Your employees want and need help with health care coverage. Now there s a way to provide it. Colonial Health AdvantageSM

Transcription

1 Your employees want and need help with health care coverage. Now there s a way to provide it. Colonial Health AdvantageSM

2 Now affordable health care coverage is within reach for you and your employees. In today s times, employees not only want affordable health care coverage, they need it. But if you re like many employers today, it s becoming harder and harder to provide it. It s often just too difficult to squeeze the cost of any type of health care coverage into your business or your employees budget. But there is a solution: the Colonial Health Advantage sm plan. Retirement Medical Wages Income Protection Catastrophic Illness As a result of high health insurance costs, 266,000 firms 90 percent of which employ 3-23 workers stopped offering health coverage between 2000 and Employer-sponsored insurance is likely to continue to decline as increasing premiums and the souring economy will likely lead more employers to drop coverage, and increasing unemployment and shifts to part-time and temporary work will reduce access to employer-sponsored insurance. 2 1 The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey, September The Henry J. Kaiser Family Foundation. The Fraying Link between Work and Health Insurance: Trends in Employer-Sponsored Insurance for Employees, , November 2008.

3 Help With the Basics Colonial Health Advantage is designed to be simple to understand and use. It provides indemnity benefits flat benefit amounts for specific services instead of co-pays and annual deductibles, with the exception of the pharmacy benefit, which has a co-pay. It is a group limited benefit plan; not a major medical plan, and not a supplement for existing health care plans. With the Colonial Health Advantage limited benefit medical plan, you can provide your employees with limited coverage that helps toward the everyday health care expenses they typically incur, such as: doctor s office visits prescriptions diagnostic tests and X-rays hospital confinement It also has a benefit for preventive care to help cover services such as: routine physical exams well-baby check-ups immunizations mammograms prostate cancer screenings 2

4 Colonial Health Advantage sm Plans Hospital Indemnity Benefit 60-day maximum per covered person, per year Doctor s Office Visit Benefit Maximum of 6 days per covered person, per year, including 1 emergency room sick visit Diagnostic Testing, X-ray, & Lab Benefit Maximum of 3 days per covered person, per year Preventive Care Visit Benefit Maximum of 2 days per covered person, per year Surgical Benefit (maximum per procedure) Anesthesia 20% of surgical benefit shown on Surgical Schedule (maximum per procedure) $200/day $200/day $300/day $400/day $40/day $40/day $50/day $50/day $40/day $40/day $50/day $50/day $40/day $50/day $75/day $75/day $0 $0 $0 $500 (See Surgical Schedule) $0 $0 $0 $100 (See Surgical Schedule) Pharmacy Co-Pay Benefit Benefits provided for generic prescription drugs, for which the covered person pays a $15 co-pay to the pharmacy for each 30-day supply. For brand-name drugs, the covered person pays the pharmacy the greater of a $50.00 co-payment or 50% of the prescription amount for each 30- day supply. Mail-order service available for generic and brand prescription drugs. $0 Maximum benefit of $150 per covered person, per calendar month Maximum benefit of $150 per covered person, per calendar month Maximum benefit of $150 per covered person, per calendar month Intensive Care Unit (ICU) Benefit Maximum of 15 days per covered person, per year Hospital Admission Benefit Maximum of 1 admission per covered person, per year Ambulance Benefit Maximum of 3 trips per covered person, per year $400/day $400/day $600/day $800/day $0 $0 $250 lump sum $250 lump sum $0 $50/trip $100/trip $100/trip Accident Benefit Maximum of 3 accidents per covered person, per year $100 lump sum $200 lump sum $300 lump sum $300 lump sum Accidental Death & Dismemberment (AD&D) Benefit Benefit is 50% for spouse and dependent children if covered $25,000/ covered accident for named insured $25,000/ covered accident for named insured $25,000/ covered accident for named insured $25,000/ covered accident for named insured Coverage levels: employee, employee + spouse, employee + dependent children, employee + spouse + dependent children 3 *The brand discount is available through Express Scripts and is not underwritten by Colonial Life & Accident Insurance Company.

