Because the challenges of small businesses are anything but small

Transcripción

1 Colorado Small Group BeneFits Health Care Plans Comparison Guide Designed for businesses with 1-50 employees. Just the right fit for your business HEALTH DENTAL VISION LIFE DISABILITY Because the challenges of small businesses are anything but small Effective 10/1/2009 ECOHB1165A 7/08

2 BeneFits BeneFits from Anthem Blue Cross and Blue Shield just the right fit for your business Have you considered health coverage for your business but run into roadblocks? Our BeneFits portfolio keeps health coverage simple and affordable for small businesses just like yours. Whether you are a sole proprietor or have 50 employees, we invite you to try BeneFits on for size. Ready to say goodbye to roadblocks and hello to simplicity and savings? You need only 60 percent of your employees to enroll in order to qualify for the many advantages of health coverage. The chart on page 3 shows just how easy that can be! Your contribution to each employee s monthly premium can be as low as 25 percent or if you d rather pay a flat dollar amount as low as $50. When you add life coverage or both life and dental, you can actually save money on your premiums making valuable coverage more affordable than ever. Use this guide to check out our seven BeneFits plans. And feel free to call your Anthem Blue Cross and Blue Shield (Anthem) broker at any time for more details. Because everyone deserves a good fit. Easier to afford. Easier to enroll. 2

3 BeneFits keeps it simple A good fit should feel comfortable As you move forward with the day-to-day challenges of your business, this simple and affordable health coverage should fit right in. When you select BeneFits, you get: Seven health plans with different deductibles and a range of benefits Control over your cash flow, because you choose either a traditional contribution of a percentage of premium (as low as 25 percent) or a fixed dollar contribution (as low as $50) and your employees pay the rest through payroll deductions Guaranteed rates and benefits for one year (along with guaranteed coverage) Tax advantages for your company Our 360 Health programs to help your employees maintain their health The ability to manage your benefits in one seamless online experience with EmployerAccess Fewer employees need to participate For BeneFits, required participation is only 60 percent of eligible employees. Anthem also gives participation waivers for employees who don t want to participate for allowable reasons. Here s an example that shows how that might work for a small business with eight employees (including the owner): TOTAL EMPLOYEES 8 Waive those who don t participate for allowable reasons: One employee wants to keep existing Individual plan -1 One employee is covered by spouse s employer group plan -1 ELIGIBLE EMPLOYEES 6 Subtract those who don t participate for other reasons: Two just don t want to participate -2 ELIGIBLE ENROLLING EMPLOYEES 4 To calculate employee participation, the number of eligible enrolling employees is divided by the number of eligible employees, resulting in a participation percentage. In this example: Eligible Enrolling Employees 4 or Eligible Employees 6 =66% With the BeneFits program, this group meets the 60 percent participation requirement. 3

4 BeneFits You re an expert in your business you shouldn t have to be an expert in health coverage, too In larger companies, there s usually a full-time person on staff with the experience (and time) to handle health coverage for your employees. But what if you don t have a lot of experience with health coverage? Seven simple plans. Five smart reasons to offer them. 1 BeneFits makes it affordable. Contact your local broker for more information. 2 It s all about sharing. You don t have to fund the entire cost. You can share the premiums with your employees. In fact, with BeneFits your contribution can be as low as 25 percent or $50 per employee. Give yourself a tax break. Did you know that your coverage contributions can be 100 percent tax-deductible as business expenses on both your federal and state income taxes? And you may get to deduct other coverage-related costs such as contributions made to your employees health savings accounts. Consult your tax professional for more information. 3 4

5 You want to keep the employees you ve got. Offer health benefits, and your most valued employees are more likely to stick around. 4 5 You want to keep your employees healthy and productive. Because people wear so many big hats in a small business, one employee calling in sick can send everyone scrambling. Providing health coverage keeps employees more productive because it can help to keep them healthier. Starting to sound like a good fit? 5

6 BeneFits For a good fit, you need choices. And here they are. Take a glance at our seven sensational plans. And if the plan fits... The descriptions of our BeneFits plans that follow show the amounts that members are responsible for paying for covered in-network services. When you choose BeneFits from Anthem, you decide how many of the plans to offer your employees. You can offer all or just one it s your choice. Cutout flyers are included in the back of this booklet with more detailed information. Each is printed in English on one side and Spanish on the other these plan summaries are for your employees. 6

7 Hospital BeneFits Our most affordable BeneFits PPO plan offers hospital-only coverage with a reasonable deductible and access to generic-only prescription drugs... at budget-friendly prices. Hospital BeneFits Plus This affordable PPO plan provides hospital coverage, a lower deductible, enhanced benefits (including some doctor visits), and access to generic-only prescription drugs. If you wish to see drug tier information, please go to anthem.com for more details. Hospital BeneFits Preferred This affordable PPO plan features hospital benefits, access to generic-only prescription drugs, even more benefits (including some doctor visits at an even lower deductible), plus basic dental and vision. PPO $35 Copay GenRx This PPO plan provides comprehensive coverage with a generic-only drug benefit to help keep premiums affordable. PPO $25 Copay $2,000 Deductible Plan This PPO plan offers richer benefits while providing comprehensive prescription drug benefits. Lumenos HSA 3000 (HSA-Compatible) This health savings account (HSA)-compatible PPO plan offers comprehensive health coverage and a savvy financial strategy all in one. And it features 100 percent preventive care coverage when included in the member s health plan. Classic HMOSelect TM Our Classic HMOSelect plan works well for those wanting simplified decision-making and predictable out-of-pocket costs. The Classic HMOSelect plan utilizes a unique network of primary care physicians in seven Denver metropolitan counties and three southern Colorado counties. EmployerAccess There s an easy way to manage your company s health benefits all year long. With EmployerAccess, our online benefit administration tool, you can quickly and conveniently perform simple benefit functions in real time. Here s what you can do: View your employees coverage Enroll employees and add dependents Change or cancel coverage for employees and dependents Request ID cards View open invoices Pay bills online And more Gain more control and enjoy the benefits of managing your health, dental, vision and life coverage in one seamless online experience. 7

