Slide 1

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
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© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
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© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

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© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

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© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
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o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
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© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
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© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

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© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 2

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 3

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 4

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 5

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 6

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 7

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 8

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 9

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 10

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 11

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

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© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 12

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 13

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 14

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 15

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 16

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 17

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 18

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 19

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 20

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 21

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 22

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 23

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 24

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 25

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 26

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 27

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 28

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 29

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 30

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

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© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 31

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 32

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation


Slide 33

2015 IBM Benefits Program Overview for
Long Term Supplemental Employees
(Module I)
November 2014

1

© 2014 IBM Corporation

Agenda
Module I
• IBM Benefits Overview
• Healthcare Enrollment Choices
• Tobacco Surcharge
• Health Savings Account (HSA) Incentives
• Administrators, Alternate Networks and Plan Administrators Contact Information
• Global Assignee Healthcare Plan
• Integrated Health Services Program
• Managed Pharmacy Program
• Dental Benefits
• Vision Plan and Vision Discount Card
• Monthly Contributions and Medical Plan Opt Out Credit
• Flexible Spending Accounts
• Dependent Eligibility
• New IBMer Enrollment
Module II
• Additional Benefit Programs
• Available Resources
• Appendix
2

© 2014 IBM Corporation

Overview of IBM Benefits
IBM offers a competitive benefits program, designed to help employees
build a solid financial foundation and meet a diverse array of needs
Key Features:
• Health Benefits Portfolio that provides strong support for employee wellbeing and preventive care, comprehensive coverage to meet a range of
medical situations and solid protection against the cost of serious illness or
injury
• Retirement Program that helps build future financial security through the
401(k) Plus Plan and other capital accumulation programs
• Income Protection in case of serious illness, injury or death, including life
insurance and disability benefits
• Opportunity to follow leisure pursuits through vacation and holiday
programs
3

© 2014 IBM Corporation

IBM Healthcare Enrollment Choices
Medical

Dental

o
o
o

o
o
o
o

o
o
o
o
o

PPO
PPO Plus
Exclusive Provider Organization
(EPO)
PPO w/HSA
PPO Plus w/HSA
HMO (Where available)
Global Assignee Medical Plan (For
Employees working Outside US)
No Coverage Credit for Medical

Dental Basic
Dental Plus
Cigna DMA (Where available)
No Coverage

Health Savings Account (HSA)
o $500 IBM deposit
o Earn additional IBM Healthy Living
Incentives ranging from $300 $1,100

Vision

Flexible Spending Accounts

o
o
o

o
o
o

IBM Vision Plan
Vision Discount Card
No Coverage

Health Care Spending Account
Dependent Care Spending Account
No Coverage

Long Term Disability (LTD)
o
o
o
4

50%
66 2/3%
No Coverage

4

© 2014 IBM Corporation

IBM Medical Plan Options
• IBM PPO Provides in- and out-of network coverage, available at a low cost for employee-only coverage
• IBM PPO Plus Provides a higher level of benefits than the IBM PPO, in exchange for higher monthly
•

•
•

•
•
5

contributions
IBM Exclusive Provider Organization (EPO) You must use network providers in order to receive
benefits; you pay either a coinsurance or a fixed copayment, depending on the service
o Higher Contributions with No Deductible
o Co-pays for Inpatient Hospital and Surgery
IBM PPO with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires the highest deductible;
available at no cost for employee-only
IBM PPO Plus with Health Savings Account (HSA) Features a health savings account with IBM
contributions of $500, and employee can earn additional incentives, but requires higher deductible;
available at low cost for employee-only
HMO Provides care through a specific network of providers and pay fixed co-pay for medical services;
participants are not covered for care received outside of HMO network
IBM Global Assignee Medical Plan is an indemnity plan for employees on International Assignment
working in other countries
© 2014 IBM Corporation

* A broad provider network is available for the PPO and EPO plan options; HMOs available in certain locations

Your Medical Options At-A-Glance
The chart below shows what you pay for covered services under each IBM medical option. Information for HMOs is available from your Benefits Election page on
netbenefits.com/ibm. There is no lifetime benefit maximum for eligible services received in-network; a $1 million lifetime benefit maximum applies for out-of-network care.
Annual Deductible1
(Individual/Family)

