FIND THE COVERAGE THAT FITS YOUR BUSINESS NEEDS. Iowa Plan Comparison Guide for groups of 1 50 employees

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1 FIND THE COVERAGE THAT FITS YOUR BUSINESS NEEDS Iowa Plan Comparison Guide for groups of 1 50 employees

2 Comprehensive coverage options to fit your needs and your budget Know your options As a small business owner, every decision you make has an impact on your bottom line, including what health insurance plan to offer. Protect your most valuable asset your employees by offering competitive benefits that include Wellmark health insurance. With a comprehensive suite of health plans created just for small businesses, Wellmark delivers an affordable mix of coverage options, ranging from traditional copay and coinsurance plans to HSA-compatible and defined contribution packages all designed to meet your needs and the needs of your employees. Each Wellmark plan comes with best-in-class service and network choices you value most, plus built-in extras for your employees to stay healthy and make the most of their coverage. Plans also include services such as Blue365 healthy deals, mywellmark, and the Wellness Center powered by WebMD. Wellmark also offers non medical benefits. Ask your Wellmark representative for details. When every decision you make impacts your bottom line, choice is good. Especially when it comes to health insurance. We re here to help you find the right coverage for your business and your employees! All Wellmark health plans meet the Affordable Care Act (ACA) standards, including: No exclusions for pre-existing conditions No waiting periods for over 90 days Coverage of essential health benefits percent coverage for in-network preventive care and annual checkups Out-of-pocket maximums (cost-sharing limits) that align with ACA limits 1 These plans do not include pediatric dental services as described under the federal Patient Protection and Affordable Care Act. This coverage is available in the insurance market and can be purchased as a stand-alone product. Please contact your insurance carrier, producer, or Iowa s Partnership Marketplace Exchange if you wish to purchase pediatric dental coverage or a stand-alone dental services product.

3 CHOOSE THE HEALTH PLAN THAT FITS THE NEEDS OF YOUR BUSINESS AND YOUR EMPLOYEES There are two approaches to offering health plans to your employees: Choose the defined benefit route, where you can pick up to three plans to offer your employees (pages 4-11). Choose the defined contribution route, where you can choose from among three packages with five plans each (pages 12-13). NO MATTER WHAT YOUR APPROACH, WELLMARK CAN HELP YOU. Before making your health plan choice, be sure to consider: NETWORK OPTIONS. With Wellmark, you can choose between a Preferred Organization (), Point of Services (POS) or Health Maintenance Organization (HMO) plan. In and POS networks, your employees have access to the expansive BlueCard network which includes more than 90 percent of hospitals and 80 percent of physicians nationwide. 1 WELLMARK BLUE SM plans keep your employees covered anywhere, anytime. Employees reduce their out-of-pocket costs when they choose a network provider. WELLMARK BLUE HMO SM plans cover care within Iowa, but it s not the HMO network of the past. With the Wellmark Blue HMO network, 100 percent of hospitals and 96 percent of doctors are covered in Iowa. 2 Out-of-state coverage is still available, in emergency and accidental injury situations. WELLMARK BLUE POS SM plans combine elements of both HMO and plans with benefit levels varying depending on whether the employee receives care from providers in- or out-of-network. Like a plan, employees may receive care from out-of-network providers, but with greater out-of-pocket costs. WELLMARK BLUE REWARDS POS SM plans are flexible, and let you choose how to use them every time you need care. The amount you pay out-of-pocket is determined by the tier your provider is in, and you ll pay less by choosing Blue Rewards providers. The new Wellmark Blue Rewards POS network plans are unique to Wellmark and even allow you to earn rewards for healthy behavior. COST-SHARE OPTIONS. Cost-sharing refers to the costs employees pay out-of-pocket for medical services covered by their plan. This generally includes coinsurance, copays, s and other similar charges. It typically does not include premiums, balance billing amounts for non-network providers or spending for non-covered services. Select a level to offer your employees. METALLIC TIERS. There are four basic tiers Bronze, Silver, Gold and Platinum. Each tier is defined by the portion of the claims paid by the insurer. For instance, in the Gold tier, the plan typically pays 80 percent of the cost and your employees are responsible for the remaining 20 percent through out-of-pocket costs such as copays, coinsurance and s. THE KEY TO UNDERSTANDING METALLIC TIERS Employee pays Employee pays Employee pays Employee pays 10% Insurance plan pays 60% Insurance plan pays 70% Insurance plan pays 80% Insurance plan pays 90% BRONZE GOLD PLATINUM 1 Blue Cross and Blue Shield Association, BlueCard is only available for emergency situations if purchasing an HMO plan. 2 Wellmark Network Administration, HMO products are not available to residents of Allamakee, Fayette and Winneshiek counties. Plan Comparison Guide

