lumenos HRA plan includes a Traditional Health Coverage component. This plan works a lot like the health plan you may have now. This coverage begins after you've paid your annual deductible (annual HRA allocation + your out-of-pocket responsibility). See the Anthem Lumenos HRA Plan Summary for more details. FUJ.F14.HRA.QA

2 Your Health Reimbursement Account (HRA) Q: How much money is allocated to my Health Reimbursement Account (HRA)? A: Fujitsu allocates $1,000 in your HRA if you elect employee coverage, $1,500 if you elect employee + one coverage, and $2,000 for employee + two or more coverage. If you enroll in the plan during the year, your HRA allocation is pro-rated on a quarterly basis. If you have any questions about your allocation amount or how pro-ration is determined, contact a Customer Service Advocate by calling toll-free at Q: When can I use my HRA allocation? A: You can start using it as soon as your plan becomes effective. Your HRA is used to pay for 100% of your covered medical expenses, as long as HRA funds are available. Q: What type of services may I pay for with my HRA funds? A: You can use your HRA to cover the cost of covered services including routine medical expenses like office visits, prescription drugs and lab tests. Check the Anthem Lumenos HRA Plan Summary for information on covered services. Q: Do I pay for prescription drugs from my HRA? A: Yes. You pay for 100% of your prescription drug costs from your HRA. You can find information on how to go about getting your prescription drugs later in this document. Q: How do I find out what my HRA balance is? A: It's easy. The Benefits page on our online health site at will show you how to keep track of your HRA activity and balance, as well as get details on all of their medical claims. Q: Can I roll over all the money in my HRA at the end of each plan year? A. Yes, you can save the dollars that remain in your HRA at the end of the year for future health care expenses. Please see your Anthem Lumenos HRA Plan Summary for more details on this limit. Q: If I leave the Anthem Lumenos plan, what happens to my HRA? A: Your HRA will roll over as long as you are actively enrolled in the plan. If you leave the Anthem Lumenos plan the funds in your HRA will be forfeited and returned to your employer. Q: What if I join the Anthem Lumenos plan during 2016? A: If you enroll during 2016, the contribution to your HRA and your out of pocket deductible responsibility are pro-rated based on the quarter in which your coverage takes effect. For example, if you join the HRA plan in April with employee-only coverage, then you qualify for 75% of your annual HRA allocation of $1000, or $750. The amount you pay out of pocket is 75% of your annual out of pocket cost of $650, or $ Remember, your Total Annual Deductible is your HRA allocation plus the deductible amount you pay out of pocket. Therefore, your Total Annual Deductible for the remainder of 2016 is your HRA allocation ($750) plus your out of pocket deductible ($487.50), or $ If you have questions, contact a Customer Service Advocate by calling toll-free at , or refer to the Anthem Lumenos Plans Summary Plan Description (Appendix C), posted on the member website at 2

