client Introduction
Annual enrollment is your opportunity to learn about the 2021 Health Care Program, review your current coverage and choose the best options for you and your family. Please review our 2021 Enrollment Guide and attend our upcoming education session to learn more about our 2021 benefits offerings
Education Session : (if conducting live sessions vs using a video)
Join us for the education session below to learn more about our 2021 benefits programs
Date:
Time:
Benefits Overview
Read about what is new for 2021 (insert what's newdocument via Add resource)
- Review all your benefits plans, options, and rates for 2021 (insert the full benefits guide via Add resource)
- Watch this short video to learn more about your 2021 benefit options (Add video via Add resource)
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Medical & Pharmacy BenefitsBase PlanComparison PlanPlan NamePlan 1Plan 2Plan TypePPOPPOHSA/HRA Employer Seed Annual SeedN/AN/AIn-Network Annual Deductible$150 / $300$150 / $300Individual Deductible in Family TierEmbeddedEmbeddedCoinsurance (member pays)15%15%Out-of-Pocket Maximum$500 / $1,000$500 / $1,000Individual Out-of-Pocket in Family TierEmbeddedEmbeddedPCP Office Visit$25 copay$25 copaySpecialist Office Visit$25 copay$25 copayUrgent Care$50 copay$50 copayEmergency Room$50 copay$50 copayHospital Inpatient15% after deductible15% after deductibleOutpatient Surgery15% after deductible15% after deductibleOut-of-Network Annual Deductible$250 / $500$250 / $500Coinsurance (member pays)30%30%Out-of-Pocket Maximum$2,500 / $5,000$2,500 / $5,000Prescription Drug Annual DeductibleNoneNoneOut-of-Pocket Maximum (OOP)$2,000$2,000Retail Generic Formulary / Tier 110% (max $20 copay)
deductible waived10% (max $20 copay)
deductible waivedBrand Formulary / Tier 220% (max $30 copay)
deductible waived20% (max $30 copay)
deductible waived
sections client
The Children's Health Insurance Program Reauthorization Act of 2009
(CHIPRA) requires that a group health plan allow an employee or dependent
to enroll in the plan within 60 days of the employee's Medicaid or CHIP
coverage being terminated or upon eligibility for employment assistance under
Medicaid or CHIP. In addition, employers that maintain a group health plan in a
state that provides medical assistance or child health assistance under a state
Medicaid or state child health plan are required to provide the Employer CHIP
Notice. The following states meet this standard: AL, AK, AR, CO, FL, GA, IN,
IA, KS, KY, LA, ME, MA, MN, MO, MT, NE, NV, NH, NJ, NY, NC, ND, OK, OR,
PA, RI, SC, SD, TX, UT, VT, VA, WA, WV, WI and WY. The law is unclear on
whether self-insured Indian Tribal plans are subject to HIPAA Portability
provisions. Such plans should seek legal counsel. A model notice is available.
How To Enroll
- Visit (URL) to review your current coverage and enroll and modify your elections for 2021.
- If you'd like to change your existing coverage or make new elections, you must do so by November XX. Your current medical, dental and vision elections will carry forward to 2021 if you don't make a new election.
- To participate in a Health Savings Account or Flexible Spending Account in 2021, you must make an active election, even if you're already participating in 2021.
New Section
Civil penalties of up to $117 (2019) per
day for failure to comply with the new
notice and disclosure requirements
may be assessed.
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There are two types of wellness programs, those that base a reward on
participation only, and those that base a reward on satisfying a health
standard (health-contingent). If the program is only participation-based but
provides a reward such as a premium discount or reduction in copays or
deductibles, then the program must be available to all similarly situated
individuals in order to comply with the HIPAA nondiscrimination requirements.
If the program bases the reward on satisfying a health standard- whether
activity-only, or outcomes-based (such as not smoking