8 BeneFits Helpful Definitions * Annual Deductible - the amount you have to pay first, before your health plan starts to pay. Annual Out-of-Pocket Maximum - the most you pay in any one calendar year for qualified in-network covered services before your plan pays 100 percent of your eligible covered costs** for the rest of the year (you will pay more for out-of-network services). Coinsurance - the percentage you pay when you receive covered services. Copayment - the dollar amount you pay for an office visit when you see the doctor or receive another covered service. Family Aggregate - all covered family members eligible expenses can be combined to satisfy the family maximum requirement. Generic Drug - a drug identical to its brand-name equivalent in active ingredient, dosage form, strength, quality and intended uses, as well as its physiological and pharmacological effect. * The following are general definitions of words commonly used to describe health plans and health plan benefits. Refer to your specific health plan materials (Certificate/Evidence of Coverage) for further information. **Subject to coinsurance, deductibles and health necessity. Anthem makes it easy to get a complete benefits package that will take less time to administer and you may qualify for savings, too! Anthem Blue Cross and Blue Shield can offer you a total benefits solution by packaging basic health coverage with our Specialty products, including: Dental Vision Life and accidental death & dismemberment (AD&D) Long-term disability Short-term disability Plus, an Employee Assistance Program (EAP) Not only will your employees appreciate having a single ID card for their health, dental and vision coverage, but our combined administration process, including a single billing statement, makes it easy for you to do business with us. We also offer one enrollment application for health, dental, vision, life and disability and one bill and premium check for health, dental, vision, life and disability. Plus, a single employer portal where you can manage your health, dental, vision, life and disability benefits! And to top it off, you may be eligible to save 6% off your life premium and 6% off your dental premium when you purchase $25,000 or more in life and any of our dental plans at the same time. Ask your Anthem broker how you can get the total benefit package from Anthem and possibly save some money while you re at it! Try dental, vision, life and disability coverage on for size. Dental coverage Our dental plans are easy to use and give your employees access to more than 80,000 dental provider locations nationwide --with more than 2,000 in Colorado alone, including general practitioners and dental specialists. And, just like with our health plans, the amount you contribute toward premiums is up to you. 8 Vision coverage Our vision plans include comprehensive eye exams, fast delivery of eyewear and a retail frame allowance that fits the bill. Choose from two plans, both offering a broad, convenient, national network of more than 44,000 providers and provider locations--with more than 1,000 in Colorado alone--including many independent ophthalmologists and optometrists, as well as national retail locations such as LensCrafters, Target Optical, Sears Optical SM, JCPenney Optical and Pearle Vision. Many of these locations are conveniently open in the evenings and on weekends.

9 HMO - a health maintenance organization offers comprehensive health care to enrolled members in a particular geographic area, through doctors in its network who make referrals to specialists when healthly necessary. There are no benefits when you see an out-of-network doctor or use an out-of-network hospital. HSA - a health savings account can be funded by your own pre-tax contributions. Others can also contribute money to your HSA on your behalf. You can use money in your HSA to pay for your health care, including prescriptions when enrolled in an HSA-compatible plan. In-Network - an in-network doctor, dentist, specialist, hospital or pharmacy has a contract with Anthem to provide our members with services at a reduced fee. If you go out-of-network, you pay more. PPO - a preferred provider organization is a health insurance plan that lets members receive more coverage if they choose health care providers in the plan s network. Basic term life coverage When you offer basic term life coverage, your employees and their families will gain extra peace of mind and financial support in the event of untimely death or serious physical loss. You can select a level of basic term life coverage from $15,000 to $250,000. With any level of coverage, Accidental Death & Dismemberment (AD&D) benefits are included automatically. The Life benefit is payable in the event of death at any time, with the automatic AD&D feature providing employees with an additional benefit equal to the amount of the life benefit in case of an accidental death or a serious qualifying accident. The Living Benefit allows employees diagnosed with a 12-month life expectancy due to a terminal illness to request up to 50% of their life benefit. Extras included with AD&D coverage An annual college education benefit for eligible dependents of the lesser of 25% of the AD&D coverage amount or $12,000 if your employee should pass away while their children are still in school A seat belt provision that adds the lesser of 10% of the coverage amount or $25,000 to the AD&D benefit A $5,000 maximum repatriation benefit for preparation and transportation services should death occur more than 75 miles from home It takes just one employee enrolled in our health plan(s) to get guaranteed issue life coverage -- this means no underwriting and no forms to fill out! Guaranteed issue is available for up to $30,000 of life coverage for groups with two to nine employees; up to $50,000 of life coverage for groups with 10 or more employees; and up to $100,000 of life coverage for groups with 25 or more employees. If your business enrolls 10 or more employees for life coverage, you ll automatically receive composite life rates. This means that your employees will receive a single rate per $1,000 of life coverage, regardless of age and sex so older employees will pay the same rate as younger employees. It adds up to easier administration. For groups that enroll between two and nine employees, each employee s premium will be based on the group s rate table, using five-year age bands. Disability coverage Anthem Life Insurance Company s short-term disability insurance pays bi-weekly benefits to employees whose income is temporarily interrupted due to a nonoccupational disability, including pregnancy*. Long-term disability insurance provides income protection if an employee s income is interrupted for an extended period of time due to a disability. * Groups with 2+ lives who purchase short-term disability coverage must also purchase life coverage. 9

