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Employee Benefit Plan Effective January 1, 2013. Baker College. New Health Insurance. ASR Health Benefits will be the new benefits administrator for Baker College beginning January 1, 2013 for the following coverages : Medical Prescription Dental Vision. What is not changing?.
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Employee Benefit Plan Effective January 1, 2013 Baker College
New Health Insurance • ASR Health Benefits will be the new benefits administrator for Baker College beginning January 1, 2013 for the following coverages: • Medical • Prescription • Dental • Vision
What is not changing? • Employee contributions = $0 • Deductibles and co-pays for all medical plans • Retail and Mail Order prescription co-pays • Dental maximums and percentages
PPO Plans • No change to the employee deductibles • Enhanced Plan - $500/Individual; $1,000/Family • Standard Plan - $1,000/Individual; $2,000/Family • Benefits that do not require satisfaction of deductible: • Routine/Preventative benefits are paid at 100%, deductible waived • $15 (Enhanced) or $30 (Standard) copayment for office visit/urgent care/second surgical opinion/chiropractic • $50 (Enhanced) or $150 (Standard) co-payment for Emergency Room treatment
Prescription Plans • Enhanced Plan • $10 copay for generic • $40 copay for brand name • Mail order filled for 90 days for twocopays • Standard Plan • $15 copay for generic • $50 copay for brand-name formulary drug • $70 copay for brand-name non-formulary drug • Mail order filled for 90 days for twocopays
What is changing? • Vision Benefit • New ID Cards • Certification Requirement • PPO Network Coverage • Pharmacy Benefit Manager • Employee Website • HRA Questionnaire
New ID Cards • A new ID card will be mailed directly to your home mid December • Present your ID card to your provider or pharmacy FRONT OF CARDBACK OF CARD
Certification Requirement A Covered Person must call (800) 638-0573 as soon as possible before a hospital admission and certain outpatient procedures, but in no event later than 48 hours after obtaining services. The penalty for noncompliance is $250.00. Services requiring pre-certification include the following: • 1. Inpatient Hospital Confinements • 2. Home and Outpatient Rehabilitative Therapy • 3. Rental and Purchase of Durable Medical Equipment • 4. Home Health Care • 5. Purchase of Custom-Made Orthotic or Prosthetic Appliances • 6. Oncology Treatment
PPO Network Coverage New and improved network choices! • To search for a provider, go to www.physicianscare.com • Note: Participants may self-refer to any specialist as long as they are in the network
PPO Network Coverage National network coverage through Cigna or Multiplan
Pharmacy Benefit Manager Navitus Health Solutions Note: Navitus/WellDyne cannot begin taking calls about benefits until after December 1 2012 • Beginning January 1, 2013, please begin using your new insurance ID card at your local pharmacy. • Register on-line at www.navitus.com for benefit information and www.welldynerx.com to take • advantage of mail order • IMPORTANT: If mail order is currently being utilized, a new prescription will need to be sent to WellDyneRx. Please refer to the instructions within the Navitus WellDyneRx welcome letter within your packet. A 90 day supply of a prescribed medication can be purchased at a participating pharmacy (retail level), subject to mail order co-payments.
Employee Website • Employee Website • www.physicianscare.com • Enrollment • Order additional ID cards • Claim status • PPO networks • Plan documents
Enrollment Materials Plan Enrollment Form Sign your enrollment form! Complete PHI Authorization If everyone in your family is waiving all coverage, complete the “Waiver of Group Coverage” on the back of the enrollment form
Enrollment Materials Waiver Form If part of your family is declining coverage, please complete this form
Enrollment Materials Spousal Insurance / Coordination of Benefits Form Complete spouse’s insurance information if applicable Complete Coordination of Benefits Information Don’t forget to sign the form!
Wellness Program • All employees will be enrolled in the Enhanced Plan • Biometric Screenings will be held on the campuses in January 2013 • On-line Health Risk Assessment (HRA) completion, January & February, 2013 • Health Coaching required for those with a chronic condition • Those not completing HRA or complying with Health Coaching will be moved to the Standard Plan July 1, 2013 and will remain there until July 1, 2014
STEP 1… Biometric Screenings You may take advantage of receiving a biometric screening in January at one of Baker’s campus locations (dates and times will be announced) -OR- You may schedule an appointment with your doctor’s office and have them perform the biometric screening IMPORTANT: You must complete the biometric screening first before completing the on-line health risk assessment
STEP 2… Complete a Health Risk Assessment (HRA) on-line at www.ahdi.com. NOTE: You cannot begin completing this assessment until after January 1, 2013.
Wellness Program Chronic Conditions Requiring Health Coaching • Asthma • Atherosclerosis • Atrial Fibrillation • Chronic Obstructive Pulmonary Disease • Chronic Renal Insufficiency • Congestive Heart Failure • Coronary Artery Disease • Depression • Diabetes • Epilepsy • Human Immunodeficiency Virus Infection • Hyperlipidemia • Hypertension • Pre-Diabetes • Pulmonary Htn/Cor Pulmonale • Pulmonary Htn/Cor Pulmonale with COPD • Rheumatoid Arthritis • Schizophrenia • Sleep Apnea • Thrombo-embolic Disease • Ulcerative Colitis • Hyperthyroidism • Hypothyroidism • Metabolic Syndrome • Multiple Sclerosis • Parkinson’s Disease • Polymyalgia Rheumatica