1 Welcome to Insurance Coordinator Option Period Training 2020 This publication is issued by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. Copies have not been printed but are available through the agency website. This work is licensed under a Creative Attribution‐NonCommercial‐NoDerivs 3.0 Unported License. 4036 Agenda • Option Period materials. • Important dates. • Option Period information. • 2020 plan changes. • Life, health, dental and vision plans. • Helpful hints. Option Period Material
Transcript
1
Welcome to Insurance Coordinator Option Period Training
2020
This publication is issued by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. Copies have not been printed but are available through the agency website. This work is licensed under a Creative Attribution‐NonCommercial‐NoDerivs 3.0 Unported License.
4036
Agenda• Option Periodmaterials.• Important dates.• Option Period information.• 2020 plan changes.• Life, health, dental and vision plans.• Helpful hints.
Option Period Material
2
Option Period Material
Hea lth Plan
Den ta l P lan
Vis ion Plan
Prima ry Vis ion Ca re Service s (PVCS)Superior Vis ion
Em ploye e Life Plan
(Keep e mployee life in $20,000 units )
Dependen t Life Pla n (Em ploye e Life Requ ired )
Employe e life CANNOT be adde d or incre ase d us ing this form. A se parate Life Insurance Application must be completed a nd a pproved to add or increas e life insurance cove rage.
Hea lthChoice Bas ic* or Bas ic Alternative (re fer to Option Pe riod materials )No change
Drop all health Hea lthChoice High* or High Alterna tive (re fe r to Option Period materials )
No changeDrop all de ntal
No cha nge
Drop a ll life insura nce
No changeDrop de pendent lifeAdd or incre ase to premier optionAdd or incre ase /decre as e to s ta nda rd option
SECTION A: EMPLOYEE INFORMATION SECTION B:
* 0 9 9 9 9 9 9 9 *
Decreas e total life ins ura nce to: $
Employe e prima ry de ntis t(prepaid only)
New pa tient Curre nt pa tie nt
Cigna De ntal Care Plan (Prepa id)
Delta De ntal PPO-ChoiceHea lthChoice Dental P lan
Ch eck a box to ADD o r CHANGE plan s :
Che ck a b ox to ADD or CHANGE p lans :
No changeDrop all vis ion
Che ck a b ox to ADD or CHANGE p lans :
Add or decreas e to low option
See ba ck o f fo rm fo r requ ired s ignatu re s and c hanges to dependen t cove ra ge .
The coverage be low reflects your m os t
I have added o r m ade c han ge s on the bac k o f th is form fo r my dependen ts .
A 1
ARTHUR WEASLEY
*OP2020*
cu rren t benefits in ou r s ys tem .
SECTION C: ALL CHANGES ARE EFFECTIVE J AN. 1, 2020
THE BURROWOTTERY S T CATCHP OLE FL 99999-9999
Entity: MINIS TRY OF MAGIC MIS US E OF MUGGLE ARTIFACTSMembe r ID: 09999999Birth Date : 2/6/1950Phone: 9999999999Alt Phone:Marita l S ta tus : MARRIED
Delta De ntal PPO
*Req u ires c o mple tion o f o n line To b a c c o-Fre e Atte s ta tion o r rea s o n a ble a lte rna tive .
Vis ion Care Dire ctVSP (Vis ion Service Pla n)
Hea lthChoice High Deductible Hea lth Plan
CommunityCare HMOGlobalHe alth HMO
Employee primary phys ician (HMO Only)New pa tient Current pa tient
Me tLife High Class ic MACMe tLife Low Cla ss ic MACSun Life Pre ferre d Active PPO
Employee s Group Insura nce Division
CURRENT EMPLOYEES2020 OPTION P ERIOD ENROLLMENT/CHANGE FORM
THIS FORM MUST BE RETURNED TO YOUR INSURANCE COORDINATOR
BlueLincs HMO
He a lth Aetna HMO (e nding 12/31/18)
De nta l Sun Life P re fe rred Active PP O
Vision Prima ry Vis ion Ca re Se rvice s
Life $500,000
Disa bilityHEA DEN VIS LIFE
MOLLY PREWETT 10/30/1949 X X X $20,000
CHARLES 12/12/1972 X X X $10,000
FRED 4/1/1978 X X X $10,000
GEORGE 4/1/1978 X X X $10,000
GINEVRA MOLLY 8/11/1981 X X X $10,000
P ERCY IGNATIUS 8/22/1976 X X X $10,000
RONALD BILIUS 3/1/1980 X X X $10,000
WILLIAM ARTHUR 11/29/1970 X X X $10,000
HARRY J AMES 7/31/1980 X X X $10,000
HERMIONE J EAN GRANGER 9/19/1979 X X X $10,000
Hea lth Plan
Den ta l P lan
Vis ion Plan
Prima ry Vis ion Ca re Service s (PVCS)Superior Vis ion
Em ploye e Life Plan
(Keep e mployee life in $20,000 units )
Dependen t Life Pla n (Em ploye e Life Requ ired )
Employe e life CANNOT be adde d or incre ase d us ing this form. A se parate Life Insurance Application must be completed a nd a pproved to add or increas e life insurance cove rage.
Hea lthChoice Bas ic* or Bas ic Alternative (re fer to Option Pe riod materials )No change
Drop all health Hea lthChoice High* or High Alterna tive (re fe r to Option Period materials )
No changeDrop all de ntal
No cha nge
Drop a ll life insura nce
No changeDrop de pendent lifeAdd or incre ase to premier optionAdd or incre ase /decre as e to s ta nda rd option
SECTION A: EMPLOYEE INFORMATION SECTION B:
* 0 9 9 9 9 9 9 9 *
Decreas e total life ins ura nce to: $
Employe e prima ry de ntis t(prepaid only)
New pa tient Curre nt pa tie nt
Cigna De ntal Care Plan (Prepa id)
Delta De ntal PPO-ChoiceHea lthChoice Dental P lan
Ch eck a box to ADD o r CHANGE plan s :
Che ck a b ox to ADD or CHANGE p lans :
No changeDrop all vis ion
Che ck a b ox to ADD or CHANGE p lans :
Add or decreas e to low option
See ba ck o f fo rm fo r requ ired s ignatu re s and c hanges to dependen t cove ra ge .