10 BeneFits Why offer a PPO? PPO means preferred provider organization. With a PPO, your employees can choose any doctor, specialist or hospital they want within our large network of contracted providers. They can also go outside our network, but if they do, their out-of-pocket costs will be higher. Generally the monthly premiums for PPO plans are lower than for other plans. Monthly premiums can be even lower with some PPOs, such as those that offer generic-only prescription drug coverage. Our PPO plans feature: Access to over 10,000 Colorado PPO network doctors and specialists and more than 75 Acute Care hospitals so chances are your employees doctors are in our network. Out-of-state coverage our health coverage goes with your employees when they travel. $6,000,000 for most covered services in lifetime benefits per member. Why offer an HMO? HMO stands for health maintenance organization. With an HMO, your employees choose a primary care physician who oversees their health care and provides referrals when needed. Generally, employees out-of-pocket health care costs with an HMO plan are more predictable than with a PPO plan. Our Classic HMOSelect plan includes: Access to a unique network of over 9,000 primary care physicians, specialists and ancillary providers throughout Colorado. This convenient network is designed to be close to where your employees live and work. Out-of-state coverage for emergency services so peace of mind goes with your employees when they travel. Unlimited lifetime benefits for most covered services per member. Open access to specialists within the network (no referral required). 72 Acute Care hospitals -- so chances are your employees doctors are in our network. Interested in an HSA-compatible plan? HSA is short for health savings account. Our HSA-compatible plan Lumenos HSA 3000 is a high-deductible plan that can be teamed with an HSA. Your employees can use an HSA to pay for their health care expenses and get tax advantages. Of course, we recommend that they talk to their tax advisor for all the details. For your employees convenience, we ve aligned with Mellon Bank so they can apply for our HSA-compatible plan and an HSA at the same time...or they can set up an HSA at a financial institution they choose. Our HSA-compatible plan offers the advantages of our PPO plans, including access to our vast PPO network. 10

11 360 Health a valuable part of every plan, all year round Quite simply, 360 Health gives you a way to help your employees be as healthy as they can be. 360 Health is a comprehensive suite of programs and services that works together to achieve optimal health outcomes. It offers access to: Online resources (including helpful decision-making tools) Interactive health programs Discounts on health-related products 24/7 NurseLine with access to qualified registered nurses anytime 360 Health gives you access to a health and wellness communications toolkit to implement in your workplace. Your employees will also appreciate the personalized programs that help manage and coordinate care for over 40 chronic conditions. 360 Health can help your employees at all stages of their lives, and wherever they are along the health spectrum. Note: For Lumenos plans, 360 Health programs may vary. Time Well Spent A valuable component of 360 Health, Time Well Spent is a health and wellness promotional campaign designed to help you build a culture of health in your workplace. Accessible through anthem.com, this program connects you to communication resources and information for educating your employees about healthy lifestyle changes. Resources you can access include: Health articles Posters Payroll stuffers Healthy recipes and cooking tips Healthy Bytes - short, positive bits and facts on making healthier choices As an employer, you have an incredible opportunity to make Time Well Spent a health revolution right where your employees spend the majority of their time. And no matter how long it takes, working to improve the health of your employees and their overall wellness is well worth it. Employee Assistance Program (EAP) * As an employer you make a significant investment in your employees. Their emotional well-being can greatly impact work performance and your organization s success. Yet, employees with personal concerns are absent from work two to four times more often than the average employee.** For pennies a day, you can offer Anthem EAP a benefit that will provide easily accessible resources to help them stay happy, healthy and productive. Whether your employees are seeking guidance with a family problem, options for elder care, assistance with substance abuse or other personal issues, Anthem EAP offers the support they need. *Available to groups with 10 or more employee participants **CCH Unscheduled Absence Survey,

12 BeneFits Healthy Lifestyles for a healthier workforce Helping to improve the wellness of your employees is one of the best long-term strategies for helping to reduce your company s health care costs. Unhealthy lifestyle choices can directly have an impact on more than your organization s bottom line. Tobacco use, obesity, stress and physical inactivity also have a significant effect on employees productivity and happiness. Transforming unhealthy lifestyles is not easy, which is why we focus on five key behaviors that have a great impact on both your employees health and the overall health of your organization: Tobacco Cessation Weight Management Stress Management Physical Activity Diet & Nutrition Healthy Lifestyles empowers employees with support to help them improve their health by: Understanding the total effect of unhealthy behaviors on their overall health Realizing how unhealthy choices and behaviors impact their lives Envisioning how their lives could be better by making healthier choices 4. Identifying the daily situations that spark these behaviors in the first place and deciding how to deal with those situations 5. Building and following a personalized strategy that can help change and improve lifestyle choices Let us help your organization transform unhealthy habits and control costs with our Healthy Lifestyles program. Sit back and relax and let our solutions work for you. As part of the largest health benefits company in the country, we have the experience, strength and stability to create and stand by solutions that work for you and your employees. We re proud to work with you now and as your business grows... keeping it simple and affordable, every step of the way

