Presentation is loading. Please wait.

Presentation is loading. Please wait.

BAART (Addiction Research & Treatment, Inc.) Benefits Presentation BAART (Addiction Research & Treatment, Inc.) Benefits Presentation Northern CA Ed.10/15/2008.

Similar presentations


Presentation on theme: "BAART (Addiction Research & Treatment, Inc.) Benefits Presentation BAART (Addiction Research & Treatment, Inc.) Benefits Presentation Northern CA Ed.10/15/2008."— Presentation transcript:

1 BAART (Addiction Research & Treatment, Inc.) Benefits Presentation BAART (Addiction Research & Treatment, Inc.) Benefits Presentation Northern CA Ed.10/15/2008

2  Demonstrates commitment to employees  Provides a competitive and comprehensive package  Serves as a key component of total compensation  Strives to maintain reasonable costs for employees  Demonstrates commitment to employees  Provides a competitive and comprehensive package  Serves as a key component of total compensation  Strives to maintain reasonable costs for employees

3 Time to review your benefits and make any changes …..

4  “Managed” Health Care  Must Use Only Contracting Facilities and Doctors  You do not need to elect a primary care physician (PCP), but it is recommended  No Deductibles  100% Payment for Most Services  No Claim Forms  “Managed” Health Care  Must Use Only Contracting Facilities and Doctors  You do not need to elect a primary care physician (PCP), but it is recommended  No Deductibles  100% Payment for Most Services  No Claim Forms

5  DeductibleNone  Coinsurance100%  Office Visit $15 copay  Hospitalization 100%  Chiropractic*$10 copay 30 visits/year maximum benefit  Lab Services100% *Chiropractic care accessed through American Specialty Health Plan (ASHP) participating providers.  DeductibleNone  Coinsurance100%  Office Visit $15 copay  Hospitalization 100%  Chiropractic*$10 copay 30 visits/year maximum benefit  Lab Services100% *Chiropractic care accessed through American Specialty Health Plan (ASHP) participating providers.

6  Retail Prescription  Generic Formulary$10 copay  Brand Formulary$20 copay  Non-FormularyPCP Approval  Supply Limitation100 days  Retail Prescription  Generic Formulary$10 copay  Brand Formulary$20 copay  Non-FormularyPCP Approval  Supply Limitation100 days

7  Two Plans In One  Annual Deductibles  No PCP Requirements  No Referrals Needed  Cost Savings Using PHCS Network  Freedom of Choice  How “Swing” Plan Works  Two Plans In One  Annual Deductibles  No PCP Requirements  No Referrals Needed  Cost Savings Using PHCS Network  Freedom of Choice  How “Swing” Plan Works

8 NetworkNon-Network DeductibleDeductible Individual Individual Family Family$500$1,500 CoinsuranceCoinsurance 90% after ded. 70%, after ded. Office VisitOffice Visit $25 copay 70% after ded. HospitalizationHospitalization $250 copay, then 90% after ded. $500 copay, then 70% after ded. EmergencyEmergency Room Room $100 copay, then 90% after ded.

9 NetworkNon-Network Lab Services 90% after ded. 70% after ded. Chiropractic & Acupuncture 90% after ded.* 70%, after ded.* *$1,000 maximum benefit per calendar year for chiropractic and acupuncture services combined.

10  Retail Prescriptions*  Generic $15 copay  Brand Name$40 copay  Self-Administered Injectables70% (other than insulin)  Supply Limitation30 days  Retail Prescriptions*  Generic $15 copay  Brand Name$40 copay  Self-Administered Injectables70% (other than insulin)  Supply Limitation30 days If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.

11  Mail Order Prescriptions*  Generic $30 copay  Brand Name$80 copay  Supply Limitation100 days (Self-administered injectables (other than insulin) are not available through the mail order program) MMail Order Prescriptions* GGeneric$30 copay BBrand Name$80 copay SSupply Limitation100 days (Self-administered injectables (other than insulin) are not available through the mail order program) If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.

12 Offers Helpful Resources Including: Benefit & Open Enrollment Announcements Carrier Contact Information & Group Numbers Insurance Benefit Summaries Frequently Asked Questions HIPAA Compliance Materials Carrier Links And much more! Offers Helpful Resources Including: Benefit & Open Enrollment Announcements Carrier Contact Information & Group Numbers Insurance Benefit Summaries Frequently Asked Questions HIPAA Compliance Materials Carrier Links And much more!

