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© 2010 Wittenberg University Springfield, Ohio New Health Care Plan For Retirees Under 65 Effective Oct. 1, 2010
© 2010 Wittenberg University Springfield, Ohio Agenda I.Medical/Dental Insurance Plan Design Review Employee Contributions II.Anthem Resources Anthem.com Look up providers, manage prescriptions etc. General Information
© 2010 Wittenberg University Springfield, Ohio General Information New Plan is Effective 10/1/2010 Self-Funded Plan subject to ERISA and plan document Partnering with Anthem Blue Cross & Blue Shield Blue Access PPO network – national network 4 Plan Types: Employee plan, Employee + spouse plan, Employee +children plan, & Family plan
© 2010 Wittenberg University Springfield, Ohio General Information Dental continues to be a part of the Medical Plan Your deductible accrual that started on January 1, 2010 will remain intact. In other words, plan members will not need to restart their deductible accumulations with the Oct. 1 onset of the Anthem plan. The healthcare plan will continue to operate on a calendar year. Deductibles, out-of-pocket maximums etc. will be calculated based on the calendar year.
© 2010 Wittenberg University Springfield, Ohio Glossary of Terms Co-pay – a flat dollar amount that is paid at the time of service. Co-pay does not apply to the deductible Deductible – annual amount of money a member must pay before benefits are paid at the co-insurance %. Co-insurance – a percentage that a member pays for services received after they have met their deductible. Member pays in full until deductible is met. Out-of- pocket limit – the most an employee would pay in deductible and co-insurance during a plan year (Jan-Dec) for healthcare services excluding prescription drugs. Services with a % = Co-insurance. Services with a $ = Co-pay.
© 2010 Wittenberg University Springfield, Ohio Wittenbergs Blue Access PPO Health Plan MEMBER PAYS Deductible $400 individual /$800 family Emergency Room Services 10% after deductible In-Network Benefit Out-of-Pocket Limit $1,200 individual /$2,000 family Physician Office visits $20 co-pay Preventive Care visits Covered at 100% Urgent Care $20 co-pay Inpatient/Outpatient Services 10% after deductible
© 2010 Wittenberg University Springfield, Ohio Wittenbergs PPO Health Plan Out-of-network benefit Out-of- Pocket Limit $1,300 individual /$2,200 family Physician Office visits 30% after deductible Preventive Care visits Urgent Care Inpatient/Outpatient Services Balance billing: Providers and hospitals who are out-of-network will bill you for the difference between the amount the plan pays and the usual and customary amount.
© 2010 Wittenberg University Springfield, Ohio Deductibles and Out-of-Pocket Limit Deductible The $400/$800 deductible simultaneously applies to both in and out-of-network services. In other words, there is not a separate deductible for out-of-network. Out-of-Pocket Limit (OOP) There is a separate out-of-pocket limit for in-network and out-of-network co-insurance expenses. Co-insurance costs for services received in-network only apply to the in-network OOP. Co-insurance costs for services received out-of- network only apply to the out-of-network OOP. In-network - $1,200/$2,000 Out-of-network - $1,300/$2,200
© 2010 Wittenberg University Springfield, Ohio Deductibles and Out-of-Pocket Limit Three Possible Scenarios Illustration: OOP costs based on an Individual Member 1.Member receives all services from in-network providers = $1,200 per individual OOP limit. ($400 deductible + $800 additional co-insurance expenses) 2.Member receives all services from out-of-network provider = $1,300 per individual OOP limit plus any balance billing. ($400 deductible + $900 additional co-insurance expenses…plus balance billing)
© 2010 Wittenberg University Springfield, Ohio Deductibles and Out-of-Pocket Limit 3. Individual Member receives in-network AND out-of -network services. Member must satisfy OOP limit under each benefit. OOP limit = $1,200-$2,100 depending on the cost of the out-of-network service. $1,200 in-network OOP limit plus the cost of the out-of-network service up to a maximum of $900 additional cost. Plus any balance billing.
© 2010 Wittenberg University Springfield, Ohio Tiered Prescription Benefit Prescription Drug Retail $10/$25/$40 Express Scripts Prescription Drug Mail Order $20/$50/$80 3-month supply Anthem Tiered Drug List You will need a new script to initiate the new mail order service Prescription co-pay OOP limit: $1,200 single/$2,000 family Note: This OOP limit is completely separate and unrelated to the OOP for medical.
© 2010 Wittenberg University Springfield, Ohio Wittenberg Dental Plan MEMBER PAYS Deductible $25 single /$75 family Annual Maximum (per covered member) $1,500 Diagnostic and Preventive No Charge to member Minor Restorative 20% after deductible Oral Surgery 20% after deductible Endodontic Services 20% after deductible Periodontal Services 20% after deductible Prosthodontic Services 50% after deductible Orthodontic Services 50% no deductible Orthodontic Lifetime Maximum $1,000 Orthodontic Age Limit Child to age 19
© 2010 Wittenberg University Springfield, Ohio /20 Contribution Medical/Dental Plan
© 2010 Wittenberg University Springfield, Ohio /20 Contribution Medical/Dental Plan Nationally, Healthcare Costs will continue to trend up. Expect Future Rate Increases
© 2010 Wittenberg University Springfield, Ohio Anthem.com website Your Personal Account Summary Manage your Prescription Benefit – Express Scripts Information about the plan benefits and PPO providers Valuable Tools Health and Wellness Discounts and Special Offers You must Register to have access to the website Anthem
© 2010 Wittenberg University Springfield, Ohio Registration Registering for anthem.com is quick and easy and designed to ensure that your personal information is kept safe and secure First, go to anthem.com. Click on the Register link.Register
© 2010 Wittenberg University Springfield, Ohio How to Find a Provider Click on Find a Doctor on the right side of the page Choose the state that you want to search Choose the Blue Access PPO for the Medical Plan network Choose the type of Provider you want to find You can then search by provider name, address, zip code etc.
© 2010 Wittenberg University Springfield, Ohio New Health Care Cards Anthem will mail your new cards directly to your home before the end of September. Note: You can register on Anthem.com as soon as you have your new benefit card. There is information you can access without registering such as the list of PPO providers and tiered drug formulary information.
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