IBM PPO with HSA

Annual Out-of-Pocket
Maximum2
(Individual/Family)

Routine
Preventive
Services

Other Office Visits and
Outpatient Surgery

Urgent Care and Walk-in
Clinics

Inpatient Hospital and
Surgery

Emergency Room

Other Services4

1Annual

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,550 / $5,5005
Out-of-Network
IBM PPO Plus with HSA

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

►IBM will contribute $500 to your HSA and you can earn between $300 and $1,100 in tax-free incentives to be deposited in your HSA◄

In-Network

$6,450 / $12,900

$0, no deductible

PCP3: $0, after
deductible
SCP3: 25%, after
deductible

25% after deductible

30%, after deductible

$15,600 / $23,500

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$2,000 / $4,0005
Out-of-Network

30%, after deductible
plus $150 copay (copay
waived if admitted)

30%, after deductible

45%, after deductible

IBM PPO
In-Network

$1,350 / $4,000

$6,600 / $13,200

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

In-Network

$300 / $600

$6,100 / $9,100

$0, no deductible

PCP3: $0, no deductible
SCP3: 25%, no
deductible

25% after deductible

Facility: 20%, after
deductible
PCP3: 20%, after
deductible
SCP3: 25%, after
deductible

Out-of-Network

$2,350 / $7,200

$15,000 / $27,000

45%, no deductible

45%, after deductible

45%, after deductible

45%, after deductible

$0 / $0

$6,600 / $13,200

$0

25%

25%

$903 copay

20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

IBM PPO Plus
20%, after in-network
deductible plus $150
copay (copay waived if
admitted)

20%, after deductible

45%, after deductible

deductible applies to medical and
mental health/substance abuse services
combined.
2Prescription drug coinsurance and
copayments apply to the annual out-ofpocket maximum.
3PCP = Primary Care Physician; SCP =
Specialty Care Physician
4Other Services include: imaging, X-rays,
durable medical equipment (DME),
prosthetics and lab services (no
deductible for lab); precertification is
required for CT scans, MRIs, sleep
studies, and cardiac studies.
5If you enroll in Family coverage under an
HSA-eligible health plan option, you must
meet the Family deductible before the
plan begins to pay benefits. Individual
deductibles do not apply.
Note: For Out-of-Area options, benefits
for medical services will be paid at the innetwork level for all IBM PPO options.
Mental health/substance abuse care will
be paid at the in-network level if care is
pre-certified and provided by an innetwork provider (or other provider if
there is no in-network provider at your
location).

IBM EPO
In-Network

6

$184 copay plus $150
copay ($150 copay
waived if admitted)

$0 for X-rays, DME and
prosthetics; 20% for
other imaging services

© 2014 IBM Corporation

Tobacco Surcharge
• A $50 per month surcharge will apply if you and/or your enrolled spouse/domestic partner have
used any tobacco products within six months of the date your IBM medical coverage begins
o The $50 monthly surcharge will apply for each individual indicating tobacco use
o Surcharge helps offset the additional healthcare costs typically incurred by tobacco users

• Employees or spouse/domestic partner will have the opportunity to receive a full refund of
surcharges paid upon the successful completion of health plan administrator’s Smoking Cessation
Program within 6 months or by December 31, 2015, whichever occurs first
• During enrollment, you will be asked to choose from the following options for yourself and a
separate option for your spouse/domestic partner:
o Non-Tobacco User: Select this option if you have not used any tobacco products within the last
six months
o Tobacco User: Select this option if you have used any tobacco products within the last six
months and do not wish to participate in your health plan administrator’s tobacco cessation
program
o Cessation Program: Select this option if you have used any tobacco products within the last six
months but agree to complete a cessation program

7

© 2014 IBM Corporation

IBM PPO or PPO Plus with Health Savings Account (HSA)
• The HSA lets you use tax-free dollars to pay for current healthcare expenses or save for future
•
•
•
•
•