The coverage be low reflects your m os t
I have added o r m ade c han ge s on the bac k o f th is form fo r my dependen ts .
A 1
ARTHUR WEASLEY
*OP2020*
cu rren t benefits in ou r s ys tem .
SECTION C: ALL CHANGES ARE EFFECTIVE J AN. 1, 2020
THE BURROWOTTERY S T CATCHP OLE FL 99999-9999
Entity: MINIS TRY OF MAGIC MIS US E OF MUGGLE ARTIFACTSMembe r ID: 09999999Birth Date : 2/6/1950Phone: 9999999999Alt Phone:Marita l S ta tus : MARRIED
Delta De ntal PPO
*Req u ires c o mple tion o f o n line To b a c c o-Fre e Atte s ta tion o r rea s o n a ble a lte rna tive .
Vis ion Care Dire ctVSP (Vis ion Service Pla n)
Hea lthChoice High Deductible Hea lth Plan
CommunityCare HMOGlobalHe alth HMO
Employee primary phys ician (HMO Only)New pa tient Current pa tient
Me tLife High Class ic MACMe tLife Low Cla ss ic MACSun Life Pre ferre d Active PPO
Employee s Group Insura nce Division
CURRENT EMPLOYEES2020 OPTION P ERIOD ENROLLMENT/CHANGE FORM
THIS FORM MUST BE RETURNED TO YOUR INSURANCE COORDINATOR
This publication was printed by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. 500 copies have been printed at a cost of $2.30. A copy has been submitted to
Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62 O.S. 2012, § 34.11.3). This work is licensed under a Creative Attribution‐NonCommercial‐NoDerivs 3.0
Unported License.
EGID Life Premium Chart for Current Employees Jan. 1 through Dec. 31, 2020
The coverage levels and monthly premiums listed below include Basic Life.
*Chart based on member's age as of Jan. 1, 2020.
**Basic Life must be purchased before Supplemental Life coverage is available.
Option Period Material
This publication was printed by the Offic
e
of Ma nageme nt and En t er pr ise Ser vi ces as aut hor ized by Title 62, Section 34. 1,000 copies have been printed at a cost of $39.60. A copy has been submitted to Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62 O.S. 2012, § 34.11.3). This work is licensed under a Creative Attribution-NonCommercial-NoDerivs 3.0 Unported License.
4017
Annual Option PeriodDuring the annual Option Period, you may change or enroll in:
Health coverage.Dental coverage.Vision coverage.Life insurance coverage.(A life insurance application is required.)
Please contact your insurance coordinator for procedures, deadlines and forms.
Your IC is:
Phone number:
Complete forms and return to the IC by:
PRESENTATION DATES ENROLLMENT DATES
This publication was printed by the Offic
e
of Ma nageme nt and En t er pr ise Ser vi ces as aut hor ized by Title 62, Section 34. 1,000 copies have been printed at a cost of $39.60. A copy has been submitted to Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62 O.S. 2012, § 34.11.3). This work is licensed under a Creative Attribution-NonCommercial-NoDerivs 3.0 Unported License.
4017
Annual Option PeriodDuring the annual Option Period, you may change or enroll in:
Health coverage.Dental coverage.Vision coverage.Life insurance coverage.(A life insurance application is required.)
Please contact your insurance coordinator for procedures, deadlines and forms.
Your IC is:
Phone number:
Complete forms and return to the IC by:
PRESENTATION DATES ENROLLMENT DATES
3
Important Dates
Start Stop
Web enrollment Sept. 19 Nov.8
Life insurance applications Sept. 19 Oct. 31
Paper forms — Oct. 31
Employee meetings Sept. 27 Oct. 31
Option Period Information
OMES Website
• Find us on our website – it’s easy.
• Go to omes.ok.gov.
• Select Services from the top menu.
• Select Employees Group Insurance Division.
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IC Responsibilities
• Set your Option Period deadline.
• Schedule employee Option Period meetings.
• Know the benefits available to your employees.
• Communicate Option Period deadlines with your employees.
• Send the Summary of Benefits and coveragenotification.
• Generate pre‐bill for 2020.
Option Period Reminders• This is the time when eligible employees can enroll, add or drop family members, and change or drop coverage.
• Employees receive Option Period Enrollment/Change Forms.
• If no changes are made, EGID does not need the form. You may keep a copy for your records.
• Take time to verify your mailing and email addresses.
Confirmation Statement• Employees are mailed a confirmation statement when they enroll or make changes.
• Includes:— Coverage changes.— Effective date.
— Premium amounts.
• Employees who do not make changes are not mailed a statement.
• Employees should verify coverage and contact you if their statement is incorrect.
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Life, Health, Dentaland Vision Plans
Life Insurance
• Employees can enroll.— During Option Period.
—Within 30 days of a midyear qualifying event.
—Within 30 days of the loss of other group life coverage.
• Employees can apply to increase Supplemental Life up to a maximum of $500,000 with a life insurance application.
• Employees can add or increase Dependent Life coverage.
• Encourage employees to update their beneficiary designation.
DeadlineOct. 31
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Health Plans
Health Carriers Offered for 2020
• BlueCross BlueShield of Oklahoma.• CommunityCare.• GlobalHealth.• HealthChoice.• Selman & Company (TRICARE Supplement).
