Transcript BAART/CDP - Benefits Information Center
BAART
(Addiction Research & Treatment, Inc.)
Benefits Presentation
Southern CA Ed.10/15/2008
Demonstrates commitment to employees Provides a competitive and comprehensive package Serves as a key component of total compensation Strives to maintain reasonable costs for employees
Time to review your benefits and make any changes …..
“Managed” Health Care Must Use Only Contracting Facilities and Doctors You do not need to elect a primary care physician (PCP), but it is recommended No Deductibles 100% Payment for Most Services No Claim Forms
Deductible Coinsurance Office Visit None 100% $15 copay Hospitalization 100% Chiropractic * $10 copay 30 visits/year maximum benefit Lab Services 100%
*Chiropractic care accessed through American Specialty Health Plan (ASHP) participating providers.
Retail Prescription
Generic Formulary
Brand Formulary
Non-Formulary
Supply Limitation $10 copay $20 copay PCP Approval 100 days
Two Plans In One Annual Deductibles No PCP Requirements No Referrals Needed Cost Savings Using PHCS Network Freedom of Choice How “Swing” Plan Works
Network Non-Network
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Deductible Individual Family
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Coinsurance
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Office Visit
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Hospitalization
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Emergency Room 90% after ded.
$500 $1,500 70%, after ded.
$25 copay 70% after ded.
$250 copay, then 90% after ded.
$500 copay, then 70% after ded.
$100 copay, then 90% after ded.
Lab Services Chiropractic & Acupuncture Network 90% after ded.
90% after ded.
* Non-Network 70% after ded.
70%, after ded.
* *$1,000 maximum benefit per calendar year for chiropractic and acupuncture services combined.
Retail Prescriptions *
Generic Brand Name Self-Administered Injectables
(other than insulin)
Supply Limitation $15 copay $40 copay 70% 30 days If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.
Mail Order Prescriptions *
Generic $30 copay
Brand Name
Supply Limitation $80 copay 100 days (Self-administered injectables (other than insulin) are not available through the mail order program) If a member requests a brand name drug when a generic equivalent is available, then the member will pay the brand name copay PLUS the difference in cost between the brand name and generic drug. However, if a physician writes “dispense as written” on the prescription order, then only the brand name copay will apply.
Offers Helpful Resources Including:
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Benefit & Open Enrollment Announcements Carrier Contact Information & Group Numbers Insurance Benefit Summaries Frequently Asked Questions HIPAA Compliance Materials Carrier Links And much more!
Kaiser/KPIC members are eligible for an exciting discount program! This program is offered by American Specialty Health (ASH) and includes a 25% discount on:
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Chiropractic, acupuncture and massage therapy
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Fitness Club Memberships Health Tools and Health Products
To locate ASH providers visit: www.kp.org/healthyroads or call 877.335.2746
BAART Medical Plans - HOT TOPICS
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Dependent age limitation is to age 19 or to age 24 if full time student.
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If you child has attained the age of 19 AND is a full time student, you MUST complete a student certification form. The form MUST human resources WITH be returned to a copy of the child’s school registration.
BAART Medical Plans - HOT TOPICS
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You will need to complete the student certification form ONCE a year in order for the child to remain on the insurance plan(s).
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Pre-Certification (PPO members)
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KPIC Billing Address (PPO Members) P.O. Box 26115 Plano, TX 75026
BAART Medical Plan - HOT TOPICS
It is YOUR responsibility to notify human resources upon your child’s attainment of age 19. Failure to notify human resources may result in your child being terminated from coverage, may result in claims being denied or delayed, and may forfeit the child’s right to COBRA continuation protection (should the child not be a full time student) as outlined under Federal legislation.
DMO Member selects a primary care dentist. Dentist coordinates dental care; scheduled copays; no deductibles to be met PPO Two plans in one; deductibles in and out of network; cost savings when using network providers
Deductible Preventive Services Basic Services Major Services Calendar Year Max.
Orthodontic Care None 100% 100% 60% None (Unlimited) Not a covered benefit (Late entrants eligible for preventive services only for the first 12 months.)
Deductible *
Preventive Svc.
Basic Services
Major Services
Cal. Year Max.
Network $50/person 100% 80% 50% $1,500 Non-Network $50/person 100% of UC 80% of UC 50% of UC $1,500
Orthodontic Care Not covered------------------- *Deductible waived for preventive services
Aetna members have access to exciting discount programs that include:
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Alternative Health Care Discount Program
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Vision One Discount Program
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Fitness Discount Program AND MUCH MORE!
Group Term Life Insurance Flat $10,000 (all guarantee issue) Convertible Within 30 Days Beneficiary Designation -- May Change at Any Time
You are required to complete a Kaiser / KPIC medical enrollment form if you are electing medical coverage (or adding/deleting dependents). If you would like to make a change to the Aetna dental plan, you must also complete an enrollment form. All forms MUST be returned to Human Resources no later than December 15, 2008.
If you’ve had a life change since you enrolled in the Life/AD&D plan, you may want to update your beneficiary(ies) designation(s).
Claim Issues -- contact Human Resources or BAART’s benefits broker at 877.866.2623 for assistance.