•

healthcare needs
For 2015, IBM will contribute $500 to an HSA for active employees who enroll in the IBM PPO with
HSA or the IBM PPO Plus with HSA
Additional incentives may also be earned ranging from $300 for individual coverage to $1,100 for
family coverage; incentives earned will be deposited into your HSA
In order to receive the IBM contribution or any earned incentives you must open an HSA account
with Fidelity. Additional forms and agreements required
Employees may contribute up to the annual contribution limit of $3,350 for single coverage and
$6,650 for a couple or family set by the Internal Revenue Service (IRS)
Unlike a Health Care Spending Account, unused HSA funds remaining at the end of the plan year
are not forfeited and remain in your account
Deductible and out-of-pocket maximum are administered differently compared to other plan options:
o Those who enroll one or more dependents:
o Must meet the Family Deductible before the plan will pay benefits for covered services
o Must meet the Family Out-of-Pocket Maximum before plan will begin paying 100% for the remainder of the year

o Certain preventive prescription drugs, however, are not subject to the deductible

• You may not contribute to an HSA if:
o Your spouse covers you or any eligible dependents under a different health plan
8

o You or your spouse participates in a health care flexible spending account

© 2014 IBM Corporation

Health Savings Account (HSA) Incentives
If you enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Individual
coverage

You can earn two $150 incentives when you complete the program requirements.

$150 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$150 Wellness Checkpoint Health Risk Assessment
In addition, you’ll have access to the Active Track Fitbit Program

9

Family coverage

You can earn the two $150 incentives above plus two additional $400 incentives when your
spouse/domestic partner or family completes the program requirements.

$400 Consumer Education (choose one of the following):
o
HSA education
o
ALEX
o
Better Choices, Better Health

$400 Wellness Checkpoint Health Risk Assessment

How incentives
are paid

Payments will be processed after you certify that you have completed all program requirements
and will be deposited in your HSA; payments are not subject to taxes.

© 2014 IBM Corporation

IBM Medical Plan Administrators by State
AK

ME

WA
ND

MT

VT

MN

OR

NY
ID

WI

SD

MI

WY

PA
IA
IL

NV
UT

CO

KS

MO

OK

VA

Albany/Poughkeepsie/
Binghamton/Endicott

DE

DC

NC
SC

AR

NM

MS

HI

WV

K
Y
TN

CA

AZ

IN

NJ

MD

OH

NE

NH
MA
CT
RI

AL

GA

LA
TX
FL

Aetna
Anthem Blue Cross Blue
Shield
MVP

* Plan Administrators for IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO
with Health Savings Account, IBM PPO Plus with Health Savings
Account
10

10

UnitedHealthcare

© 2014 IBM Corporation

Anthem Alternate Networks for Certain Locations
State

Service Area

Alternate Network

Georgia

Entire State

Blue Open Access POS

Kansas

Kansas City (Includes Counties of Johnson & Wyandotte)

Preferred Care Blue PPO

Kansas City (Includes the Counties of Andrew, Atchison,
Missouri

Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton,
Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson,
Johnson, Lafayette, Livingston, Mercer, Nordaway, Pettis, Platte,
Ray, Saline,
St. Clair, Vernon, and Worth)

Preferred Care Blue PPO
&
Blue Access Choice

St Louis (Includes the city of St. Louis and the Counties of
Franklin, Jefferson, St. Charles, St. Louis and Warren)

New Hampshire

Entire State

Blue Choice Open Access
POS

NY City and Suburbs (Includes Doctors & Hospitals in 28
New York

Tennessee

Eastern NY Counties: Albany, Bronx, Clinton, Columbia,
Delaware, Dutchess, Essex, Fulton, Greene, Kings, Montgomery,
Nassau, New York, Orange, Putnam, Queens, Rensselaer,
Richmond, Rockland, Saratoga, Schenectady, Schoharie,
Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester)

Entire State

Empire POS

Network S

I.
II.

Alternate Networks apply to those enrolled in the IBM PPO, PPO Plus, EPO or High Deductible PPO or PPO Plus w/ HSA in these service areas.
If you reside in one of these areas you must use a provider that participates in the alternate provider network when obtaining services to receive the higher, InNetwork Benefit. If you use a provider that does not participate in the alternate provider network you will receive the Out-of-Network Benefit (or No Benefits if you are
in enrolled in the IBM EPO) and your Out-of-Pocket costs will be higher.
III. Outside these areas, you will have access to the Blue Card PPO network.
IV. Many providers participate in both the current Anthem network and the alternate provider network. Go to www.anthem.com to check your provider’s participation.
Select “Find a Doctor”, enter the provider your seeking (The name if you know it) or use the Specialty drop down box. From the Search Results page, choose
“Insurance Options, ” choose “Add/Edit Selections.” A new window will open. Enter the state where you reside, choose “Alternate Network” for the type of Health
Medical Plan and choose your alternate network from the drop down menu. Select “Search” to see your In-Network providers. You should also confirm your
provider’s participation directly with your provider by giving him/her the specific name of your alternate network as shown above.
11