4 QUESTIONS TO CONSIDER WHEN CHOOSING COVERAGE What is most important to you and your business when considering employee health care coverage? The cost of the plan to your business Use the cost legend located at the top of each plan comparison chart to compare plans easily and quickly. The benefits provided to employees Refer to Understanding Health Coverage Benefits (See page 3) for an overview and to the plan charts for detailed comparisons. How costs are divided between employer and employee Learn about defined contribution plans and how they can work for you and your employees. (See page 13) Ensuring employees can get coverage from the health care provider of their choice Choose from four networks to get the provider access that s right for your employees. What are the needs of your employees? Do a majority of employees have additional family members on the plan? Use the plan charts to view single and family annual s and out-of-pocket amounts. What is the employee comfort level with lower premium/higher s or higher premiums/copays? Consider myblue HSA SM plans on page 10, if employees are comfortable with higher s in exchange for lower premiums. Do any employees receive care outside of Iowa? Solve the need for care outside of Iowa with POS and plans. Are your employees wondering if the coverage you offer is ACA compliant? Rest assured all plans offered in this booklet are ACA compliant. Are there other business goals that Wellmark can help you achieve? Ancillary products Create a total benefit solution by offering ancillary products and services provided by Wellmark-preferred service providers to help attract and retain employees. Health and care management Positively affect your bottom line with Wellmark s health and care management programs and services. Help make sure your employees get the right care at the right time, while reducing health care utilization and costs when you offer these programs and services: Advanced care Personal health assistant 24/7 Pregnancy support Condition support Utilization management Workplace wellness Improve employee health while reducing absenteeism and claims costs. An easy way to get started with workplace wellness is to connect employees to the health tools and resources built into their Wellmark health plan. The Wellness Center on mywellmark.com is where employees can find out about getting and staying healthy: Take a wellness assessment Check medical symptoms Get the latest health, fitness and nutritional information Use health trackers and tools Research health topics For more information about ancillary, health and care management, and wellness products, contact your Wellmark representative. 2 Plan Comparison Guide 2015

5 UNDERSTANDING HEALTH COVERAGE BENEFITS Effective January 1, 2014, all of the health insurance plans found in this booklet include the following 10 Essential Health Benefits as required by the Patient Protection and Affordable Care Act (ACA): 1 Preventive and wellness service and chronic disease management 2 Prescription drugs 3 Pediatric services and vision care 1 4 Ambulatory patient services 5 Emergency services 6 Hospitalization 7 Laboratory services 8 Maternity and newborn care 9 Mental health and substance use disorder services, including behavioral health treatment 10 Rehabilitative and habilitative services and devices Your employees are covered for these most common services. A complete and detailed list of covered services and exclusions will be in the coverage manual your employees receive when they enroll in a Wellmark plan. Please visit Wellmark.com for services that require certification and prior approval. Preventive Services Cost-sharing requirements, such as copay, coinsurance or, are waived when receiving preventive services from in-network or participating providers. Some of the preventive services included at no cost-share are annual wellness exam, gynecological exam, age appropriate mammograms and wellchild care (i.e. normal newborn care, physical examinations, assessments and immunizations). Please note: If you choose one of our HMO products or Blue Rewards products, you are required to see your designated Primary Care Physician (PCP) or OB/GYN for the annual wellness exam and gynecological exam. Prescription Drug Levels of Benefits 1 Drug Tier 1 has the lowest payment obligation for you. It includes most generics and select branded drugs that have no generic equivalent. 2 Drug Tier 2 has a higher payment obligation than Tier 1 and is made up of drugs that are designated preferred because they have been proven to be effective and favorably priced compared to other drugs that treat the same condition. 3 Drug Tier 3 also increases the payment obligation. It consists of non-preferred drugs that have reasonable, more cost effective alternatives on Tier 1 or Tier 2. There are also specialty preferred drugs in this tier that are used to treat complex or rare conditions. 4 Non-preferred specialty is the highest payment obligation. These drugs do not have sufficient clinical evidence that they provide a significant benefit over available preferred alternatives. Pediatric Vision Services Wellmark s pediatric vision benefits are administered through Avēsis 1, Wellmark s preferred vision vendor. Benefits are available for children under age 19. Your is waived for all plans except myblue HSA. myblue HSA plans will waive the for routine vision exams only. For myblue HSA plans where the and out-of-pocket maximum (OPM) are equal once the /OPM are reached there s no additional cost to you for pediatric benefits. The details One routine vision exam per benefit year at no cost One frame and one pair of lenses per benefit year or contact lenses instead of frames and lenses Up to 130 for one frame per benefit year (80% coinsurance for covered charges more than 130) Up to 130 per benefit year for non-medically necessary contact lenses (85% coinsurance for covered charges more than 130) Medically necessary contact lenses Please note, this policy does not include pediatric dental services as described under the federal Patient Protection and ACA. This coverage is available in the insurance market and can be purchased as a stand-alone product. Contact your insurance carrier, producer, or Iowa s Partnership Marketplace Exchange if you wish to purchase pediatric dental coverage or a stand-alone dental product. 1 Wellmark s pediatric vision coverage is administered by Avēsis, an independent company providing network and claims administration on behalf of Wellmark for the pediatric vision benefits. Plan Comparison Guide