13 BeneFits Plan Comparison and Overview The member pays all amounts shown unless otherwise noted. Amounts shown are for covered in-network services only; the member pays more out-of-network for plans 1 through 6. The Classic HMOSelect plan does not include out-of-network coverage. 1 Hospital BeneFits PPO Plan 2 Hospital BeneFits Plus PPO Plan 3 Hospital BeneFits Preferred PPO Plan 4 PPO $35 Copay GenRx Plan 5 PPO $25 Copay $2,000 Deductible Plan 6 Lumenos HSA 3000 Plan 7 Classic HMOSelect Plan Lifetime Covered Charges paid by Anthem Blue Cross and Blue Shield $6,000,000 for most covered services Unlimited for most covered services Annual Deductible (excludes copayments) Amount member pays first for covered services before plan benefits start; waived for some services $1,250 per member $2,500 family aggregate $1,000 per member $2,000 family aggregate $750 per member $1,500 family aggregate $500 per member $1,000 family aggregate $2,000 per member $4,000 family aggregate $3,000 for individual $6,000 family includes health and pharmacy costs $0 Annual Out-of-Pocket Maximum (excludes copayments) The most a member pays in a year for qualified covered services before plan pays 100% for most in-network services Individual: Deductible plus $2,500 per member Family: Deductible plus $5,000 aggregate $3,500 per member $7,000 aggregate Individual: Deductible plus $3,000 Family: Deductible plus $6,000 $4,000 for individual/$8,000 family includes deductible and includes health and pharmacy costs $3,000 per member $6,000 aggregate Retail Prescription Drug NextRx mail service pharmacy can help you save call to learn more. $15 copayment per prescription up to a 30-day supply for generic drugs; Only generic drugs listed on the drug formulary are covered. Brand-name drugs are not covered but can be purchased at Anthem-negotiated savings from in-network pharmacies by presenting your Anthem health plan ID card. 30% coinsurance for generic self-injectables when filled through an in-network pharmacy Tier 1: $15 copayment Tier 2: $30 copayment Tier 3: $50 copayment Tier 4: 30% coinsurance to a maximum of $250. Amounts shown are for up to a 30-day supply. Tier 1: $15 copayment Tier 2: $40 copayment Tier 3: $60 copayment Tier 4: 30% coinsurance after deductible to a maximum of $250. Amounts shown are for up to a 30-day supply. Tier 1: $15 copayment Tier 2: $40 copayment Tier 3: $60 copayment Tier 4: 30% coinsurance to a maximum of $250. Amounts shown are for up to a 30-day supply. Doctor s Office Visits and Related Professional Services No benefits 50% coinsurance for first $1,000 of covered expenses (maximum Anthem payment of $500 per year) 1 (not subject to deductible) 50% coinsurance for first $1,500 of covered expenses (maximum Anthem payment of $750 per year) 1 (not subject to deductible) Office visits: $35 copayment per visit 2 Professional services: 30% coinsurance Office visits: $25 copayment per visit Professional services: 20% coinsurance In-network: $0 Out-of-network: 30% coinsurance In-network preventive care is $0 Office visits: $20 copayment for primary care physician; $40 copayment for specialists Professional services, including lab and X-ray: No copayment MRI/MRA/CT/PET scans: $100 per procedure Inpatient Hospital Coverage 30% coinsurance 20% coinsurance In-network: $0 Out-of-network: 30% coinsurance $500 copayment per admission Emergency Room $100 copayment waived if the member is admitted $100 copayment plus 30% coinsurance and deductible 30% coinsurance 20% coinsurance In-network: $0 Out-of-network: 30% coinsurance $100 copayment per admission Dental Coverage None Standalone coverage available None Standalone coverage available Up to $500 in benefits After $25 deductible* None Standalone coverage available None Standalone coverage available None Standalone coverage available None Standalone coverage available Vision Coverage None Standalone coverage available None Standalone coverage available $25 exam copayment $120 for frames* $115 for lenses* None Standalone coverage available None Standalone coverage available None Standalone coverage available None Standalone coverage available NextRx mail service pharmacy can help members save - call to learn more. 1 The maximum payment applies to covered expenses for doctor s visits and related services (lab, X-rays, etc.), even when those related services are performed outside the doctor s office or by another provider. 2 The copayment includes routine diagnostic, lab and X-ray charges when performed in the doctor s office and billed by the doctor. Routine diagnostic, lab and X-ray benefits do not include MRI/MRA/CT/PET scans, nuclear medicine or other high-tech services. This is a high-level overview only; refer to the Health Benefit Plan Description Form and certificate for a comprehensive description of coverage, benefits, special circumstances and limitations. Please note that, except for the Classic HMOSelect plan, in-network providers accept Anthem-negotiated fee rates as payment in full for covered services based on the maximum benefit allowance (MBA). Nonparticipating providers may charge more than the MBA. In-network providers and out-of-network participating providers accept Anthem Blue Cross and Blue Shield s MBA as payment in full for covered services. For most out-of-network benefits, when a member receives services from a nonparticipating provider, the member must pay any difference between our MBA and the provider s billed charges, plus any applicable copayment, deductible and/or coinsurance. *Dental and vision benefit amounts cover Anthem Blue Cross and Blue Shield s payments for eligible expenses only as outlined in the Health Benefit Plan Description Form. If you wish to see drug tier information, please go to anthem.com for more details. The Classic HMOSelect plan is offered by HMO Colorado, a subsidiary company of Anthem Blue Cross and Blue Shield