3 Your Anthem Lumenos HRA Plan Benefits Q: What services does the Anthem Lumenos plan cover? A: The Anthem Lumenos plan covers a range of health care services, from routine checkups and prescription drugs to major surgery. Basically, the same services you would find covered by most health plans. Check the Anthem Lumenos HRA Plan Summary to see the services covered by your Anthem Lumenos plan. Q: Do I use my HRA for preventive care services? A: In addition to your HRA, the Anthem Lumenos plan includes a benefit to cover the cost of preventive care services. Covered preventive care services are based on guidelines from the U. S. Preventive Services Task Force, American Cancer Society and the American Academy of Pediatrics. It includes screening tests, immunizations and counseling services designed to detect and treat medical conditions early in their development. All discounted rates and allowed amounts will be paid by the plan at 100%, with no out-ofpocket costs for eligible preventive services or deduction from the HRA. Charges over the allowed amount will be deducted from the HRA, if available, or will be paid by the employee out-of-pocket. Q: Does the Anthem Lumenos plan cover prescription drugs? A: Yes. You must first pay for your prescription drugs from your HRA. If you have depleted your HRA, you will have to pay out-of-pocket. Once the Traditional Health Coverage component of the plan begins, you will pay the appropriate coinsurance for any of your prescription drugs. Q: What if I need a compound drug? A: Compound drugs costing more than $500 are subject to preauthorization review. A message will be sent electronically to the dispensing pharmacy letting them know that prior authorization is required, and providing them with a toll free number to call and provide the claim details. The claim will then be processed or if denied the member will be sent a letter. Q: What does "Out-of-Pocket" mean? A: Out-of-pocket expenses are those you pay yourself. If you spend all of your HRA dollars, you will need to pay a specific amount out-of-pocket to meet your out-of-pocket responsibility. If you need to use the Traditional Health Coverage component, you ll have to pay for a percentage of coverage, called coinsurance. You are responsible for this paying this expense. Q: What is the most I will pay out-of-pocket in the Anthem Lumenos HRA plan? A: The Anthem Lumenos HRA plan includes an out-of-pocket maximum defined in your Plan Summary. Funds you use from your HRA, the amount you pay out-of-pocket and any coinsurance you pay all count toward this limit. Your limit is lower if you receive care from in-network providers. (The HRA and out-of-pocket amounts depend on whether you have coverage for you or yourself and one or more dependents.) Your out-of-pocket costs may be higher if you spend a portion of your HRA dollars on services from health care providers who are not in-network. However, this will not apply unless you spend all of your annual HRA allocation and satisfy your out-of-pocket responsibility during the year. Please refer to your Anthem Lumenos HRA Plan Summary for more information on your annual out-of-pocket maximums. 3

4 Your Behavioral Health and Substance Abuse Benefits Q: Does the Anthem Lumenos HRA plan provide Behavioral Health and Substance Abuse (BH/SA) coverage? A: Yes, when you elect medical coverage, for you and any eligible family members, you and your enrolled family members will automatically receive BH/SA coverage. Members in the Anthem Lumenos HRA plan receive BH/SA services through the Magellan Behavioral Health Plan. Q: How are BH/SA claims handled? A: The claims are processed by Magellan Behavioral Health and due to recent legislative changes, BH/SA benefits are treated like other medical benefits. This means that they are included in the same limits for deductible, coinsurance and out-of-pocket maximums under the Anthem Lumenos HRA plan. Thus, any amounts you pay out-of-pocket may be applied to your Anthem Lumenos HRA Plan annual deductible and coinsurance maximums. Q: How do I ensure the amounts I pay out-of-pocket are applied to my Anthem Lumenos HRA, annual deductible and coinsurance maximums? A: To ensure that the amounts you pay out-of-pocket are applied to your Anthem Lumenos HRA, annual deductible, and coinsurance maximums, the following processes will apply: If you are in the Annual Deductible portion of the plan, Magellan processes the claim and you pay for services. The amount you pay out-of-pocket is sent to Anthem by Magellan to be applied to your Annual Deductible. If you are in the Traditional Health portion of the Anthem Lumenos HRA plan, you pay a coinsurance amount to the provider: 20% or 40%. Magellan processes the claim and pays the provider for services. Your coinsurance amount is sent by Magellan to Anthem to be applied to your coinsurance maximum. If you have funds in your HRA, you may request reimbursement from your HRA for amounts you pay out-of-pocket by submitting a Qualified Healthcare Expense Claim Form to Anthem. NOTE: Anthem will not automatically reimburse you or pay the provider. Q: If I have funds in my HRA, how do I request reimbursement from Anthem for my out-of-pocket BH/SA expenses? A: You must submit the Qualified Healthcare Expense (QHE) Claim Form to Anthem to request reimbursement for BH/SA services. The QHE Claim Form is located on the Fujitsu Benefits Service Center intranet site at or at When filling out the form, enter your Anthem Member ID into the box where it says, member ID. Q: May I use this process for any other types of claims? A: No, you may not use this process to pay for any other types of claims. Only BH/SA claims may be reimbursed from the HRA by submitting the QHE Claim Form. 4