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts
IBM Self Insured Medical
Plan Administrators:

Aetna

Anthem BC & BS

MVP

UnitedHealthcare

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 6:00 pm (ET)

Mon-Fri, 8:00 am - 8:00 pm. (ET)
Sat., 8:00 am - 4:00 pm. (ET)

Mon-Fri, 8:00 am - 8:00 pm (ET)

Phone Number

888-725-1841

800-238-6597

800-765-3773

877-222-4261

TTY

877-301-5038

800-241-6895

800-662-1220

877-218-7138

Outside US

860-273-0123

845-695-4505

518-370-4793 (call collect)

877-265-9200

Web Address

www.aetna.com

www.anthem.com

www.mvpselectcare.com/ibm

www.myuhc.com

Login Details

Not Required

Not Required

Not Required

Username: IBM; Password: IBM

Carrier Name

Aetna Inc

Anthem Blue Cross Blue Shield

MVP Select Care

UnitedHealthcaare

719982

0003330081

N/A

401010

Aetna Choice POS II
(Open Access)

Refer to Page 9 for Network
Details

MVP Select Care

UHC Choice Plus

Customer Services Hours

Group Contract Number
Network Name

Prescription Drug
Administrator
Customer Service Hours

CVS/caremark

Mental Health & Substance
Abuse Administrator

24 hours a day, 365 days a year
Customer Service Hours

Phone Number

855-465-0030

TTY

800-863-5488

Phone Number

Outside US

855-465-0030

TTY

Web Address

*

www.caremark.com

Optum
Claims Customer Service: Mon-Fri,
8:00 am - 7:00 pm (ET)

Outside US

800-445-9720
Dial 711 and enter 800-445-9720
267-216-3277

The HMO Plan Administrator contacts are located within the HMO Plan Detail Sheets on the Transition Website

** Plan Administrator web sites have current information on participating Network Providers
*** The IBM Employee Services Center is available @ 800.426.2008 before Date of Hire & @ 800.796.9876 after DOH
12

© 2014 IBM Corporation

IBM Health Plan Administrator Contacts - Continued
Global Assignee Medical Plan
IBM Global Assignee
Medical Plan

CIGNA Global Health Benefits

Phone Number: North America
Clients

Direct Fax

In US: 1.800.441.2668
International: Use the country AT&T Code or
+1.302797.3100 (Reverse Charges
Accepted)
302.797.3150

Web Address

IBM Vision Plan
Phone Number

24 Hours per day / 7 Days per week / 365 Days
per year

Customer Service Hours

Vision Options

www.cignaenvoy.com

Anthem Blue View Vision
855-765-4552

Web Address

www.anthem.com

Login Details

Employer ID = IBM

EyeMed Discount Card
Phone Number
Web Address

EyeMed Vision Care
855-245-0621

www.eyemedvisioncare.com

Dental Options
IBM Dental Basic & Plus
Plans
Customer Service Hours

Mon-Fri, 8:00 am - 11:00 pm (ET); Automated
System, 24 hours per day/7 days per
week

Phone Number

800-872-6963

TTY

800-843-2896

Outside US
Web Address

CIGNA Dental
Maintenance. Alternative
Customer Service Hours
Phone Number

13

MetLife

Web Address

AT&T Access Code + 1-866-989-8542
www.metlife.com/MyBenefits

Cigna
Available 24 hours a day/ 7 days a week
800-CIGNA24
www.cigna.com

© 2014 IBM Corporation

IBM Global Assignee Plan
•
•
•
•

Available to employees on International Assignments; Administered by Cigna Global Health Benefits
Provides Medical, Dental and Vision Coverage
Annual Deductible: $100 Single / $200 Family
Annual Out-of-Pocket Maximum:
o

In-Network:
o Out-of-Network:

$2,000 Single / $4,000 Family
$3,000 Single / $6,000 Family

• Medical Coverage Highlights:
o
o

o
o
o
o
o
o

Preventive Medical and Wellness Care covered @ 100%
Coinsurance: 80% In-Network / 60% Out-of-Network (Applies to services received in US only)
Prescription Drug Coverage
Emergency Evacuation and Repatriation Benefits @ 100%
Immediate access to on-duty Physicians around the world (via telephone)
Access to Nurses and/or Medical Clinicians throughout the world & coordination of Hospital Admissions
Guaranteed/advance payment of hospital and clinic fees
A dedicated 24/7/365 Multilingual Help Line

• Vision Coverage
o

Annual Eye Exam at 100% Reimbursement
o $200 per year allotted for Frames, Lenses, or Contacts per year

• Dental Coverage
o
o
o
o
o
14 •

100% of Eligible Preventive Care and 2 Routine Exams per year
80% of Basic Restorative Care (Fillings, Extractions, etc.)
50% of Major Restorative Care (Crowns, Bridges, etc.)
$2,000 per individual Calendar Year Maximum
Orthodontia (dependent children under age 19), $2,000 lifetime maximum

A complete Summary Plan Description Document will be available during the open enrollment period

© 2014 IBM Corporation

Integrated Health Services Program
• Employees have a unique opportunity to met their health care needs through our
innovative integrated health services program
• Think of it as a one-stop shop for all clinical services, including disease management,
through the IBM Self-insured Medical Plan options (IBM PPO, IBM PPO Plus, IBM
EPO, IBM PPO with HSA and IBM PPO Plus with HSA), at no cost to participants
• Employees will have access to a personal care coordinator who can help them
navigate the complex health care system and assist with questions regarding any
aspect of their health care
• Disease management services are available under the program

15

© 2014 IBM Corporation

IBM Managed Pharmacy Program
• CVS/caremark administers the IBM Managed Pharmacy Program
• Covers IBM employees enrolled in the IBM PPO, IBM PPO Plus, IBM EPO, IBM PPO with HSA and
•
•
•
•
•

•
•
•

16

IBM PPO Plus with HSA Plan options
Per prescription maximums are different for traditional medications and specialty medications
Members will save on out-of-pocket costs when they choose generic over brand name drugs
Some prescriptions require prior authorization
Under both HSA-eligible health plan options, preventive prescription drugs are not subject to annual
deductible
CVS/caremark Network has nearly 68,000 retail pharmacies; including 7,100+ CVS/caremark
Pharmacies
Participants can choose to receive their 90-Day maintenance medication prescriptions through the mail
or at one of the 7,100 CVS/caremark Pharmacy locations nationwide for the same price as mail order
View information on new prescription Benefits, including drug costs, network pharmacy locations and
the formulary list at: www.caremark.com/ibmactives
Customer Service Team for IBM is available at: 855.465.0030 (TTY: 800.863.5488) 24 hours a day, 7
Days a week

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO, IBM PPO Plus or IBM EPO
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $24

20% of discounted cost, up to $26

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$90*

20% of discounted cost, up to
$225*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$180*

50% of discounted cost, up to
$450*

55% of actual cost

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

20% of discounted cost, up to $31

20% of discounted cost, up to $33

30% of actual cost

Formulary Brand

20% of discounted cost, up to
$97*

20% of discounted cost, up to
$244*

30% of actual cost

Non- Formulary Brand

50% of discounted cost, up to
$201*

50%of discounted cost, up to $503*

55% of actual cost

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

17

17

© 2014 IBM Corporation

IBM Managed Pharmacy Program Per Rx Maximums for
employees who enroll in the IBM PPO with HSA or IBM PPO Plus with HSA
Traditional Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Up to 30-Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

Specialty Medications

Participating Pharmacies

Mail Order

Non-Participating Pharmacies

(Special Handling Required)

(Up to 30 -Day Supply)

(Up to 90-Day Supply)

(Up to 30-Day Supply)