6 COPAY WELLMARK BLUE REWARDS SM PLANS Plan Name Metallic Tier Your Premium Network Type 1 (What you pay for Tier 1 and Tier 2 services is applied to both amounts.) Tier 1 Tier 2 Tier 3 Tier 1 Coinsurance Tier 2 Tier 3 Out-of-Pocket Maximum 1 (Tier 1 and Tier 2 out-of-pocket costs are applied to both OPM amounts.) Tier 1 Tier 2 Tier 3 Blue Rewards SM 1000 Single / Family 2 GOLD POS 1,000 / 2,000 2,000 / 4,000 4,000 / 8,000 2,000 / 4,000 4,000 / 8,000 6,000 / 10,000 Blue Rewards SM 1500 Single / Family 2 POS 1,500 / 3,000 3,000 / 6,000 6,000 / 12,000 5,000 / 10,000 6,600 / 13,200 9,000 / 18,000 Blue Rewards SM 5000 Single / Family 2 BRONZE POS 5,000 / 10,000 6,600 / 13,200 8,000 / 16,000 0% 60% 6,600 / 13,200 6,600 / 13,200 9,000 / 18,000 Tier 1 = Wellmark Blue Rewards POS providers Tier 2 = Wellmark Blue POS providers Tier 3 = Out-of-network providers LET WELLMARK HELP YOU SAVE Wellmark, Hy-Vee 3 and UnityPoint Health are excited to announce a new collaboration to bring you three new plan options called Wellmark Blue Rewards. Blue Rewards plans are only available in certain counties. Visit Wellmark.com/BlueRewards to see if it s offered in your area. By choosing one of these plans, you have access to: A quality Wellmark plan with benefit flexibility that lets your employees choose how they use those benefits every time they need care. Physicians and hospitals right where your employees live, work and play. With this access, you ll see the lowest out-ofpocket costs when you get care from a Blue Rewards provider. Coverage for prescriptions filled exclusively at Hy-Vee pharmacies, as well as consultations with registered Hy-Vee dieticians for a copay. Rewards for healthy behavior. Your employees have the opportunity to earn rewards for behaviors that support getting healthy. 1 Both Tier 1 and Tier 2 amounts count toward each other, but do not apply toward BlueCard or Tier 3 out-of-network s. Tier 1, Tier 2 and BlueCard expenses count toward each others out-of-pocket maximums (OPM), and out of network expenses apply to Tier 3 OPM. Tier 1 and Tier 2 out-of-pocket maximum amounts will also count toward each other. 2 The family can be met through any combination of family members. No one member will be required to meet more than the single amount to receive benefits for covered services during a benefit period. 3 Hy-Vee is an independent company providing affinity/rewards services in support of the Blue Rewards program. 4 Plan Comparison Guide 2015

