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Anthem’s Lumenos HRA Plan. A health plan that is part of the solution. How Does the Lumenos HRA Plan Work?. Anthem’s Lumenos HRA Plan. Preventive Care 100% In-Network >. Stay healthy with Preventive Care coverage Your employer makes an annual allocation to your account
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Anthem’s Lumenos HRA Plan A health plan that is part of the solution
Anthem’s Lumenos HRA Plan Preventive Care 100%In-Network> • 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 • + + Out-of-Pocket = Annual Deductible Traditional Health Coverage
Your HRA Plan Details At-a-Glance *OOP amount = annual deductible minus employer annual HRA allocation
Meet Carol Lewis | Single Coverage Preventive Care 100% • HRA $500 • + Year 1 Out-of-Pocket $500 = Annual Deductible $1,000 Traditional Health Coverage • 80% In-Network Providers • 60% Non-Network Providers
Meet Carol Lewis | Single Coverage Preventive Care 100% • HRA $500 • + Year 2 Out-of-Pocket $500 = Annual Deductible $1,000 Traditional Health Coverage • 80% In-Network Providers • 60% Non-Network Providers
Meet the Wilsons | Family Coverage Preventive Care 100%In-Network • HRA $1,000 • + Year 1 Out-of-Pocket $1,000 = Annual Deductible $2,000 Traditional Health Coverage • 80% In-Network Providers • 60% Non-Network Providers
Preventive Care 100%In-Network • HRA $1,000 • + Out-of-Pocket $1,000 = Annual Deductible $2,000 Traditional Health Coverage • 80% In-Network Providers • 60% Non-Network Providers Meet the Wilsons | Family Coverage Year 2
HRA Consumer Experience Physician Service 2) Doctor submits claim to Anthem 3) Anthem determines consumer’s benefits and HRA funds available 1) Consumer visits doctor 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 Pharmacy Service with Medco as PBM 2) Pharmacy connects to Medco -- Medco “pings” Anthem to determine consumer’s benefit and funds available 1) Consumer visits Pharmacy to fill a prescription 3) Anthem determines consumer’s benefits “real-time” and passes back to Medco the amount the consumer is responsible for paying 5) Pharmacy provides consumer with prescription. Consumer pays nothing out of pocket 4) Anthem debits consumer’s HRA and pays Pharmacy for the prescription
360 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
Anthem’s Lumenos HRA Plan Questions???