5 Q: Where do I find the QHE Claim Form? A: You may find the QHE Claim Form on the Fujitsu Benefits Service Center intranet site at or at Using Your Anthem Lumenos Plan to Get Care Q: How do I know if my doctor is an in-network provider? A: With the Anthem Lumenos plan, you can see any licensed doctor you want. However, you can make the most of your health care dollars by visiting one of the providers participating through the Blue Cross and Blue Shield PPO Network (BlueCard PPO Network). To find a list of in-network doctors, log in to our educational health site and use the Find a Doctor tool. To access the educational web site, go to and enter the password fujitsu. (After January 1, 2016, please visit enrollment.anthem.com/fujitsu.) Q: If my doctor is not in the network, can I still use his or her services? A: You can visit any licensed doctor you choose and you won t need a referral to see a specialist. You may save money, though, when you visit an in-network doctor. Also, if you see an out-of-network doctor, you may have to file a claim yourself. Q: Does the Anthem Lumenos HRA Plan require pre-notification before being hospitalized? A: Yes. Your doctor must notify Anthem prior to hospitalization so we can coordinate care and offer you assistance from a health coach. Q: What do I do when I need to see a doctor? A: When you enroll in the plan, you'll receive an Anthem ID card. Present your Anthem ID card when you visit your doctor and point out the Anthem Blue Cross logo on the card. This will ensure you receive the discount. Your Anthem Lumenos HRA plan allows you the flexibility to visit any licensed doctor you want, but the method of payment varies for doctors who are in-network or out-of-network. If you visit an in-network doctor, typically the doctor's staff will photocopy your ID card and submit a claim to Anthem for payment. If your medical expense is a covered service, it will automatically be deducted from your annual HRA allocation. If you have depleted all of the funds in your HRA, you will need to pay out-ofpocket to satisfy your out-of-pocket responsibility. Once the Traditional Health Coverage component of the plan begins, you will pay only the appropriate coinsurance for covered services, up to your out-of-pocket maximum. If you visit an out-of-network doctor, you most likely will be asked to pay at the time of your appointment. If so, you will need to send a claim to Anthem for reimbursement. If you have depleted all of the funds in your HRA, you will need to pay out-of-pocket until you have satisfied your out-of-pocket responsibility. Once Traditional Health Coverage begins, you will pay only the appropriate coinsurance for covered services, up to your out-of-pocket maximum. Keep in mind: you ll likely pay a higher rate with an out-of-network provider. Additionally, you ll be responsible for any charges from doctors that are above the allowed amount. 5

6 Q: What do I do when I need to get a prescription drug? A: When you enroll in the plan, you'll get an Anthem ID card. This is the same ID card you will use for doctor visits. Present your Anthem ID card when you visit your pharmacy. Be sure to point out the Anthem Blue Cross logo on the card. This will ensure you receive the discounted drug price. You can use the Find A Doctor tool on our online health site to find one of the pharmacies participating in our network. If you have funds remaining in your HRA, you ll pay nothing at the pharmacy. A claim will automatically be filed for you and the cost of your prescription will be deducted from your HRA. If you have depleted your HRA, you will need to pay for the expense out-of-pocket until you have satisfied your out-of-pocket responsibility. Once Traditional Health Coverage begins, you will pay only the appropriate coinsurance amount at the pharmacy. You also have the option of ordering your prescriptions by mail. The payment works the same. The only difference is you must provide a credit card number when submitting the mail service form. Your card will be charged if you have used all of your HRA funds. Q: If I use mail order pharmacy, will I get a discount? A: You ll pay the amount the mail order pharmacy charges for the drug, which may be less than what you d pay at the retail pharmacy. Q: Do I need to use a particular pharmacy for specialty drugs? A: Our preferred pharmacy for specialty drugs offers a robust support program to help people taking specialty medications achieve the best possible results from the treatments. Please contact a Customer Service advocate for more details on specialty drugs coverage. Q: If I need to file a claim, how do I get reimbursed? A: In most cases, you won't need to file a claim if you visit an in-network doctor. If you visit an out-of-network doctor, you might have to file a claim, depending on the doctor's policy. If you do need to submit a claim yourself, you will need to send a claim to Anthem for reimbursement. Q: Do you provide quality information on doctors and hospitals? A: The Anthem Lumenos HRA plan provides physician and hospital quality information by combining data from multiple sources including public and proprietary databases, consumer ratings, and physician self-reported information. These ratings can be found on physicians and hospitals on the online health site at Q: Can I visit any doctor or hospital while traveling? A: Yes. You may see any licensed doctor or use any hospital. Remember that some may offer discounts and some may not. You can find a list of in-network doctors by using the Find a Doctor tool on our online health site. Your plan also includes coverage for covered services while traveling outside of the U.S. For more information, please contact a Customer Service Advocate by calling toll-free at