7 Lowest cost Lower cost Low cost Higher cost Tier 1 Office Services Tier 2 Tier 3 Tier 1 Inpatient Services / Outpatient Surgery Tier 2 Tier 3 Emergency Room Care (Waive copay if admitted immediately following visit.) Laboratory and X-Ray Services Includes routine diagnostic lab and X-ray 5 Prescription Drugs Blue Rx Essentials SM (Tier 1) Office Lab and X-Ray (Tier 1) Independent Lab PCP 4 : 15 Non-PCP: copay coinsurance; waived Hy-Vee Pharmacies only 6 Tier 1: 10 Tier 2: 35 Tier 3/Preferred specialty drugs: 70 Non-preferred specialty drugs: PCP 4 : 30 Non-PCP: copay coinsurance; waived Hy-Vee Pharmacies only 6 Tier 1: 10 Tier 2: 35 Tier 3/Preferred specialty drugs: 70 Non-preferred specialty drugs: PCP 4 : 40 Non-PCP: 80 60% 0% 60% Hy-Vee Pharmacies only 6 (waived for Tier 1) Tier 1: 20 Tier 2, Tier 3/Preferred specialty drugs, Non-preferred specialty drugs: Tier 1 and coinsurance apply Wellmark Blue Rewards POS SM plans, like other Wellmark Blue POS SM plans, combine elements of both and HMO plans. The amount employees pay out-of-pocket is determined by the level of provider care they choose. These new Wellmark Blue Rewards POS network plans provide your employees the opportunity to spend less on their health care expenses by seeing a Blue Rewards provider. They can also earn rewards for healthy behavior. Your employees also have coverage when seeing BlueCard providers outside Iowa. Depending on the BlueRewards plan selected, the BlueCard and the BlueCard out-of-pocket maximum (OPM) may be the same as when receiving care from a Tier 2-Wellmark Blue POS provider, or may be the same as when receiving care from an out of network provider. The coinsurance amount for BlueCard providers is always the same as when seeing out of network providers. For more information on out-of-pocket costs when seeing BlueCard providers, and how these costs apply to your OPM, please visit Wellmark.com/BlueRewards. 4 The primary care office copay to Family Practitioners, General Practitioners, Internal Medicine Practitioners, Obstetricians/Gynecologists, Pediatricians, Physicians Assistants and Advanced Registered Nurse Practitioners. This lower office copays also to in-network chiropractors and in some cases mental health or chemical dependency visits. All other in-network practitioners are subject to the non-primary care office copay. The copay per practitioner, per date of service. 5 Advanced radiological imaging and outpatient labs & X-rays will always apply and coinsurance. Cost-share for labs and X-rays may vary if visit is for mental health or chemical dependency. 6 Under this plan, you may only fill prescriptions at Hy-Vee pharmacies. You only have coverage for drugs filled at other pharmacies in case of emergency. Plan Comparison Guide

8 COPAY PLANS Plan Name Metallic Tier Your Premium Network Type 1 In-network Coinsurance Out-of-Pocket Maximum 1 In-network PremierBlue SM 500 B PLATINUM 500 / 1,000 10% 1,000 / 2,000 2,000 / 4,000 EnhancedBlue SM 1000 GOLD 1,000 / 2,000 4,000 / 8,000 8,000 / 16,000 CompleteBlue SM ,750 / 3,500 6,250 / 12,500 9,500 / 18,500 CompleteBlue SM 2000 B 2,000 / 4,000 6,250 / 12,500 9,500 / 18,500 CompleteBlue SM ,500 / 5,000 6,000 / 12,000 9,000 / 18,000 CompleteBlue SM 3000 B 3,000 / 6,000 6,000 / 12,000 9,000 / 18,000 SimplyBlue SM 5500 BRONZE 5,500 / 11,000 60% 6,250 / 12,500 9,500 / 18,500 1 Both in-network and out-of-network services aggregate toward a single. However, the out-of-pocket maximum for in-network services aggregates to the in-network out-of-pocket maximum only and the out-of-pocket maximum for out-of-network services aggregates to the out-of-network out-of-pocket maximum only. 2 The family can be met through any combination of family members. No one member will be required to meet more than the single amount to receive benefits for covered services during a benefit period. 6 Plan Comparison Guide 2015

9 Lowest cost Lower cost Low cost Higher cost In-network Office Services Inpatient Services/ Outpatient Surgery Emergency Room Care (Waive copay if admitted immediately following visit) Laboratory and X-Ray Services Includes routine diagnostic lab and X-ray 4 Prescription Drugs Blue Rx Essentials SM Office Lab and X-Ray Independent Lab PCP 3 : 15 copay Non-PCP: 30 copay 10% 200 copay 10% coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 20 copay Non-PCP: 40 copay 250 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 45 copay Non-PCP: 90 copay 300 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 40 copay Non-PCP: 80 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 30 copay Non-PCP: 60 copay 350 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 25 copay Non-PCP: 50 copay 350 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 50 copay Non-PCP: coinsurance 60% Applies to your Tier 1: 15 ( waived) Tier 2, Tier 3/Preferred specialty, Non-preferred specialty: 3 The primary care office copay to Family Practitioners, General Practitioners, Internal Medicine Practitioners, Obstetricians/Gynecologists, Pediatricians, Physicians Assistants and Advanced Registered Nurse Practitioners. The lower office copays also apply to in-network chiropractors and in some cases mental health or chemical dependency visits. All other in network practitioners are subject to the non-primary care office copay. The copay per practitioner, per date of service. 4 Advanced radiological imaging and outpatient labs & X-rays will always apply and coinsurance. Cost-share for labs and X-rays may vary if visit is for mental health or chemical dependency. Plan Comparison Guide

