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RESURRECTION HEALTH CARE PHYSICIANS’ HEALTH INSURANCE INITIATIVE Presented by: Steve Guarino PBT Health Insurance Program.

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Presentation on theme: "RESURRECTION HEALTH CARE PHYSICIANS’ HEALTH INSURANCE INITIATIVE Presented by: Steve Guarino PBT Health Insurance Program."— Presentation transcript:

1 RESURRECTION HEALTH CARE PHYSICIANS’ HEALTH INSURANCE INITIATIVE Presented by: Steve Guarino PBT Health Insurance Program

2 Physicians’ Benefits Trust presents a group health plan offering specifically created for Resurrection Health Care physicians, their employees and their families. The PBT Advantage: Designed by physicians to meet the health plan needs of medical professionals. The Program continues to be managed by physicians. A wholly owned subsidiary of ISMIE Mutual Insurance Company. The plans are completely portable for physicians and their families. If a physician leaves the Resurrection Health Care affiliation, coverage is guaranteed under a standard PBT health plan. Dependant coverage up to age 25. (Older if they are students.)

3 PBT Health Insurance Program The PBT Advantage Cont.: Continuation of PBT coverage if retirement occurs before age 65. Eligibility to transfer to PBT Medicare supplement plans post 65 without pre- existing condition limitations. No pre-certification or second-opinion requirements (except for Organ Transplant). Group bill specific to each physician or physician group. Free and unrestricted choice of doctors and hospitals with higher benefit levels for care received at Resurrection Health Care facilities. PBT Dedicated Customer Service teams to ensure accurate and quick responses and claims handling.

4 PBT Health Insurance Program RHC Physicians’ Initiative / PBT Health Plan Offering: PBT has designed the following 3-tiered health benefit plans specifically for RHC affiliated physicians and their employees. Consideration has been given for when members seek care at RHC facilities and a higher benefit (1st tier) is paid for those services. (Plan designs and rate details are attached.) Preferred Provider Options:  Plan A: 80/60/50 Deductible Options - $300, $500, $1000, $2000 or $3000  Plan B: 90/80/50 Deductible Options - $300, $500, $1000, $2000 or $3000  Plan C: 100/90/50 Deductible Options - $2500 or $5000

5 PBT Health Insurance Program RHC Physicians’ Initiative / PBT Health Plan Offering Cont.: HSA Qualifying High Deductible Plan:  100/80/60 Plan Individual/Family Deductible Options - $1800/$3600 or $2900/$5600 All plans include $10,000 of Term Life Coverage and co-pay Caremark prescription plan. Dental coverage with $25 or $50 deductibles can also be made available.

6 PBT Health Insurance Program Program General Guidelines and Eligibility Requirements: Employer groups can offer up to three different RHC plans and three deductibles. The plan is only open to physicians affiliated with Resurrection Health Care, their employees and their families. Each group enrolling must have at least one physician insured in the plan. Quotes will be provided for the entire group. However, not all group employees need to participate and can elect to decline coverage on the application form. PBT has contracted with a large preferred provider network to provide second tier facility services and in-network physician services.

7 PBT Health Insurance Program Preferred Provider Options Plan Designs

8 PBT Health Insurance Program Preferred Provider Option Deductible Choices$300 $500, $1,000, $2000,$3000 RHC FacilitiesIn - NetworkOut-of-Network Hospital Coinsurance Percentage PBT pays 80% of Next $5,000 of Eligible Charges* PBT Pays 60% of Next $5,000 of Eligible Charges* PBT Pays 50% of Next $5,000 of Eligible Charges* Physician Coinsurance Percentage PBT pays 80% of Next $5,000 of Eligible Charges* PBT Pays 60% of Next $5,000 of Eligible Charges* Individual Annual Out-of- Pocket Maximum* $1,000 Plus Deductible$5,000 Plus Deductible Physician Office Visit$20 Co-Pay then 100%Subject to Deductible & Coinsurance Preventative Care Benefit80% Not subject to Deductible 50% Subject to Deductible Maximum Benefit $500 Managed Care Requirements None - Except for organ transplants * Physician Charges and Hospital Charges are combined toward the $5,000 threshold. ** Family Deductible and Out-of-Pocket Maximum is two times the individual. RHC PHYSICIANS’ PBT Plan A

