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When Am I Eligible? - Easterseals€¦ · When Am I Eligible? NH, VT, ME, –full year Benefits are effective on the first of the month following 60 days of employment. ... making

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When Am I Eligible?

NH, VT, ME, – full year Benefits are effective on the first of the month following 60 days of employment.

Employees must work 30+ hours a week to be eligible for benefits.

INCENTIVE PROGRAM

Step 1. Tobacco Affidavit & PCP form

Affidavit: Signed as a non-smoker, or enroll &

complete an agency-approved tobacco cessation

program within 120 days of the medical plan

effective date

PCP form: Includes Biometric screening

information & provider signature

Step 2. Online Health Risk Assessment

The link will be sent to you from The Lawson

Group ([email protected]) after submission

of step 1.

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Key terms

CopayA flat amount you pay for covered services like doctor visits or prescription drugs.

DeductibleThe amount you pay each year before your plan starts to pay for care.

Your percentage of the costs (coinsurance)After meeting your deductible, this is the percentage of the costs you pay for care.

Out-of-pocket maximumThe most you have to pay out of pocket each plan year for covered services. All copays, deductibles and coinsurance are part of your out-of-pocket maximum.

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HMO Blue New England ChoiceImportant plan features :

• PCP selection are required to be on file with Anthem for claims to process

• You MUST call member services at Anthem 800-870-3122 as soon as you received your ID cards

• PCP referrals are required if seeing a specialist

• Two Tiered benefit plan design

• Tier 1 lower deductibles and copayments

• Tier 2 higher deductibles and copayments

• Preventive Care covered at 100% (including 1 eye exam)

• All participating Blue Cross Blue Shield providers in CT, ME, NH, VT, MA, RI are your network

• No cost laboratories (Lab Corp, Quest, NorDx)

• Vitals Smart Shopper program is available to help you choose less costly facilities and rewards you for

making good choices.

• Annual Out of Pocket Limit is now set at $7,150 per Member and $14,300 per family; this includes all

copayments (including pharmacy), coinsurance and deductibles

Tier 1 – Cost Share• $20 PCP Copayment• $50 SCP Copayment• $125 ASC Copayment• $3,000 Single Deductible• $6,000 Family Deductible• 0% Coinsurance • $250 ER Copayment*• $125 UC Copayment*

Tier 2 – Cost Share• $30 PCP Copayment• $50 SCP Copayment• $125 ASC Copayment• $5,000 Single Deductible• $10,000 Family Deductible• 20% Coinsurance • $250 ER Copayment*• $125 UC Copayment*

* Tier 1 Deductible will apply for some services.

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Deductible:

– In patient hospitalization

– High tech imaging (CT scans, x-rays, MRI’s etc.)

– Labs (if you don’t go to a participating provider)

– Durable Medical Equipment (hearing aids, crutches etc.)

– ER & Urgent care visits - after the co-pay

Co-Pay:

– PCP – non-preventive care - $20 or $30

– Specialist visits - $50

• PT, OT or speech therapy

• Chiropractic visits

– Mental health or substance abuse outpatient - $20

– Urgent care & ER visits (then deductible applies) - $125 / $250

– Ambulatory Centers - for day surgery - $125

Medical Benefits

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If you can, go to an urgent care center instead of an emergency room. Unless you have an

immediate emergency, you can save money by choosing an urgent care center. You pay a $125 urgent care copay or a $250 copay at the ER.

Call Vitals Smart Shopper Program vitalsmartshopper.com / 1-800-824-9127Call or shop online for cost effective choices of common medical services . Avoid paying higher costs and earn rewards.

Use the mail order program and generic drugs whenever possible.Mail order home delivery service saves you money on copayments as do generic drugs. Speak with your doctor about what is right for you.

See your PCP. Be sure to get your annual physical exam and annual dental cleanings.Tier 1 physicians / facilities will cost less

Use Site of Service Independent Labs and Ambulatory Surgery Centers (ASC) whenever possible. Save here on your deductible with labs covered at 100% and a lower copayment for outpatient surgeries

https://www11.anthem.com/siteofservicenh/ some labs are: Quest, LabCorp, NorDx

LiveHealth Online – a new way to receive low cost, convenient service.Save with low copayments and quick and convenient service in the comfort of your home or while traveling.

Ways to save

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HMO Blue New England ChoiceWhich Hospitals are in Tier 1 and Tier 2 in NH?

Tier 1 Hospitals

• Alice Peck Day Memorial Hospital• Cheshire Medical Center• Cottage Hospital• Elliot Hospital• Frisbie Memorial Hospital• Monadnock Community Hospital• Parkland Medical Center• Portsmouth Regional Hospital• Southern NH Medical Center• Speare Memorial Hospital• St. Joseph Hospital• The Memorial Hospital• Wentworth Douglass Hospital• Memorial Hospital

Tier 2 Hospitals

• Androscoggin Valley Hospital• Catholic Medical Center• Concord Hospital• Dartmouth Hitchcock• Exeter Hospital• Franklin Regional Hospital• Huggins Hospital• Lakes Region General Hospital• Littleton Hospital• Mary Hitchcock Memorial Hospital• New London Hospital• Upper Connecticut Valley Hospital• Valley Regional Hospital• Weeks Medical Center

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other New England States

• ME – All providers are in Tier 1 benefit plan

• VT – All providers are in Tier 1 benefit plan

• MA – We follow MA BCBS Tier 1 and Tier 2 structure. Please see BCBSMA website for more details.