10 COPAY PLANS POS/HMO Plan Name Metallic Tier Your Premium Network Type 1 Innetwork Coinsurance Out-of-Pocket Maximum 1 Innetwork EnhancedBlue SM 1250 GOLD POS 1,250 / 2,500 Level 1-2 Level 3 4,000 / 8,000 8,000 / 16,000 CompleteBlue SM 1500 POS 1,500 / 3,000 Level 1-2 Level 3 6,250 / 12,500 9,500 / 18,500 SimplyBlue SM 5000 BRONZE POS 5,000 / 10,000 Level 1-2 Level 3 60% 6,250 / 12,500 9,500 / 18,500 PremierBlue SM 500 A PLATINUM HMO 500 / 1,000 10% N/A 1,000 / 2,000 N/A EnhancedBlue SM 500 GOLD HMO 500 / 1,000 N/A 3,750 / 7,500 N/A CompleteBlue SM 2000 A HMO 2,000 / 4,000 N/A 6,250 / 12,500 N/A CompleteBlue SM 3000 A HMO 3,000 / 6,000 N/A 6,000 / 12,000 N/A SimplyBlue SM 4750 BRONZE HMO 4,750 / 9,500 N/A 6,250 / 12,500 N/A BRONZE SimplyBlue Max SM 6250 HMO 6,250 / 12,500 0% N/A 6,250 / 12,500 N/A 1 Both in-network and out-of-network services aggregate toward a single. However, the out-of-pocket maximum for in-network services aggregates to the in-network out-of-pocket maximum only and the out-of-pocket maximum for out-of-network services aggregates to the out-of-network out-of-pocket maximum only. 2 The family can be met through any combination of family members. No one member will be required to meet more than the single amount to receive benefits for covered services during a benefit period. 8 Plan Comparison Guide 2015

11 Lowest cost Lower cost Low cost Higher cost In-network Office Services Out-of-network Inpatient Services/ Outpatient Surgery Emergency Room Care (Waive copay if admitted immediately following visit.) Laboratory and X-Ray Services Includes routine diagnostic lab and X-ray 5 Prescription Drugs Blue Rx Essentials SM Office Lab and X-Ray Independent Lab Level 1 (PCP) 3 : 25 copay Level 2 (non-pcp): 50 copay 250 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: Level 1 (PCP) 3 : 40 copay Level 2 (non-pcp): 80 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: 0 for the first office exam in a benefit period. Subsequent visits,. 4 60% Applies to your Tier 1: 15 ( waived) Tier 2, Tier 3/Preferred specialty, Non-preferred specialty: PCP 3 : 15 copay Non-PCP 30 copay No out-of-network benefits unless emergency 10% 200 copay 10% coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 30 copay Non-PCP 60 copay No out-of-network benefits unless emergency 250 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 40 copay Non-PCP 80 copay No out-of-network benefits unless emergency coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: PCP 3 : 25 copay Non-PCP 50 copay No out-of-network benefits unless emergency 350 copay coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: 0 for the first office exam in a benefit period. Subsequent visits,. 4 No out-of-network benefits unless emergency Applies to your Tier 1: 15 ( waived) Tier 2, Tier 3/Preferred specialty, Non-preferred specialty: 50 per visit for the first 3 office exam occurrences in a benefit period. Subsequent visits,. 4 No out-of-network benefits unless emergency Applies to your 3 The primary care office copay to Family Practitioners, General Practitioners, Internal Medicine Practitioners, Obstetricians/Gynecologists, Pediatricians, Physicians Assistants and Advanced Registered Nurse Practitioners. This lower office copays also to in-network chiropractors and in some cases mental health or chemical dependency visits. All other in-network practitioners are subject to the non-primary care office copay. The copay per practitioner, per date of service. 4 The copay is taken per office exam occurrence and each occurrence will count towards the visit limit. Preventive visits do not apply to the limit 5 Advanced radiological imaging and outpatient labs & X-rays will always apply and coinsurance. Cost-share for labs and X-rays may vary if visit is for mental health or chemical dependency. Plan Comparison Guide

