Buchanan Hauling & Rigging 2018 Complete Benefits Guide May 1, 2018 – April 30, 2019
2018 Buchanan Hauling Benefit Guide
Associates, Our Annual Benefit Enrollment Period will be April 10 through April 16, 2018. During this time, you will be able to review your benefits and make any desired updates for the 2018-2019 plan year. We are committed to providing a strong benefit package to help you and your family achieve and maintain optimum health and wellness. Buchanan Hauling & Rigging’s management team strive to offer comprehensive benefit options while also managing costs. In addition we hold true to the corporate beliefs that have guided us for the last 20+ years one of which is to treat our employees as we would expect to be treated. The Buchanan Hauling Marketplace is an online store stocked with a wide variety of products and programs with which you choose what you NEED. We recognize that every individual and family has different needs. Therefore the Buchanan Hauling Marketplace provides a way for each of us to purchase what works the best with our individual situation. The Buchanan Hauling Marketplace will ask you some questions to determine your particular needs and situation. It will then recommend a personalized benefits portfolio for you. Please be assured that all of the information you share is private and in full compliance with the HIPAA privacy regulations. This year we are also providing you with a Benefits Guide which has detailed information on the new coverage and changes for 2018. Please review the guide to understand the new additions and important changes and keep this for your reference throughout the year. In this economic and health care environment, it is essential that we all work together to manage health care costs. As a company, we encourage all Associates to focus on wellness and to take preventive measures to increase both mental and physical well- being. As individuals, we can all become better health care consumers. As you consider your benefit elections for 2018, please read this Benefits Guide in its entirety to fully understand your options. We also encourage you to engage with your spouse when you log into the Buchanan Hauling Marketplace to gain further insights and answers regarding your 2018 benefits. It is our goal through this guide and open enrollment meetings followed by the personal marketplace enrollment to insure that you enroll in what is the best package for your life situation. We appreciate your involvement, and thank you again for taking an active role in managing your health and our company’s health
care costs. Sincerely,
Buchanan Hauling & Rigging
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2018 Buchanan Hauling Benefit Guide
Use this guide to explore all of the features of your Buchanan Hauling Employee Benefit Marketplace and to find the right plans for you and your dependents. If you have any questions regarding the information in this brochure, please email hr@buchananhauling.com
Table of Contents
Enrollment Information
3
Important Dates
4
ComPsych
5
Defined Contribution
6
Medical Plan Information & Overviews
7
Dental Plan Information & Overviews
12
Vision Plan Information & Overview
13
Life, AD&D, Critical Illness, and Accident Insurance Information
14
Disability Insurance Information & Overview
15
Wellness By Choice
16
Healthcare Bluebook
17
Gallagher Marketplace Help Center
19
Important Definitions
20
Notes
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2018 Buchanan Hauling Benefit Guide
Annual Enrollment 2018
ENROLLMENT INFORMATION
CHANGING YOUR BENEFITS DURING THE YEAR Make your elections carefully during your enrollment period because you can only make changes during the year if you have a qualified life event (QLE). The following events qualify for a mid-year change in coverage: • Marriage • Birth or adoption of a child • Loss of other coverage • Change in your employment status or that of a spouse • Divorce or legal separation • Entitlement to Medicare/Medicaid • A qualified domestic relations order or a similar court order • Ineligibility of a dependent • Significant change in health coverage attributable to your employment or that of your spouse If you experience a QLE and want to change your benefits, you must make the change within 30 days after the event occurs. Changes cannot be made before the event occurs. If you miss the window for making a change, you will need to change your elections during the next annual enrollment period. Benefits requiring a QLE to make a change: • Medical • Dental • Critical Illness and Cancer • FSA • Voluntary Life • Disability • Accident • Vision • Life and AD&D
WHO IS ELIGIBLE? If you are a full-time associate (working 30+ hours per week) you are eligible to enroll in the benefits described in this guide. The following family members are eligible: • Your spouse unless legally separated • Your children according to age definitions HOW TO ENROLL Review your current benefit elections and attend the open enrollment group meetings. Following the group meetings you will be able to go online to the Buchanan Hauling Marketplace (“Exchange”) to learn about your benefit options and make the best selection for you and your family. Once you have made your elections, you will not be able to change them until the next open enrollment period unless you have a qualified life event (QLE). YOUR USERNAME AND PASSWORD FOR THE MARKETPLACE https://login.gallaghermarketplace.com USERNAME: BHR + First Initial + Last Initial + Last 5 digits of your SSN/EID (not case sensitive) INITIAL PASSWORD: Social Security Number Example: John Doe, SSN: 123-45-6789 and date of birth January 1, 1990: username = BHRJD56789 password = 123456789 HEALTH CARE REFORM • Under federal law dependent children up to their 26th birthday who DO NOT have other group health insurance coverage may be added to your health care plans.
