Health Benefits Simplified Wasatch Product Development, LLC Medical Benefits Overview

Transcription

1 Health Benefits Simplified Wasatch Product Development, LLC Medical Benefits Overview

2 Welcome! HealthEZ is proud to continue to serve as your benefit administrator. We help companies all over the US provide custom, personalized benefits, and we re here to make your life easier! We are a familyowned business serving families like yours for over 35 years. Your employer selected HealthEZ because we are truly a different kind of health care company. We understand health insurance can be very complicated, and it s our goal to help you navigate the health care maze. We are here to serve you! We start by answering our phones with human beings if you re sick or just have a simple question about your benefits, we are here to listen and help you. You have one dedicated phone number to call no matter what you need. We provide you with a simple online statement once a month if we have processed any claims making it easy for you to understand what your doctor billed, what your insurance paid and what you owe. You can even pay your part of the bill online! HealthEZ doesn t serve clients; we serve people. We are here to take care of you.

3 Personalized Customer Service Wasatch Product Development, LLC has a dedicated phone number that is answered by humans between the hours of 8 a.m. and 7 p.m. Central Time. No phone trees! After business hours, you simply press 3 to reach our 24/7 nurseline. Care Management and Nurseline You have 24/7 access to HealthEZ s team of experienced nurses and doctors. Have a health-related question or need help finding the right doctor? Give us a call at We would love to help you! One Simple Statement HealthEZ provides all of your expenses in one document. The consolidated monthly statement provides a level of straight forward convenience unique in the industry. The EZ Way to Pay Your Medical Bills Pay your medical bills the easy and accurate way. Safe Secure Easy You click, we pay! Your Personal Benefits Website Once you receive your ID card, you ll be able to set up your online account to view all your information related to your benefits, including your statements, account balances, recently processed claims, and access your EZpay accounts. Benefit information, your plan overview, forms and education, access to customer service is also available on the custom website - everything you need, all in one place. Visit

4 Your primary medical network is Health West / EMI for Utah members. Your primary medical network is Arizona Foundation for Arizona members. Your primary medical network is PHCS for members in all other states. Get maximum coverage with the smallest bill possible by ensuring the provider you select is part of your provider network(s). To find a doctor, visit Your pharmacy benefit manager is CVS Caremark. The same prescription rarely costs the same price. Be a savvy customer and price compare your prescriptions at different pharmacies to get the best price. Ask your doctor to start you on the lowest cost alternative Check out the $4 Prescriptions at places like Wal-Mart Price Shop your prescriptions at Sam s Club and Costco; you don t have to be a member to access their pharmacy! Go to for more information on prescriptions that will save you money! Boost Your Baby Healthy moms, happy babies. Planning a family? Call us! Boost Your Baby helps moms and dads during and after pregnancy to have healthy and happy babies. Our team includes Mommy Mentors, specialist nurses, doctors, and mothers committed to serve you. Visit for more information. Health Savings Account A Health Savings Account (HSA) provides you an easy way to save and pay for your qualified medical, dental, pharmacy, and vision expenses, 100% tax free! Unlike a Flexible Spending Account, you will not lose your HSA balance, as it rolls over from year to year. The money in an HSA belongs to the account holder, allowing your savings to grow and earn interest over time. You can contribute up to $3,450 for single coverage and $6,850 for family coverage in Those that are age 55+ are allowed to contribute an additional $1,000 per year.

5 Summary of Medical Benefits PPO Plan In-Network Calendar Year Deductible Out-of-Network Employee Only $500 $750 Family $1,500 $1,500 Coinsurance 20% 50% Out-of-Pocket Maximum Employee Only $5,000 $6,000 Family $10,000 $12,000 Preventative Care 100% Covered Not Covered Physician Services Primary $25 Copay $25 Copay, then 50%* Specialist $40 Copay $40 Copay, then 50%* Hospital Services 20%* 50%* Emergency Services Emergency Room $250 Copay Ambulance 20%* Urgent Care Clinic Intermountain InstaCare $40 Copay 50%* Intermountain Kids Care $25 Copay Not Covered Chiropractic Services $25 Copay 50%* Mental Health / Chemical Dependency Inpatient 20%* 50%* Outpatient Office Visit $40 Copay $40 Copay, then 50%* Prescription Drug Coverage Retail 30 Day Supply Mail Order 90 Day Supply Generic $10 Copay $10 Copay Preferred Brand 25% 25% Non-Preferred Brand 50% 50% Specialty 20% Not Available NOTES: This serves as a summary of your benefit plan only. Please refer to your Summary Plan Description for actual coverage, limitation and exclusion provisions. *After Deductible

6 Calendar Year Deductible Summary of Medical Benefits HSA Plan In-Network Out-of-Network Employee Only $2,700 $5,200 Family $5,200 $10,400 Coinsurance 30% 50% Out-of-Pocket Maximum Employee Only $5,200 $10,400 Family $10,400 $20,800 Preventative Care 100% Covered Not Covered Physician Services Primary 30%* 50%* Specialist 30%* 50%* Hospital Services 30%* 50%* Emergency Services Emergency Room 30%* 50%* Ambulance 30%* 50%* Urgent Care Clinic Intermountain InstaCare 30%* 50%* Intermountain KidsCare 30%* Not Covered Chiropractic Services 30%* 50%* Mental Health / Chemical Dependency Inpatient 30%* 50%* Outpatient Office Visit 30%* 50%* Prescription Drug Coverage Retail 30 Day Supply Mail Order 90 Day Supply Generic 30%* 30%* Preferred Brand 30%* 30%* Non-Preferred Brand 30%* 30%* Specialty 30%* Not Available NOTES: This serves as a summary of your benefit plan only. Please refer to your Summary Plan Description for actual coverage, limitation and exclusion provisions. *After Deductible

