Health Plan Comparison
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- Ira Riley
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1 Freedom. Choice. Flexibility. For Agent Use Only Health Plan Comparison Starmark Signature Plans Starmark Consumer Health Plans Fully insured health plans specifically for small businesses.
2 Flexible plan designs to meet client needs and budget. Starmark is the perfect choice for the healthcare needs of small businesses: Easy paperless enrollment for employees online or via phone through Express Connect. Unparalleled personal service, including a personal welcome call for each new group. Plus, Starmark follows up to ensure customer satisfaction continues throughout the year and personally assists in plan renewal. Health and wellness management tools to help members get and stay healthy. Truly flexible plan designs your clients can customize to meet their needs and reach desired premium, including HSA-friendly plans. Starmark HRA features seamless integration of claims processing and HRA administration, and encourages the cost-effective use of healthcare services. Quick claims turnaround with one of the fastest, most efficient systems in the industry. Starmark Signature and Starmark Consumer Health Plans feature: Plan design flexibility to meet employer needs and budget Resources to simplify healthcare and promote employee health and wellness Freedom to choose any provider Starmark Signature Plans Choice of three traditional plans provides familiarity through office visit features -- with or without labs, and offers true flexibility. Starmark Consumer Health Plans Choice of three consumer-directed plans gives members more control over their healthcare decisions. Plans can be paired with an HSA for tax advantages. All plans feature: Preventive care benefits Lab programs CareChampion 24/7 health advocacy program YourCare health and wellness outreach program 24-hour nurse line MaternaLink maternity wellness program Cost-saving prescription drug programs Discounts on vitamins, and vision and hearing services/supplies 1 1 The discount program, provided by New Benefits, Ltd., a discount medical plan organization, is not insurance and is not available to Vermont residents. Trustmark and Starmark are not affiliated with New Benefits, Ltd. 2
3 Signature Plans Consumer Health Plans Lifetime Maximum Benefit Individual Calendar-Year Deductible Family Calendar-Year Deductible Deductible Type Coinsurance Signature Advantage SM $ 0/$3,000 $ 250/$750 $ 500/$1,500 $ 750/$1,500 $ 1,000/$2,000 $ 1,500/$3,000 $ 2,000/$4,000 $ 2,500/$5,000 $ 3,000/$6,000 $ 4,000/$8,000 /$10,000 /$20,000 In- and out-of-network deductibles accrue separately. The $0/$3,000 deductible can be selected only with the 50/50 coinsurance. Signature Advantage 100/80 90/70 80/60 70/50 60/40 50/50 Signature Select SM (combined in- and out-of-network) $ 250 $ 500 $ 750 $ 1,000 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 4,000 Signature Freedom SM $ 250 $ 500 $ 750 $ 1,000 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 4,000 Two times the individual calendar-year deductible. In- and out-of-network deductibles accrue separately on Signature Advantage. Benefits are payable for a member once either the individual deductible is met, or for the entire family once the family deductible is met. Signature Select 100/80 90/70 80/60 70/50 60/40 Signature Freedom The 100 coinsurance can be selected only with individual calendar-year deductibles of $1,000 or higher. Unlimited for essential health benefits (as defined by federal regulation) Consumer Health Advantage SM $ 1,200/$2,400 $ 1,500/$3,000 $ 2,000/$4,000 $ 2,500/$5,000 $ 3,000/$6,000 $ 4,000/$8,000 /$10,000 In- and out-of-network deductibles accrue separately. Consumer Health Advantage 100/80 90/70 80/60 70/50 60/40 Consumer Health Select SM (combined in- and out-of-network) $ 1,200 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 4,000 Consumer Health Select 100/80 90/70 80/60 70/50 60/40 Consumer Health Freedom SM $ 1,200 $ 1,500 $ 2,000 $ 2,500 $ 