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Anthem’s Lumenos HRA Plan A health plan that is part of the solution.

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Presentation on theme: "Anthem’s Lumenos HRA Plan A health plan that is part of the solution."— Presentation transcript:

1 Anthem’s Lumenos HRA Plan A health plan that is part of the solution

2 How Does the Lumenos HRA Plan Work?

3 3 Anthem’s Lumenos HRA Plan Stay healthy with Preventive Care coverage Your employer makes an annual allocation to your account Use your account dollars to pay for medical care and prescription drugs Once you spend all of the funds from your HRA, you pay an out-of-pocket amount to satisfy your annual deductible Unused funds rollover year to year to help offset future out-of-pocket costs Traditional Health Coverage then covers additional expenses (using the open access POS network) An annual out-of-pocket maximum protects you from large medical expenses + HRA Funded by annual employer allocation + Preventive Care 100% In-Network> Traditional Health Coverage Annual Deductible = Out-of-Pocket

4 4 Your HRA Plan Details At-a-Glance *OOP amount = annual deductible minus employer annual HRA allocation Lumenos HRA Plan Single Coverage Singe + 1 Coverage Family Coverage Preventive Nationally recommended services No cost deduction from HRA HRA Employer's annual allocation $500$750$1,000 Traditional Health Coverage Out-of-pocket amount to satisfy remaining annual deductible $500$750$1,000 Your OOP amount will vary depending on whether you have rollover funds available Then, you pay for coinsurance for covered services 20% for In-Network Services 40% for Non-Network Services Plan pays 100% after annual out-of-pocket maximum In-network: $2,500 In-network: $3,500 In-network: $5,000 (consists of annual deductible and coinsurance amounts) Non- Network: $3,000 Non-Network: $4,500 Non-Network: $7,000

5 Using the HRA Plan

6 6 Meet Carol Lewis | Single Coverage Carol Lewis’ Lumenos HRA Plan $500 allocation from employer$500 Expenses: OB/GYN visit & lab tests - $350 Prescription drugs - $150 $500 Paid by Preventive Care benefit at 100%$350 Paid from HRA$150 HRA Rollover to Year 2$350 Year 1 HRA $500 + Preventive Care 100% Traditional Health Coverage 80% In-Network Providers 60% Non-Network Providers Annual Deductible $1,000 = Out-of-Pocket $500

7 7 Carol Lewis’ Lumenos HRA Plan HRA Balance: $350 rollover from Year 1 plus $500 Year 2 allocation $850 Expenses: OB/GYN visit & lab tests - $150 Physician visits - $100 Prescription drugs - $200 $450 Paid by Preventive Care benefit at 100%$150 Paid from HRA$300 HRA Rollover to Year 3$550 Year 2 Meet Carol Lewis | Single Coverage HRA $500 + Preventive Care 100% Traditional Health Coverage 80% In-Network Providers 60% Non-Network Providers Annual Deductible $1,000 = Out-of-Pocket $500

8 8 The Wilsons’ Lumenos HRA Plan $1,000 allocation from employer$1,000 Expenses:Preventive visits & lab tests - $500 Physical therapy - $600 Prescription drugs - $250 $1,350 Paid by Preventive Care benefit at 100%$500 Paid from HRA$850 HRA Rollover to Year 2$150 Meet the Wilsons | Family Coverage Year 1 HRA $1,000 + Preventive Care 100% In-Network Traditional Health Coverage 80% In-Network Providers 60% Non-Network Providers Annual Deductible $2,000 = Out-of-Pocket $1,000

9 9 The Wilsons’ Lumenos HRA Plan HRA Balance: $1,000 Year 2 allocation plus $150 rollover from Year 1$1,150 Expenses: Preventive visits & lab tests - $300 Hospital and surgery - $14,300 Prescription drugs - $450 $15,050 Paid by Preventive Care benefit at 100%$300 Paid from Year 2 HRA allocation$1,000 Year 1 Rollover help pay out-of-pocket to meet annual deductible$150 Charges paid by Traditional Health Coverage (80% x $14,750 = $10,800)$10,800 Wilsons pay coinsurance under Traditional Health Coverage (20% x $14,750 = $2,950) $2,950 Total amount HRA and Plan pay$12,250 Total amount Wilson’s pay$2,950 HRA Rollover to Year 3$0 Year 2 Meet the Wilsons | Family Coverage HRA $1,000 + Preventive Care 100% In-Network Traditional Health Coverage 80% In-Network Providers 60% Non-Network Providers Annual Deductible $2,000 = Out-of-Pocket $1,000

10 10 1) Consumer visits doctor 2) Doctor submits claim to Anthem 3) Anthem determines consumer’s benefits and HRA funds available 4) Anthem debits consumer’s HRA and applies amount to network deductible, then pays doctor for the services 5) Consumer pays nothing out of pocket. Anthem sends consumer Claims Recap record of benefit applied and account funds used HRA Consumer Experience Physician Service

11 11 1) Consumer visits Pharmacy to fill a prescription 2) Pharmacy connects to Medco -- Medco “pings” Anthem to determine consumer’s benefit and funds available 3) Anthem determines consumer’s benefits “real-time” and passes back to Medco the amount the consumer is responsible for paying 4) Anthem debits consumer’s HRA and pays Pharmacy for the prescription 5) Pharmacy provides consumer with prescription. Consumer pays nothing out of pocket HRA Consumer Experience Pharmacy Service with Medco as PBM

12  Health Programs 360°Health is our approach to surrounding you with the resources, tools, guidance and support to help you manage your health MyHealth Coach Future Moms Healthy Lifestyles ConditionCare Programs ComplexCare 24/7 NurseLine

13 Anthem’s Lumenos HRA Plan Questions???


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