7 Deductibles Employee Only Family Out-of-Pocket Maximum Employee Only Family Summary of Medical Benefits Minimum Essential Coverage Plan In-Network Out-of-Network Limitations None None No Coverage No Coverage Preventative Care 100% Covered No Coverage Benefits are limited to the following services. Non-network services will be payable at the network benefit level if the service is not available at a network provider. Prescription Drug Coverage 100% Covered Select FDA approved drug products related to preventative health services. The following are considered Preventive Services an are covered by the Plan and payable at 100% when services are rendered at an in-network provider. However, non-network charges are subject to usual and customary fee limitations. This plan only covers preventive pharmacy claims required under PPACA. Covered Preventative Services for Adults - Abdominal Aortic Aneurysm: One time screening for age Alcohol Misuse: Screening and counseling - Aspirin: Use for men ages & for women ages to prevent Cardiovascular Disease when prescribed by a physician - Blood Pressure: Screening for all adults - Cholesterol: Screening for all adults - Colorectal Cancer: Screening for adults starting at age 50 limited to one every 5 years - Depression: Screening for adults - Type 2 Diabetes: Screening for adults - Diet: Counseling for adults - HIV: Screening for all adults - Obesity: Screening and counseling for all adults - Routine Annual Physical: Ages 18 and older - Sexually Transmitted Infection (STI): Prevention counseling and screening for adults - Syphilis: Screening for all adults - Tobacco Use: Screening for all adults and cessation interventions - Immunization Vaccines for Adults: - Tetanus, Diptheria, Pertussis - Hepatitis A - Measles, Mumps, Rubella - Varicella - Hepatitis B - Influenza (Flu Shot) - Herpes Zoster - Human Papillomavirus - Meningococcal - Pneumococcal

8 Covered Preventative Services for Women - Anemia: Screening on a routine basis for pregnant women - Bacteriuria: Urinary tract or other infection screening for pregnant women - BRCA: Counseling and genetic testing for women at higher risk - Breast Cancer Mammography: Screenings every year for women age 40 and over - Breast Cancer Chemoprevention: Counseling for women - Breastfeeding: Comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women. Non-network services will be payable as network services. - Cervical Cancer screening - Chlamydia Infection screening - Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs - Domestic and Interpersonal Violence: Screening and counseling for all women - Folic Acid: Supplements for women who may become pregnant when prescribed by a physician - Gestational Diabetes: Screening - Gonorrhea: Screening for all women - Hepatitis B: Screening for pregnant women - Human Immunodeficiency Virus (HIV): Screening and counseling - Human Papillomavirus (HPV) DNA Test: HPV DNA testing every three years for women with normal cytology results who are 30 or older - Osteoporosis: Screening over age 60 - Routine Annual Physical - Routine Prenatal Visits: For pregnant women - RH Incompatibility: Screening for all pregnant women and follow-up testing - Sexually Transmitted Infections (STI): Counseling - Syphilis: Screening - Tobacco Use: Screening and interventions for all women, and expanded counseling for pregnant tobacco users - Well-woman Visits: To obtain recommended preventive services Covered Preventative Services for Children - Alcohol and Drug Use: Assessments - Autism: Screening for children limited to two screenings up to 24 months - Behavioral: Assessments for children limited to 5 assessments up to age 17 - Blood Pressure: Screening - Cervical Dysplasia: Screening - Congenital Hypothyroidism: Screening for newborns - Depression: Screening for adolescents age 12 and older - Developmental Screening: For children under age 3, and surveillance throughout childhood - Dyslipidemia: Screening for children - Fluoride Chemoprevention: Supplements for children without fluoride in their water source when prescribed by a physician - Gonorrhea: Preventive medication for the eyes of all newborns - Hearing: Screening for all newborns - Height, Weight and Body Mass Index: Measurements for children - Hematocrit or Hemoglobin: Screening for children - Hemoglobinopathies or Sickle Cell: Screening for newborns - HIV: Screening for adolescents - Iron: Supplements for children up to 12 months when prescribed by a physician - Lead: Screening for children - Medical History: For all children throughout development (ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years) - Obesity: Screening and counseling - Oral Health: Risk assessment for young children up to age 10 - Phenylketonuria (PKU): Screening in newborns - Routine Annual Physical - Sexually Transmitted Infection (STI): Prevention counseling and screening for adolescents - Tuberculin: Testing for children - Vision: Screening for all children under the age of 5 - Immunization: Vaccines for children from birth to age 18 -doses, recommended ages, and recommended populations vary - Haemophilus Influenzae Type B - Hepatitis A - Tetanus, Diptheria, Pertussis - Meningococcal - Measles, Mumps, Rubella - Pneumococcal - Influenza (Flu Shot) - Hepatitis B - Inactivated Polio Virus - Varicella - Human Papillomavirus - Rotavirus