Generic

10% of discounted cost after
deductible, up to $150

10% of discounted cost after
deductible, up to $450

30% of actual cost after
deductible

Formulary Brand

30% of discounted cost after
deductible, up to $150

30% of discounted cost after
deductible, up to $450

40% of actual cost after
deductible

Non- Formulary Brand

50% of discounted cost after
deductible, up to $150

50% of discounted cost after
deductible, up to $450

55% of actual cost after
deductible

* If a generic with the identical active ingredient is available, and you choose the equivalent brand name drug instead, you will pay the generic
coinsurance plus the difference between the generic and the applicable brand name drug; per prescription maximums will not apply
**Employees enrolling in IBM Self Insured Medical Plan options will receive a prescription ID Card from CVS/caremark

18

18

© 2014 IBM Corporation

Dental Benefits
Below is a summary of the dental options with plan features IBM offers:
Plan Feature

IBM Dental Basic

IBM Dental Plus

CIGNA DMA

In network: None
Annual Deductible

None

Annual Benefit Maximum
(Excludes Orthodontia)

$500

$2,000 per person
(Excludes orthodontia)

None

Lifetime Benefit Maximum

None

None

None

In network: No charge

In network: No charge

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Diagnostic/Preventive Care

Out-of-network: $50 per person
(Waived for Preventive Care)

In network: 20% of negotiated fee

In network: 20% of negotiated fee

Minor Restorative Care

Out-of-network: 20% of U&P plus
any amount over the U&P

Out-of-network: 20% of U&P plus
any amount over the U&P

Major Restorative Care

Not covered

Orthodontic Treatment

Not covered

Orthodontic Lifetime Benefit
Maximum

N/A

In network: 35% of negotiated fee

Out-of-network: 35% of U&P rate
plus any amount over the U&P
In network: 50% of negotiated fee

19

Out-of-network: 50% of U&P plus
any amount over the U&P
$2,500 per person
(In and Out-of-Network combined)

None

No charge

No charge

Copayments vary
($0 - $350)

Up to $2,450
(24 Months)

None
© 2014 IBM Corporation

IBM Vision Plan
•
•
•
•
•
•

The IBM Vision Plan provides coverage for standard eye exams, glasses and contacts
Participants can receive benefits from In or Out-of-Network providers
Out-of-Network reimbursement is based on a schedule of benefits
The Vision Plan is administered by Anthem Blue View Vision
Anthem is available by phone at: 855.765.4552 or online: www.anthem.com
An ID Card will be issued on enrollment
Below is a summary of coverage:
Plan Feature

In-Network

Out-of-Network

Annual eye exam

Full eligible charge

Up to $35

Glasses - Lenses

Single vision: Covered @ 100%
Bifocal:
Covered @ 100%
Trifocal:
Covered @ 100%

Single vision: up to $25
Bifocal:
up to $40
Trifocal:
up to $55

Additional Savings on lens options (i.e.,

Lens Options

Polycarbonate, progressive, transition and
anti-reflective coating)

Additional Savings Not available

Frames

$120 Allowance, then 20% off balance

Up to $35

Elective:

Elective:

- Conventional Lenses: $120, then 15% off balance
- Disposable Lenses: 120 Allowance

- Conventional Lenses: Up to $105
- Disposable Lenses: Up to $105

- Non Elective: Covered in Full

- Non Elective: Up to $165

Laser Vision Correction Surgery

Savings available via www.anthem.com/special
offers

See any provider

Eligible Providers

Go to www.anthem.com

See any provider

Filing Claims

Providers file claims on your behalf

You pay for services then submit the bill to
Anthem for reimbursement

Contact Lenses

20

© 2014 IBM Corporation

Vision Discount Card
• EyeMed is IBM’s Administrator for the Vision Discount Card
• The free EyeMed Vision Discount Card enables you to save money on eye exams,
eyewear and other vision care services from EyeMed’s nationwide network of
providers
• Up to 40% Savings on Frames, Lenses, Lens Options and Contact Lenses
• You can choose to enroll in the IBM Vision Plan or in the EyeMed Vision Discount
Card, but not both
• Questions about discounts available or to locate a provider can be directed to EyeMed
Vision Care directly at: 855.245.0621

21

© 2014 IBM Corporation

2015 Monthly Contributions for Full Time Employees
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child (Up
to 6)

IBM PPO

$15

$247

$142

IBM PPO Plus

$73

$315

$176

IBM EPO

$93

$335

$186

$0

$98

$68

$10

$193

$116

National Avg. = $103
(Cost varies by HMO)

National Avg. = $350
(Cost varies by HMO)