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Prescription Drug Plan

Save yourself some money

• Ask your doctor if there’s a generic equivalent for the brand-name medications you’ve been taking.

• Get a 90-day supply of maintenance drugs by mail for less than what you will pay at a pharmacy.

• Ask Accredo Specialty Pharmacy for copayment assistance. (specialty medication only)

• Tier 1a - $5 per fill

• Tier 1b - $20 per fill

• Tier 2 - $40 per fill

• Tier 3 - $70 per fill

• Tier 4 - $100 per fill – Specialty Medication Only

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• Yearly exams for a $20 co-pay

• Allowances ($100) for eye ware, contacts etc. every 2 years

Blue View Vision SM

Search for doctors.

Check your claims.

Estimate your costs.

Review your medical benefits.

View your ID card.

Refill a prescription.

Register at anthem.com

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When you register online, you have great personalized tools to help you:

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Northeast Delta Dental

Preventive covered in FULL

• Cleanings (4x year)

• Oral examinations (2 per year)

• Normal x-rays

• Fluoride treatment (up to age 19)

• Space Maintainers (up to age 16)

• Sealant (up to age 19)

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• Basic Service – 6 month wait period– Cost share 80% (NEDD) / 20% (Subscriber)

• Extraction / fillings / pulp capping / root canals

• Major Services – 12 month wait period– Cost share 50% / 50%

• Bridges / crowns / dentures

• Orthodontia – 24 month wait period• Cost share 50% / 50% to max of $1,000

Calendar Year maximum $2,000 /per person

Voluntary Vision / Blue View Vision

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$ 10 copays

$130 allowance for glasses or contacts

Every 12 months

Life Insurance

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Basic life insurance = 1x annual salary rounded up. • Automatically enrolled

– Submit beneficiary form along with completed enrollment forms

Supplemental life insurance

• 1x, 2x, or 3x annual salary – See your enrollment forms for individual pricing

Guaranteed Issue Amount– if enrolling now & amount elected is less than $150,000

Otherwise must fill out Evidence of Insurability (medical questionnaire) for any amount elected or if electing during open enrollment

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Life Insurance

• Spousal Life - $5,000 / $10,000– Guaranteed issue if sign up now

– Otherwise subject to the medical questionnaire

• Child Life - $2,000 / $4,000 – Per family total

If enrolling in spousal or child life, a Supplemental life policy must be elected also.

Disability

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Short Term Disability

Income replacement if your are hurt off the job. 1 week elimination period /13 week max pay out• Pre-Existing Condition Clause (12 months)

• Weekly available amounts are listed on your enrollment forms– Ex. - Short term disability 100 = $100 week / up to 13 weeks

Long Term Disability (Agency paid policy)

– 90 continuous days out of work

– 50% of monthly base earnings to a $5000 max / month

403(b) Retirement plan

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• All employees are eligible to participate upon hire

• Matched dollar for dollar up to 2% (20+ hours)

• $200 minimum employee contribution per year to

receive match

• Vested after 3 years based on date of hire

• Choose your own elections using offered choices

Or Default to pre-arranged models – see booklet

• Can enroll at any time

PTO & XIB

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• Accrues effective date of hire

can not use time for a three month period

• Accrual rate depends on your hire details – hourly vs. salary / number of hours per week

• Your sick, vacation, personal & bereavement time

• Extended Illness Bank (XIB) – after one year of service / 3-5 days each year till max of 60 days

• PTO at time of separation is paid at a percentage of the balance.

Holiday

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• Some staff may be required to work

on a holiday. Another day may be

taken as a holiday. At the discretion

of the supervisor, and extra day’s pay

may be given if a day off cannot be

scheduled.

• Holiday must fall on your regularly

scheduled work day.

• Must work normally scheduled work

day prior to and after the holiday to be

compensated for the holiday unless

prior approval has been given.

Flexible Spending Accounts

Flexible Spending Account (FSA) -Healthcare?

• Pre-tax dollars you designate to cover medically related expenses.

• Maximum contribution $2600

How does it work?

• Pre-Loaded Visa Card with the amount you choose. Your election is split over the remaining pay periods in the plan year and a deduction is made each pay period from your check. (i.e. $1,000 / 26 = $38.46)

• The elected amount is pretax.

What can I use it for?

• Co-Pays, deductibles, eyeglasses/contacts, dental visits, prescriptions , etc.

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Flex Spend Account - Dependent Care

– Maximum contribution $5,000

– Money not preloaded on card

– Call to discuss

What can I use it for?

• Dependent care expenses, child care, summer camp for children under 12.

What are the drawbacks?FSA is use or lose! You must use your total amount by 6/30 or forfeit the balance.

Open Enrollment -

Making Changes to your benefits mid year

• Changes to benefits OUTSIDE of open enrollment can be made if one of the following takes place:

• Marriage/Divorce

• Birth/Adoption

• Loss of insurance coverage

• Etc.

• There are only 30 days after a life changing event to make changes to your benefits

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Open Enrollment takes place

each year, during the month

of May, with an effective date

of July 1st

Accident Critical Care

Hospital Short Term Disability

Cancer Life

• Group rated / pre-tax or post tax deduction / portable

• Payroll deductions for FT staff

David Healey

(603) 682-8095 cell

(888) 875-0147 fax

[email protected]

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Questions ?

Leslie – (603) 621-3529

Kathy - (603) 621-3415

Thank you!

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