Open Enrollment Guide 2009


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Open Enrollment Guide 2009

  1. 1. 2009 Open Enrollment Guide APPLIED CHOICES ® Take Charge of Your Life
  2. 2. Welcome to the Applied Industrial Technologies Open Enrollment for healthcare benefits. As an Applied® associate, you have the opportunity each year to select the healthcare plans that best meet the needs of you and your eligible dependents. During this Open Enrollment period, you’ll be making your plan choices for the 2009 calendar year. The Open Enrollment period begins with your receipt of this Guidebook and materials. The Electronic Benefit System is open and available beginning Monday, November 3 for you to make your benefit selections for 2009. The system will remain open through Friday, November 21, 2008. You must complete your plan selections by November 21, 2008.
  3. 3. Open Enrollment Guidebook 2009 Table of Contents Benefit Plan Changes for 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Open Enrollment Period Before You Enroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 The benefits Open Enrollment Period begins November 3, 2008 How To Enroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 and ends November 21, 2008. Changing Your Plan Coverage In The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Your Medical Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Your Prescription Drug Plans* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Notice of “Creditable” Coverage (Medicare Part D) . . . . . . . . . . . . . . . . . . . 12 Your Dental Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Your Vision Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Flexible Spending Accounts (FSAs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 A Summary Of Your Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 What You Need To Do. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 For More Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 About This Guidebook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 * Review Carefully – New Plan Information IMPORTANT We urge you to keep this Guidebook with your personal records throughout 2009. The Guidebook contains valuable information, which will be helpful to you if you have future questions about your benefit plan selections.
  4. 4. Benefit Plan Changes for 2009 Applied® is committed to providing eligible Self-Insured associates with quality healthcare plan options, at competitive levels of associate contributions. Since Applied® is ‘self-insured’ Applied® does not pay a for virtually all the healthcare expenses of monthly insurance premium our associates and their eligible dependents, to an insurance company. we recognize that rising healthcare costs Rather, the Company pays all are placing an increased financial burden healthcare expenses incurred on both our associates and the Company. by our associates and their Nevertheless, in 2009 Applied® will continue eligible dependents out of the to pay the majority of the healthcare expenses general assets of the Company. for these benefit plans. Therefore, these expenses Medical Plan Changes directly impact our bottom line. • Associate contributions for 2009 will be increased consistent with the increase in medical inflation as well as the benefits paid under each plan. Anthem Healthplan Mandatory Mail order • The Basic PPO prescription plan annual Participants: PrograM: maximum benefit will be increased to $2,500. Anthem’s MyHealth The Anthem mail order program, serviced Risk Assessment by WellPoint NextRx, must be used for all long-term maintenance medication needs. Dependent Eligibility: Maintenance medications are those that a physician prescribes on a long-term basis To control costs for all Applied® associates If you graded your health today, (60 days or more) for continuing care of a who participate in our healthcare plans, it what score would you get? health condition. Examples of maintenance is important that only those dependents Anthem offers you the ability to prescriptions would be diabetic medicine, who are eligible for benefits are enrolled not only measure your overall cholesterol medicine, or any other drug that in the plan(s). Detailed information health, but it also provides is taken on a daily or consistent basis. All regarding the definition of an “Eligible you with specific action steps Applied® associates with Anthem are required Dependent” can be found at the HR for changing your habits and to participate in the mail order program if Intranet site under OE 2009. reducing your health risks. they, or a covered dependent, are prescribed a As you participate in the Electronic Open How to get started? maintenance drug. There are no exceptions to Enrollment process, please use these the mail order program. Simply log in at descriptions to determine who is eligible and click on MyHealth ➟ for enrollment in the plan(s). You will Flexible Spending (FSAs) Personalized Health Manager ➟ be required to confirm that you have MyHealth Assessment. Remember, you must re-enroll each year reviewed the eligibility of the dependents that you wish to maintain an FSA. Review that are covered on your Company page 19 for details regarding the program. sponsored healthcare plans. If you have a question regarding the eligibility status of any person you wish to enroll in the Applied® healthcare plan(s), you are encouraged to call the Human Resource Services Call Center at 216-426-4269 prior to completing the electronic Open Enrollment process. 4 Applied Choices