Note: Aetna will not be available for 2020.
Plan ChangesSelectedBenefit Changes
Premium Changes
BCBSOK – BlueLincs HMO Yes Yes
CommunityCare HMO No Yes
GlobalHealth HMO Yes Yes
HealthChoice Yes Yes
TRICARE Supplement No No
Value‐added benefits (required for PY2021): CDC‐Recognized National Diabetes Prevention Program and bariatric surgery.
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Plan ChangesSelected Benefit Changes
BCBSOK –BlueLincs HMO
• Diabetes Prevention Program – Covered at 100%.• Bariatric Surgery – $250 per day, $750 maximum
per admission.
GlobalHealth • There is no longer a separate physician cost‐share for inpatient, outpatient and emergency room stays.
• Hospital inpatient, mental health and substance abuse inpatient – $300/day up to $900/stay.
$400 non‐preferred.• Diabetes Prevention Program – $0.• Bariatric surgery – $300/day up to $900/stay.
HealthChoice • Addition of nationally recognized CDC‐approved Diabetes Prevention Program.
All Health Plans Include:• Out‐of‐pocket maximums.• Prescription drug benefits.• Designated provider networks.• Preventive services.• No pre‐existing condition exclusions.• Coordination of benefits.• Coverage of emergency care.
Some Health Plans Have:• Calendar‐year deductibles.• Referral process for specialist visits.• Preauthorization requirement for certain
medical services.
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All HMO Plans Have:• No deductibles.• No coinsurance.• No balance billing.• A requirement that a primary care physician
be selected.• ZIP code service area – live or work.
Health Plan Presentations
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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BlueLincs HMO
At least
SM
ZEROCost For
DeductibleCo-InsurancePrimary Care Physician Visits
Home Health VisitsRoutine Lab & X-RaysDiabetes Prevention Program
Preventive Health ServicesPreferred Generic Drugs Maternity Care
$0 Copay For
Network
Largest HMO network in Oklahoma
Coverage in all 77 counties
No referrals required within HMO network
Health & Wellness
Diabetic prevention and management
Health and nutrition management
Fitness program discounts
Well onTarget®
Customer Resources
24/7 Availability
Blue Access for Members SM
(BAMSM)
20% lower20% lowerthan other
HMO Options
www.bcbsok.com/state
More Information About BlueLincs HMOSM
Customer Service:1-855-609-5684
Operating Hours:24 hours a day, 7 days per week
State of Oklahoma Employees Website:
- Find a doctor- Check prescription drug coverage- Log into Blue Access for MembersSM (BAMSM)
State, Education & Local Government2020 Active & Pre-Medicare Benefits
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2020 Provider Network
The State network includes Saint Francis and St. John Health Systems in Tulsa, Broken Arrow, Owasso, Sapulpa, Bartlesville, Nowata, Muskogee and Vinita. There are other network providers that are affiliated with 12 other hospitals throughout northeastern Oklahoma.
Multifaceted coordination with focus on compliance and control of complex high risk conditions.
Owner systems EMR (Electronic Medical Record) accessible to providers across the spectrum of care.
Premier facilities that offer full continuum of care.
2020 Health Plan Overview
No Deductible
Out‐of‐Pocket Maximum: $4,000 Individual /$8,000 Family
Office Visit: $35 PCP / $50 Specialist Copay (no referral)
Preventive Care: $0 Copay
Diagnostic Lab & X-ray: $0 Copay
Emergency Room: $200 Copay
Urgent Care: $50 Copay
Outpatient Surgery: $300 Copay
Inpatient Hospital: $350 Copay/Day (max $1,750 per admit)
2020 Pharmacy Benefit Overview
Prescription Copays: $15 Preferred Generic
*$40 Preferred Name Brand
*$70 Non‐Preferred
*$160 Specialty
Mail Order: CVS Caremark & AllianceRx Walgreens Prime– (90 day supply)
$0 Copay Program: Select Generic Medications
Blood Pressure
Cholesterol
Anti‐Depressants
Anti‐Inflammatory
* If generic equivalent is available, you’ll pay the copayment plus the difference in cost between the brand name drug and its generic equivalent. The difference in cost will not count toward your annual out‐of‐pocket maximum.
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Value Added Services
CommunityCare continues to maintain a custom website just for
State, Education & Local Government employees! state.ccok.com
• View benefits, providers & formulary guide
• Log in to the Member Connection
View and print your EOB’s
View claim history & out‐of‐pocket
Print temporary ID cards
Order replacement ID cards
2020 Reminders
The pharmacy network includes CVS, Target, Walgreens, Walmart, Sams Club, Costco, Reasor’s and other local pharmacies.
24/7 Nurse Line Including weekends and major holidays. Registered nurses are
standing by on the telephone with confidential medical advice.
COB (Coordination of Benefits) Notices Sent around March 1st.
Every Member of the family can choose a different PCP. Call Customer Service to change primary care doctors.
All members will receive new ID cards.
2020
Fewer expenses. Greater care. Less worry.
Your Health Plan Should Cover What Matters
16Continuous years
serving State of Oklahoma employees and educators
Offered in all 77counties in Oklahoma
MPP 2020 MLGMH20-ST
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Unlimited $0 Primary Care
Physician Visits
Zero Deductibles
$25 Urgent Care Copay
$500 Maternity Delivery Copay
GlobalFit®
Gym Membership Discounts
$10 Tier 1 Generics
for a 30 day supply
Three-month prescriptionfor 2 copays for most
prescriptions.
We help you stay ahead of whatever life throws your way with:
For complete listing of plan benefits and administration go to our website www.GlobalHealth.com/state/member-materials/.