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2018 Buchanan Hauling Benefit Guide
Important Dates April 9 th & 10 th , 2018 Annual enrollment information meetings for associates and their families will be offered. Spouses are welcome to attend as well. ANNUAL ENROLLMENT: APRIL 10 THROUGH APRIL 16 All associates enrolled in Buchanan Hauling’s Medical plans will only receive new membership cards if they make a plan change. MAY 1, 2018 The new 2018 benefit premiums will take effect on your first May paycheck. If you have payroll deductions and they are incorrect, you have until the end of June to notify the HR department of any discrepancies. No reimbursements due to administrative errors will be made after June, 2018. It is the employee’s responsibility to check their deductions on the first May 2018 paycheck to verify that all deductions and elections are correct.
WHAT CAN I DO DURING ANNUAL ENROLLMENT? Enrollment is your annual opportunity to: • Verify benefit elections for yourself and your dependents. • Enroll yourself and any dependents in health care benefits for the first time. • Waive health care benefit coverage for yourself or dependents. • Add dependents up to age 26 to your health care coverage who do NOT have other group health insurance coverage available.
• Add, drop, increase, or decrease your Supplemental or Dependent Life insurance. Evidence of Insurability (EOI) rules will apply at some benefit levels. • Add or drop Short Term and Long Term Disability Coverage. • Add or drop Accident, Critical Illness or Cancer coverage.
REMEMBER:
After annual enrollment ends, no changes can be made to your benefits. You may only make mid-year changes if you experience a qualifying life event.
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2018 Buchanan Hauling Benefit Guide
Call ComPsych ® GuidanceResources ® anytime for confidential assistance. Personal issues, planning for life events or simply managing daily life can affect employees’ work, health and family. The suite of confidential services offered by ComPsych® provides support, resources and information for personal and work-life issues. This flyer explains how ComPsych services can help employees and their families deal with everyday challenges.
Legal Support and Resources Expert info when you need it. Talk to our attorneys by phone. If you require
Health Care Navigation Helping you make better health care choices. HealthChampion® provides confidential assistance with: › Claims review and fee negotiation › Cost estimates for health care treatments › Explanation of health plan coverage › Understanding diagnosis and treatment options › Preparation and support for medical appointments and procedures Confidential Counseling Someone to talk to. This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultants SM —highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse Guidance Resources Online is your one stop for expert information on the issues that matter most to you... relationships, work, school, children, wellness, legal, financial, free time and more. › Timely articles, HelpSheets, tutorials, streaming videos and self-assessments › “Ask the Expert” personal responses to your questions › Online wellness tools with a Health Risk Assessment Guidance Resources® Online Knowledge at your fingertips.
representation, we’ll refer you to a qualified attorney in your area for a free 30-minute consultation with a 25% reduction in customary legal fees thereafter. Call about: › Divorce and family law › Debt and bankruptcy › Landlord/tenant issues › Real estate transactions › Civil and criminal actions › Contracts
Work-Life Solutions Delegate your “to-do” list.
Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for:
› Child and elder care
› Moving and relocation
› Making major purchases › College planning › Pet care › Home repair
Financial Information and Resources Discover your best options. Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues, including: › Retirement planning › Credit Card of Loan problems › Estate planning › Tax questions › Saving for college CALL ANYTIME TO SCHEDULE AN APPOINTMENT Call: 888.628.4809 TDD: 800.697.0353 Online: guidanceresources.com Your company Web ID: GALLAGHER › Getting out of debt
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2018 Buchanan Hauling Benefit Guide
Buchanan Hauling Employer Defined Contribution This is the annual amount that Buchanan Hauling & Rigging provides you to spend towards your medical plan. Any leftover funds will be forfeited.