7 Health & Wellness and Rewards Q: What are Health & Wellness programs? A: Health & Wellness programs are our approach to surrounding you with the resources, tools, guidance and support to help you manage your health and to help you make the right health care decisions for you and your family. The tools and health coaching programs described in the next few questions are just some of the resources available to you through Health & Wellness. To find out more about these programs and to access services please call Q: What are the rewards for healthy behaviors? A: Rewards are one of the ways the Anthem Lumenos HRA plan makes it easier for you to do the right things when it comes to your health. This program provides additional HRA dollars to encourage you to take certain steps that can maintain and improve your health. Q: What is the Health Assessment? A: The Health Assessment is an online health assessment that takes only a few minutes to complete. It helps you identify possible health risk factors, based on your current health, medical history, lifestyle and other factors. And, like all of the tools on our online health site, the Health Assessment is confidential. The information is not shared with your employer and it is protected by the highest level of online security available. You and your covered spouse are eligible to complete the Health Assessment. Q: How does the Health Assessment help me earn rewards? A: You and your covered spouse are eligible to earn $100 in your HRA per plan year for completing the Health Assessment. For existing employees the Health Assessment must be completed by 3/31/16 to earn rewards dollars. New employees must complete the MyHealth Assessment within 90 days of employment to earn rewards dollars. Q: What are health coaching programs? A: The health coaching programs team consumers who have certain ongoing health conditions and other health needs with a specially trained registered nurse to help them manage their health condition. Q: What health coaching programs are available with my Anthem Lumenos HRA plan? A: The following programs are available at no cost to you: Condition Care for ongoing conditions such as asthma, diabetes, heart failure, coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD). MyHealth Coach for most other health needs, with an emphasis on high blood pressure, high cholesterol, low back pain, pre- and post-surgery support and certain types of cancer and musculoskeletal/arthritis conditions. Future Moms to assist mothers-to-be in making informed health care decisions for a healthy pregnancy and delivery. ComplexCare to support consumers with multiple ongoing health conditions. 7

8 Q: How do the health coaching programs help me earn rewards? A: If you or your covered family members have an eligible condition and qualify to participate in a health coaching program, you ll receive $100 in your account for enrolling in the program (one reward per covered person per year). You ll receive $200 for achieving your health goals and graduating from the program (one reward per covered person per year). Q: What is the Healthy Lifestyles: Tobacco Free Program? A: The Tobacco Free Program is a step-by-step program that uses proven techniques and personalized support to help you stop using tobacco and improve your health for total well-being. It features one-on-one telephone counseling sessions to help you develop your own Tobacco Free plan, including determining what nicotine-replacement products may work best for you. The program also includes coverage for nicotine-replacement products (gum or patch). You and your covered family members over age 18 are eligible for this program. Q: How does the Tobacco Free Program help me earn rewards? A: You and your covered family members over age 18 are eligible to receive $100 in your HRA (one reward per covered person per year) for completing this program. Q: What is the Healthy Lifestyles: Healthy Weight Program? A: Our Healthy Weight Program includes one-on-one telephone counseling sessions designed to help you achieve a weight that supports good health. Working with a registered dietitian and health educator, you ll have confidential phone sessions to discuss topics like healthy eating, physical activity and exercise, stress management, maintenance and relapse. It s available to you and your covered family members age 18 and older who have a Body Mass Index (BMI) of 25 or higher. Q: How does the Healthy Lifestyles: Healthy Weight Program help me earn rewards? A: You and your covered family members 18 and older are eligible to receive $100 in your HRA (one reward per covered person per year) for completing the program. Personal Health Services: Health Coaching Q: What is a health coach? A: A health coach is a specially trained registered nurse to help you manage a health condition. Q: If a health coach contacts me, what can I expect? A: The health coach will ask you some general health questions. Following your initial confidential consultation, your health coach will set up regular phone meetings with you. Remember: What you and your coach talk about is always confidential and is never shared with your employer. Q: Do health coaches actually provide care? A: No. However, he or she might discuss treatment plans with you and your doctor to figure out how to help you receive the best care. 8