12 COINSURANCE PLANS Plan Name METALLIC TIER YOUR PREMIUM Network Type Medical 1 Innetwork Coinsurance Out-of-Pocket Maximum 1 Innetwork PremierBlue SM 750 PLATINUM 750 / 1,500 10% 1,500 / 3,000 3,000 / 6,000 EnhancedBlue SM 1500 GOLD 1,500 / 3,000 3,000 / 6,000 6,000 / 12,000 CompleteBlue SM 2000 (Coinsurance) 2,000 / 4,000 6,250 / 12,500 9,500 / 18,500 QUALIFIED, HIGH-DEDUCTIBLE HEALTH PLANS Plan Name METALLIC TIER YOUR PREMIUM Network Type Medical 1 Innetwork Coinsurance Out-of-Pocket Maximum 1 Innetwork myblue HSA SM Gold 2000 GOLD 2,000 / 4,000 0% 2,000 / 4,000 4,000 / 8,000 myblue HSA SM Silver ,000 / 6,000 0% 3,000 / 6,000 6,000 / 10,000 myblue HSA SM Bronze 3500 BRONZE 3,500 / 7,000 6,250 / 12,500 12,500 / 25,000 myblue HSA SM Silver 2000 HMO 2,000 / 4,000 N/A 6,000 / 12,000 N/A 1 Both in-network and out-of-network services aggregate toward a single. However, the out-of-pocket maximum for in-network services aggregates to the in-network out-of-pocket maximum only and the out-of-pocket maximum for out-of-network services aggregates to the out-of-network out-of-pocket maximum only. 2 For all plans except myblue HSA, the family can be met through any combination of family members. No one member will be required to meet more than the single amount to receive benefits for covered services during a benefit period. For myblue HSA plans the family amount is reached from amounts accumulated on behalf of any family member or combination of family members and the entire family must be met before benefits are payable. 10 Plan Comparison Guide 2015

13 Lowest cost Lower cost Low cost Higher cost Innetwork Office Services Inpatient Services/ Outpatient Surgery Emergency Room Care (Waive copay if admitted immediately following visit.) Laboratory and X-Ray Services Includes routine diagnostic lab and X-ray 3 Prescription Drugs Blue Rx Essentials SM Office Lab and X-Ray Independent Lab 10% coinsurance; waived 10% 200 copay 10% coinsurance; waived 10% coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: coinsurance; waived 250 copay coinsurance; waived coinsurance; waived Tier 1: 5 Tier 2: 35 Tier 3/Preferred specialty: 70 Non-preferred specialty: coinsurance; waived 350 copay coinsurance; waived coinsurance; waived Applies to your Tier 1: 15 ( waived) Tier 2, Tier 3/Preferred specialty, Non-preferred specialty: Innetwork Office Services Inpatient Services/ Outpatient Surgery Emergency Room Care Laboratory and X-Ray Services Includes routine diagnostic lab and X-ray 3 Prescription Drugs Blue Rx Essentials SM Office Lab and X-Ray Independent Lab Applies to your 0% Applies to your 0% Applies to your No out-of-network benefits unless emergency. Applies to your 3 Advanced radiological imaging and outpatient labs & X-rays will always apply and coinsurance. Cost-share for labs and X-rays may vary if visit is for mental health or chemical dependency. Plan Comparison Guide