Specialty Scans:• $250 each in a preferred facility• $750 each in a non-preferred facility
Outpatient Surgery:• $300 each in a preferred facility• $800 each in a non-preferred facility
Inpatient Hospital:• $300 per day;
$900 maximum per admission
$10 X-Rays & Lab Copay
$35 Physical Therapy Copay
$50 Specialist Visits
2017
“I am blessed to know the sweet people at GlobalHealth. It’s like a gift from heaven. I love the whole GlobalHealth team. GlobalHealth is the best insurance I’ve had in my 8 decades of life, and so are all the sweet workers. I LOVE GLOBALHEALTH!”Ruth O. GlobalHealth Member
“I recently called GlobalHealth to speak to someone about my behavioral health benefits. I was very pleased with how kind, compassionate and knowledgeable she was in helping me with my benefits. I love how GlobalHealth takes care of and values their members!”Brenda R. GlobalHealth Member
“When I learned I was diagnosed with Ovarian Cancer, the last thing I wanted was to go through it alone. My GlobalHealth case manager was by my side from the very beginning till the end of all my treatments. And I still talk to her weekly! GlobalHealth provided me with the peace of mind knowing that all I need to do is focus on healing.”Cynthia B. GlobalHealth Member
Choose a plan that puts its members first
Provider Networkas of August 2019
Tulsa Area● Harvard Family Physicians.● Utica Park Clinic Physician Group.● Hillcrest Medical Center.● Hillcrest South Hospital.● Hillcrest Hospital Claremore.● Hillcrest Hospital Pryor.● Tulsa Spine & Specialty Hospital.● Oklahoma Heart Institute.● Oklahoma Surgical Hospital.● OSU Medical Center.● OSU Physicians.● Bailey Medical Center, Owasso.● Oklahoma Spine and Brain
Institute.● McAlester Regional Health Center.
Oklahoma City Area● Centennial Health.● Mercy Hospital.● Mercy Primary Clinics.● Integris Baptist Medical Center.● Integris Health Edmond.● Integris Southwest Medical Center.● Integris Primary and Specialty Care
Clinics.● Integris Deaconess Hospital.● Oklahoma Heart Hospitals (North &
South).● Bone and Joint Hospital at St. Anthony.● St. Anthony Hospital.● Variety Care Clinic.● Lakeside Women’s Center of Oklahoma.
This is not a full list of providers. Other providers are available in our network. The provider network may change at any time. You will receive notice when necessary. To see if your local provider or hospital is in network, visit www.GlobalHealth.com/search or call Customer Care at 1-877-280-5600.
Out-of-network care is not covered except for emergency or urgent care.
We offer a Medicare Advantage plan for State of Oklahoma retirees. If you are a state of Oklahoma Retiree, call us today or visit
www.GlobalHealth.com/osr to learn more about this plan.
• HealthChoice High – Lowest deductible and out-of-pocket maximum and simple office visit copays.
• HealthChoice Basic – First-dollar benefit and no office visit copays . • High and Basic members who cannot attest as tobacco free or meet one
of the reasonable alternatives will automatically be enrolled in the High Alternative or Basic Alternative plans. The Alternative plans have a deductible that is $250 higher.
• High Deductible Health Plan – Lowest premium, combined medical and pharmacy expenses apply to deductible and it works with an HSA.
Network pharmacy benefits available on all plans with simple copays after deductible .
• $1,750 individual.• $3,500 family.• Combined medical
and pharmacy.• Out-of-pocket:
• $6,000 individual.• $12,000 family.
• After deductible, plan mirrors HealthChoice High plan.
• No referrals needed. • 10,000 network providers and facilities. • Access to Select networks. • Non-network services available. • Value-added services.
Easy to Use Benefits
• Bariatric services.• HealthChoice Select. • Care Management.• Telemedicine.• Complex Care Program.
Value-added Services
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• Several procedures available.• Must be on HealthChoice for 12 months.• Five convenient locations.• Subject to deductible and copays.
Bariatric Surgery
Select Program
Select is available to all HealthChoice plans.• 100% of certain services and procedures.• No out-of-pocket costs for members of the
HealthChoice High, High Alternative, Basic and Basic Alternative Plans.
• No out-of-pocket costs for members of the HealthChoice High Deductible Health Plan after deductible is met.
• Learn what procedures are covered at 100% by going to the Select webpage on www.healthchoiceok.com.
Care Management Program
Care Management and Care Coordination are available to all HealthChoice members. A dedicated care coordination team is waiting to provide assistance in coordinating health care needs of members and will:
• Assist with where and when to seek medical care.• Assist with understanding medications.• Assist when transitioning home.• Identify and contact members with care gaps – preventive care and
medication adherence. • Ensure members are comfortable in their understanding of directions given
at doctor’s office or hospital.
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• Program provides treatment and care of serious, rare or complicated conditions.
• You will be contacted directly if identified with:• Multiple health issues.• Rare medical issues.• Health problems that remain unresolved.
Complex Care Program
COMING in 2020!
• Available 24/7/365. • Basic physician services. • Secure. • User-friendly.• Unlimited, immediate and
easy access.
Telemedicine
HealthChoice Connect: Member Self-service Portal
Your online source for:
• Access to claims history.• Benefit information.• Update annual Verification of Other Insurance Coverage.• Ability to order ID cards.• Review out-of-pocket amounts.
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Tobacco-Free Attestation
• Must complete online HealthChoice Tobacco-Free Attestation for Plan Year 2020 to remain in High or Basic plan.
• HealthChoice waives the attestation the first year of enrollment in High or Basic plan but requires it each year thereafter.
• Does not apply to HealthChoice High Deductible Health Plan.
• Deadline to complete the attestation is Nov. 8, 2019.
New for 2020: Complete the HealthChoice Tobacco-Free Attestation and update the annual Verification of Other Insurance Coverage at the same time!
