Health Care Reform Beginning Jan 1, 2015 HCR Requires: Large employers must offer a health plan: – To employees averaging 30+ hrs per week – That is considered HCR affordable – That provides min. essential benefits – Or, the employer must pay a penalty
2014 Health Insurance Options Provider Networks BlueCross BlueShield of Tennessee Cigna Premium Levels Employee only Employee + child(ren) Employee + spouse Employee + spouse + child(ren) Benefit Levels Partnership Plan Standard Plan Limited Plan
2015 Health Insurance Options Premium Levels Employee only Employee + child(ren) Employee + spouse Employee + spouse + child(ren) Benefit Levels Partnership Plan Standard Plan New Option Limited + Beazley Gap Plan Provider Networks BlueCross BlueShield of Tennessee Cigna
The Limited PPO Overview Same covered and non-covered services as the Partnership / Standard options Same healthcare network providers (BCBST & Cigna networks) Premiums are lower, but Out-of-Pocket costs like deductibles and copays are higher There are no wellness requirements to qualify for the lower Limited PPO premiums IT IS NOT LIMITED COVERAGE…
Let’s Review… * Review the state health plan and Gap plan benefit summaries for complete details, exclusions, and limitations. The above information is a brief summary and is for illustrative purposes only. Type of ServiceLimited PPO BenefitsGap Benefits In-Patient Hospital CareSubject to Ded / CoinsurGap Pays Surgery In HospitalSubject to Ded / CoinsurGap Pays Out-Patient Surgery in Hospital or ClinicSubject to Ded / CoinsurGap Pays Diagnostic Tests in Hospital & Out-patient CenterSubject to Ded / CoinsurGap Pays In and / or Out-Patient Radiation & ChemotherapySubject to Ded / CoinsurGap Pays In and/ or Out-Patient Drug & Alcohol TreatmentSubject to Ded / CoinsurNot Reimbursed Ambulance ServicesSubject to Ded / CoinsurNot Reimbursed Doctors Office, Specialist, & Urgent Care CenterSubject to CopayNot Reimbursed PrescriptionsSubject to CopayNot Reimbursed Out-Patient Physical, Speech, Rehab TherapySubject to Copay or Ded / CoinsurNot Reimbursed Durable Medical Equipment (DME)Subject to Ded / CoinsurNot Reimbursed Out-Patient Kidney DialysisSubject to Ded / CoinsurNot Reimbursed
2015 Employee Monthly Cost 1. BCBST Limited PPO + Gap Plan Partnership PPOStandard PPO Employee (EE)$0.00$27.04$52.04 EE + Child(ren)$142.75$267.65$292.65 EE + Spouse$168.70$316.32$366.32 EE + Sp. + Child(ren)$224.94$421.75$471.75 2. Cigna Open Access Employee (EE)$0.00$47.04$72.04 EE + Child(ren)$152.75$307.65$332.65 EE + Spouse$178.70$356.32$406.32 EE + Sp + Child(ren)$234.94$461.75$511.75
Want the Limited PPO + Gap Plan? You must pick the Limited PPO during your open enrollment Annual open enrollment is Oct 1 – Oct 31 It’s as easy as 1,2,3: 1.Go to the state health plans website 2.Log in & pick the Limited PPO you want 3.Enroll family members to be covered You and covered family members on the Limited PPO will be auto enrolled for Gap Your benefits department can help if needed
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