3,000 $ 4,000 Two times the individual calendar-year deductible. In- and out-of-network deductibles accrue separately on Consumer Health Advantage. Employers choose one. Aggregate: Benefits are payable once the entire family deductible is met. Embedded: Benefits are payable for a member once either the individual deductible is met, or for the entire family once the family deductible is met. For the plan to be qualified for use with an HSA, the embedded deductible must be selected only with individual deductibles of $2,500 ($5,000 for families) or higher. Consumer Health Freedom The 100 coinsurance cannot be selected with the $1,200 individual calendar-year deductible. 3
4 Signature Plans Consumer Health Plans Coinsurance Limit Signature Advantage SM Signature Select SM (combined in- and out-of-network) Signature Freedom SM Consumer Health Advantage SM Consumer Health Select SM (combined in- and out-of-network) Consumer Health Freedom SM /$15,000 /$20,000 $ 15,000/$30,000 $20,000/$40,000 $ 15,000 $ 20,000 $ 15,000 $ 20,000 /$10,000 /$20,000 $ 15,000/$30,000 $ 15,000 $ 15,000 Annual Out-of-Pocket Limits Prescription Benefit Emergency Room Access Fee The percentage of covered charges the member must pay each year. The family out-of-pocket limit is one or two times the individual out-of-pocket limit, depending on the multiplier selected. The annual out-of-pocket limit does not include the deductible. Refer to the rate proposal for the annual out-of-pocket limits applicable to the plan. In- and out-of-network out-of-pocket limits accrue separately on Signature Advantage. Prescription Calendar-Year Deductible Choices: $0 per person $250 per person $500 per person Retail Copay (up to a 30-day supply) Mail Service Copay (up to a 90-day supply) Generic Preferred Nonpreferred Generic Preferred Nonpreferred Brand Brand Brand Brand $ 0 $ 30 $ 50 $ 0 $ 75 $150 $ 0 $ 45 $ 75 $ 0 $110 $225 $10 $ 30 $ 50 $20 $ 75 $150 $15 $ 45 $ 75 $30 $110 $225 $20 $60 $100 $40 $150 $300 Prescription deductible must be met in full every year by each member; does not apply to generics. The $0 generic prescription drug copays can be selected only with the $0 prescription calendar-year deductible. The prescription copay and calendar-year deductible do not apply toward the individual or family calendar-year deductibles, or toward out-of-pocket limits. Credit from prior plan drug card deductibles and carryover provisions do not apply to the prescription calendar-year deductible. $75 per occurrence; waived if admitted as inpatient to the hospital. After the additional emergency room access fee is paid, covered charges are subject to the calendar-year deductible and coinsurance. The emergency room access fee does not apply toward individual or family calendar-year deductibles, or toward out-of-pocket limits. 4 The percentage of covered charges the member must pay each year. The family out-of-pocket limit is one or two times the individual out-of-pocket limit, depending on the multiplier selected. The annual out-of-pocket limit does not include the deductible. Refer to the rate proposal for the annual out-of-pocket limits applicable to the plan. In- and out-of-network out-of-pocket limits accrue separately on Consumer Health Advantage. The Price Assurance Program is included and provides prescription drug savings at thousands of participating pharmacies nationwide. When members present their medical ID card at a participating pharmacy, they receive: The lowest price available in that store, on that day Generic drug savings Drug utilization review The Price Assurance Program includes most drugs that, by federal law, require a prescription. If a prescription drug is excluded from coverage under the health plan, members may still receive a discount on their prescription through this program. Covered prescription drugs are subject to the in-network calendar-year deductible and coinsurance on Consumer Health Advantage and Consumer Health Select. No emergency room access fee. Covered charges are subject to the calendar-year deductible and coinsurance.