Dental Plans
• Cigna.• Delta Dental.• HealthChoice.• MetLife.• Sun Life.
Dental Carriers for 2020
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Plan Renewals
Premium Changes
Cigna Dental Care Plan (Prepaid) No
Delta Dental PPO Yes
Delta Dental PPO – Choice No
HealthChoice Dental Yes
MetLife High Classic MAC Yes
MetLife Low Classic MAC Yes
Sun Life Preferred Active PPO Yes
Note: There were no changes in suppliers, plans or benefits from 2019.
All Dental Plans Include:
• Preventive care.• Basic care.• Major care.• Orthodontic care.
Dental Plan Presentations
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YOUR DENTAL PLAN OPTIONS
Plan year: Jan. 1, 2020 –Dec. 31, 2020
862420 b
Offered by Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.
A plan where one dentist coordinates your care within a networkthat provides general and specialty dental care
• You choose a primary care dentist in the DHMO network where you can receive all your care
• By using dentists in the DHMO network you may pay less than you would with other types of dental plans
• You pay an office visit fee and the charge listed on your Patient Charge Schedule
• There is no out-of-network coverage (except in emergencies)**
• There are no deductibles and no annual dollar maximums
Cigna Dental Care® Dental Health Maintenance Organization (DHMO*)
DHMO
Preventive care, such as cleanings and exams, at no added or low cost
Additional cleanings, fluoride, and fluoride varnish available for a copay
Temporomandibular joint (TMJ) diagnosis
General anesthesia/IV sedation when medically necessary
Coverage for brush biopsy, a noninvasive diagnostic procedure for detecting oral cancer
Coverage for teeth whitening (take-home bleaching gel with trays) and athletic mouth guards
No age limit on sealants
Coverage for advanced procedures like crowns and bridges over implants
Second opinions covered
Emergency care
Orthodontic coverage for children AND adults
DENTAL:DHMOCoverage with no deductibles or waiting periods
Examples of covered services*
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Cigna Dental Oral Health Integration Program®
Dental Services Heart Disease
Stroke Diabetes MaternityChronic Kidney Disease
Organ Transplants
Head and neck cancer
radiation
Periodontal treatment and maintenance (D4341, D4342, D49101)
Periodontal evaluation (D0180)
Oral evaluation (D01202, D01402, D01502)
Cleaning (D11103)
Emergency palliative treatment (D91104)
Topical application of fluoride and topical application of fluoride varnish (D12065)
Topical application of fluoride – excluding varnish (D12085)
Sealants (D13515)
Sealant repair – per tooth (D13535)
Available to ALL Cigna Dental customers with qualifying condition(s)
Articles on behavioral issues linked to oral health
40% off* average retail prices on certain prescription dental products*
More programs More wellness More discounts
1. Four times per year.2. One additional evaluation.3. One additional cleaning
4. No limitations.5. Age limits removed, all other limitations apply.
PROGRAMS & SERVICES
By phone – 800.244.6224
• Call anytime day or night for live customer service
• Ask for a Spanish-speaking representative or speak with us in your preferred language – interpreter service is available in over 200 languages
• Get help finding a dental office
• Check your eligibility
We’re here 24/7/365
myCigna – online or through the mobile app
• Review your plan information and check a claim status
• Find network dentists
• Print temporary ID cards
• Change your DHMO dental office*
• View year-to-date dental costs and estimate approximate costs prior to treatment
• Take oral health assessments that you can share with your dentist
TOOLS & RESOURCES
Download the myCigna Mobile App*** for easy access on the go!
Dentists who participate in Cigna’s network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. The information in thispresentation summarizes the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see youremployer’s plan booklet, evidence of coverage, insurance certificate, or summary plan description – the official plan documents. If there are any differences between theinformation in this presentation and the plan documents, the information in the plan documents takes precedence.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Cigna Dental Care (DHMO) plans are insured by CignaDental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Healthof Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NB), CignaDental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna DentalHealth of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health ofVirginia, Inc. In other states, Cigna Dental Care plans are insured by Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company(CGLIC), or Cigna HealthCare of Connecticut, Inc., and administered by Cigna Dental Health, Inc. Cigna Dental PPO plans are insured or administered by CHLIC or CGLIC,with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice,and this plan uses the national Cigna DPPO network. Policy forms: OK - Dental Indemnity/PPO: HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); DHMO: HP-POL115(CHLIC), GM6000 DEN201V1 (CGLIC); TN – Dental Indemnity/PPO: HP-POL69/HC-CER2V1 et al, DHMO: HP-POL134/HC-CER17V1 et al (CHLIC). The Cigna name, logo,and other Cigna marks are owned by Cigna Intellectual Property, Inc.
Minnesota Residents: When enrolling in a DHMO plan, you must visit your selected network dentist in order for the charges on the Patient Charge Schedule to apply. You may also visit other dentists that participate in our network or you may visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist’s usual fee. We will pay 50% of the value of your network benefit for those services. You’ll pay less if you visit your selected Cigna Dental Care network dentist. Call Customer Service for more information.
Oklahoma Residents: DHMO for Oklahoma is an Employer Group Pre-Paid Dental Plan. You may also visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist’s usual fee. We pay non-network dentists the same amount we’d pay network dentists for covered services. You’ll pay less if you visit a network dentist in the Cigna Dental Care network. Call Customer Service for more information.