13 Kaiser/KPIC members are eligible for an exciting discount program! This program is offered by American Specialty Health (ASH) and includes a 25% discount on: Chiropractic, acupuncture and massage therapy Fitness Club Memberships Health Tools and Health Products Kaiser/KPIC members are eligible for an exciting discount program! This program is offered by American Specialty Health (ASH) and includes a 25% discount on: Chiropractic, acupuncture and massage therapy Fitness Club Memberships Health Tools and Health Products To locate ASH providers visit: or call To locate ASH providers visit: or call

14 HOT TOPICS BAART Medical Plans - HOT TOPICS Dependent age limitation is to age 19 or to age 24 if full time student. If you child has attained the age of 19 AND is a full time student, you MUST complete a student certification form. The form MUST be returned to human resources WITH a copy of the child’s school registration. Dependent age limitation is to age 19 or to age 24 if full time student. If you child has attained the age of 19 AND is a full time student, you MUST complete a student certification form. The form MUST be returned to human resources WITH a copy of the child’s school registration.

15 HOT TOPICS BAART Medical Plans - HOT TOPICS You will need to complete the student certification form ONCE a year in order for the child to remain on the insurance plan(s). Pre-Certification (PPO members) KPIC Billing Address (PPO Members) P.O. Box Plano, TX You will need to complete the student certification form ONCE a year in order for the child to remain on the insurance plan(s). Pre-Certification (PPO members) KPIC Billing Address (PPO Members) P.O. Box Plano, TX 75026

16 HOT TOPICS BAART Medical Plan - HOT TOPICS It is YOUR responsibility to notify Human Resources upon your child’s attainment of age 19. Failure to notify human resources may result in your child being terminated from coverage, may result in claims being denied or delayed, and may forfeit the child’s right to COBRA continuation protection (should the child not be a full time student) as outlined under Federal legislation.

17 DMO Member selects a primary care dentist. Dentist coordinates dental care; scheduled copays; no deductibles to be met PPO Two plans in one; deductibles in and out of network; cost savings when using network providers DMO Member selects a primary care dentist. Dentist coordinates dental care; scheduled copays; no deductibles to be met PPO Two plans in one; deductibles in and out of network; cost savings when using network providers

18  DeductibleNone  Preventive Services100%  Basic Services100%  Major Services 60%  Calendar Year Max.None (Unlimited)  Orthodontic Care Not a covered benefit (Late entrants eligible for preventive services only for the first 12 months.)

19 Network Non-Network  Deductible* $50/person$50/person  Preventive Svcs. 100% 100% of UC  Basic Services 80% 80% of UC  Major Services 50% 50% of UC  Cal. Year Max. $1,500 $1,500  Orthodontic Care Not covered *Deductible waived for preventive services Network Non-Network  Deductible* $50/person$50/person  Preventive Svcs. 100% 100% of UC  Basic Services 80% 80% of UC  Major Services 50% 50% of UC  Cal. Year Max. $1,500 $1,500  Orthodontic Care Not covered *Deductible waived for preventive services

20 Aetna members have access to exciting discount programs that include: Alternative Health Care Discount Program Vision One Discount Program Fitness Discount Program AND MUCH MORE! Aetna members have access to exciting discount programs that include: Alternative Health Care Discount Program Vision One Discount Program Fitness Discount Program AND MUCH MORE! Pick up a flyer for more information today!

21  Group Term Life Insurance  Flat $10,000 (all guarantee issue)  Convertible Within 30 Days  Beneficiary Designation -- May Change at Any Time

22  You are required to complete a Kaiser / KPIC medical enrollment form if you are electing medical coverage (or adding/deleting dependents). If you would like to make a change to the Aetna dental plan, you must also complete an enrollment form. All forms MUST be returned to Human Resources no later than DECEMBER 15,  If you’ve had a life change since you enrolled in the Life/AD&D plan, you may want to update your beneficiary(ies) designation(s).  Claim Issues -- contact Human Resources or BAART’s benefits broker at for assistance.

23 Questions and Answers…


Download ppt "BAART (Addiction Research & Treatment, Inc.) Benefits Presentation BAART (Addiction Research & Treatment, Inc.) Benefits Presentation Northern CA Ed.10/15/2008."

Similar presentations


Ads by Google