  5. 5. Before You Enroll… If, for some reason, you are unable to enroll What You Need to through the Electronic Benefits Enrollment We encourage you to choose your benefit system, request assistance from your location Do On-Line plans wisely. To help in the selection process, manager or supervisor. a Case Study & Personal Worksheet can be If you have any questions, please contact the found on the HR Intranet site under OE Human Resource Services Call Center at 1. If you are keeping the same 2009. The goal of these tools is to assist you 216-426-4269. benefits coverage (except in performing a careful financial analysis FSAs) for 2009, no action of your medical expenses. Please refer to it Confidentiality and Information is required. You will be frequently as you consider your options for Security automatically re-enrolled 2009. in the same medical plan(s) Regardless of the PC you use, you can be How to Enroll for 2009. Confirmations will assured that all of your personal information be mailed mid-December When you are ready to enroll, log on to is secure and confidential. Each associate’s confirming your elections. You can enroll from enrollment information is protected by 2. If you are making changes in your home computer or at work. technology that encrypts all sensitive your medical coverage, simply information. To Log on From Your Home Computer click on the medical plan you (with Internet access): Confirmation of Your Selections want to select and follow the • Type This will take screen prompts. The decisions you make using the Electronic you to the log on screen. Benefits Enrollment system will be confirmed • Next, enter your JD Edwards User Name to you in two ways: and Password. If you do not currently have 1.) While you are still logged on to the a JDE User Name and Password, you will Electronic Enrollment system, you will be Summary Plan be required to complete the registration given the option, at the end of the process, process within JD Edwards to obtain one. Descriptions to “Print” a hard copy of your 2009 benefit Detailed instructions can be found on the selections. We encourage you to print that HR Intranet site under the “JD Edwards” screen for your own records. tab. Anthem Booklets, known as 2.) In December 2008, you will receive a • Enter your one-time activation code (if you Summary Plan Descriptions, personalized letter from the Human Resource have not already done so in 2008) found are available online at www. Services Department. This letter will confirm in the upper right-hand corner of the Simply click on the benefit selections you made during enrollment letter included in this packet. the “Forms” tab located on the the Open Enrollment process. Again, we menu bar of the home page and • Once you have reached the myApplied. encourage you to save the confirmation letter choose the appropriate booklet. com home page, select “Enrollment” from for your personal records. the menu to begin the on-line process. To Log on From the PC at Your Service Center or Other Work Location: If you are accessing the Internet at work and have the Company Intranet site called “Within Applied” set as your default log on, simply click on the link. OR, • Launch Internet Explorer. • Type • Once you have completed the enrollment process, be certain to close the Internet Explorer to ensure that your information remains confidential. 5 Applied Choices
  6. 6. Changing Your Plan Coverage In The Future The choices you make during this Open Newborn Baby/ Qualified Status Changes Enrollment period will remain unchanged until December 31, 2009. The only way you Adoption Reminder • Marriage/Divorce can change the dependents listed on your • Birth/Adoption plan is if you experience a Qualified Status Change. • Death In order to be covered under an You must contact the HR Department within Applied® health plan, you MUST • Disability 31 days of event occurrence for any of the enroll your newborn or newly • Termination of your employment Qualified Status Changes. adopted child within 31 days • Loss of a dependent’s eligibility of the date of birth or date of Your change in coverage must be consistent placement. Be certain to contact • Loss of coverage due to a change in with a change in status that affects eligibility the Corporate Human Resource your spouse’s employment for coverage. For example, if you have a baby, Services department within 31 adding a dependent to your coverage would • Issuance