Coverage Level
Annual Medical Employer Contribution
Single
$5760
Employee + Spouse
$8340
Employee + Child(ren)
$7080
Employee + Family
$9000
Buchanan HSA Funding Contribution Buchanan Hauling & Rigging will contribute toward your HSA (only if you elect to enroll into a HDHP).
Coverage Level
Annual HSA Contribution
Single
$480
Employee + Spouse
$480
Employee + Child(ren)
$480
Employee + Family
$480
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2018 Buchanan Hauling Benefit Guide
Medical MEDICAL BENEFIT PROGRAM: UNITED HEALTHCARE
What are my options? Employer-sponsored plan
Buchanan Hauling will continue to offer health insurance coverage. You can stay enrolled and purchase through our private marketplace. Federal Marketplace New way to buy health insurance. This is an option.
Buchanan Hauling is excited to announce that United Healthcare will continue be our medical benefit provider for the 2018-2019 plan year. BENEFITS YOU WILL ENJOY WITH UNITED HEALTHCARE • Extensive Network of Hospitals and Doctors • Regardless of where you live or work, you should be able to find a doctor close by. • To find a doctor, simply visit the website at o www.myuhc.com Choose Benefits, then select network “Choice Plus for PPO plans
Government Program Medicare, Medicaid, etc.
o www.myuhc.com Choose Benefits, then select network “Choice” for POS plans HOW THE PLAN PAYS • For all of the health insurance plans preventive care is covered 100%. • The PPO plans offer prescription drug coverage with no deductible. With the HSA you will need to pay out of pocket (with pre-tax HSA dollars) for prescription drugs until you meet your deductible. Once your out-of-pocket expenses reach the annual maximum, all plans will pay 100%. UNITED HEALTHCARE IS READY WHEN YOU ARE T ake advantage of United Healthcare’s dedicated Customer Service representatives, 24/7 online access to your benefits, and resourceful web tools to help you and your family live healthier lives. Go to your www.myuhc.com or www.welcometouhc.com PRESCRIPTION DRUG BENEFITS Whether you choose the PPO, POS or HDHP/HSA plans, prescription drug coverage is included. Your cost for a prescription depends on the type of drug you receive and where you obtain it. Under the HDHP/HSA plans, you pay the full cost, either out of pocket or with pre-tax HSA dollars, until you reach the deductible. Prescriptions can be filled at any UHC network pharmacy which includes many major chains and independent pharmacies. For your convenience, you can use the mail-order service to order maintenance prescriptions. Access pharmacy benefit for OptunRX thru www.myuhc.com for a more integrated experience. PRESCRIPTION BENEFIT PROGRAM – HOW TO SAVE MONEY: Prescription drugs can be quite expensive, especially if you have one or more maintenance prescriptions. There are several ways you can save on prescription drugs by understanding how the Buchanan Hauling prescription drug benefits work. The following are helpful hints: • Generic drugs are often the least expensive alternative. Ask your doctor if there is a generic option every time you are given a prescription. • For all maintenance medications – generic or brand – use the United Healthcare mail order program. Your prescription will be mailed directly to you.
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2018 Buchanan Hauling Benefit Guide
• Use the pre-tax accounts to pay your out-of-pocket prescription expenses with tax-free money. You must enroll into an HSA for this benefit.
WHY CHOOSE GENERIC? Generic drugs are essentially the same as the brand-name drug in safety, strength, quality performance, and intended use. They also meet the same strict approval process by the Food and Drug Administration (FDA). Generic manufacturers don’t have expensive research and advertising costs which leads to lower pricing. 24/7 NURSELINE United Healthcare’s 24/7 NurseLine gives you access to qualified registered nurses. Nurses can help you understand how to handle a medical issue, decide the right level of care and answer your questions. To get answers any time of the day or night, call the number on your health plan ID card or log into www.myuhc.com. VIRTUAL DOCTOR VISITS Through UHC’s virtual provider network, you can connect with a doctor from your mobile device or computer 24/7. Doctors can diagnose and treat a wide range of non-emergency medical conditions and even write prescriptions. And, the cost of a Virtual Visit is typically lower than being treated at a doctor’s office, urgent care center or emergency room. Call the number on your medical plan ID card or connect through myuhc.com.
