BAART(Addiction Research &
Treatment, Inc.)
Benefits Presentation
BAART(Addiction Research &
Treatment, Inc.)
Benefits Presentation
Northern CA Ed.10/15/2008
Demonstrates commitment to employees
Provides a competitive and comprehensive package
Serves as a key component of total compensation
Strives to maintain reasonable costs for employees
Demonstrates commitment to employees
Provides a competitive and comprehensive package
Serves as a key component of total compensation
Strives to maintain reasonable costs for employees
Time to review your benefits and make any
changes …..
Time to review your benefits and make any
changes …..
“Managed” Health Care Must Use Only Contracting Facilities
and Doctors You do not need to elect a primary
care physician (PCP), but it is recommended
No Deductibles 100% Payment for Most Services No Claim Forms
“Managed” Health Care Must Use Only Contracting Facilities
and Doctors You do not need to elect a primary
care physician (PCP), but it is recommended
No Deductibles 100% Payment for Most Services No Claim Forms
Deductible None Coinsurance 100% Office Visit $15 copay Hospitalization 100% Chiropractic* $10 copay 30 visits/year maximum
benefit
Lab Services 100%
*Chiropractic care accessed through American Specialty Health Plan (ASHP) participating providers.
Deductible None Coinsurance 100% Office Visit $15 copay Hospitalization 100% Chiropractic* $10 copay 30 visits/year maximum
benefit
Lab Services 100%
*Chiropractic care accessed through American Specialty Health Plan (ASHP) participating providers.
Retail Prescription
Generic Formulary $10 copay
Brand Formulary $20 copay
Non-Formulary PCP Approval
Supply Limitation 100 days
Retail Prescription
Generic Formulary $10 copay
Brand Formulary $20 copay
Non-Formulary PCP Approval
Supply Limitation 100 days
Two Plans In One Annual Deductibles No PCP Requirements No Referrals Needed Cost Savings Using PHCS
Network Freedom of Choice How “Swing” Plan Works
Two Plans In One Annual Deductibles No PCP Requirements No Referrals Needed Cost Savings Using PHCS
Network Freedom of Choice How “Swing” Plan Works
NetworkNetwork Non-NetworkNon-Network
•DeductibleDeductible IndividualIndividual FamilyFamily
$500$500$1,500$1,500
•CoinsuranceCoinsurance 90% after ded.90% after ded. 70%, after ded.70%, after ded.
•Office VisitOffice Visit $25 copay$25 copay 70% after ded.70% after ded.
•HospitalizationHospitalization $250 copay, then $250 copay, then 90% after ded.90% after ded.
$500 copay, then $500 copay, then 70% after ded.70% after ded.
•Emergency Emergency RoomRoom
$100 copay, then 90% after ded.$100 copay, then 90% after ded.
NetworkNetwork Non-NetworkNon-Network
Lab ServicesLab Services 90% after ded.90% after ded. 70% after ded.70% after ded.
Chiropractic &Chiropractic &
AcupunctureAcupuncture
90% after ded.90% after ded.** 70%, after ded.70%, after ded.**
*$1,000 maximum benefit per calendar year for chiropractic and acupuncture services combined.*$1,000 maximum benefit per calendar year for chiropractic and acupuncture services combined.
Retail Prescriptions* Generic $15 copay Brand Name $40
copay Self-Administered Injectables 70%
(other than insulin) Supply Limitation 30 days
Retail Prescriptions* Generic $15 copay Brand Name $40
copay Self-Administered Injectables 70%
(other than insulin) Supply Limitation 30 days
If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.
If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.
Mail Order Prescriptions*Generic $30 copayBrand Name $80 copaySupply Limitation 100 days
(Self-administered injectables (other than insulin) are not available through the mail order program)
Mail Order Prescriptions*Generic $30 copayBrand Name $80 copaySupply Limitation 100 days
(Self-administered injectables (other than insulin) are not available through the mail order program)
If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.
If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.
Offers Helpful Resources Including:• Benefit & Open Enrollment Announcements• Carrier Contact Information & Group Numbers• Insurance Benefit Summaries• Frequently Asked Questions• HIPAA Compliance Materials• Carrier Links• And much more!
Offers Helpful Resources Including:• Benefit & Open Enrollment Announcements• Carrier Contact Information & Group Numbers• Insurance Benefit Summaries• Frequently Asked Questions• HIPAA Compliance Materials• Carrier Links• And much more!