National Avg.= $193
(Cost varies by HMO)

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
IBM PPO Plus with HSA
HMO (National Average is listed;
actual cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Full Time active and Long Term Supplemental employees with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on
NetBenefits or can be provided by the IBM Employee Services Center during enrollment.
22

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 27 – 32 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$72

$275

$156

IBM PPO Plus

$130

$346

$191

IBM EPO

$150

$366

$201

IBM PPO Plus with HSA

$67

$228

$132

IBM PPO with HSA

$67

$228

$132

National Avg. = $160
(Cost varies by HMO)

National Avg. = $378
(Cost varies by HMO

National Avg. = $207
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 27-32 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
23

© 2014 IBM Corporation

2015 Monthly Contributions for Part-Time Employees
Working 20 – 26 Hours Per Week
Cost for Employee

Cost for Spouse or
Domestic Partner

Cost for Each Child
(Up to 6)

IBM PPO

$112

$295

$166

IBM PPO Plus

$170

$364

$200

IBM EPO

$190

$384

$210

IBM PPO Plus with HSA

$97

$158

$97

National Avg. = $199
(Cost varies by HMO)

National Avg. = $397
(Cost varies by HMO

National Avg. = $217
(Cost varies by HMO

IBM Dental Basic

$22

$22

$15

IBM Dental Plus

$52

$52

$34

CIGNA Dental Maintenance Alt.

$37

$37

$24

$8.90

$8.90

$8.90

$0

$0

$0

Plan

IBM PPO with HSA
HMO - National Average is listed;
Cost will vary by HMO)

IBM Vision Plan
EyeMed Vision Discount Card

* These Contributions are for Part Time employees working 20 - 26 hours a week with no dependents on Medicare
** HMO Contributions will vary by Plan and are affected by Plan Experience and Geography. They will be available on NetBenefits or can be provided by the IBM Employee Services
Center during enrollment.
24

© 2014 IBM Corporation

Medical Plan Opt Out Credit
• If you decline Medical coverage, you can receive a $30 per month credit for opting out
of Medical coverage
• The credit is paid in semi-monthly paycheck; treated as taxable income
• If you elect No Medical Coverage, you will not be able to enroll in Medical Benefits until
the next annual enrollment period, unless you experience a qualified status change
that allows you to enroll

25

© 2014 IBM Corporation

Flexible Spending Accounts
Health Care Spending Account (HCSA)
• You can set aside $10 to $208.34 monthly in pre-tax dollars to pay for eligible, unreimbursed health care expenses
up to the Annual IRS Maximum limit of $2,500
• You can claim reimbursement for expenses incurred by any dependent claimed on your Federal Tax Return
• Eligible expenses include deductibles, co-payments and other unreimbursed medical, dental, vision and hearing
costs
• See IRS Publication 502 for a complete list of eligible HCSA expenses at: http://www.irs.gov/uac/Publication502,-Medical-and-Dental-Expenses-1
• Monies not used during the coverage period are subject to forfeiture
• A Health Debit Card can be used at a participating CVS/caremark retail pharmacies or through CVS/caremark’s Mail
Order Service to purchase prescription drugs only
• Per IRS rules, you may enroll in the HCSA or a Health Savings Account (HSA), but not both
Dependent Care Spending Account (DCSA)
• You can set aside as little as $20 monthly and as much as $5,000 annually in pretax dollars to pay for eligible
dependent care expenses
• Reimburses care that enables both you and your spouse to work, or you to work and your spouse to attend school
full-time
• Eligible expenses include day care and certain elder care expenses
• Monies not used during the participation period of subject to forfeiture
26

© 2014 IBM Corporation

Dependent Eligibility
• Eligible Dependents
o Your spouse
o A qualified, same-gender domestic partner
o Your natural and legally-adopted children to age 26
o Your stepchildren to age of 26
o Other children to age 26 for whom IBM determines that you have been granted

permanent legal guardianship of the child’s person and property by a court of law
o A child who is incapable of self-support and was mentally or physically handicapped
before age 26 who meets the criteria for continued coverage upon reaching age 26 as
determined by IBM

Note: Some HMOs do not offer domestic partner coverage. To find out more you will need to contact the HMO directly.