DHMO for residents of Minnesota and Oklahoma
2020 Dental Benefits Optionsfor State, Education & Local Government Employees
We Deliver a Superior Customer Experience
DDOK does not denycoverage due topre-existing conditions
No waiting periods before you can begin receiving treatment
Our coverage includes replacement of a missing
tooth, even if it was lost prior to your DDOK coverage
We allow benefits for comprehensive orthodontic cases, even if treatment was
started prior to DDOK coverage
Overall member satisfaction rating – and percentage of inquiries (calls) resolved
during initial contact
22
We Deliver the Largest Network of Dentists
Our unmatched network strength meansyour dentist likely participates with Delta Dental –ask if your dentist is a Delta Dental PPO providerto enjoy maximum savings!
Oklahoma’s Largest Dental
Network
NationwideAccess
Nearly 1,800 dentists practice in the state, and more than 1,100 of those dentists participate in Delta Dental’s PPO network.
Option 1: Delta Dental PPO*
**DEPENDENTS ELIGIBLE TO AGE 26
†If you receive treatment from a Delta Dental Premier provider, you will be responsible for the difference between the PPO allowable and Premier allowable amounts. If you are treated by a dentist who does not participate with Delta Dental (out‐of‐network), you will be responsible for the difference between the dentist charge and the PPO allowable amount.
Example
This plan option provides access to both the Delta Dental PPO and the Delta Dental Premier networks. Subscribers of this plan are welcome to receive treatment from the licensed dentist of their choice, but will have lower out-of-pocket expenses when they visit a Delta Dental PPO participating dentist.
Payment of a covered Class II dental service**
Option 1: Delta Dental PPO
**Assumes deductible is satisfied
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Members who select this low-cost program have access to the Delta Dental PPO network and will be responsible for the amounts reflected in the Delta Dental PPO – Choice Description of Covered Services and Enrollee Co-payments table along with any deductible. Their out-of-pocket expenses will be lower if they use a Delta Dental PPO provider.
EXAMPLES OF COVERED SERVICES & ENROLLEE CO-PAYMENTS
*Assumes deductible is satisfied
Option 2: Delta Dental PPO – Choice**
**DEPENDENTS ELIGIBLE TO AGE 26
To learn more about the plans and services available to you with Oklahoma’s leading dental benefits provider, please visit DeltaDentalOK.org/client/OK
Review Plan Information
Search for Participating Dentists
Access Monthly Health Tip
Learn Answers to FAQs
Register for Spotlight to access:‒ electronic ID card‒ plan information,
including Explanation of Benefits (EOBs)‒ claim status and history, and more!
We would welcome the opportunity to serve you and your family in 2020. Please do not hesitate to contact us with any questions.
Live Answer Customer Service
DeltaDentalOK.org/client/OK
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Dental PlanThePlanofChoice
When using a network provider:• Preventive care is covered at 100%.• A$25 deductible applies to basic and major
care. • After the deductible, you pay:
— 15% for basic care.— 40% for major care.
• Orthodontic care is covered at 50%.— No calendar year or lifetime maximum.— A 12-month waiting period applies.
• $2,500 calendar year maximum benefit for all other services.
Dental Plan
• You have the option to see any dental provider you choose, network or non-network.
• Using a network provider will provide you a higher level of benefit.
• Network providers will not balance bill.• Find a network provider on healthchoiceok.com under Find a
Provider.
Dental Plan Providers
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Covered services include:• Cleanings.• Bitewing X-rays, routine oral examinations (2 times per year).• Full mouth X-rays (1 time per 36 months).• Topical fluoride treatments (2 times per year).• For more covered services refer to the HealthChoice Dental
Plan handbook.
Preventive Services
Covered services include:• Extractions, including wisdom teeth.• Oral surgeries.• Composite filling restorations.• Endodontic treatments. • For more covered services refer to the HealthChoice Dental
Plan handbook.
Basic Restorative Services
Covered services include:• Initial placement of dentures.• Dental implant systems.• Inlays.• Onlays.• Restorations. • For more covered services refer to the HealthChoice Dental
Plan handbook.
Major Restorative Services
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Covered services include:• Orthodontic services for members under age 19.• Orthodontic services for treatment of TMD for members at any
age (certification required). • Molar uprighting. • For more information on orthodontic services refer to the
Choice of the dental plan that’s right for you based on your needs and budget: High Classic MAC Plan – Highest PPO benefit levels ($5,000 annual maximum and
lifetime adult orthodontia of $2,000) Low Classic MAC Plan – Competitive premiums (less than $340/year for EE only)
No cost for in-network cleanings, x-rays and exams1
No waiting periods, including for Orthodontia
* Savings from a MetLife Dental plan near Oklahoma City and Tulsa as compared to the cost of not having insurance** These are hypothetical examples only. Actual costs and savings may vary
State of Oklahoma employees and educators
1 Subject to frequency limitations2 Based on MetLife data. Negotiated fees refers to the fees that in‐network dentists have agreed to accept as payment in full for covered services, subject to any co‐payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.3 Savings from enrolling in a MetLife Dental Plan featuring the Preferred Dentist Program will depend on various factors, including the cost of the plan, how often participants visit the dentist and the cost of services rendered.* Savings calculations based on analysis of 2019 claims information, comparing participating dentists’ reported usual charges for services to negotiated fees for those same services**Please note: These are hypothetical examples. They assume services are performed by an in‐network dentist, that the annual deductible has been met and annual maximums have not been reached. Fees and savings in your area may be different. .
To use the MetLife mobile app, employees can choose to register at metlife.com/mybenefits from a computer or directly through the app. (Certain features of the MetLife Mobile App are not available for all MetLife Dental Plans)
Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, limitations, reductions, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.
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SLPC 27622
GVMPPPT-EE-4496B
Dental Coverage Overview
• Calendar Year Maximum (type I, II, and III) = $2,000 per person
• Ortho Maximum = $2,000 lifetime per child under age 19
SLPC 27622
DENTAL INSURANCE
Procedure Type In-Network Out-of-Network
I - Preventive Services 100% 100%
II - Basic Services 85% 70%
III - Major Services 60% 50%
IV - Ortho Services 60% 50%
GVMPPPT-EE-4496B
Network dentists can save you* $$
You could save $171 by going to a network dentist!!
