Details of your employee benefits for 2015.

1. Employee Benefit Guide
Open Enrollment Presentation
November 2014

2. Introduction
• New plan administrator-J.P. Farley for the medical and prescription
drug coverage.
• All employees will be required to make their Benefit Elections via
the ADP website. You must make your Benefit Elections no later
than November 21, 2014 to ensure your changes/additions for the
2015 Plan year.
• ID cards are mailed directly to your home address, watch your mail.
• Should you choose to waive coverage at this time, you must wait
until next open enrollment.

3. Today’s Discussion
• JP Farley: Medical/RX
o Referenced Based Pricing
• Anthem: Dental
• Aetna:
o Life and Voluntary Life
o Short Term Disability (STD)
• Allstate:
o Contact Information
• Next Steps for Enrollment
• Questions

4. Plan Features
• Your plan utilizes an enhanced network.
o The plan covers all legal and appropriate providers of covered services.
o Providers that were considered out of network in prior years will be
covered.
o Your health plan will reimburse your claims on a set fee schedule
• You will have an ID card
o This card will have all the information providers need:
• Submit a claim to your health plan for payment.
• More information about the specific benefits your plan covers.

5. Plan Features
• Connected Care Management Services
o Nurse Care Manager provides a customized, coordinated treatment plan and education
that compliments your health care providers’ on-going care.
• 24/7 Website Access : JPFarley.com
o Plan information
o Claims information
o Plan forms
o Wellness tools
• Patient Advocacy Services
o Billing and out-of-pocket collections assistance:
• Help with favorable payment arrangements
• Protect against aggressive medical bill collectors
• Provide support to advocate for the participant’s patient rights

6. Patient Advocacy Q & A
• What if my provider bills me differently than my plan
states?
o Should you receive a bill from your provider asking you to pay more for a
service than what matches up with the Explanation of Benefits (EOB)
statement, call J.P. Farley and speak with a Patient Advocate.
• Balanced Billed?
1. Contact Patient Advocate Services
2. Patient Advocate will engage you and forward appropriate documentation to provider and
credit bureaus
3. Patient Advocate will maintain follow up and communication
4. Standard process usually only entails the need for two dispute letters
5. If collection notifications or aggressive bill collection attempts continue, Patient Advocate
will provide direction to legal resources to assist

7. How to Read Your Explanation(EOB) of Benefits Statement

8. Medical Details
Deductible (Embedded/Per Person) $250/ $500
Coinsurance 80%
Out-of-Pocket Limit
Plan pays 100% after annual out-of-pocket
maximum (includes deductible and coinsurance)
$2,000 / $4,000
Preventive
Nationally recommended services
No Cost Share
Urgent Care $35 copay
Emergency Room $75 copay
Inpatient / Outpatient Services @ Hospital 80%
Precertification will be required if you have any of the following: Inpatient hospitalization,
Inpatient surgery, Outpatient surgery, Diagnostic testing and imaging studies, Mental health
and chemical dependency services.

9. Prescription Drug
Retail (up to 31 day supply)
Tier 1/ Tier 2/ Tier 3
Mail Order
Tier 1/ Tier 2/ Tier 3
*Mandatory Generic DAW2*
**Required mail services after 3rd fill at
retail**
$10 copay /$30 copay/$50 copay
$20 copay/$60 copay/$100 copay
Up to OOP

10. Prescription Drug
• Pharmacy Benefit
o Prescription Benefit Coverage is designed to provide coverage for retail and
mail order prescriptions. Your medical plan enrollment provides you
access to benefit. Options include home delivery and 90-day retail
supplies.
• Rx Precertification
o Required for all medications that cost $750+ per month or per
dose. We can assist you with additional care and assistance in
obtaining the full advantages of the best specialty pharmacy
benefit options in the marketplace today.