of a Court Order or administra- days. Elections received after the be consistent as your baby would be newly tive decree that requires coverage for a 31st day will not be accepted, eligible. Adding coverage for your spouse dependent child and you must wait until the next because his/her insurance contributions • Significant change in your spouse’s Open Enrollment period. increased would not be considered a benefits (increases in plan contributions Qualified Status Change. You may not switch required by any employer do not meet plan options mid year for any reason, other this standard) than a Qualified Status Change. • Relocation of your home or work site, or Requesting A Change that of your spouse or eligible depen- dent, which takes you out of, or into, the Any of the above changes must be requested plan’s service area (may require a plan within 31 days of the Qualified Status option change) Change. If you miss that deadline, you must wait until the next annual Open Enrollment period to make the change. To make a change, you must obtain an Applied® Choices enrollment form. Forms can be found on the HR Intranet site under “Your Benefits” and on under “Forms–Medical.” This form must be returned within 31 days of the date of the Qualified Status Change. Be sure to notify Human Resources within 31 days of marriage if you wish to add your spouse to your healthcare coverage. 6 Applied Choices
  7. 7. Your Medical Plans This section of the Guidebook addresses the Coverage Levels: With all medical plan Eligible Dependent medical plan providers and the plan designs options, you can choose: that are available to Applied® associates. It Reminder • Associate Only, also provides the 2009 associate contributions • Associate + 1, for each plan. • Associate + 2 or More, or Eligible dependents include: current legal spouse and • No Coverage. unmarried natural born children, Important Note: You can choose medical, stepchildren, adopted children, dental and vision coverage separately. custodial agreement children, However, you must use the same coverage incapacitated children and level for all your choices. For example, if guardianship children up to you choose “Associate Only” coverage for the age 19 or 25 if full-time your medical plan, then you must choose students. Complete information “Associate Only” coverage for the dental and definitions can be found on and/or vision plans. the HR Intranet site under OE Dependent Children: Unmarried dependent 2009. children are covered under all the medical The health plan prohibits plans. Under the Anthem BCBS plans, enrolling ineligible dependents children can be covered to age 19, or to age in the plan. Be certain to notify 25 if they are full-time students. Please check the Human Resource Services the plan descriptions carefully, or contact department within 31 days of your HMO directly. a change in dependent status. Prescription Drug Coverage: All of the Ineligible dependents may not Applied® medical plans include prescription use the health plan beyond the Your Medical Choices drug coverage. date the dependent becomes Medical Plan Options: You may choose a ineligible. Please remember, medical plan design. However, the medical you will be responsible for plan options available to you depend on reimbursing the company for those available to your work location. Not any benefits paid beyond the all medical plans are available in all Applied® last day of eligible coverage. locations. Please refer to the personalized letter included in your Open Enrollment packet to learn which medical plan options are available to you. Persons NOT Eligible for Enrollment The Women’s Health & Cancer Rights Act This Federal legislation requires all medical plans to provide • Ex-Spouse coverage for breast reconstruction following a mastectomy, (Regardless of court order) including: • Domestic Partners • Reconstruction of the breast on which the mastectomy was performed, • Same Sex Marriage • Surgery and reconstruction of the other • Part Time Students breast to produce a symmetrical • Married Child appearance, and • Other Relatives • Prosthesis and treatment for physical • Other Household Residents complications in all stages of the mastectomy, including lymphedema. 7 Applied Choices
  8. 8. Medical The Anthem BCBS Plan Designs Non-Duplication of Through Anthem BCBS, Applied® offers three Benefits Provision very different PPO plan designs. Each plan varies in the level of coverage it provides Applies to All and the associate contributions are reflective Anthem BCBS of the level of plan benefits you choose. Medical and CIGNA Remember to carefully complete the Case Study found on the HR Intranet site under Dental Plans OE 2009 to ensure you are receiving the most economical plan for your healthcare needs. The Anthem BCBS plans are described below. The benefits provided by our A summary of the various plan coverages medical and dental plans will be may be found on Page 10 of this Guidebook. coordinated with the benefits provided