9 Q: Will my employer know if I am enrolled in a health coaching program? A: No. The only way your employer will know is if you tell them. Information shared by you or your physician will not be released unless you have given written permission. Q: I m healthy and only need to go to the doctor once or twice a year. Can a health coach help me? A: The health coaching programs are for people with ongoing conditions or certain other health needs, so you may not need a coach. You can, however, use the 24/7 NurseLine at any time to discuss other health problems. You can also explore the Health & Wellness pages on our online health site at to find answers to your health questions. Q: How will contact be initiated with a health coach? A: There are several ways contact can be initiated: Follow the hospital notification requirements, which are printed on the back of your ID card. A health coach may work with you to coordinate care. Call a Customer Service Advocate and ask to learn more if you are pregnant or have diabetes, heart disease, asthma, cancer or other chronic or serious conditions. If you are facing an elective surgical procedure such as back or joint surgery, call a Customer Service Advocate and ask about the MyHealth Coach program for education on these types of procedures. Finally, if you get a call or letter from a health coach, call back. It takes only a few minutes and could be just the help you need. Q: What information or services can a MyHealth Coach provide if I am facing an elective surgical procedure? A: Your MyHealth Coach can help you understand: The procedure itself why it is performed, potential complications and typical recovery periods. Other treatment options that may be available. Questions to ask the doctor before undergoing the procedure. The tools available on our online health site tools that can explain (and in many cases show) how the procedure is accomplished, help you compare hospitals where you might undergo the procedure and help you learn more about other treatments. Personal Health Services: 24/7 NurseLine Q: What is the 24/7 NurseLine? A: The 24/7 NurseLine is a service you can call to get answers to your immediate health care questions. Registered nurses are on hand to answer your calls 24 hours a day, 7 days a week. Please call to speak with a registered nurse. 9

10 Your Privacy Q: Is the online health site secure? A: Yes. Our customers-only Web site is password-protected and secure. In addition, all of your personal data is encrypted using 128-bit encryption, which is currently the highest level available. Q: What is your privacy policy? A: You can read our privacy policy anytime by visiting our online health site at Getting Help Q: I have questions about the Anthem Lumenos HRA plan, who can I contact? A. If you have questions about your plan, call a Customer Service Advocate toll-free at Q: After I join, whom should I call if I have a problem with the plan or a doctor or with getting reimbursed? A: You can log in to the Web site to answer a lot of your questions at or you can call us toll-free at We'll be happy to help you. Q: When will I get my Anthem ID card? A: Newly enrolled participants will receive their identification cards approximately days after enrollment data is received by Anthem. For 2016 replacement identification cards, contact Anthem at Once you are enrolled in your plan, you can print a temporary ID card online through the anthem.com/ca website. Call Anthem customer service at to ask for your medical ID#. You may then go on line at and register. Once registered, click on the Print Temporary ID Card link. Don t forget: For more information, visit the online educational health site at and enter the password fujitsu. (After January 1, 2016, please visit enrollment.anthem.com/fujitsu.) Anthem Blue Cross Life and Health Insurance Company provides administrative services only and does not assume any financial risk or obligation with respect to claims. Blue Cross of California, using the trade name Anthem Blue Cross, administers claims on behalf of Anthem Blue Cross Life and Health Insurance Company and is not liable for benefits payable. Independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association. 10