14 Want all the details? Read the following pages and share them with your employees.

15 You can detach this page at the perforated line and make copies for your employees to tell them about the BeneFits plan your company offers. Each summary is printed in English on one side and Spanish on the other. Cut Here! Cut Here Hospital BeneFits The member is responsible for all amounts listed, unless otherwise noted. Always use in-network providers and save with Anthem-negotiated prices Benefits for eligible covered services In-network Out-of-network Annual deductible (excludes copayments) You pay for eligible covered services up to this amount, and then plan benefits begin. Hospital coinsurance After meeting your annual deductible, you pay this percentage for covered inpatient hospital services. Annual out-of-pocket maximum Once you have paid this amount for eligible covered services during the year, the plan pays for the covered services allowed by the plan at in-network hospitals for the rest of the year, excluding deductible and copayments. Lifetime covered charges paid by Anthem Blue Cross and Blue Shield Generic prescription drugs NextRx mail service pharmacy can help you save - call to learn more. Office visits and related professional services These services are related to covered charges only. Emergency room The $100 copayment is waived if you are admitted. Individual: $1,250 per member Family: $2,500 aggregate 30% 50% coinsurance, up to a maximum of $650 per day Individual: $2,500 per member, excluding deductible and copayments Family: $5,000 aggregate, excluding deductible and copayments $6,000,000 for most covered services $15 copayment per prescription up to a 30-day supply when filled through an in-network pharmacy; 30% coinsurance for generic self-injectables No benefits $100 copayment plus 30% coinsurance and deductible Dental No benefits Vision No benefits Not covered Your plan is packed with valuable programs and services...all at no additional cost! Tired of running in circles when it comes to diet, exercise and reaching your health goals? Then it s time to surround yourself with easy, practical ways to improve and manage your health! Quite simply, our 360 Health programs and services help you be as healthy as you can be. 360 Health offers you access to: Online resources (including helpful decision-making tools) Interactive health programs Discounts on health-related products 24/7 NurseLine, which offers access to qualified registered nurses anytime You ll also appreciate the personalized programs that help manage and coordinate care for over 40 chronic conditions. 360 Health is here to help you at all stages of your life, and wherever you are along the health spectrum. Surround yourself with a healthy lifestyle now! Note: Remind doctors that your plan covers generic medications listed on the generic formulary only. Generics must meet the same Food and Drug Administration standards for safety and effectiveness as brand-name drugs, and may cost less. If your doctor believes a brand-name drug is necessary, you will receive Anthem-negotiated savings if you use an in-network pharmacy, but you will pay more. This is a high-level overview only; refer to the Health Benefit Plan Description Form and certificate for a comprehensive description of coverage, benefits, special circumstances and limitations. Please note that in-network providers accept Anthem Blue Cross and Blue Shield negotiated fee rates as payment in full for covered services. Benefits listed are based on the maximum benefit allowance (MBA). Nonparticipating providers may charge more than the MBA. In-network providers and out-of-network participating providers accept Anthem Blue Cross and Blue Shield s MBA as payment in full for covered services. For most outof-network benefits, when a member receives services from a nonparticipating provider, the member must pay any difference between our MBA and the provider s billed charges, plus any applicable copayment, deductible and/or coinsurance. ECOHB1165A 6/09 Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Health Service, Inc. Life products are underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM and 360 HEALTH are registered trademarks of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 15