by any other plans that cover you and your eligible dependents. This does not apply to benefits provided by the Anthem WellPoint NextRx PPO STANDARD PLAN Associate prescription plan or VSP. This is the “standard” plan of the healthcare PPO Monthly This means that if the Applied® industry. Often referred to as an “80/20” Standard Contribution plan provides secondary plan, the PPO Standard Plan is similar to that coverage for your dependents, Associate Only: offered by most employers today. The PPO then the Applied® plan will Standard Plan offers Applied® associates a Full Rate $86 adjust its benefits so that the quality healthcare plan at a very competitive total benefits payable under all Non-Smoker Discount* $78 price. Carefully review your anticipated plans, for eligible charges, do Associate +1: healthcare costs for 2009. You may find that not exceed the eligible charges Full Rate $214 the PPO Standard Plan is the most efficient payable under the primary plan way to provide quality healthcare for you and Non-Smoker Discount* $190 (other coverage). For example, if your eligible dependents. the primary plan would normally Associate +2: pay $80 of a $100 eligible Full Rate $240 expense and the secondary Non-Smoker Discount* $214 plan would pay $90, then the secondary plan (Applied®) would pay only an additional $10. Because our plan contains a Non-Duplication of Benefit Terms to Know • Co-pay – a fixed amount you pay when Provision, Anthem sends letters you receive a specific service (for example, out each year in order to verify if • In-network – doctors and facilities that an office visit). there might be other insurance have a contract with a health plan. When coverage. In order to avoid • Co-insurance – the percentage you pay you use a doctor or facility that’s in-net- delays in processing claims, when you receive care (for example, under work, your out-of-pocket costs are lower. please be certain to respond to the PPO Plan, X-rays may cost $200. If • Out-of-network – doctors and facilities Anthem’s inquiry promptly. your deductible is already met, the plan that do not have a contract with a health would pay 80%, or $160, and your co- plan are not part of the network. When insurance would be 20%, or $40). you use a doctor or facility that does not • Out-of-pocket maximum – the maxi- participate in the network, your out-of- mum amount you must pay before the pocket costs are much higher. plan pays 100% for covered services. This • Deductible – the amount you must pay amount does not include deductibles. first before the plan begins paying ex- • Out-of-pocket cost – the amount you penses for a service. Co-pays do not apply pay when you receive care. toward your deductible. * You nor any of your dependents can use tobacco products, and you must live in a smoke-free environment. 8 Applied Choices
  9. 9. PPO BASIC PLAN Tobacco-Free Associate If you and your eligible dependents are PPO Monthly Household Discount in good general health, and you do not Basic Contribution anticipate the need for extensive medical Associate Only: services in 2009, the PPO Basic plan design It’s a fact that people who do may be a good option for you. The co-pays Full Rate $32 not smoke and who are not and out-of-pocket maximums are higher, Non-Smoker Discount* $28 exposed to secondhand smoke but the associate contributions are very low. are healthier. In recognition of Associate +1: This is a great plan design to combine with that, Applied® offers a Full Rate $76 an FSA. non-smoker discount for each Non-Smoker Discount* $66 of the medical plans. If you and your covered dependents do not Associate +2: smoke or use tobacco products Full Rate $84 and live in a smoke free Non-Smoker Discount* $76 environment, you can qualify for this discount. If your household smoking status changes during the year, please contact Human Resources for premium PPO ELITE PLAN adjustments. Associate The PPO Elite Plan has this name because of PPO Monthly the very high level of benefits it provides. The Elite Contribution cost of these benefits comes at a high price, Associate Only: both to the associate and to the Company. Therefore, the PPO Elite Plan contributions Full Rate $190 are the most expensive of all the plans. Non-Smoker Discount* $168 Associate +1: Full Rate $460 Non-Smoker Discount* $410 Associate +2: Full Rate $510 Non-Smoker Discount* $456 INDEMNITY PLAN Associate (Note: this plan is only available if an associate has Monthly no access to the Anthem BCBS network) Indemnity Contribution With this plan, an associate may receive Associate Only: healthcare services from any medical provider. There are no network restrictions. Full Rate $86 However, the cost of medical care is not Non-Smoker Discount* $78 “discounted” by the medical provider, and the Associate +1: associate must pay a fixed percentage of the full cost of medical care. Full Rate $214 Non-Smoker Discount* $190 Associate +2: Full Rate $240 Non-Smoker Discount* $214 * You nor any of your dependents can use tobacco products, and you must live in a smoke-free environment. 9 Applied Choices