5 Optional Coverage to Help with Catastrophic Costs How It Works To provide your employees with financial protection in case a catastrophic illness occurs, you can choose to add the Critical Illness benefit to your group s Colonial Health Advantage plan. This benefit provides a lump-sum payment upon diagnosis of a covered critical illness, including: cancer stroke heart attack major organ transplant coronary artery bypass end-stage renal failure If you decide to add this benefit to your plan, your employees would then choose the benefit amount and level of premium that best fits their needs. They can choose from benefit levels of: $2,500 $5,000 $7,500* $10,000* * requires underwriting approval. Colonial Health Advantage features a broad network of providers that, if used, provide a discount on services, which means Colonial Health Advantage policyholders can pay less out of pocket if they use a network provider: The policyholder goes to a doctor or other health care provider. He presents his Colonial Health Advantage ID card. The provider files a claim for services and is paid the indemnity benefit amount provided for that specific service. If the provider s fee is greater than the benefit amount, the policyholder pays the provider directly for the difference. Example Doctor Office Visit: Joe goes to his doctor. The usual charge for an office visit is $60, but it is only $47 because the doctor is in the provider network. Joe also has some lab work done. The usual charge is $70, but because of the network discount, the charge is $ The doctor files the claims and receives the $40 benefit for a Doctor s Office Visit and the $40 benefit for Diagnostic, X-Ray and Lab. He charges Joe the balance of $9.75, which Joe pays out of his pocket. $ doctor fee $ lab fee network discount network discount $ charged charged doctor s office visit diagnostic, X-ray & lab benefit $ 7.00 Joe pays $ 2.25 Joe pays Joe pays without CHA Standard Plan benefits: $ Joe pays with CHA Standard Plan benefits: $9.25 4

6 Pharmacy Co-Payment Benefit Generic The Pharmacy Co-Payment Benefit is $15 for a 30-day supply for a generic prescription drug. Jerry goes to his pharmacy and the charge for the 30-day supply of the generic prescription is $22. The pharmacy takes Jerry s Colonial Health Advantage ID card and files the claim. Jerry must pay the $15 co-pay. Colonial Life pays the remaining $7 as the pharmacy benefit. $ cost for 30-day supply of generic prescription drug plan pays $ co-pay Jerry pays to pharmacy Quality, Experienced Service As with all Colonial Life products, you can expect our long-standing tradition of high-quality service, for both you and your employees. To ensure we maintain the same standards of excellence with Colonial Health Advantage, we partnered with three of the most respected health care vendors in the industry to provide benefit and claims support: Harrington Health is a nationally recognized benefits administration expert with 50+ years of outstanding customer service experience. Harrington Health administers claims and ID card services for our Colonial Health Advantage product. One of the largest and fastest-growing PPOs in the country, that offers physicians, acute care facilities, and ancillary care provider locations in your state. Express Scripts, one of America s largest pharmacy benefit managers, that serves the prescription needs of more than 50 million Americans. The patients it serves fill their prescriptions at more than 59,000 retail pharmacies across the country or through their home delivery pharmacies. 5

7 Why Should You Consider Colonial Health Advantage? With the Colonial Health Advantage limited benefit medical plan, you can offer your employees affordable, limited health care coverage. In addition: It can help you recruit and retain your employees, and increase their productivity because they have better access to health care. Your employees will have a plastic Colonial Health Advantage ID card to present to providers as proof of coverage, which will help them have better access to care, and make it easier for them to get care when they need it since they have a way to help cover the costs. Since it s a limited plan, it s affordable for you and your employees. You can choose to pay all or some of the premiums, or you can have your employees pay their own. If you pay 100% of the premium, you may qualify for a premium discount.* It s easy to offer and administer. There are no complicated participation or up-front premium requirements. And if you take advantage of our electronic billing services, you simply submit an electronic file and we ll reconcile your invoice for you. It comes with Colonial Life s benefits communication and enrollment services, through which our benefit counselors can meet with each employee and explain the Colonial Health Advantage plan, how it works and what it costs, from the employee s paycheck. * available to accounts with a minimum of 25 employees. Now, affordable health care coverage for you and your employees is within reach. Make it available today. See your Colonial Life benefits counselor for more information. 56