16 Puede desprender esta página en la línea perforada y hacer copias para sus empleados para avisarles sobre el plan BeneFits que ofrece su compañía. Cada resumen está impreso en inglés de un lado y en español del otro. Cortar aquí! Cortar aquí Hospital BeneFits El afiliado es responsable de todos los montos listados, a menos que se indique de otro modo. Siempre utilice los proveedores dentro de la red para ahorrar con los precios negociados por Anthem Beneficios para servicios cubiertos idóneos Dentro de la red Fuera de la red Deducible anual (excluye los copagos) Usted paga por los servicios cubiertos idóneos hasta este monto, y luego comienzan los beneficios del plan. Coseguro hospitalario Después de cumplir con su deducible anual, usted paga este porcentaje para los servicios cubiertos en el hospital como paciente hospitalizado. Máximo anual del propio bolsillo Una vez que haya pagado este monto por los servicios cubiertos idóneos durante el año, el plan paga todos sus cargos cubiertos en hospitales dentro de la red por el resto del año (excluye el deducible y los copagos). Cargos vitalicios cubiertos pagados por Anthem Blue Cross and Blue Shield Medicamentos genéricos recetados Los beneficios están disponibles inmediatamente. Visitas al consultorio y servicios profesionales relacionados Relacionados únicamente a los cargos cubiertos. Sala de emergencia Se suspende el copago de $100 en caso de ser admitido al hospital. Individuo: $1,250 por afiliado Familia: $2,500 agregado 30% después del deducible Coaseguro del 50% después del deducible, hasta un máximo de $650 por día Individuo: $2,500 por afiliado; excluye el deducible y los copagos Familia: $5,000 agregado, excluye el deducible y los copagos $6,000,000 para la mayoría de los servicios cubiertos $15 de copago por medicamento con receta por un suministro máximo para 30 días cuando se obtiene en una farmacia de la red; 30% de coseguro para medicamentos genéricos que usted se inyecta a sí mismo. Sin beneficios $100 de copago más 30% de coseguro y deducible Dentales Sin beneficios Vista Sin beneficios Sin cobertura Su plan está repleto de programas y servicios valiosos todo ello sin costo adicional! Está cansado de dar vueltas en cuanto a dietas, ejercicios y alcanzar sus metas de salud? Entonces, llegó el momento de rodearse con maneras fáciles y prácticas de mejorar y administrar su salud! En pocas palabras, nuestros programas y servicios 360 Health le ayudan a estar tan sano como usted puede estar. 360 Health le brinda acceso a: Recursos en línea (inclusive herramientas útiles para tomar decisiones) Programas interactivos de salud Descuentos en productos relacionados con la salud NurseLine, disponible 24 horas, 7 días a la semana, que ofrece acceso a enfermeras registradas en cualquier momento También apreciará los programas personalizados que ayudan a administrar y coordinar los cuidados para más de 40 afecciones crónicas. 360 Health está aquí para ayudarle en todas las etapas de su vida, y dondequiera que se encuentre en el espectro de salud. Rodéese con un estilo de vida saludable hoy mismo! Nota: Recuerde a los médicos que su plan cubre medicamentos genéricos incluidos únicamente en el formulario de genéricos. Los medicamentos genéricos deben satisfacer los mismos estándares de seguridad y eficacia que la Administración de Alimentos y Medicamentos impone a los medicamentos de marca, y pueden costar menos. Ésta es sólo una descripción de alto nivel; consulte el formulario de descripción del plan de salud y el certificado para obtener una descripción completa de la cobertura, beneficios, circunstancias especiales y limitaciones. Tenga en cuenta que los proveedores dentro de la red aceptan cuotas negociadas por Anthem Blue Cross and Blue Shield para sus honorarios como pago total por los servicios cubiertos. Los beneficios listados se basan en el límite máximo de beneficio (MBA). Los proveedores no participantes pueden cobrar más que el MBA. Los proveedores dentro de la red y los proveedores participantes fuera de la red aceptan el MBA de Anthem Blue Cross and Blue Shield como pago total por los servicios cubiertos. Para la mayoría de los beneficios fuera de la red, cuando un afiliado recibe servicios de un proveedor no participante, el afiliado deberá pagar cualquier diferencia entre nuestro MBA y los cargos facturados por el proveedor, además de cualquier copago, deducible y/o coseguro aplicable. ECOHB1165A 6/09 Anthem Blue Cross and Blue Shield es la marca comercial de Rocky Mountain Hospital and Health Service, Inc. Concesionarios independientes de Blue Cross and Blue Shield Association. ANTHEM y 360 HEALTH son marcas registradas de Anthem Insurance Companies, Inc. Los nombres y símbolos de Blue Cross and Blue Shield son marcas registradas de Blue Cross and Blue Shield Association. 16

17 You can detach this page at the perforated line and make copies for your employees to tell them about the BeneFits plan your company offers. Each summary is printed in English on one side and Spanish on the other. Cut Here! Cut Here Hospital BeneFits Plus The member is responsible for all amounts listed, unless otherwise noted. Always use in-network providers and save with Anthem-negotiated prices Benefits for eligible covered services In-network Out-of-network Annual deductible (excludes copayments) You pay for eligible covered services up to this amount, and then plan benefits begin. Hospital coinsurance After meeting your annual deductible, you pay this percentage for covered inpatient hospital services. Annual out-of-pocket maximum Once you have paid this amount for eligible covered services during the year, the plan pays for the covered services allowed by the plan at in-network hospitals for the rest of that year, excluding deductible and copayments. Lifetime covered charges paid by Anthem Blue Cross and Blue Shield Generic prescription drugs NextRx mail service pharmacy can help you save - call to learn more. Office visits and related professional services 1 These services are related to covered charges only. Emergency room The $100 copayment is waived if you are admitted. Individual: $1,000 per member Family: $2,000 aggregate 30% 50% coinsurance, up to a maximum of $650 per day Individual: $2,500 per member, excluding deductible and copayments Family: $5,000 aggregate, excluding deductible and copayments $6,000,000 for most covered services $15 copayment per prescription up to a 30-day supply when filled through an in-network pharmacy; 30% coinsurance for generic self-injectables Not covered 50% coinsurance for the first $1,000 of covered expenses; Anthem pays up to $500 per calendar year $100 copayment plus 30% coinsurance and deductible Preventive care Preventive care services, which include the office visit and related preventive care, such as laboratory services, are covered by the office visit copayment when services are submitted with a preventive diagnosis. Dental No benefits Vision No benefits Your plan is packed with valuable programs and services...all at no additional cost! Tired of running in circles when it comes to diet, exercise and reaching your health goals? Then it s time to surround yourself with easy, practical ways to improve and manage your health! Quite simply, our 360 Health programs and services help you be as healthy as you can be. 360 Health offers you access to: Online resources (including helpful decision-making tools) Interactive health programs Discounts on health-related products 24/7 NurseLine, which offers access to qualified registered nurses anytime You ll also appreciate the personalized programs that help manage and coordinate care for over 40 chronic conditions. 360 Health is here to help you at all stages of your life, and wherever you are along the health spectrum. Surround yourself with a healthy lifestyle now! Note: Remind doctors that your plan covers generic medications listed on the generic formulary only. Generics must meet the same Food and Drug Administration standards for safety and effectiveness as brand-name drugs, and may cost less. If your doctor believes a brand-name drug is necessary, you will receive Anthem-negotiated savings if you use an in-network pharmacy, but you will pay more. 1 The maximum payment applies to covered expenses for doctor s visits and related services (lab, X-rays, etc.), even when those related services are performed outside the doctor s office or performed by another provider. This is a high-level overview only; refer to the Health Benefit Plan Description Form and certificate for a comprehensive description of coverage, benefits, special circumstances and limitations. Please note that in-network providers accept Anthem Blue Cross and Blue Shield negotiated fee rates as payment in full for covered services. Benefits listed are based on the maximum benefit allowance (MBA). Nonparticipating providers may charge more than the MBA. In-network providers and out-of-network participating providers accept Anthem Blue Cross and Blue Shield s MBA as payment in full for covered services. For most out-of-network benefits, when a member receives services from a nonparticipating provider, the member must pay any difference between our MBA and the provider s billed charges, plus any applicable copayment, deductible and/or coinsurance. ECOHB1165A 6/09 Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Health Service, Inc. Life products are underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM and 360 HEALTH are registered trademarks of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 17