9 PBT Health Insurance Program RHC PHYSICIANS’ PBT Plan B Preferred Provider Option (PPO B 90% Plans) Deductible Choices $300, $500, $1000, $2000, $3000 RHC FacilitiesIn - NetworkOut-of-Network Hospital Coinsurance Percentage PBT pays 90% of Eligible Charges* after Deductible PBT Pays 80% of Next $10,000 of Eligible Charges* PBT Pays 50% of Next $10,000 of Eligible Charges* Physician Coinsurance Percentage PBT pays 90% of Eligible Charges* after Deductible Subject to Deductible then PBT Pays 80% of Eligible Charges Physician Office Visits*** First 3 annually at 90% (not subject to deductible) First 3 annually at 80% (not subject to deductible) Individual Annual Out-of- Pocket Maximum* $500 plus Deductible$1,000 Plus Deductible Preventative Care Benefit90% Not subject to Deductible 80% (not subject to deductible) Maximum annual benefit $500 Managed Care RequirementsNone - Except for organ transplants * Physician Charges and Hospital Charges are combined toward the $10,000 threshold. ** Family Deductible and Out-of-Pocket Maximum is two times the individual. *** In -and-Out -Network: Thereafter, deductible and coinsurance applies.

10 PBT Health Insurance Program RHC PHYSICIANS’ PBT Plan C Preferred Provider Option Deductible Choices$2500 or $5000 RHC FacilitiesIn - NetworkOut-of-Network Hospital Coinsurance Percentage PBT pays 100% of Eligible Charges* after Deductible PBT Pays 90% of Next $10,000 of Eligible Charges* PBT Pays 50% of Next $10,000 of Eligible Charges* Physician Coinsurance Percentage PBT pays 100% of Eligible Charges* after Deductible Subject to Deductible then PBT Pays 90% of Eligible Charges Individual Annual Out-of- Pocket Maximum* Deductible Amount$1,000 Plus Deductible Preventative Care Benefit100% Not subject to Deductible 90% (not subject to deductible) Maximum annual benefit $500 Managed Care RequirementsNone - Except for organ transplants

11 PBT Health Insurance Program HSA Qualified High Deductible Plans Plan Design

12 PBT Health Insurance Program Health Savings Account Qualifying High Deductible Plan Deductible Choices$1,800 ($3,600 Family) or $2,900 ($5,600 Family) RHC Facilities $1,800 and $2,900 Plans In - Network $1,800 and $2,900 Plans Out-of-Network $1,800 Deductible Out-of-Network $2,900 Deductible Hospital Coinsurance Percentage After deductible, PBT pays 100% of Eligible Charges After deductible, PBT pays 80% of Eligible Charges After deductible, PBT pays 60% of next $6,750 ($13,500 for families*) of eligible charges** After deductible, PBT pays 60% of next $5,000 ($15,500 for families*) of eligible charges** Physician Coinsurance Percentage After deductible, PBT pays 100% of Eligible Charges After deductible, PBT pays 60% of next $6,750 ($13,500 for families) of eligible charges* After deductible, PBT pays 60% of next $5,000 ($15,500 for families) of eligible charges* Your Annual Out-of-Pocket Maximum Individual $1,800 Family: $3,600 or Individual $2,900 Family $5,600 Individual: $3,150 Family: $6.300 Individual: $3,500 Family: $6,800 Physician Office VisitPayable as any other benefit. Preventative Care Benefit Not subject to deductible. Payable at 100% Not subject to deductible. Payable at 80%. Maximum annual benefit $500 Managed Care Requirements None - Except for organ transplants * Then 100% of eligible charges. RHC Physicians' PBT Plan


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