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Open Enrollment PowerPoint

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  • 1.State Employee Health Plan Non State Group Open Enrollment 2010

2. Changes for 2010

  • Medical Plans
    • Plan changes for Plan A
      • Deductible increased to $150/$300
      • Coinsurance maximum increased to $1,200/$2,400
      • Quest LabCard added
    • No plan changes for Plan B and Plan C
  • Prescription Drug Plan
    • Adding Performance Drug List
  • Dental Plan
    • Deductible increased to $50/$150
    • New value-based plan design

3. MedicalPlan Options Plan A Plan B Plan C Blue Cross and Blue Shield of Kansas Coventry Health Care Preferred Health Systems UMR a UnitedHealthcare Co. 4. Medical Plan

  • Standardized Plan designs :
    • All plans include preventive care
    • Not all services are covered
      • Review the benefit description
      • Questions - contact plans customer service
  • Differences:
    • Provider networks
      • All plans are Preferred Provider Organizations (PPO)
    • Rates
    • Additional services/discounts offered on Medical Plans websites

5. Selecting a Medical Plan

  • Pick a plan design (Plan A, B or C)
  • Review the Provider Networks
  • Each of the medical plans uses adifferent provider network
  • Review the other services each medical plan offers
  • 4.Review the premiums

6. PPO Providers

  • Claims paid based on the network status
  • Network providers accept the plan allowance
  • Non Network Providers can balance bill
    • Non Network Providers may work at Network Facilities -examples :
      • P athologists
      • E mergency Room Providers
      • A nesthesiologists
      • R adiologists
      • L aboratory Technicians

7. Plan A - Network Provider Service on 1/2/2010 Plan Pays Member Pays Provider Write Off Billed Charge $1,500 Allowed Charge $1,400 $100$150Deductible ($150) $150 20% Coinsurance$1,250$1000$250 Total $1,000$400$100Plan A - Non Network Provider Service on 1/2/2010 Plan Pays Member Pays Provider Write Off Billed Charge $1,500 Allowed Charge $1,400 $100$0$500 Deductible ($500) $500 50% Coinsurance$900$ 450 $450 Total $450$1050$0 8. Primary Care Providers

    • General practice
    • Family practice
    • Geriatrics
    • Internal medicine
    • Physician extenders
    • Pediatrics

Primary Care Providers (PCPs) are defined as:

    • Use a network provider
    • Referrals not required by the medical plan

9. Preventive Care

  • Physical Exams
    • Well Woman
    • Well Man
    • Well Baby
    • Well Child
  • Immunizations
    • Over age 60 shingles vaccine
    • Flu shots
  • Vision Exam
  • Hearing Exam
  • Bone Density Screening
  • Mammogram
  • Colonoscopy

10. Plan A Network Providers

  • Preventive Care Covered at 100%
  • Office Visit Copays
    • $20 for Primary Care Office Visits
    • $40 for Specialist Office Visits
  • $150/$300 Deductible
  • 20% Coinsurance
  • Coinsurance Max $1,200/$2,400
  • Quest LabCard Benefit

11. Quest LabCard

  • Optional benefit
    • You will need to request tests are sent to Quest or..
    • Use a Quest collection site
    • The decision is up to you and your provider
  • 100% coverage of eligible outpatient lab tests
    • Saves you and the plan money
    • For non-emergency outpatient lab work only
    • Testing must be performed and billed by Quest
  • You will receive a Quest ID card
    • Quest logo will also be on your medical card

12. Plan B Network Providers

  • Preventive Care Covered at 100%
  • Primary Care Office Visits
    • $20 Adult Copay
    • $10 Children age 18 and under Copay
  • Specialist Office Visits
    • $40 Adult Copay
    • $25C hildren age 18 and under Copay
  • No Deductible
  • 30% Coinsurance
  • Coinsurance maximum $2,200/$4,400
  • Quest LabCard benefit

13. Quest Lab Card Savings

  • Current Lab Fees
  • Billed $194.83
  • Allowed: $155.86
  • Coinsurance 80%
  • Plan pays $124.69
  • Member pays$31.17
  • LabCard Fees
  • Total Charges$35.33
  • Coinsurance 100%
  • Plan Pays $35.33
  • Member Pays$0

Charges on a typical lab claim for:CBC, Lipid Panel, TSH & Basic Metabolic Panel Plan saves $89.36 and Employee saves $31.17 Source: Quest Diagnostics, Inc. 14. Plans A & B - Non Network Providers

  • $500/$1,500 Deductible
  • 50% Coinsurance
  • Coinsurance Max $3,650/$7,300
  • Preventive carenotcovered

15. Drug Plan

  • Generic Drugs
    • 20% Coinsurance
  • Preferred Brand
    • 35% Coinsurance
  • Special Case Medications
    • $75 per 30-day supply
  • Non Preferred Brand
    • 60% Coinsurance
  • Discount Tier
    • 100% Member responsibility

16. Drug Plan

  • Print out the PDL and take it with you
    • Preferred Drug List (PDL) available on website
      • PDL is updated quarterly
  • Talk to your doctor about prescription drug options
  • Using Generics will save you money
  • Specialty, Special Case and injectables lists
  • on the website
    • www.khpa.ks.gov
    • www2.caremark.com/kse/

17. Performance Drug List

  • Three drug classes of Performance Drug List:
    • ACE/ARBs Blood pressure lowering
    • HMGs Cholesterol lowering
    • PPIs Stomach acid reducers
  • Must try a Generic before using a Non Preferred Brand Name Drug
    • Claim system will review members history
  • Generic and Preferred Brands not effected
  • Those using a Non Preferred drug will be notified by Caremark

18. Performance Drug List

  • PreferredACE/ARBs
  • Generic
    • benazepril & benazepril HCT
    • captopril & captopril HCT
    • enlapril & enlapril HCT
    • fosinopril & fosinopril HCT
    • lisinopril & lisinopril HCT
    • moexipril & moexipril HCT
    • quinapril & quinapril HCT
    • ramipril
    • trandolapril
  • Preferred Brands
    • Benicar & Benicar HCT
    • Micardis& Micardis HCT
  • Non Preferred ARBs
  • Diovan & Diovan HCT
  • Teveten & Teveten HCT
  • Tekturna & Tekturna HCT
  • Angiotensin Converting Enzyme Inhibitors (ACEs)
  • Angiotensin II Receptor Antagonists (ARBs) &
  • Direct Renin Inhibitors & Combinations

Blood Pressure Lowering 19. Performance Drug List

  • Preferred HMGs
  • Generic
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