14 DEFINED CONTRIBUTION PLANS As an employer you re looking to control health care spending while giving your employees more choices to get the coverage that s best for them. A defined contribution package from Wellmark offers the stability and flexibility you re looking for. Lowest cost Lower cost Low cost Higher cost DEFINED CONTRIBUTION PLANS PACKAGE A Plan Name Metallic Tier Network Type Coinsurance Out-of-Pocket Maximum Office Services PCP / Non-PCP CompleteBlue SM 1500 POS 1,500 6, / 80 CompleteBlue SM 2000 B 2,000 6, / 80 myblue HSA SM Bronze 3500 BRONZE 3,500 6,250 SimplyBlue SM 4750 BRONZE HMO 4,750 6,250 followed by coinsurance First exam is free, then subsequent visits CompleteBlue SM ,500 6, / 60 DEFINED CONTRIBUTION PLANS PACKAGE B Plan Name Metallic Tier Network Type Coinsurance Out-of-Pocket Maximum Office Services PCP / Non-PCP EnhancedBlue SM 1000 GOLD 1,000 4, / 40 CompleteBlue SM 1500 POS 1,500 6, / 80 CompleteBlue SM 2000 (Coinsurance) 2,000 6,250 coinsurance CompleteBlue SM 3000 A HMO 3,000 6, / 50 myblue HSA SM Silver ,000 0% 3,000 DEFINED CONTRIBUTION PLANS PACKAGE C Plan Name Metallic Tier Network Type Coinsurance Out-of-Pocket Maximum Office Services PCP / Non-PCP PremierBlue SM 500 B PLATINUM % 1, / 30 EnhancedBlue SM 1000 GOLD 1,000 4, / 40 EnhancedBlue SM 1500 GOLD 1,500 3,000 coinsurance myblue HSA SM Gold 2000 GOLD 2,000 0% 2,000 EnhancedBlue SM 500 GOLD HMO 500 3, / 60 This health plan does not include pediatric dental services as described under the Federal Patient Protection and Affordable Care Act. Pediatric dental coverage is available in the insurance market and can be purchased as a standalone product. Please contact your insurance carrier, producer, or Iowa s Partnership Marketplace Exchange if you wish to purchase pediatric dental coverage or a stand-alone dental services product. Note: Family s and family OPMs are two times the single amounts reflected above. All benefits above are in-network. 12 Plan Comparison Guide 2015

15 What is defined contribution? It s money you give employees to offset the cost of health insurance. This concept allows you to offer your employees health insurance coverage, even if you can t afford to fund the full amount. There s no contribution requirement, so you can choose the amount that s right for your business. You are able to offer a valued employee benefit, while controlling your health care expenses. DEFINED CONTRIBUTION OFFERS: No minimum contribution Business sets level; controls cost More choices Three health packages with five plans to choose from Reclaims administrative time Easy enrollment through mywellmark.com Savings opportunity To help budget your health care expenses How does it work? Select from one of three packages, each with five health plans. You give a defined contribution each month toward health insurance, and determine how you want to distribute your contribution, such as to employees or to employees and their dependents. This annual benefit amount is a tax-free allowance. Through mywellmark.com, employees can then review the available plans and shop for the benefits that best fit their needs. Employees put your contribution toward the monthly premium, leaving any premium over that amount as employee expense each month. Employees enroll in the plans they choose and receive their benefits information online. That means no hassles and no paperwork for you. EMPLOYER - SAM EXAMPLE Sam owns a printing business and based on his benefits budget, has set a monthly contribution amount that s available to each employee. SETS contribution amount: Sam s amount is 350/month Sam has three defined contribution package choices: A, B or C to offer his employees. CHOOSES health plan package: Sam chooses Package B EMPLOYEE - MARY Each of Sam s employees have access to the online shopping tool to help them select one of the five plans in Package B. Mary is an employee who chooses a plan. CHOOSES from available health plans: Mary chooses a plan with a premium of 400/month Employees can also select vision benefits; however, the defined contribution set by the employer can only be applied to the health plan. SELECTS additional benefits: Mary selects dental with a premium of 30/month If the employee s monthly premium is more than the employer s monthly contribution, the employee is then responsible for the difference in premium to get the level of coverage he or she wants. PAYS the difference: Mary pays the difference of 80/month For illustration purposes only. These are not actual rates. Plan Comparison Guide

16 WE HELP YOU GET THE MOST OUT OF WHAT YOU RE PAYING FOR Take advantage of these value-added programs and services that are built into our small business plans. It s pretty simple: you want to get good value for your health care dollars. In addition to great coverage, with each Wellmark plan, your employees get access to extras to stay healthy, and make the most of their coverage. Personal Health Assistant Any time employees need help, Personal Health Assistant 24/7 is here to answer their health concerns, direct them to providers or resources, and offer solutions for everyday health care problems. BlueCard Program With the BlueCard program, your employees can travel with peace of mind. Visit the BlueCard Doctor and Hospital Finder at or call BlueCard Access at BLUE (2583). With our Wellmark Blue HMO plans, you re typically only protected from emergency situations when traveling outside of Iowa. Blue365 Program This member program gives exclusive access to discounts and resources that help your employees live a healthier lifestyle. Visit Wellmark.com/Blue365. Blue SM Magazine Each quarterly issue features health and wellness articles, consumer tips, health plan news and healthy recipes. It helps employees get the most from their plan and from life. Members can also enjoy it free online at Wellmark.com/Blue. HELP YOUR EMPLOYEES SAVE WITH AN HSA A health savings account (HSA) is an individual savings account that you can contribute to, invest in and receive certain distributions. The HSA is generally not subject to taxes. It can be used to pay for qualified medical expenses tax-free. Some expenses include doctor s visits, prescription drugs, eyeglasses and dental care. To open and contribute to an HSA, you must first be enrolled in a qualified, high- health plan (HDHP). Contact your authorized Wellmark representative for more information. 14 Plan Comparison Guide 2015