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2018 Buchanan Hauling Benefit Guide
2018 Benefit Summaries UNITED HEALTHCARE Plans
Primary Advantage ANFQ
HG4 * (HSA eligible)
HF7 *
AGT8 *
HG2-MOD (HSA)
Network Only POS
Network Only POS
Network Only POS
PPO - In Network
PPO - In Network
Network
Choice Network
Choice Network
Choice Network
Choice Plus Network
Choice Plus Network
Deductible
$5,000 / $10,000
$5,000 / $10,000
$2,500 / $5,000
$4,000 / $8,000
$3,000 / $6,000
(Single/Family)
OOP max
$6,250 / $12,500
$6,250 / $12,500
$6,250 / $6,850
$6,650 / $13,000
$6,500 / $13,000
(Single/Family)
Coinsurance
0%
20%
50%
20%
20%
Office Visit
$30 / $60 copay after deductible
Deductible then coinsurance Deductible then coinsurance Deductible then coinsurance
$30 / $60 copay
$30 / $60 copay
$0 / $100 copay
(PCP/Spec)
Deductible then coinsurance Deductible then coinsurance
Deductible then coinsurance Deductible then coinsurance
Deductible then coinsurance Deductible then coinsurance
Inpatient Hospital
Deductible
Outpatient surgery / Physician’s office
Deductible
Preventive Care
100%
100%
100%
100%
100%
Deductible then coinsurance $300 copay then coinsurance
Deductible then coinsurance $300 copay then coinsurance
Deductible then coinsurance Deductible then coinsurance
Deductible then coinsurance $250 copay, then deductible then coinsurance Individual Ded: $250 Family Ded: $500
Outpatient Lab
Deductible
$300 copay then 100% after deductible
Emergency
RX Deductible **
N/A
N/A
N/A
N/A
Prescription Drug Retail Prescription Drug Mail Order
$10 / $35 / $60 after deductible
$10 / $35 / $60 -after deductible
$10 / $35 / $60
$10 / $35 / $60
$5 / $50 / $100 / $250
2.5 times retail
2.5 times retail
2.5 times retail
2.5 times retail
2.5 times retail
*No Out of Network Benefits
** RX Ded does not apply to Tier 1 and Tier 2
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2018 Buchanan Hauling Benefit Guide
What is an HSA? An HSA (Health Savings Account) is a tax-free account you can use to pay for current and future medical expenses (even medical expenses during retirement). An HSA has triple tax benefits: • The money goes in tax-free • The money grows tax-free • Your withdrawals for qualified medical expenses – including any earnings – are tax-free. WHO’S ELIGIBLE? You’re eligible to enroll in an HSA if: • You enroll in a high deductible health plan such as the HSA plans. • Your only coverage is a high deductible health plan, and you have not signed up for Medicare coverage. If you’re covered under your spouse’s plan and that plan is not a high deductible health plan or your spouse contributes to a Health Care FSA, then you are NOT eligible to contribute to an HSA. You can contribute to your account – You decide how much to contribute up to the IRS limits below: Opening your HSA Account As the owner of the account, employees will need to set up an account if not already completed. The website is www.HSAauthority.com. The Buchanan Hauling code is 138537 . If you have any further questions, please contact Kimberley Brown in the HR department. If you enroll in the HSA plans, your account will need to be opened with HSA Authority no later than May 1st. to facilitate pre-tax payroll deductions.