SLPC 27622
DENTAL INSURANCE
Example Network dentist Non-Network dentist
Average charge for crown** $1,145 $1,145
Minus network discount 30% NA
Actual Fee $802 $1,145
Insurance pays 50% $401 $573
Claimant pays $401 $572
*This example is for illustrative purposes only. Cost of dental procedures may differ depending on location or dental provider. Savings may also differ in cases when deductibles apply or if the dentist’s discount differs from 30%
**Based on 2017 Sun Life claims data. Figures have been rounded to the nearest dollar.
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GVMPPPT-EE-4496B
How to find a dentist
• Visit www.sunlife.com/findadentist
– Select Sun Life Dental Network®, the PPO network for your plan
– Enter your search criteria and a list of participating dentists will be provided
• Call customer service at 800-442-7742 for assistance in locating a network dentist
• Use the Provider nomination card if your dentist is not in our network of dentists
SLPC 27622
DENTAL INSURANCE
GVMPPPT-EE-4496B
Questions?
GVMPPPT-EE-4496B
The Sun Life Financial group of companies operates under the “Sun Life Financial” name. In the United States and elsewhere, insurance products are offered by members of the Sun Life Financial group that are insurance companies. Sun Life Financial, Inc., the publicly traded holding company for the Sun Life Financial group of companies, is not an insurance company and does not guarantee the obligations of these insurance companies. Each insurance company relies on its own financial strength and claims-paying ability.
Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 93P-LH, 98P-ADD, 07-SL REV 7-12, 07P-LH-PT/07C-LH-PT, 01P-ADD-PT/01C-ADD-PT, GP-A, GC-A, 12-GP-01, 15-GP-01, 12-DI-C-01, 16-DI-C-01, 13-SD-C-01, 13-SDPort-C-01, 12-AC-C-01, 12-ACPort-C-01, 16-AC-C-01, 16-ACPort-C-01, 13-ADD-C-01, 13-ADDPort-C-01, 15-ADD-C-01, 12- GPPort-P-01, 12-STDPort-C-01, 16-SD-C-01, 16-SDPort-C-01, 16-CAN-C-01, 16-CANPort-C-01, 15-LF-C-01, 15- LFPort-C-01, 16-DEN-C-01, 16-VIS-C-01, TDBPOLICY-2006, and TDI-POLICY. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 15-GP-01, 13-GP-LF-01, 13-LF-C-01, 13-GP-LH-01, 13-ADD-C-01, 12-DI-C-01, 16-DI-C-01, 13-LTD-C-01, 13-STD-C-01, 06P-NY-DBL, 07-NYSL REV 7-12, GC-A, GP-A, 12-GP-SD-01, 13-SD-C-01, 13-SDPort-C-01, 12-GP-01, 12- AC-C-01, 12-ACPort-C-01, 12-GPPort-01, 13-LFPort-C-01, 13-ADDPort-C-01, 15-LF-GP-01, 15-SD-GP-01, and 12- STDPort-C-01. Product offerings may not be available in all states and may vary depending on state laws and regulations. The group insurance policies described in this advertisement do NOT provide basic hospital, basic medical, or major medical insurance.
• Superior Vision.• Vision Care Direct.• VSP (Vision Service Plan).
Vision Carriers Offered for 2020
Plan RenewalsPremium Changes
PVCS Yes
Superior Vision No
Vision Care Direct No
VSP No
Note: There were no changes in suppliers, plans or benefits from 2019.
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All Vision Plans Include:• Coverage for exams, lenses, frames, contact lenses andmore.
• Designated provider networks.
• Limited coverage for services by non‐network providers.
Laser Vision Correction
An Oklahoma Vision Care Company
www.pvcs-usa.com | 888-357-6912
Comprehensive Continuous Coverage with PVCS
*Wholesale cost is the manufacturers published list price plus tax and shipping rounded up to the nearest $5. It is roughly 50% less than retail prices.
PVCS BENEFITS
EXAMS
• $0 COPAY
• Not limited to once a year
FRAMES
• Member pays “Wholesale Cost*” for Frames
LENSES
• Member pays “Wholesale Cost*” for prescription lenses and lens options
CONTACT LENSES
• Member pays “Wholesale Cost*” for Contact lenses
• Copay for 1st time fittings
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• Over 350 Independent Optometrists and Ophthalmologists
• All Providers dispense glasses and contacts
• Glasses can be made at the lab of their choice, including their own lab resulting in quick delivery
Our Network
An Oklahoma Vision Care Company
www.pvcs-usa.com | 888-357-6912
Network Benefits
• No ID Cards required
• Simply select a PVCS Provider and identify yourself as a PVCS Member
• Eye Exams are covered 100% and not limited to once a year
• Members are eligible for Glasses and Contact lenses in the same plan year
• Get as many pairs of Prescription Glasses as you want or need
• Prescription Glasses and Contact lenses are provided at “Wholesale Cost”
Non‐Network
• Customer Service: 888‐357‐6912
• Website: www.pvcs‐usa.com
• Email: email@pvcs‐usa.com
An Oklahoma Vision Care Company
www.pvcs-usa.com | 888-357-6912
Lasik
• Save up to $1000 on Lasik with PVCS and nJoy Vision in Oklahoma City and Tulsa!
Questions?
• Non‐Network reimbursement up to $40 for an eye exam and up to $60 for prescription glasses or contact lenses in lieu of Network Benefits.