  10. 10. Medical Your BCBS Medical Plans At-a-Glance Here’s a closer look at each of the BCBS plans and the key services covered under each one. The plans pay all eligible co-insurance (for example 80%) after you meet the deductible, if applicable. PPO-Standard PPO-Basic PPO-Elite INDEMNITY In- Out-of- In- Out-of- In- Out-of- Network Network Network Network Network Network DeDuCTIble Individual $200 $600 $1,500 $3,000 None $1,500 $200 Family $600 $1800 $3,000 $6,000 None $3,000 $600 OuT-Of-POCKeT MAxIMuM (does not include deductible) Individual $1,000 $3,000 $5,000 $10,000 $500 $5,000 $1,000 Family $2,000 $6,000 $10,000 $20,000 $1,000 $10,000 $2,000 lIfeTIMe MAxIMuM Unlimited Unlimited Unlimited Unlimited Unlimited $2.5 million Unlimited OffICe vISITS $20 co-pay* 60% $25 co-pay* 50% $20 co-pay 50% 80% PReveNTIve CARe Not Not Not (includes physical exams, $20 co-pay* $25 co-pay* $20 co-pay 80%* covered covered covered immunizations, OB-GYN, well child visits***) eMeRgeNCy CARe Doctor’s office $20 co-pay* 60% 75% 50% $20 co-pay 50% 80% $100 co-pay $100 co-pay Hospital 80% 80% 75% 75% 80% (waived if admitted) (waived if admitted) Urgent care 80% 80% 75% 75% $25 co-pay $25 co-pay 80% Out of area 80% 80% 75% 75% $50 co-pay $50 co-pay 80% Ambulance 80% 80% 75% 75% No charge No charge 80% INPATIeNT HOSPITAl 80% 60%* 75%* 50%* $250 co-pay 50% 80% OuTPATIeNT HOSPITAl 80% 60%* 75%* 50%* $125 co-pay 50% 80% SuRgeON’S feeS 80% 60%* 75%* 50%* No charge 50% 80% x-RAyS/lAb 80% 60%* 75%* 50%* No charge 50% 80% DuRAble MeDICAl 80% 80% 75% 75% 100%‡ 50% 80% eQuIPMeNT MeNTAl HeAlTH Outpatient $25 co-pay* 50%* $25 co-pay* 50%* $25 co-pay* 50%* 80%* Inpatient 80%* 60%* 75%* 50%* $250 co-pay* 50%* 80%* SubSTANCe AbuSe Outpatient $25 co-pay* 50%* $25 co-pay* 50%* $25 co-pay* 50%* 80%* Inpatient 80%* 60%* 75%* 50%* $250 co-pay* 50%* 80%* ClAIM fORMS? No Yes No Yes No Yes Yes HOSPITAl Doctor Associate** Doctor Associate** Doctor Associate** Associate** PReCeRTIfICATION Responsibility Responsibility Responsibility Responsibility Responsibility Responsibility Responsibility ReQuIReD? ‡Includes coverage for hearing aids – limit 2 per lifetime up to $800 each. *May be subject to certain limitations, separate deductibles or co-pays and/or plan limits per lifetime. ** $300 penalty applies for non-compliance. ***One annual routine mammogram is covered in full at an in-network facility. Office visit co-pay/deductibles apply. 10 Applied Choices
  11. 11. Health Maintenance Organizations (HMOs) How to Read the Although the Anthem BCBS network serves the vast majority of Applied® associates, it does Charts in This have a few geographic limitations. As a result, Applied offers an HMO option in those few geographic areas. You will know if you may select an HMO by reading the personalized letter Guidebook enclosed in this Open Enrollment packet. The personalized letter provides you with the plan choices for your Applied® work location. Any time you see a percentage With an HMO, you must use the medical providers in that HMO plan. If you seek medical listed in a chart, this is the treatment “out-of-network,” the HMO plan will not provide any coverage – except in the case percentage the plan pays. of a true life-threatening emergency. As an example, let’s look at the The HMO plan also provides coverage for prescription drugs. Please consult the HMO medical plan chart on page 10. summary plan description for the co-pay amounts and limitations the HMO may place on Under X-rays/lab in the prescription drug coverage. If you have questions regarding these options, contact the HR Call in-network PPO option, you’ll Center at 216-426-4269. see 80%. This is what the plan pays (after you pay the HMO Associate Monthly Contribution deductible). So, in this case, you United Healthcare Kaiser would pay 20% of the cost (plus your deductible) if you get X-rays Associate Only: taken or use a lab service. Full Rate $142 $138 Non-Smoker Discount* $128 $124 Associate +1: Full Rate $354 $330 Non-Smoker Discount* $316 $296 Associate +2: Full Rate $388 $366 Non-Smoker Discount* $348 $326 * You nor any of your dependents can use tobacco products, and you must live in a smoke-free environment. Out-of-Pocket Maximum and Co-Insurance It is very important to understand that once you reach an “out-of-pocket maximum” during a plan year, the plan you choose will pay 100% of in-network medical expenses. for example, if you incur a $20,000 hospital bill under the PPO Standard Plan, and you have already met your family’s deductible and out-of-pocket maximum earlier in the plan year, the plan will pay 100% of the $20,000 hospital bill. “Out-of-pocket maximum” does not include deductibles. Check the Anthem website at to locate a network provider, or to make certain that your doctor or hospital participates in the Anthem network. Always verify with your provider that they are part of the Anthem PPO network. 11 Applied Choices