PAY HEALTH CARE EXPENSES Each time you have a qualified expense, you decide whether to: • Pay out of your pocket and let your HSA grow, earning interest for future eligible expenses (e.g. medical expenses during retirement). • Use your HSA to pay for eligible medical expenses, such as your annual deductible and coinsurance. Your HSA can also help to pay for vision care, dental care, and prescription drugs. (For a complete list of eligible expenses, visit www.irs.gov.) ADVANTAGES OF AN HSA An HSA allows you to pay for health care expenses with pre- tax dollars. Money in an HSA can be invested much like 401(k) funds are invested. Unused money in an HSA account is not forfeited at the end of the year and is carried forward. Also, your HSA is yours to keep which means that you can take it with you if you retire.
Enrollment Tier
Amount
Employee Only Coverage
$3,450 $6,850 $1,000
Family Coverage
Additional “Catch Up” if 55 or Older
You are not required to make HSA contributions, though it is a good idea to add to your account for tax savings and to help pay for medical expenses. You can contribute with pre-tax payroll deductions or contributions made directly to HSA Authority. These amounts are based on IRS limits.
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2018 Buchanan Hauling Benefit Guide
Know the Difference between Preventive and Non-Preventive Care
Most plans cover preventive care services at 100%, however, you need to understand if your visit will be classified as preventive care or as diagnostic. Use the guide below to help you understand the difference.
Preventive Care
Non-Preventive Care
Mammogram – annually for women starting at age 40, or recommendation Colonoscopy – every 10 years starting at age 50, recommendation Annual physical/preventive care exam – includes height, weight, blood pressure Pap smear – once annually for women who are 18 years of age or older
Patient found lump in breast and doctor recommends mammogram to diagnose condition
Patient has unexplained weight loss and constipation. Afraid it’s colon cancer; schedules colonoscopy
Office visit due to fever and rash
Abnormal Pap smear; returns for second exam. This second exam would be considered non-preventive
Preventive care: Routine annual screenings to “prevent” illness or injury. Non-preventive care: If diagnosed with a condition, some screenings are often considered part of treatment. Be sure to talk to your doctor.
Services covered at 100% under Preventive Care Benefit: • Well child visits/immunizations • Routine adult physical exams • Mammograms • Routine gynecological exams including pap smear • DRE and PSA (Prostate Screening) • Colorectal cancer screening • Labs, pathology, chest x-ray, and EKG (when performed as preventive care) • Be sure your doctor codes the claim as “preventive.”
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2018 Buchanan Hauling Benefit Guide
Dental Comparison Chart Assurant/SunLife Dental
High Plan
Low Plan
In/Out of Network
In/Out of Network
Annual Deductible Individual
$25
$50
Family
$75
$150
Annual Maximum Benefit
$1,500
$1,000
Preventive Services
100%
80%
Deductible Waived?
Yes
Yes
Basic Services Major Services
80%
50%
50%
25%
Orthodontia Services
Covered
Not Covered
Lifetime Maximum
$1,000
N/A
Age Limit
26
N/A
DENTAL BENEFIT PROGRAM: ASSURANT DENTAL
continues to be https://www.slfserviceresources.com/index.html The dental network name is the “Assurant Dental Network” . Register on the site by clicking on “Register Here” then follow the online instructions. Have your membership card ready when you register. At https://www.slfserviceresources.com/index.html you can also: • Check claims history and status • Order a replacement membership card • View estimates for service Make regular dental visits a priority – Regular cleanings can help manage problems throughout the body such as heart disease, diabetes, and stroke. Your Assurant Dental plans focus on prevention and early diagnosis providing two cleanings per year.
Buchanan Hauling is pleased to announce that SunLife Dental will continue to be our dental benefit provider for 2018-2019 plan year. The SunLife Dental plan provides 100% coverage of preventive services. You pay a percentage of costs for other types of dental care you receive. The percentage you pay depends on the type of care: Preventive, Basic, Major, or Orthodontia and the plan you select. If you see a network dentist, you can simply provide your SSN and they will take care of the paperwork for your visit. If your out-of-network dentist requires you to pay up front for services, you will need to submit a claim form for reimbursement for covered amounts. Find the claim forms at https://www.slfserviceresources.com/index.html. Follow the instructions on the form to have your claim paid. FINDING A DENTIST Search for in-network providers at Sun Life Financial. Sun Life formally known as Assurant Employee Benefits. Website
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2018 Buchanan Hauling Benefit Guide
Vision Care Plan Assurant/SunLife Vision Your vision benefits are provided through the VSP network. VSP’s Signature Network offers a wide choice • To find a VSP in-network provider, log on to www.vsp.com or call 800-877-7195 • Click on “Find the right doctor for you” under “Find a Doctor” and enter your location information. Vision Impacts Overall Health Periodic eye exams are an important part of routine preventive healthcare. Because many eye and vision conditions have no obvious symptoms, you may be unaware of problems. Early diagnosis and treatment are important for maintaining good vision and preventing permanent vision loss. Routine eye exams can lead to early detection of vision problems and other diseases such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis, and rheumatoid arthritis.