5 Signature Plans Consumer Health Plans Office Visit Feature Signature Advantage SM and Signature Select SM In-Network Encounter Fee: $20 $30 $40 No office visit feature Signature Freedom SM Office Visit Deductible: $20 $30 $40 No office visit feature The Office Visit Feature is not available. Physician office visits are subject to the calendar-year deductible and coinsurance. The first $500 of covered charges per office visit is paid in full after the encounter fee or office visit deductible. This includes charges for the visit, necessary x-rays and nonsurgical injections performed at the same office visit and billed by the attending physician. Any balance as well as covered charges when no office visit feature is selected is subject to the calendar-year deductible and coinsurance. The office visit feature does not apply to preventive care services or any surgical procedure. Coverage for preventive care services is described in the Preventive Care Services section of this brochure. Surgical procedures are subject to the calendar-year deductible and coinsurance. Outpatient Laboratory Testing Outpatient Laboratory Testing Options: Labs included under the office visit feature Labs not included under the office visit feature When labs are not included under the office visit feature, they are subject to the calendar-year deductible and coinsurance. Lab Card Program This voluntary program offers 100 percent coverage for covered outpatient laboratory testing when testing is directed to a participating Quest Diagnostics laboratory as part of the Lab Card Program. Provider collection and handling fees may apply, and are subject to health benefit plan provisions. For more information, visit Note: Quest Diagnostics Incorporated is a provider of laboratory testing, information and services, and is not affiliated with the Trustmark Companies. All Signature Series plans include the Lab Card Program whether or not laboratory testing is included under the office visit feature. Covered charges are subject to the calendar-year deductible and coinsurance. Lab Card Select Program This voluntary discount program offers outpatient laboratory testing at significant savings compared with other labs when testing is directed to a participating Quest Diagnostics laboratory as part of the Lab Card Select Program. For more information, visit Note: Quest Diagnostics Incorporated is a provider of laboratory testing, information and services, and is not affiliated with the Trustmark Companies. Preventive Care Services Preventive care services, as defined by federal regulation, are paid at 100 percent when received in-network. Age and frequency schedules apply. Covered preventive care services include, but are not limited to: physician office visits for preventive care services (adult physicals, routine ob/gyn visits, well-child visits), routine mammograms, PSA (prostate-specific antigen), colonoscopy, and adult and child immunizations (including flu and pneumonia shots). 5
6 Signature Plans Consumer Health Plans Therapies Speech, Occupational and Physical Therapies: 60-visit limit per therapy per calendar year Manipulative Therapy: 20-visit limit per calendar year Chronic Pain Treatment Programs: Maximum of 10 visits per calendar year Mental Illness, Nervous Disorders, Substance Abuse and Alcohol Abuse Groups with up to 50 employees Outpatient expenses 40-visit limit per calendar year; 120 visits per lifetime Covered charges are paid at 60 percent for an in-network provider; 50 percent for an out-of-network provider or Signature Freedom SM. Inpatient expenses 20 days per calendar year; 40 days per lifetime. These limits do not apply to inpatient alcohol abuse treatment. Groups with 51 or more employees Outpatient and inpatient expenses Covered charges are paid the same as any other covered service. Groups with up to 50 employees Outpatient expenses 40-visit limit per calendar year; 120 visits per lifetime Covered charges are paid at 60 percent for an in-network provider (100 percent if the 100 in-network coinsurance is selected); 50 percent for an out-of-network provider or Consumer Health Freedom SM. Inpatient expenses 20 days per calendar year; 40 days per lifetime. These limits do not apply to inpatient alcohol abuse treatment. Groups with 51 or more employees Outpatient and inpatient expenses Covered charges are paid the same as any other covered service. Benefit Options (available on all plans) Supplemental Accident Option Supplemental accident coverage helps prepare members for an unexpected accident or injury by providing first-dollar coverage. The first $500 of covered charges per accident is paid at 100 percent. Additional covered charges are subject to the calendar-year deductible and coinsurance. Coverage includes medical charges resulting from accidental injury incurred within 90 days of the accident. Maternity Option