  12. 12. Your Prescription Drug Plans To help reduce your healthcare expenses, be Highlights of Your Categories of Drugs sure to use generic medications whenever possible. Prescription Drug There are three categories of prescription drugs: Your co-pay for a generic drug will be Plan substantially lower than your co-pay for the • Generic drug – these drugs have the brand name equivalent. exact same active ingredients as brand name drugs, but can cost one-half to Here are some key things to know about your You pay a co-pay each time two-thirds less than the brand name prescription drug plan: you get a prescription filled, so equivalent drug. Please use generic you always know up front how • The Anthem BCBS medical plans drugs whenever possible. much your prescriptions will include prescription drug coverage, also cost. • Formulary drug – these are brand provided by Anthem BCBS. Your Anthem name drugs that are listed in the Identification Card is to be used for both Prescription drug coverage is Anthem Formulary Drug List. This list medical and prescription drug services. included in the monthly cost for may be found at your medical plan. You do not • The HMO medical plans include their Because Anthem has negotiated a pay a separate amount for this own prescription drug coverage, so HMO contract price for these drugs, your benefit. participants will not receive benefits co-pay is lower when your doctor through WellPoint NextRx. Maintenance Drugs – If you are prescribes one of these medications. an Anthem participant, you and • Refer to page 13 for important information • Non-Formulary drug – also brand your eligible dependent(s) must regarding the Mandatory Maintenance name drugs, Anthem has no price use the mail order program for Drug Program. guarantee for these medications. maintenance drugs. Therefore, your co-pay is higher as well. Share the Formulary Drug List with your physician. It might be to your advantage if your physician prescribes a similar medication from the Formulary List. letter of “Creditable” Prescription Drug Coverage The Medicare Part D prescription drug program went into effect on January 1, 2006. Under this program, Applied Industrial Technologies is required to notify associates and/or their dependents who may be eligible for Medicare that the Applied® prescription coverage is considered “creditable.” This means that Applied® plan is at least as good as Medicare Part D Drug plan. Because your current prescription drug coverage through Applied® is considered at least as good as the standard Medicare Part D Prescription drug coverage, you do NOT have to enroll in Part D coverage and you can keep your Applied® coverage. Provided you do not have a lapse of more than 63 days in “creditable” prescription coverage, you will not have to pay a higher Part D premium if you decide to enroll in Medicare Part D prescription coverage at a later date. You will receive a notice of “creditable” coverage each year. 12 Applied Choices
  13. 13. Terms to Know Using Mail Order • Non-maintenance drug – a drug used to treat an occasional, short-term condition. NextRx • Co-pay – a fixed amount you pay when • Formulary drug – brand name drugs that you have a prescription filled. are included on Anthem’s Formulary Drug • generic drug – these drugs have the List. Using formulary drugs saves you money. There are three convenient ways exact same active ingredients as brand to use “NextRx,” the name • Anthem Formulary drug List – the list name drugs and are the most cost given to Anthem’s prescription of those name brand medications which effective for both you and the Company. mail order service. Anthem has selected, based on quality, • Maintenance drug – a drug used to treat safety and cost. New Presciption Orders: a chronic, long-term condition. • Telephone: 888-613-6091 • Non-Formulary drug – brand name • brand Name drug – a prescription drug NextRx Customer Service medications that are not included on that is protected by a patent that is only will contact your physician Anthem’s Formulary Drug List. These are issued to the original drug company. Some for your prescription. When the most expensive drugs and are subject examples include: Nexium, Zoloft and you call, please have the to the highest co-pay. Lipitor. following information ready: medication name, physician name and phone number, How To Fill Prescriptions your Anthem ID card, and How you get your prescriptions filled your credit card information. depends on whether you use maintenance • FAX : Using the Fax Physician or non-maintenance drugs. Maintenance Order Form, your physician drugs are drugs that are used to treat chronic, can FAX the medication order long-term conditions, such as diabetes or to NextRx from the doctor’s high blood pressure. Non-maintenance drugs office. are drugs used to treat occasional, short-term • Mail : Using the initial order conditions. form, you may mail your prescription to: Maintenance Drugs – NextRx Mail Service Pharmacy MANDATORY MAIL