8 Health AdvantageBSMB Voluntary Monthly Premiums Monthly Premiums Without Critical Illness Employee $49.50 $77.00 $99.50 $ Employee + Spouse $93.88 $ $ $ Employee + Children $89.44 $ $ $ Family $ $ $ $ Monthly Premiums With $2,500 Critical Illness Employee $55.50 $83.00 $ $ Employee + Spouse $ $ $ $ Employee + Children $98.44 $ $ $ Family $ $ $ $ Monthly Premiums With $5,000 Critical Illness Employee $61.50 $89.00 $ $ Employee + Spouse $ $ $ $ Employee + Children $ $ $ $ Family $ $ $ $ Monthly Premiums With $7,500 Critical Illness* Employee $67.50 $95.00 $ $ Employee + Spouse $ $ $ $ Employee + Children $ $ $ $ Family $ $ $ $ Monthly Premium With $10,000 Critical Illness* Employee $73.50 $ $ $ Employee + Spouse $ $ $ $ Employee + Children $ $ $ $ Family $ $ $ $ *Requires underwriting approval ** Requires underwriting approval Applicable to TX This information is only intended for proposal use with employers. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. "Colonial Health Advantage" is a service mark of Colonial Life & Accident Insurance Company Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina This is a Group Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment plan. It is not designed to replace a major medical, other comprehensive and/or catastrophic plan. This is limited coverage that may not provide a reimbursement for all medical expenses you may incur. PS01300

9 Health Advantage SM Employer Paid Monthly Premiums Discounted rates available for 100% employer paid accounts with 25 or more eligible lives Monthly Premiums Without Critical Illness Employee $42.84 $66.22 $85.34 $ Employee + Spouse $80.57 $ $ $ Employee + Children $76.79 $ $ $ Family $ $ $ $ Monthly Premiums With $2,500 Critical Illness Employee $47.94 $71.32 $90.44 $ Employee + Spouse $88.22 $ $ $ Employee + Children $84.44 $ $ $ Family $ $ $ $ Monthly Premiums With $5,000 Critical Illness Employee $53.04 $76.42 $95.54 $ Employee + Spouse $95.87 $ $ $ Employee + Children $92.09 $ $ $ Family $ $ $ $ Monthly Premiums With $7,500 Critical Illness* Employee $58.14 $81.52 $ $ Employee + Spouse $ $ $ $ Employee + Children $99.74 $ $ $ Family $ $ $ $ Monthly Premium With $10,000 Critical Illness* Employee $63.24 $86.62 $ $ Employee + Spouse $ $ $ $ Employee + Children $ $ $ $ Family $ $ $ $ *Requires underwriting approval ** Requires underwriting approval Applicable to TX This information is only intended for proposal use with employers. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. "Colonial Health Advantage" is a service mark of Colonial Life & Accident Insurance Company Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina This is a Group Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment plan. It is not designed to replace a major medical, other comprehensive and/or catastrophic plan. This is limited coverage that may not provide a reimbursement for all medical expenses you may incur.ps01301