Kaiser/KPIC members are eligible for an exciting discount program! This program is offered by American Specialty Health (ASH)
and includes a 25% discount on:
• Chiropractic, acupuncture and massage therapy
• Fitness Club Memberships• Health Tools and Health Products
Kaiser/KPIC members are eligible for an exciting discount program! This program is offered by American Specialty Health (ASH)
and includes a 25% discount on:
• Chiropractic, acupuncture and massage therapy
• Fitness Club Memberships• Health Tools and Health Products
To locate ASH providers visit: www.kp.org/healthyroads
or call 877.335.2746
To locate ASH providers visit: www.kp.org/healthyroads
or call 877.335.2746
BAART Medical Plans - HOT TOPICSHOT TOPICS
• Dependent age limitation is to age 19 or to age 24 if full time student.
• If you child has attained the age of 19 AND is a full time student, you MUST complete a student certification form. The form MUST be returned to human resources WITH a copy of the child’s school registration.
• Dependent age limitation is to age 19 or to age 24 if full time student.
• If you child has attained the age of 19 AND is a full time student, you MUST complete a student certification form. The form MUST be returned to human resources WITH a copy of the child’s school registration.
BAART Medical Plans - HOT TOPICSHOT TOPICS
• You will need to complete the student certification form ONCE a year in order for the child to remain on the insurance plan(s).
• Pre-Certification (PPO members)
• KPIC Billing Address (PPO Members) P.O. Box 26115 Plano, TX 75026
• You will need to complete the student certification form ONCE a year in order for the child to remain on the insurance plan(s).
• Pre-Certification (PPO members)
• KPIC Billing Address (PPO Members) P.O. Box 26115 Plano, TX 75026
BAART Medical Plan - HOT TOPICSHOT TOPICS
BAART Medical Plan - HOT TOPICSHOT TOPICS
It is YOUR responsibility to notify Human Resources upon your child’s attainment of age 19. Failure to notify human resources may result in your child being terminated from coverage, may result in claims being denied or delayed, and may forfeit the child’s right to COBRA continuation protection (should the child not be a full time student) as outlined under Federal legislation.
It is YOUR responsibility to notify Human Resources upon your child’s attainment of age 19. Failure to notify human resources may result in your child being terminated from coverage, may result in claims being denied or delayed, and may forfeit the child’s right to COBRA continuation protection (should the child not be a full time student) as outlined under Federal legislation.
DMOMember selects a primary care dentist. Dentist coordinates dental care; scheduled copays; no deductibles to be met
PPOTwo plans in one; deductibles in and out of network; cost savings when using network providers
DMOMember selects a primary care dentist. Dentist coordinates dental care; scheduled copays; no deductibles to be met
PPOTwo plans in one; deductibles in and out of network; cost savings when using network providers
Deductible None Preventive Services 100% Basic Services 100% Major Services 60% Calendar Year Max. None (Unlimited) Orthodontic Care Not a covered benefit
(Late entrants eligible for preventive services only for the first 12 months.)
(Late entrants eligible for preventive services only for the first 12 months.)
Network Non-Network Deductible* $50/person $50/person
Preventive Svcs. 100% 100% of UC Basic Services 80% 80% of UC Major Services 50% 50% of UC Cal. Year Max. $1,500 $1,500 Orthodontic Care Not covered--------------------
*Deductible waived for preventive services
Network Non-Network Deductible* $50/person $50/person
Preventive Svcs. 100% 100% of UC Basic Services 80% 80% of UC Major Services 50% 50% of UC Cal. Year Max. $1,500 $1,500 Orthodontic Care Not covered--------------------
*Deductible waived for preventive services
Aetna members have access to exciting discount programs that include:
• Alternative Health Care Discount Program
• Vision One Discount Program
• Fitness Discount Program
AND MUCH MORE!
Aetna members have access to exciting discount programs that include:
• Alternative Health Care Discount Program
• Vision One Discount Program
• Fitness Discount Program
AND MUCH MORE!
Pick up a
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information
today!
Group Term Life Insurance
Flat $10,000 (all guarantee issue)
Convertible Within 30 Days
Beneficiary Designation -- May Change at Any Time
You are required to complete a Kaiser / KPIC medical enrollment form if you are electing medical coverage (or adding/deleting dependents). If you would like to make a change to the Aetna dental plan, you must also complete an enrollment form. All forms MUST be returned to Human Resources no later than DECEMBER 15, 2008. If you’ve had a life change since you enrolled in the Life/AD&D plan, you may want to update your beneficiary(ies) designation(s). Claim Issues -- contact Human Resources or BAART’s benefits broker at 877-866-2623 for assistance.
Questions and Answers…