The maternity option provides members with peace of mind when planning for pregnancy and delivery. Normal maternity and nursery care covered charges are payable the same as any other covered service. Dual Plan Designs Dual plan designs offer flexibility for today s employers. Employers simply combine currently marketed plans using the established guidelines to create a plan to meet their business needs and budget. Employers should consult with their tax advisor to ensure that their multiple-plan offerings comply with applicable non-discrimination rules. Marketing Materials Signature Plans Brochure: MK74 MK80 (used in select states) Signature Select Flyer: MK110 Signature Freedom Flyer: MK111 Consumer Health Plans Brochure: MK75 MK81 (used in select states) Consumer Health Select Flyer: MK112 Consumer Health Freedom Flyer: MK113 6
7 An expert in small group healthcare benefits. Resources to Help Members Get and Stay Healthy Starmark offers resources to help simplify healthcare and maximize the health potential of plan members. CareChampion 24/7, is a health advocacy service that supports members as they navigate through the healthcare system. Advisors are available anytime, day or night, and can help members find a doctor or hospital in-network, understand healthcare benefits and claim payments, identify cost-saving opportunities, handle eldercare issues and more! Healthy Foundations provides a comprehensive suite of health and wellness management tools to help maximize the health potential of every plan member. Healthy Foundations includes the YourCare health and wellness outreach program, MyNurse 24/7, MaternaLink maternity wellness program, online support tools and the Healthy Foundations wellness e-newsletter. Why Starmark Small business is our only business. For more than 25 years, Starmark s sole focus has been serving small businesses. This expertise enables us to help you work with your clients to achieve their needs. Robust benefits, tailored to fit. Starmark offers a wide range of benefit plans employers can customize to meet their needs and budget, including HSA- and HRA-friendly plans and dual plan designs. Greater provider choice. Strong network access nationwide allows clients freedom of choice in provider care, exceptional negotiated arrangements when using in-network providers and PHCS-negotiated discounts when outside the primary PPO service area through PHCS Healthy Directions. Financial strength. Trustmark Life Insurance Company insures the fully insured plans in the Starmark portfolio. Trustmark Life is rated A- (Excellent) by A.M. Best. To learn more about CareChampion 24/7 and Healthy Foundations, visit 7
8 The information contained in this brochure is a general summary of plan highlights only, and all benefits are subject to the plan conditions and limitations of Trustmark Life Insurance Company policy number SMP/1003. Limitations, exclusions, renewability and pre-existing condition limitations apply and are described in the product brochures. For detailed product information, please refer to the applicable product brochure and Certificate of Insurance. The Certificate of Insurance is the prevailing document and the basis for benefit payment. Federal IRS restrictions and state mandates may apply. Plan benefits are subject to change to comply with federal healthcare reform, as necessary. Plan availability and/or coverage may vary by state. For more details, refer to the separate state insert page (MK10) or ask your Starmark distribution partner. Coverage is not effective without written notification from Trustmark Life Insurance Company or Star Marketing and Administration, Inc. 400 Field Drive Lake Forest, Illinois Starmark is a distinguished leader in small group healthcare benefits. By offering flexible health plans, unparalleled personal service, innovative, paperless employee enrollment, comprehensive health and wellness management tools, nationwide network access, and seamless HRA administration, Starmark is the choice to meet the diverse needs of small businesses today Star Marketing and Administration, Inc. MK77 (12-10)
9 Starmark Health Plan Comparison Brochure Insert Use this insert in conjunction with the Starmark Signature and Consumer Health Plans Comparison brochure [MK77 (12-10)] and the Starmark Healthy Incentives Health Plan Comparison brochure [MK99 (2-11)]. These brochures will be revised at reprint to incorporate the information contained in this insert. Lab Vendor Programs The Lab Card and Lab Card Select programs are not available when the GWH-Cigna Network is selected. Labs are covered subject to the plan deductible and coinsurance Star Marketing and Administration, Inc. MK129 (7-12)
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://www.whyviva.com/memberaccess.aspx or by calling 1-800-294-7780.
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