27

© 2014 IBM Corporation

Dependent Eligibility Confirmation

Sample of DEC envelope mailed to your home

• Employees must provide documentation supporting their
eligibility after enrollment

• Reference the Dependent Eligibility Process on the

Benefits Page of the Transition website for details on
required documentation

• Within three weeks, you will receive a package from the
Dependent Eligibility Confirmation Center, administered
by Budco, describing the process, the due date, and
acceptable documents you need to provide to confirm
your dependent’s eligibility

• If you do not provide sufficient documentation by the

required date indicated in your package, your dependent
will be removed from IBM benefits coverage
approximately 60 days after your IBM date of hire

28

© 2014 IBM Corporation

Healthcare Enrollment
• Your HR Transition Manager will provide further information regarding the dates for the

health care benefits enrollment period, and the materials available to you on the medical,
dental and vision options.
• IBM Employee Services Center:
o Before your Date of Hire: 800.426.2008 (TTY: 800.426.6537)
o After your Date of Hire:
800.796.9876

• When the enrollment period opens: you may call the IBM Employee Services Center

between 8:30 a.m. and 8:30 p.m. ET to enroll. To protect your privacy and guard against
identity theft, you will be asked a few questions for authentication purposes

• After your IBM Date of Hire you may also enroll via NetBenefits: http://netbenefits.com
• You must make your elections by the enrollment deadline date; otherwise, you and your
eligible dependents will have No Medical, Dental, or Vision Coverage for the entire Plan
Year unless you have a qualified status change. You will also be defaulted to 50% LTD
coverage and be charged for any associated premium

• Coverage is generally effective as of your Date of Hire

29

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll
• Generally, it will take a minimum of three weeks (or Longer), from the time you enroll in IBM

Benefits, for eligibility information to be processed by IBM’s Plan Administrators, for you to be
recognized by the administrators Customer Service Teams and/or for you to be able to
register/print Medical ID Cards on the administrators web sites.

• We encourage you to refill any prescriptions and/or to obtain any known necessary medical
services under your previous employer’s benefits prior to starting with IBM.

• In the event of a True Medical Emergency, you should obtain the medically necessary care

immediately, at the closest Hospital. The IBM Plan and most HMOs will cover Emergency Care
rendered by Out-of-Network providers at the In-Network Benefit level until the point where you
can be stabilized and be safely moved to an In-Network facility.

• You may call the IBM Employee Services Center @ 1-800-426-2008 to request an Emergency
Enrollment if you are admitted to a hospital. You will need to explain the nature of the
emergency, and if it meets the definition of a “True Emergency” resulting in a Hospitalization
the ESC representative will work to process your enrollment within 24 hours. As noted earlier,
there is a $150 ER Surcharge if you are not admitted.

30

© 2014 IBM Corporation

What to Do if You Need Care Before You Enroll - continued
• Once the Plan Administrator has your enrollment information you can request their help in

validating you as a new member to your providers so you will not have to pre-pay for services
and so the services you receive will be billed and considered by the IBM Plan first (at the InNetwork Benefit level if appropriate) before you are billed.
• Employees requiring non-emergency care, where they are not admitted to a hospital, should:
(1) Ensure the providers they wish to see are In-Network for the IBM Medical Plan option and
respective Administrator they wish to enroll; (2) Obtain and pay for any medically necessary
services; and (3) Submit a claim form to the Plan Administrator once the enrollment is
processed. Claim forms are available on request from the Plan Administrator and enrollments
will be processed retroactively back to an employee’s IBM Date of Hire.
• Review your medical plan coverage options, which are normally effective retroactive to the IBM
Date of Hire
o Services rendered from the Benefits effective date may affect your enrollment decision
and reimbursement
o The IBM PPO, IBM PPO Plus, IBM PPO with HSA & IBM PPO Plus with HSA provide a
higher level of benefits if you use an In-Network provider, but coverage is available from
Out-of-Network providers at a lower Benefit level
o True emergencies are covered at the In-Network Benefit level under the IBM PPO and
EPO options, regardless of where care is received
o Most HMOs only cover Medically Necessary In-Network treatment, and Out-of-Network
services only when such services meet the definition of a True Medical Emergency and
where care is “Medically Necessary”
© 2014 IBM Corporation
31

End of Module I

32

© 2014 IBM Corporation

Thank You

© 2014 IBM Corporation