Low Plan In Network
Office Visits Exam
$10 Copay
Materials
Lenses Frames
$25
$130 Wholesale Allowance
Contact Lenses (In lieu of glasses) Medically Necessary
100%
$105 allowance
Elective
Frequency of services Exam
Every 12 months Every 12 months Every 24 months Every 12 months
Lenses Frames
Contact Lenses
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2018 Buchanan Hauling Benefit Guide
Life, AD&D, Critical Illness, and Accident Insurance SunLife Employee Benefits
CRITIAL ILLNESS AND CANCER INSURANCE
LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCE: Part of planning for the financial health of your family is to make sure they are taken care of, even in the event of a death or accident. To help you protect your family, Buchanan Hauling offers basic life and AD&D insurance that can be purchased on the Marketplace. Coverages Basic Life and Accident Insurance Buchanan provides the opportunity to purchase life insurance in increments of $10,000 up to a maximum of $100,000. The minimum benefit is $20,000 and the maximum without completing medical questions is $100,000. Spouse: You may also purchase life insurance on your spouse in $5,000 increments up to $50,000, not to exceed 50% of your life benefit. Children: Insurance may be purchased for children from live birth through 19 or under 25 (if full-time student) in amounts of $1,000, $5,000, or $10,000 not to exceed the spouse’s benefit amount.
Critical Illness insurance provides a lump sum cash benefit when the insured experiences a covered condition. This lump sum payment can be spent on anything – whether it is directly related or not to the critical illness including: • Medical copays and deductibles • Mortgage and rent payments • Other household expenses Your benefit is paid in full regardless of any other insurance you may have in force. Critical illness typically covers the following: • Heart Attack • Variety of other conditions depending on the policy Also included is a wellness benefit that pays the cost of one health screening test per calendar year, up to $50 maximum. ACCIDENT INSURANCE Accident insurance provides coverage for a wide variety of accidental injuries, including broken bones, concussions, and burns, and covered events such as medical treatment or hospitalization due to an accident. It pays benefits according to a flat schedule . • Stroke • Cancer
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2018 Buchanan Hauling Benefit Guide
Disability Programs SunLife
Buchanan Hauling provides full-time employees with the opportunity to enroll in Short Term and Long Term Disability income benefits. In the event you become disabled from a non-work-related injury or sickness, disability income benefits are provided as a source of income. You are not eligible to receive Short Term Disability benefits if you are receiving Workers Compensation benefits. Short Term Disability (STD) and Long Term Disability (LTD) The STD and LTD benefit details are as follows: SHORT AND LONG-TERM DISABILITY
Short Term Disability
Long Term Disability
60%
60%
Benefit Amount
$1,000 weekly
$6,000 monthly
Maximum Benefit
13 days
90 days
Elimination Period
n/a
12 months
Mental Illness Limit
13 weeks
Later of age 65 or 24 months
Benefit Duration
n/a
3 months
Survivor's Benefit
6/12/12
6/12/12
Pre-Existing Condition Exclusion
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2018 Buchanan Hauling Benefit Guide
Wellness By Choice HEALTHY COACH
As a result of the Build your Benefits responses, we offer you a new and innovative approach to personal health education. An interactive, multimedia on-line product is coupled with your own personal health coach. This powerful approach will enhance your knowledge and keep you healthy. Ultimately it gives you the tools to avoid lifestyle related costs while enrolled in a high deductible plan. The online product has been developed in partnership with the Duke University Medical Center — a world-renowned leader in health promotion and wellness. Your personal health coach is a registered nurse highly trained in behavior modification science. Together these resources give you the tools to ultimately live a healthier lifestyle and avoid unnecessary health care costs. Within your own personalized online environment and with the support of your health coach you have the ability to uncover your individual health risks such as: • Diabetes • Heart Disease • Stroke • Stress & Mental Health Concerns Next, your health coach works cooperatively with you to develop a plan of care based on your individual health risks. This skilled professional dialogues with you regularly and is able to explain risks, uncover barriers to change that you may possess and provide valuable planning assistance. This dynamic approach ultimately helps you meet your goals and keep your costs down.