10 Colonial Health Advantage sm Customer Service Guide Your Colonial Health Advantage sm plan was designed to be easy to understand and use, and we hope you find it that way. To further help you understand how the plan works, please review these Frequently Asked Questions and keep this document for reference. How does this plan work? Can I go to any doctor or hospital? You may go to any doctor or facility you choose. The benefit payable under the plan does not vary based on which provider you use. However, if you go to a doctor or facility that is a member of the NPPN network, the out-of-pocket expenses that remain after your Colonial Health Advantage plan benefit is paid may be less. Through Colonial Health Advantage, you have access to NPPN*, Coalition America s Preferred Provider Organization that is one of the nation s largest and fastest-growing networks. The network currently lists more than 550,000 physicians, nearly 4,000 acute care facilities and 90,000 ancillary care provider locations nationwide. To determine if your health care provider is in NPPN s network, or to nominate your provider to be in the network, go to the NPPN website at or call I have not yet received my ID card but need to go to a provider now. What do I do? If your coverage is in effect but you have not received your Colonial Health Advantage ID card, go to sign up as a member and print off a temporary card. You should use this temporary card at both your provider s office as well as the pharmacy, if your plan includes pharmacy benefits. If you don t use a card, you will be required to pay your provider or pharmacy the entire fee out of pocket, then submit a claim to Harrington Health or Express Scripts to receive your benefit(s). What does the per day maximum mean? Several benefits contained in the Colonial Health Advantage plan are limited to a certain benefit amount per day. This means that, no matter how much expense you incur for a certain type of service on one day, the benefit payable for that type of service will not be greater than the daily maximum noted. What do I do when I go to a medical provider? Simply give your ID card to the provider, who should file a claim for services and will be paid an amount equal to the benefits shown in your plan. If the provider s fee exceeds your plan benefit, the provider will bill you directly for the balance. Most providers will file your claim; however, if one does not, you will need to pay the provider s entire fee at the time of service and then file a claim with our claims administrator, Harrington Health, to receive the benefit provided by your plan. You may obtain claim forms at or call *NPPN is not underwritten by Colonial Life & Accident Insurance Company.

11 How does the pharmacy benefit work? Can I go to any pharmacy? Certain Colonial Health Advantage plans offer a pharmacy benefit. If your plan offers the pharmacy benefit, a covered person can receive a prescription benefit for a generic drug by paying a $15 co-pay, and we will pay the remaining cost for the prescription, up to a maximum benefit of $150 per covered person, per month, for all generic prescription drugs and brand name prescription drugs combined regardless of whether purchased at a retail pharmacy or through mail order. Simply present your ID card to the pharmacy and they should apply your co-pay. If the cost of your generic prescription is actually less than the $15 co-pay, you will be charged the actual cost. If you visit a pharmacy that is not a member of the Express Scripts network of pharmacies, you will need to pay the full amount for your prescription and submit a claim to Express Scripts to receive the benefit provided by your plan. You can obtain a claim form from the Express Scripts website at or call If you need a brand-name prescription, you will pay either a $50 co-pay or 50% of the prescription cost for a 30-day supply whichever is greater. Your pharmacy benefit is administered through Express Scripts, one of America s largest pharmacy benefit managers, which provides access to more than 59,000 retail pharmacies across the country. For information on which of your local pharmacies are in their network, go to or call Do I need to file a claim for my health care? If so, how do I do that? In most cases, your provider will file a claim with Harrington Health for your medical expenses, then bill you directly for any difference. However, if they do not, you can use the claim form available at to file for your benefits or call to obtain a claim form. Complete the form and send it to Harrington Health as the form instructs. For pharmacy claims, if you use a pharmacy that does not participate in the Express Scripts pharmacy network, you ll need to complete an Express Scripts claim form, which you can obtain from If my policy is underwritten by Colonial Life & Accident Insurance Company, why do I file my claim with Harrington Health? Your Colonial Health Advantage policy is underwritten by Colonial Life & Accident Insurance Company. Colonial Life is a national leader that has excelled in providing quality voluntary insurance products and service for nearly 70 years. We know the value of experience in providing quality benefits administration. To administer claims under the Colonial Health Advantage plan, we searched for an expert in health care benefits administration and determined that Harrington Health, a nationally recognized leader in benefits administration for more than 50 years, is one of the very best. Harrington Health is very similar to us, particularly with their high service standards. With Colonial Life and Harrington Health working together, you have the benefit of long-standing expertise in supplemental benefits, benefits administration and service excellence. How do I file a claim for my Critical Illness benefit? If your plan includes a Critical Illness benefit, file your claim through Harrington Health as you do for other benefits. I also have a Colonial Life accident policy. If I am in an accident, do I file all of my claims with Colonial Life? No. If you give your provider your Colonial Health Advantage card, they should file your claims for the Colonial Health Advantage benefits with Harrington Health. If they do not, you must complete and submit a claim form to Harrington Health to receive your Colonial Health Advantage benefits. You should also complete and submit a Colonial Life claim form to Colonial Life for any Colonial Life coverage that you may have, such as Accident insurance or Disability insurance.

