Welcome to Your 2023 Benefits Overview!
Welcome!
Overview of Your 2023 Benefits Offerings
MEDICAL/RX: Anthem Blue Cross Blue Shield will continue to be the carrier for Medical and Prescription Drugs effective May 1, 2023 with two medical plan options.
Plan Network: Anthem utilizes the Blue Access PPO Network
Medical Plans:
- Medical Plan 1: HSA3000 - $3,000 single / $6,000 family in-network deductible
- Medical Plan 2: PPO3500 - $3,500 single / $7,000 family in-network deductible
Prescription Drug: Express Scripts
DENTAL: Guardian will continue to be the carrier for dental insurance
Dental Network: DentalGuard Preferred
- Dental Plan: $50 single / $150 family deductible
VISION: Guardian will continue to be the carrier for vision insurance
Vision Network: VSP Choice
- Vision Plan: $10 exam copay / $10 single lens copay
Medical - Plan 1 - HSA 3000
DEDUCTIBLE:
- Single Deductible - $3,000
- Family Deductible - $6,000
COINSURANCE (applies after deductible is met): 100%
COINSURANCE MAX SINGLE: $0
COINSURANCE MAX FAMILY: $0
MEMBER COPAYMENT(S):
- Preventative Exam - 100% no deductible
- Primary Care (PCP) - Office Visit - 100% after deductible
- Specialist - Office Visit - 100% after deductible
- Urgent Care Facility - 100% after deductible
- Emergency Room Visit - 100% after deductible
OUT-OF-POCKET (OOP) MAXIMUM:
- Single Out of Pocket Maximum - $6,000
- Family Out of Pocket Maximum - $12,000
EMPLOYEE CONTRIBUTION - PER PAY (26 PAYS):
- Employee - $61.59
- Employee+Spouse - $216.61
- Employee+Child(ren) - $166.35
- Family - $304.22
Medical - Plan 2 - PPO 3500
DEDUCTIBLE:
- Single Deductible - $3,500
- Family Deductible - $7,000
COINSURANCE (applies after deductible is met): 100%
COINSURANCE MAX SINGLE: $0
COINSURANCE MAX FAMILY: $0
MEMBER COPAYMENT(S):
- Preventative Exam - 100% no deductible
- Primary Care (PCP) - Office Visit - $30
- Specialist - Office Visit - $60
- Urgent Care Facility - $75
- Emergency Room Visit - $450
OUT-OF-POCKET (OOP) MAXIMUM:
- Single Out of Pocket Maximum - $7,000
- Family Out of Pocket Maximum - $14,000
EMPLOYEE CONTRIBUTION - PER PAY (26 PAYS):
- Employee - $92.02
- Employee+Spouse - $283.50
- Employee+Child(ren) - $217.72
- Family - $398.16
Prescription Drugs/Rx
Save Money With Generic (Tier 1) Drugs
Ask your doctor if it’s appropriate to use a generic drug rather than a brand. Generic drugs are less expensive, and according to the FDA, they contain the same active ingredients and are identical in dose, form and administrative method as a brand name.
IN-NETWORK
Plan 1 - HSA 3000:
Retail 30 Day Supply
Rx Deductible - Medical Deductible Applies
TIER 1 (Value/Generic) - $15/$25 (L2)
TIER 2 - $45/$55 (L2)
TIER 3 - $90/$100 (L2)
TIER 4 - $275/$375 (L2) (30 Day Only)
Mail Order 90 Day Supply
Rx Deductible - Medical Deductible Applies
TIER 1 (Value/Generic) - $38
TIER 2 - $135
TIER 3 - $270
Plan 2 - PPO 3500:
Retail 30 Day Supply
Rx Deductible - Medical Deductible Does Not Apply
TIER 1 (Value/Generic) - $15/$25 (L2)
TIER 2 - $45/$55 (L2)
TIER 3 - $90/$100 (L2)
TIER 4 - $275/$375 (L2) (30 Day Only)
Mail Order 90 Day Supply
Rx Deductible - Medical Deductible Does Not Apply
TIER 1 (Value/Generic) - $38
TIER 2 - $135
TIER 3 - $270
Where Can I Find a Drug List?
Typically, a full listing of covered drugs is found on your provider’s website. A drug list, also called a formulary, is a list of generic and brand-name drugs covered by a health plan. Although a drug may be on the drug list, it might not be covered under every plan. Review the plan materials for details on specific benefits. You can use drug lists to see if a medication is covered by your health insurance plan. You can also find out if the medication is available as a generic, needs prior authorization, has quantity limits and more.
Helpful Rx Cost Savings Tools & Tips
MAIL ORDER - Many drugs are available in a 90-day supply, rather than the 30-day retail supply. Typically, you will pay less if you choose to get a mail order 90-day supply.