11. Practical Prescription Tips
$4 Generic Programs
o Walgreens, CVS, Wal-Mart, K Mart, Marcs, Giant Eagle, Sam’s Club
o Fill your 30 day generic Rx for $4
– Only applicable for select generic Rx’s
Free Medications
o Giant Eagle
o Blood Pressure, Antibiotics
– Only applicable on select medications
**No insurance is necessary when purchasing medications
though these special programs**

12. Prevention is Key
• Some of the recommended services you’ll have coverage for include:
o Immunizations and wellness visits for children
o Routine preventive exams for adults
o Adult immunizations
o Adult screenings (e.g. mammogram, prostate, diabetes)
o Colorectal cancer screenings
•
• You won’t have to pay anything for these services when:
o The purpose of your visit is to get preventive care
•
• PLEASE NOTE:
o The services listed above are not preventive if you get them as part of a visit to diagnose, monitor or
treat an illness or injury. Then copays, coinsurance and deductibles apply.
o Let your network doctor know that these preventive services are covered at 100% when they are
billed as part of your preventive care.

13. Dependent Eligibility
• In order to enroll a spouse in the company sponsored health plan you must:
o Provide proof of marriage
o Your spouse must not be eligible for benefits through their own employer
o You must provide a signed affidavit from their employer stating they are not
eligible for health insurance through their company.
• Children who submit proof of eligibility are eligible for all benefits until age 26
• Proof of eligibility documents include:
o Most recent federal tax filing form with financial information blacked-off.
o Birth certificate if child covered as tax dependent by another parent
o Marriage certificate dated within the last 12 months

14. Anthem - Dental
Search For Dental Providers at: www.anthem.com
Select Find a Doctor - Dental - Search Criteria - State - Plan Type = Dental - Plan Name = Dental Blue 100/200/300.
In-Network Non-Network
Deductible
Single / Family
$50 / $150 $50/$150
Waived for Preventive Yes Yes
Preventive Services 100% 100%
Basic Services 85% 80%
Major Services 50% 50%
Annual Maximum $1,000 $1,000
Orthodontia Not Covered Not Covered

15. Aetna-Life and Voluntary Life
Basic Life/AD&D
• Employer paid benefit
• $20,000 employee coverage
Voluntary Life/AD&D
Employee:
• $10,000 increments, minimum $20,000 up to $100,000
• $100,000 guaranteed issue amount
Spouse:
Employee must elect coverage in order for spouse or child to be eligible for coverage.
• $10,000 benefit up to $50,000 (not to exceed 50% of Employee amount)
• $50,000 guaranteed issue amount
Child(ren):
• $5,000 benefit
• $5,000 guaranteed issue amount
** If you currently have coverage and elect additional coverage during annual enrollment: you may increase your coverage by
one $10,000 increment not to exceed $100,000. Amounts greater will require evidence of good health.
You may increase your spouse coverage one $10,000 increment not to exceed $50,000.**

16. Short Term
• Short-Term Disability
o 60% of your earnings up to $350 / week
o Waiting Period: 1st Day Accident / 8th Day Sickness
o Benefit Duration: 13 weeks

17. Allstate Voluntary Benefits
For more information the Allstate Voluntary Benefits please contact your
broker, Britton Gallagher at:
Voluntary Benefits
216-658-8577 or 216-658-7806
1-866-230-9184
Voluntarybenefits@brittongallagher.com

18. Next Steps for Enrollment
• All Employees are required to complete a waiver or
enrollment on ADP for Medical/RX, Dental, Vision, Life
AD&D and STD benefits
• Enrollment must be completed by November 21st
• After electing coverage, ID cards are mailed directly to the
address listed on application, watch your mail.

19. ID Cards
o Watch your mail for new ID Cards
• J.P. Farley – Medical
• Anthem – Dental (All Employees will
receive new ID cards)

20. Qualifying Events
• During the year, the only time you are permitted to make election
changes is:
o Birth of a child
o Marriage
o Divorce/Legal Separation
o Loss of coverage
o Adoption
• HR Must Be Notified within 31 Days of the Qualifying (Life
Changing) Event

21. QUESTIONS??