17 HERE TO HELP YOUR EMPLOYEES We make it easy and fast for employees to get the health information they need when they need it most, whether at home, work or on the go. mywellmark member website Get access to plan information and resources that help employees make the most of their plan. mywellmark tools help your employees: Take charge of their health with the Wellness Center powered by WebMD, one of the most trusted sources of health news and information Get a better understanding of their health care benefits Find a trusted health care provider Track and organize medical claims and expenses Keep all medical records and information in one place Sign up to receive Explanation of Benefits statements online Review pharmacy benefits, drug lists and learn how much a drug will cost Get health news, resources and tips Visit Wellmark.com to register It s app-solutely necessary The Wellmark mobile app puts the information employees need to help manage their health plan at their fingertips. The app provides a fast and convenient way to: View doctors and hospitals within the Wellmark health plan network Read reviews and rate network providers through the Find a Doctor or Hospital tool Connect to mywellmark for claims status, coverage details and Flex spending amounts View and their ID cards Call a nurse 24/7 or doctor s office with a touch of the screen Download the free app at Wellmark.com/GoMobile iphone is a trademark of Apple Inc. Plan Comparison Guide

18 COMMON SERVICES AND EXCLUSIONS For a complete list, consult your coverage manual. Common services include: Benefits for mental health and substance abuse including services for the treatment of mental illness and substance dependence and abuse. Covered services include inpatient and outpatient services. Benefits for pregnancy, maternity and newborn care Benefits for organ and tissue transplants including heart, heart and lung, lung, pancreas, kidney, simultaneous pancreas/ kidney, small bowel, liver, or bone marrow/stem cell transfers Diabetes outpatient self-management training and patient management from an approved provider Durable medical equipment Inpatient hospital benefits Outpatient hospital benefits Physical, occupational or speech therapy services Physician office services including X-ray, laboratory and pathology services performed in the physician s office, supplies used to treat the covered person during the visit, hearing exams due to illness or injury, eye exams due to illness or injury and allergy testing Common exclusions include: Services not determined to be medically necessary Elective abortions Artificial insemination; in vitro fertilization or any related fertility or infertility transfer procedure Massage therapy Cosmetic services except in the following instances; surgery that has the primary purpose of restoring function lost or impaired as a result of an illness or injury, birth defect, or breast reconstruction a mastectomy Counseling Investigational or experimental treatment Wigs Acupuncture Weight reduction programs Routine foot care Physician s services including anesthesia services, physician office and outpatient visits, radiology, pathology and other diagnostic services, surgery and surgical assistance, and inpatient hospital visits Spinal manipulations limited to 12 self-referred visits if you have a Wellmark Blue HMO product 16 Plan Comparison Guide 2015

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20 CONTACT US We re here to help you find the right coverage for your business and employees. Contact your authorized Wellmark representative Visit Wellmark.com Call Why not create a total benefit solution by considering ancillary products and services provided by Wellmark-preferred service providers? Ask your authorized Wellmark representative for more information about the types of services available. Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Health Plan of Iowa, Inc. are Independent Licensees of the Blue Cross and Blue Shield Association. Blue Cross, Blue Shield, the Cross and Shield symbols, BlueCard and Blue 365 are registered marks and SimplyBlue SM, CompleteBlue SM, EnhancedBlue SM, PremierBlue SM, myblue HSA SM, Blue Rx Essentials SM, Wellmark Blue HMO SM, Wellmark Blue POS SM, Wellmark Blue Rewards POS SM and Wellmark Blue SM are service marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans. Wellmark is a registered mark of Wellmark, Inc Wellmark, Inc. WebMD is a registered trademark of WebMD Health Services Group, Inc. WebMD is a separate company that provides wellness services on behalf of Wellmark Blue Cross and Blue Shield. M /14