GOOD Rx - There are many tools online that you can use in order to save on prescription costs. One being GoodRx.com, an online Rx database that allows you to find what pharmacy is the cheapest for your specific prescription. Additionally, you may be able to find a coupon that will greatly reduce your cost. It is important to remember that many of the coupons can only be used outside of your plan (will not count towards your maximums).
ASK YOUR DOCTOR - Make sure to ask if there are cost savings alternatives to the prescription they are providing. Many times there are generic or different manufacturers that will save you money at the pharmacy.
Virtual Visits - Sydney App
No crowded waiting rooms. No Driving. See a doctor when you need a doctor.
A virtual visit lets you see and talk to a doctor from your mobile device or computer. When you use one of the provider groups in our virtual visit network, you have benefit coverage for certain non-emergency medical conditions.
The office visit copay will apply for the PPO plan. A $49 copay for the HSA plan (unless the deductible is satisfied then it is covered at 100% for the HSA Plan only) and this must be paid by you at the time of the virtual visit and will apply toward your deductible and out-of-pocket maximum.
WHEN CAN I USE A VIRTUAL VISIT?
When you have a non-emergency condition and:
– Your doctor is not available
– You become ill while traveling
– When you are considering visiting a hospital emergency room for a non-emergency health condition.
*Your covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.
Examples of Non-Emergency Conditions:
Bladder infection, Bronchitis, Diarrhea, Fever, Pink eye, Rash, Seasonal flu, Sinus, Sore throat, Stomach
HOW DOES IT WORK?
The first time you use a Virtual Visits provider, you will need download the Sydney App or go to Anthem.com
If appropriate, you will then be connected using secure live audio and video technology to a doctor licensed to deliver care in the state you are in at the time of your visit. You and the doctor will discuss your medical issue, and, if appropriate, the doctor may write a prescription* for you.
Virtual Visits doctors use e-prescribing to submit prescriptions to the pharmacy of your choice. Costs for the virtual visit and prescription drugs are based on, and payable under, your medical and pharmacy benefit. They are not covered as part of your Virtual Visits benefit.
HOW DO I GET ACCESS?
Learn more about Virtual Visits and access direct links by downloading the Sydney app on your phone.
Dental
You have the freedom to select the dentist of your choice; however, when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf. Out-of-network dentists may bill you for the difference between the contracted rate and the dentist’s fee. Reimbursement is based on the usual, reasonable, and customary rate. In addition, insurance claim payments for out-of-network dentists are paid directly to the member and the member must pay the provider.
IN NETWORK
NETWORK: DentalGuard Preferred
DEDUCTIBLE:
- Single Deductible - $50
- Family Deductible - $150
*Deductible applies when receiving Basic or Major services (Does not apply for Preventive Services)
ANNUAL MAXIUMUM: $1,000
CLASS I: - Covered at 100% with no deductible
Diagnostic and Preventive Services - Exams, cleanings, fluoride, space maintainers, sealants, x-rays.
CLASS II: - Covered at 80% after deductible
Basic Services - Fillings, anesthesia, oral surgery, extractions
CLASS III: - Covered at 50% after deductible
Major Services - Fixed bridgework, dentures, crowns, implants, endodontics (not root canals), periodontal services (gums)
EMPLOYEE CONTRIBUTION - PER PAY (26 PAYS):
- Employee - $10.81
- Employee+Spouse - $21.94
- Employee+Child(ren) - $28.47
- Family - $42.32
Vision
Under this plan, you may use the eye care professional of your choice. However, when you visit a participating in-network provider, you receive higher levels of coverage. If you choose to receive services from an out-of-network provider, you will be required to pay that provider at the time of service and submit a claim form for reimbursement.
IN NETWORK:
NETWORK: VSP Choice
VISION EXAM - $10
COVERED SERVICES – LENSES / FRAMES
Single Lenses - $10
Bifocals - $10
Trifocals - $10
Lenticular - $10
Frames - up to $150, then 20%
Contact Lens - Up to $150, then 15%
Conventional Lens fitting - Included in allowance
BENEFIT FREQUENCY
Exams - Once every 12 Months
Lenses or Contact Lenses - Once every 12 Months
Frames - Once every 24 Month
EMPLOYEE CONTRIBUTION - PER PAY (26 PAYS):
- Employee - $4.50
- Employee+Spouse - $7.58
- Employee+Child(ren) - $7.73
- Family - $12.23
Contact Us
Client Contacts
Zach Hruby
zachhruby@orazen.com
330-577-8250
Account Team Contacts
Kevin Lurie
Producer / Sales Consultant
kevin.lurie@nfp.com
216-410-6751