33
Join us online or give us a call
• Website: superiorvision.com
• Phone: 1 (800) 507-3800
• Live support:
Monday – Friday: 8 a.m. to 9 p.m. CST
Saturday: 10 a.m. to 4:30 p.m. CST
• Benefit information
• Eligibility status
• Claims information
• Provider listings
• Assistance with issues and special requests
We have answers!Have questions?
34
100
Members can easily find a provider online
Members can:
• Get directions
• Call the provider
• Determine services offered
• See languages available
101
Your mobile app is also ready to helpIt’s easy to use and highly rated
View vision benefitsReview your vision benefits and eligibility information for yourself and for any dependents.
Create an online accountLog in with the same username and password as superiorvision.com, or create a new account in the app.
Locate a vision providerFind a vision provider in your network, call the provider, visit their website and even get directions
Display member ID cardView your member ID card full screen, print and email it.
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SIMPLE. FLEXIBLE.AFFORDABLE
2020 VISION PLAN OFFERING
LOCALLY OWNED AND OPERATED
Local Customer ServiceTax Revenue Stays LocalSupports TeachersDoctor Controlled CarePatient Focused
OklahomaProud
FOCUSED ON YOU
$15 MEMBER FEE $15 MEMBER FEE $0 MEMBER FEE
GLASSESEYE EXAMS CONTACTS
Comprehensive Eye HealthEarly Disease Detection
ANY Frame$130 Allowance
$130 Allowance
36
2020 Plan Improvements
• Over 100 New Plus Plan Providers
• Eyemart Express, Pearl Vision and more
• No Premium Increase
• Conquering Out-of-Pocket costs
Don’t break the bank!
Supercharge Your VCD Plan
BENEFITS INCLUDED
FRAME/CONTACTS Up to $130
LENSES
Single Vision
Bifocal
Trifocal
EXTRAS
HD Polycarbonate
Anti-Reflective Coating
Scratch Resistance
UV Protection
Oil & Water Repellent
Progressive (No-Line)
Get access to PLUS Plan FREE Upgrades by visiting any one of our VCD PLUS doctors!
Look for this logo when searching for a provider!!
Your VSP Vision BenefitsMembers First,Members for Life
WHY CHOOSE VSP?
Low out of pocket costs Quality care.64 years of helping peoplesee well and stay healthy
More choices.Nationwide network of
more than 38,000 providers
88 millionmembers nationwide
Providing no-cost eye care through Eyes of Hope®
Great value!VSP® is consumers’ #1choice In vision care2
1. VSP insurance plans have exclusions and limitations. For costs and complete details of the coverage, contact VSP at 800.877.7195.2. National Vision Plan Member Study, 2017.
VSP Plan at a glance
Exam • WellVision Exam covered every calendar year $10 Copay
Frame Allowance $170 Frame allowance every calendar year + extra $50 allowance for featured frame brands.
Lenses(every calendar year)
• Single vision, lined bifocal or lined trifocal lenses for adults. $25 Copay included in glasses. • Single vision, lined bifocal or lined trifocal polycarbonate lenses for children. $25 Copay included in glasses.
Lens Enhancements• Standard Progressive lenses covered with $0 copay• 20‐25% savings on lens enhancements–Scratch‐resistant, UV, Anti‐reflective coating
Contact Lens Allowance(in lieu of glasses)
$120 allowance for contacts lenses and copay up to $60 for contacts lens exam (fitting and evaluation)
Diabetic EyecarePlus Program
Services related to diabetic eye disease glaucoma, and age‐related macular degeneration. $20 Copay
Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam.
Your Monthly Contribution$8.72 Member only, $14.50 Member + spouse, $14.42 Member + child, $20.20 Member + spouse + child, $21.20 Member + 2 or more children, $26.98 Member + spouse + 2 or more children
38
Premier Program Savings
Save even more and get more through extra offers, like additional savings on frames, lenses, and contacts that are exclusive to Premier Program locations.
Access to exclusive Bonus Offers
A wide selection of featured frame brands¹
Eyewear protection warranty
The latest in performance lenses
An advanced eye exam
Participation in the VSP preventiveeye health and wellness program
Eyeconic.com
Eyeconic is the only place whereVSP members can shop online for contacts and eyewear with theirVSP insurance in-network.
Personalized: As a VSP-owned company, Eyeconic seamlessly connects VSP vision benefits to your account.
Simple: Save time and money on quality eyewear with a few easy clicks.
1. Connect your vision insurance.
2. Select your product.
3. Upload your prescription or provide your doctors contact information and we’ll take care of the rest.
Choice: Eyeconic offers a variety of well-known brands and contact lenses. Choose from over 35 eyewear brands and over 1600 styles.
Exclusive Member Extras
Big Value. More Saving with VSP Vision Care.
With Exclusive Member Extras, savings never looked so good. VSP puts members first by providing you with exclusive special offers. Discover great deals on glasses, sunglasses, contact lenses, and more.
Special Deal on Glasses —Extra $50 on Featured Frame Brands
Save 25-40% on popular lens enhancements
Save Up to $50 on Non-prescription Sunglasses
*Offers vary based on benefit plan.
39
Participating Retail Chains
Over 8,000 participating retail locations in the VSP network:
Retail Chains include:
•Walmart Vision Center.
•Pearle Vision.
•Visionworks.®
•MyEyeDr.
•Clarkson Eyecare.
•RxOptical.®
•Optyx.
•Costco® Optical.
•And More!
Using your benefit is easy
Once you’re enrolled …
• Create an account at vsp.com and review your benefit information
• Find a VSP in-network doctor by visiting vsp.com or calling 800.877.7195
• No ID card needed, at your appointment, simply tell them you have VSP
ENROLLTODAY!9/19/19 – 11/08/19
Enjoy the complete coverageand quality care you deserve.
To learn more contact usat 800.877.7195 or www.vsp.com.