ORDER PO Box 746000 If you are required to take a prescription Cincinnati, OH 45274-6000 drug for a chronic or long-term condition Refills: such as high blood pressure or asthma, you • Telephone: NextRx Customer will need to utilize the Anthem mail order Service 800-962-8192 program once you have received two “fills” • Internet: go to at your local pharmacy. This means you can have the original prescription filled and Important Reminders: then receive one additional “refill.” If you • Always allow 10-14 business need to continue to take this prescription days to receive your you should ask your doctor to write a new medication from NextRx. prescription for a 90-day supply for a one- • Prior payment of your co-pay year duration. For your convenience, mail is required before NextRx will ordered prescriptions can be refilled via the ship your medications. Internet at (members • NextRx Customer Service is log-in). Prescriptions are then mailed right to ready to assist: 800-962-8192 your home. Non-Maintenance Drugs If you need a prescription for a non- maintenance drug, you can use a retail pharmacy and receive a 30-day supply and if needed one refill. You must show your Anthem card when you pick up your prescription. 13 Applied Choices
  14. 14. Prescription Drug Prescription Plan Co-pays What You Need To Do About PPO-Standard, PPO-Elite, Indemnity Prescription Drug Mail Order 90-day Coverage Retail 30-day Supply Supply** Generic $10 co-pay $20 co-pay Formulary Brand $25 co-pay $50 co-pay Nothing. Your prescription drug plan is included with your Non-Formulary Brand $45 co-pay $90 co-pay medical coverage. PPO-Basic* Mail Order 90-day Retail 30-day Supply Supply** PPO-Basic RX Generic Coverage Update $20 co-pay $40 co-pay Formulary Brand $30 co-pay $60 co-pay Non-Formulary Brand $45 co-pay $90 co-pay The PPO-Basic prescription plan *The maximum PPO-Basic benefit per year is $2,500 per person. Once Anthem NextRx has provided $2,500 in annual maximum benefit will be prescription coverage, no additional prescription benefits will be available for the remainder of the calendar year. increased to $2,500. **Mail Order – Must be used for all maintenance drugs used to treat chronic or long-term conditions. Helpful Tip: How to Save on your Prescription Drug Costs • Review with your doctor the drugs he/she • If you want to use brand name drugs, ask has prescribed for you. Ask if a generic if your doctor thinks it is appropriate to drug is available. If not, check the Anthem prescribe drugs that are on the Anthem Formulary Drug List to see if a formulary Formulary Drug List. Using these formulary brand drug can meet your needs. This brand drugs cost you less. could decrease your costs. 14 Applied Choices
  15. 15. Your Dental Plan Your Coverage Levels CIGNA also offers You can choose: discount programs • Associate Only, to our dental • Associate + 1, participants that • Associate + 2 or More, or promote healthy • No Coverage. living. Remember, you can elect dental, medical and vision coverage separately. However, if you elect more than one, the coverage Information about these level for each one you elect must be the discount programs are listed on same. For example, if your dental coverage the Web site at is at the Associate Only level, then your or you can get information by medical and/or vision coverage must calling 1-800-870-3470. These also be at the Associate Only level. special offers and savings are in Dependent Children: Dependent children addition to the CIGNA Dental are covered under the dental plan to age PPO plan. You and all of your 19, or to 25 if they are full-time students. Your Dental Plan covered dependents are eligible. You may be able to save The dental claims administrator is even more on things that can CIGNA Dental. CIGNA’s Dental help you feel better and stay national network is one of the nation’s healthy! largest and includes more than 76,000 dentists. You can access the CIGNA network of dentists at When you visit the Web site, be sure to click on “CIGNA Dental DPPO,” and then click on “Core Network.” Also available through CIGNA Dental is a program referred to as Healthy Rewards, which provides discounts on such services as massage therapy, fitness club memberships, tobacco cessation, weight management and more. Visit the Web site at or call CIGNA at 1-800-870-3470 for a list of discounts and benefits. Terms to Know • Network – a group of dentists affiliated • Co-insurance – the percentage you pay with a dental plan. When you use a dentist when you receive care (for example, basic who’s in the CIGNA network, your out-of- services). pocket costs are lower and your benefit • Out-of-pocket cost – the amount you level is higher. pay when you receive care. • Out-of-network – dentists who are not • Annual maximum – the total amount the part of the network. When you use a plan will pay per covered person, per year. dentist who does not participate in the CIGNA network, your out-of-pocket costs • uCR – usual customary and reasonable. The prevailing amount allowed for a are higher and your benefit level is lower. service performed by a healthcare profes- • Deductible –the amount you must pay sional. first before the plan begins paying ex- • PD – predetermination estimate. penses for a service. 15 Applied Choices