18 Puede desprender esta página en la línea perforada y hacer copias para sus empleados para avisarles sobre el plan BeneFits que ofrece su compañía. Cada resumen está impreso en inglés de un lado y en español del otro. Cortar aquí! Cortar aquí Hospital BeneFits Plus El afiliado es responsable de todos los montos listados, a menos que se indique de otro modo. Siempre utilice los proveedores dentro de la red para ahorrar con los precios negociados por Anthem Beneficios para servicios cubiertos idóneos Dentro de la red Fuera de la red Deducible anual (excluye los copagos) Usted paga por los servicios cubiertos idóneos hasta este monto, y luego comienzan los beneficios del plan. Coseguro hospitalario Después de cumplir con su deducible anual, usted paga este porcentaje para los servicios cubiertos en el hospital como paciente hospitalizado. Máximo anual del propio bolsillo Una vez que haya pagado este monto por los servicios cubiertos idóneos durante el año, el plan paga todos sus cargos cubiertos en hospitales dentro de la red por el resto de dicho año (excluye el deducible y los copagos). Cargos vitalicios cubiertos pagados por Anthem Blue Cross and Blue Shield Medicamentos genéricos recetados Los beneficios están disponibles inmediatamente. Visitas al consultorio y servicios profesionales relacionados 1 Relacionados únicamente a los cargos cubiertos. Sala de emergencia Se suspende el copago de $100 en caso de ser admitido al hospital. Individuo: $1,000 por afiliado Familia: $2,000 agregado 30% después del deducible Coaseguro del 50% después del deducible, hasta un máximo de $650 por día Individuo: $2,500 por afiliado, excluye el deducible y los copagos Familia: $5,000 agregado, excluye el deducible y los copagos $6,000,000 para la mayoría de los servicios cubiertos $15 de copago por medicamento con receta por un suministro máximo para 30 días cuando se obtiene en una farmacia de la red; 30% de coseguro para medicamentos genéricos que usted se inyecta a sí mismo. Sin cobertura 50% de coseguro para los primeros $1,000 de gastos cubiertos; Anthem paga hasta $500 por año calendario $100 de copago más 30% de coseguro y deducible Atención preventiva Los servicios de atención preventiva, los cuales incluyen la visita al consultorio y la atención preventiva relacionada, tal como los servicios de laboratorio, están cubiertos por el copago para la visita al consultorio cuando se presentan con un diagnóstico preventivo. Dentales Sin beneficios Vista Sin beneficios Su plan está repleto de programas y servicios valiosos todo ello sin costo adicional! Está cansado de dar vueltas en cuanto a dietas, ejercicios y alcanzar sus metas de salud? Entonces, llegó el momento de rodearse con maneras fáciles y prácticas de mejorar y administrar su salud! En pocas palabras, nuestros programas y servicios 360 Health le ayudan a estar tan sano como usted puede estar. 360 Health le brinda acceso a: Recursos en línea (inclusive herramientas útiles para tomar decisiones) Programas interactivos de salud Descuentos en productos relacionados con la salud NurseLine, disponible 24 horas, 7 días a la semana, que ofrece acceso a enfermeras registradas en cualquier momento También apreciará los programas personalizados que ayudan a administrar y coordinar los cuidados para más de 40 afecciones crónicas. 360 Health está aquí para ayudarle en todas las etapas de su vida, y dondequiera que se encuentre en el espectro de salud. Rodéese con un estilo de vida saludable hoy mismo! Nota: Recuerde a los médicos que su plan cubre medicamentos genéricos incluidos únicamente en el formulario de genéricos. Los medicamentos genéricos deben satisfacer los mismos estándares de seguridad y eficacia que la Administración de Alimentos y Medicamentos impone a los medicamentos de marca, y pueden costar menos. 1 El pago máximo se aplica a los gastos cubiertos para visitas al médico y servicios relacionados (laboratorio, rayos X, etc.) incluso cuando dichos servicios relacionados se realizan fuera del consultorio del médico o son realizados por otro proveedor. Ésta es sólo una descripción de alto nivel; consulte el formulario de descripción del plan de salud y el certificado para obtener una descripción completa de la cobertura, beneficios, circunstancias especiales y limitaciones. Tenga en cuenta que los proveedores dentro de la red aceptan cuotas negociadas por Anthem Blue Cross and Blue Shield para sus honorarios como pago total por los servicios cubiertos. Los beneficios listados se basan en el límite máximo de beneficio (MBA). Los proveedores no participantes pueden cobrar más que el MBA. Los proveedores dentro de la red y los proveedores participantes fuera de la red aceptan el MBA de Anthem Blue Cross and Blue Shield como pago total por los servicios cubiertos. Para la mayoría de los beneficios fuera de la red, cuando un afiliado recibe servicios de un proveedor no participante, el afiliado deberá pagar cualquier diferencia entre nuestro MBA y los cargos facturados por el proveedor, además de cualquier copago, deducible y/o coseguro aplicable. ECOHB1165A 6/09 Anthem Blue Cross and Blue Shield es la marca comercial de Rocky Mountain Hospital and Health Service, Inc. Concesionarios independientes de Blue Cross and Blue Shield Association. ANTHEM y 360 HEALTH son marcas registradas de Anthem Insurance Companies, Inc. Los nombres y símbolos de Blue Cross and Blue Shield son marcas registradas de Blue Cross and Blue Shield Association. 18