12 My policy was guaranteed issue. Does that mean it covers pre-existing conditions? Your policy may or may not cover pre-existing conditions. Therefore, it is important that you check your certificate for provisions regarding coverage of pre-existing conditions. Is chiropractic care covered? Chiropractic office visits are covered under this policy s Doctor s Office Visit benefit. However, there is no additional benefit for specific chiropractic services such as manipulations. Are pregnancy and childbirth covered? Benefits provided by your Colonial Health Advantage plan would be payable for services relating to pregnancy and childbirth provided to the named insured and spouse, if covered. For example, the Doctor s Office Visit, Hospital Confinement and Surgical benefits could apply, depending on the services needed. See your certificate for more information. Pre-existing condition limitations may apply. What happens after I enroll? After you enroll, you should receive your Welcome Packet from Harrington Health within 30 days of your policy s effective date. The packet will include your Colonial Health Advantage ID card, your certificate of insurance and other reference documents. When does my coverage begin? Your coverage effective date should be indicated on your Colonial Health Advantage ID card, or you can check the certificate of coverage included in your Welcome Packet. Can I sign up for this coverage at any time? No. If you do not enroll in this product during your company s benefit enrollment period, you must wait until the next open enrollment period. You may add dependent coverage when you enroll during an open enrollment period or within 31 days of a qualifying event. See your certificate for details regarding a qualifying event. If you are a new hire and were not present for the open enrollment period, you have 31 days from your date of eligibility to enroll in this product, or you will need to wait until the next open enrollment period. Can I take this coverage with me if I leave this place of employment? Colonial Health Advantage coverage is a group policy and therefore is not portable. If you leave your place of employment, talk with your employer about how you can continue this plan for a limited time under COBRA. Can I change my coverage after it is effective? After the coverage effective date, you cannot make any changes to your coverage until your next open enrollment period, unless you have a qualifying event such as birth or adoption of a child; issuance of a court order requiring coverage of a child; marriage; divorce; or death of a covered person. Please see your certificate for details regarding a qualifying event. If you have a qualifying event, notify your plan administrator immediately. He or she will submit the necessary information to Colonial Life to handle your change. What happens if I don t see this payroll deduction on my check when my coverage begins? What should I do? If you are to be paying some or all of the premiums on this plan, and you do not see deductions for it being taken out of your paycheck, check with your company s plan administrator as quickly as possible to ensure you have coverage. What happens if I am not at work for a week and miss a deduction? You must keep your premiums current so that your claims can be paid. If you miss a payroll deduction, be sure to talk with your plan administrator to determine the best way for you to catch up on any premiums you may have missed. This is a Group Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment plan. It is not designed to replace a major medical, other comprehensive and/or catastrophic plan. This is limited coverage that may not provide a reimbursement for all medical expenses you may incur.

13 Who do I contact for what? For your claims, ID cards and coverage or benefit information for Colonial Health Advantage, contact Harrington Health: For billing or general service for Colonial Health Advantage, contact Colonial Life: W Douglas Ave. 8th Floor Wichita, KS P.O. Box 1365 Columbia, SC coloniallife.com As always, be sure to review the certificate for complete details on these and other important points of your policy. The Group Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment Insurance Certificate is not comprehensive major medical, and is not a substitute or replacement for major medical insurance. This is limited coverage. The certificate does not provide a reimbursement for all medical expenses you may incur. Certificates have exclusions and limitations that may affect benefits payable. Benefits vary by state and may not be available in all states. See your certificate for complete details. Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina coloniallife.com 2008 Colonial Life & Accident Insurance Company. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 10/ TX-1

14 This is Group Hospital Confinement Indemnity Insurance Coverage. It is not designed to replace a major medical, other comprehensive and/or catastrophic plan. Colonial Life 1200 Colonial Life Boulevard Columbia, South Carolina coloniallife.com 01/ TX Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. Colonial Health Advantage is a service mark of Colonial Life & Accident Insurance Company.