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2018 Buchanan Hauling Benefit Guide
What is Healthcare Bluebook? Healthcare Bluebook has been selected by your employer as an added healthcare benefit to help you shop for care, compare facilities, and save money on healthcare services. Did you know that in- network prices for the same procedure can vary by over 500% depending on the facility you choose? Our web and mobile applications make it easy to save money on hundreds of the most common medical services and procedures by showing you the cost ranges in your area, and providing you with a selection of FAIR PRICE facilities. We also provide detailed information on the quality of common inpatient procedures (those that require a hospital stay). We enable you to easily identify and select a facility that has a high quality rating. What is the "FAIR PRICE?"
For services that include more than one provider, separate FAIR PRICE amounts may be shown for facility, physician and anesthesiologist. How do I find a FAIR PRICE? Finding a FAIR PRICE provider is easy using Healthcare Bluebook. Type in a search term or use the drop down menus to search for a particular service. Select the service you are looking for from the search results. Review the price range in your area and find the local FAIR PRICE for your service. Scroll down the page and review provider options for the service. Bluebook conveniently color codes all the provider options to make it easy for you to identify those providers with prices at or below the FAIR PRICE. Don't see a particular provider? You can always call and ask your provider for a price estimate based upon your insurance company rate. Compare the provider's price estimate to the Bluebook FAIR PRICE to determine whether or not the provider's price is in the fair range.
The FAIR PRICE is the amount you should reasonably expect a service or procedure to cost in your area. Bluebook FAIR PRICES are based on the actual amount paid on the claim, not the billed amount, and reflect the discounts that the health plan has negotiated with the facility.
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Aren’t all hospitals good at all things? No, very few hospitals are good at all procedures. Some quality metrics use a single overall rating for each hospital. A single rating can mask important differences in the level of quality between clinical areas at the hospital. For example, a hospital can be among the highest performing facilities in the US for heart surgery, yet the same hospital can also be among the poorest performing facilities for joint replacement. How does Bluebook assign quality ratings? The Healthcare Bluebook Quality Ratings are designed to help patients understand each hospital’s specific level of quality for a particular inpatient clinical area or procedure. The Bluebook Quality Rating is calculated for each clinical area by combining a hospital’s performance in several areas: patient complications, patient safety, mortality, and compliance with standards of care. Calculations are based on a statistically significant sample drawn from Centers for Medicare and Medicaid Services (CMS) data. Our methodology is validated and published in peer-reviewed medical journals. Can Cheaper mean better Quality? YES! Providers with lower costs can have higher quality, there is no correlation between high cost and high quality. Healthcare Bluebook provides cost and quality ratings side-by-side for inpatient procedures, which is where quality matters most. Using Bluebook, it is easy to see which facilities offer the highest quality at the lowest costs. Very few hospitals are good at all procedures. Some quality metrics use a single overall rating for each hospital. A single rating can mask important differences in the level of quality between clinical areas at the hospital.
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2018 Buchanan Hauling Benefit Guide
Gallagher Marketplace Help Center –a year round resource that you can access 24/7 through the Marketplace portal
Are you looking for ways to be a smarter health care consumer? Did you know the Buchanan Hauling Marketplace has tools to help you manage your health plans, and answer questions you have about health care? Simply log into the Marketplace with the Username and password you used for open enrollment. From there, you can access the Things Change links and the Help Center to stay engaged in your health care. Have you had a qualifying event, such as a change in marital status, the birth or adoption of a child, or change in employment status for you, a spouse or dependent?