19 You can detach this page at the perforated line and make copies for your employees to tell them about the BeneFits plan your company offers. Each summary is printed in English on one side and Spanish on the other. Cut Here! Cut Here Hospital BeneFits Preferred The member is responsible for all amounts listed, unless otherwise noted. Always use in-network providers and save with Anthem-negotiated prices Benefits for eligible covered services In-network Out-of-network Annual deductible (excludes copayments) You pay for eligible covered services up to this amount, and then plan benefits begin. Hospital coinsurance After meeting your annual deductible, you pay this percentage for covered inpatient hospital services. Annual out-of-pocket maximum Once you have paid this amount for eligible covered services during the year, the plan pays for the covered services allowed by the plan at in-network hospitals for the rest of that year, excluding deductible and copayments. Lifetime covered charges paid by Anthem Blue Cross and Blue Shield Generic prescription drugs NextRx mail service pharmacy can help you save - call to learn more. Office visits and related professional services 1 These services are related to covered charges only. Individual: $750 per member Family: $1,500 aggregate 30% 50% coinsurance, up to a maximum of $650 per day Individual: $2,500 per member, excluding deductible and copayments Family: $5,000 aggregate, excluding deductible and copayments $6,000,000 for most covered services $15 copayment per prescription up to a 30-day supply when filled through an in-network pharmacy; 30% coinsurance for generic self-injectables Not covered 50% coinsurance for the first $1,500 of covered expenses; Anthem pays up to $750 per calendar year Preventive care Preventive care services, which include the office visit and related preventive care, such as laboratory services, are covered by the office visit copayment when services are submitted with a preventive diagnosis. Emergency room The $100 copayment is waived if you are admitted. $100 copayment plus 30% coinsurance and deductible Dental Up to $500 in benefits after $25 deductible In-network Out-of-network Vision $25 exam copayment $120 for frames $115 for contact lenses Maximum benefit up to $49 for exams Maximum benefit up to $50 for frames Maximum benefit up to $92 for contact lenses Your plan is packed with valuable programs and services...all at no additional cost! Tired of running in circles when it comes to diet, exercise and reaching your health goals? Then it s time to surround yourself with easy, practical ways to improve and manage your health! Quite simply, our 360 Health programs and services help you be as healthy as you can be. 360 Health offers you access to: Online resources (including helpful decision-making tools) Interactive health programs Discounts on health-related products 24/7 NurseLine, which offers access to qualified registered nurses anytime 1 The maximum payment applies to covered expenses for doctor s visits and related services (lab, X-rays, etc.), even when those related services are performed outside the doctor s office or performed by another provider. You ll also appreciate the personalized programs that help manage and coordinate care for over 40 chronic conditions. 360 Health is here to help you at all stages of your life, and wherever you are along the health spectrum. Surround yourself with a healthy lifestyle now! Note: Remind doctors that your plan covers generic medications listed on the generic formulary only. Generics must meet the same Food and Drug Administration standards for safety and effectiveness as brand-name drugs, and may cost less. If your doctor believes a brand-name drug is necessary, you will receive Anthem-negotiated savings if you use an in-network pharmacy, but you will pay more. This is a high-level overview only; refer to the Health Benefit Plan Description Form and certificate for a comprehensive description of coverage, benefits, special circumstances and limitations. Please note that in-network providers accept Anthem Blue Cross and Blue Shield negotiated fee rates as payment in full for covered services. Benefits listed are based on the maximum benefit allowance (MBA). Nonparticipating providers may charge more than the MBA. In-network providers and out-of-network participating providers accept Anthem Blue Cross and Blue Shield s MBA as payment in full for covered services. For most out-of-network benefits, when a member receives services from a nonparticipating provider, the member must pay any difference between our MBA and the provider s billed charges, plus any applicable copayment, deductible and/or coinsurance. ECOHB1165A 6/09 Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Health Service, Inc. Life products are underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM and 360 HEALTH are registered trademarks of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 19