You can submit for a change in coverage using the I want to update my coverage due to a life event link in the Things Change section. Remember, you must submit for a change in coverage within 30 days of the qualifying event. You can also
change the amount you contribute to your HSA in this section.
Do you have general benefits questions, such as how your deductible or co-insurance works, about your HSA or FSA, or want to see examples of how other people have been affected by health and life insurance?
Visit the Help Center for a variety of articles, videos, and a glossary of insurance terms.
Health care is changing – stay a step ahead by using the Marketplace to become informed and able to make the best decisions for you and your family.
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2018 Buchanan Hauling Benefit Guide
Important Definitions BENEFICIARY: The person or persons you name to receive benefits in the event of your death. You can change your beneficiary designations at any time. However, if you are married the government requires your beneficiary to be your spouse. PRIMARY BENEFICIARY: The entire death benefit will be paid in equal shares to the primary beneficiary or beneficiaries who survive you. CONTINGENT BENEFICIARY: If no beneficiary survives you, the entire death benefit will be paid to the contingent beneficiaries. A contingent beneficiary will receive a benefit if ALL primary beneficiaries predecease the participant. COINSURANCE: The percentage you pay for covered medical services. For example, if the insurance plan covers 80% and you are responsible for 20%. That 20% is coinsurance. COPAY: The flat dollar amount that you pay at the time you receive health care services. For example, the In- Network Only PPO plans have a $30 copay for visits to your primary care doctor. DEDUCTIBLE: The dollar amount that you pay out-of- pocket before the insurance plan begins to pay. EMERGENCY: An unforeseen medical condition that, if not treated immediately, could seriously jeopardize or impair your health, such as a suspected heart attack, severe burns, or broken bones. HIGH-DEDUCTIBLE HEALTH PLAN: A medical plan that meets requirements set by the IRS for a minimum deductible amount and a maximum out-of-pocket limit for in-network services. Employees in plans that meet these requirements (like the HSA) can open a Health Savings Account. IN-NETWORK PROVIDER: A physician, hospital, lab, pharmacy, or other health professional or facility that participates in United Healthcare’s network. You will receive the negotiated reduced rate from In-Network providers. MEDICARE: Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, or any age with End-Stage Renal Disease (permanent kidney failure). There are four types of Medicare. Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, and hospice and home health care. Generally there is no monthly premium if you qualify and paid Medicare taxes while working. Medicare Part B helps cover medical services like doctors’ services, outpatient care, and other
medically necessary services that Part A doesn’t cover. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible. Many people also purchase a supplemental insurance policy, such as a Medigap plan, to handle any Part A and B coverage gaps. Medicare Advantage Plans, also known as Medicare Part C , are combination plans managed by private insurance companies approved by Medicare. They typically are a combination of Part A, Part B, and sometimes Part D coverage, but must cover medically- necessary services. These plans have discretion to assign their own copays, deductibles, and coinsurance. Medicare Part D is prescription drug coverage, and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium. MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP): If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. OUT-OF-NETWORK PROVIDER: A health care provider that does not participate in United Healthcare’s health care network. Costs to visit an out-of-network provider are almost always higher. Plus you may be liable for costs over usual and customary charges (see below) at out-of-network facilities. OUT-OF-POCKET-MAXIMUM: This includes your deductible and any coinsurance or copays. This is your “worst-case scenario.” URGENT CARE: An acute, unforeseen illness or injury that requires prompt treatment, such as sprains and strains, sore throat, flu-like symptoms, vomiting, fever, cramps, rashes, or earaches. USUAL AND CUSTOMARY CHARGE: The average fee for a specific procedure in a given geographic region. If you go out-of-network, you will be responsible for any charges over the “usual and customary” cost for the same procedure at an in-network facility in that region. For example, if the set “usual and customary” rate for a procedure is $50 in- network and you visit a physician out-of-network that charges $75, United Healthcare will only provide insurance on the $50. You will pay the balance plus any copay or coinsurance.
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2018 Buchanan Hauling Benefit Guide
Notes
2018 Buchanan Hauling Benefit Guide
Notes
Version 1.4.20170308
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