  16. 16. Dental Your Dental Plan At-a-Glance What You Need to Here’s a look at the services and coverage under the dental plan: Do On-Line Dental If you are keeping the same benefits coverage (except FSAs) In-Network for 2009, no action is required. (CIgNA Dental Out-of-Network You will be automatically Core Network) (Subject to uCR) re-enrolled in the dental plan Deductible None $25 Individual/$75 Family for 2009. Annual Maximum $1,500 Per Covered Person $1,000 Per Covered Person Confirmations will be mailed mid-December confirming your Preventative Services/ 100% 100% elections. Diagnostic X-rays Oral Examinations Prophylaxis Fluoride Treatment CIGNA has Space Maintainers Emergency Care changed its dental Basic Services 90% of the CIGNA Fee 80% After the Deductible network’s name to Fillings the CIGNA Dental Oral Surgery Core Network. Root Canal Extractions Major Services 60% of the CIGNA Fee 50% After the Deductible To locate a CIGNA Dental Core Complete or Partial Dentures Network Provider: Crowns • Go to Inlays Onlays • Click “Provider Directory” at Fixed Bridges & Crowns the top of the page (when part of a bridge) • Click “Dentist” Orthodontia 50% of the CIGNA Fee 50% After the Deductible • Enter search criteria (location, Orthodontic Lifetime $1,000 Per Covered Person $750 Per Covered Person name, etc.) Maximum • Select the CIGNA Dental Temporal Mandibular 90% of the CIGNA Fee 80% After the Deductible DPPO, and in the drop down Joint Dysfunction (TMJ) menu, select “Core Network” Diagnosis surgery, in mouth appliance therapy, non-surgical treatment, and restoration and construction, which alter the jaw, jaw joints or bite relationships. TMJ Lifetime Maximum $1,500 Per Covered Person $1,000 Per Covered Person Associate Monthly Dental Contribution Associate Only: $12 Associate +1: $16 Associate +2: $22 16 Applied Choices
  17. 17. Your Vision Plan How the Plan Works Highlights of Your When you need vision care, VSP offers a Vision Plan choice of providers. • In-Network Providers: The best value in vision care lies with using a provider in • The plan provides reduced the VSP network. In doing so, your cost costs for eye exams, glasses is limited to the co-pays, unless you select and contacts. frames and/or lenses, which exceed the • The plan features in-network plan allowances. and out-of-network options. • Out-of-Network: VSP will still pay a • Plan features discount portion of your vision care expenses if towards LASIK surgery. you choose an ‘Out-of-Network’ provider. However, reimbursement for these services from VSP is limited to smaller, stated dollar amounts for specific services. Your Vision Plan Vision Service Plan (VSP) insures our vision plan. Nearly all your vision needs are covered through this benefit. VSP allows you to: • use a provider in the VSP network and receive a higher level of benefits; or • use a provider who does not participate in the VSP network and receive a lower level of benefits. Contact VSP member services at 1-800-877-7195 or check VSP’s Web site at for a list of providers in the network. Click on “Members and Consum- ers,” then “Find a Doctor.” Simply tell your provider that you participate in VSP. The plan does NOT issue ID cards. Terms to Know • In-Network – a group of vision care providers affiliated with a vision plan. When you use a provider who is in- network, your out-of-pocket costs are lower. • Out-of-network – vision care providers who are not part of the network. When you use a provider who does not partici- pate in the network, your out-of-pocket costs are higher. • Co-Pay – a fixed amount you pay when you receive a specific service (for example, an eye exam). • Out-of-pocket cost – the amount you pay when you receive vision services. 17 Applied Choices
  18. 18. Vision Your Coverage Levels What You Need to Remember, you can elect dental, medical and vision Remember,separately. However, ifmedical and vision coverage you can elect dental, you elect more than You can choose: Do On-Line coverage separately.level for eachyou elect more must be one, the coverage However, if one you elect than one, • Associate Only, the coverage level for each youryou elect must beis at same. the same. For example, if one dental coverage the the • Associate + 1, For example, if your dental coverage is at the family level, family level, then your medical and/or vision coverage If you are keeping the same then your medical and/or vision coverage must also be at must also be at the family level. • Associate + 2 or More, or benefits coverage (except FSAs) the family level. • No Coverage. for 2009, no action is required. You will be automatically Dependent Children: Dependent children are covered under the vision plan to age 19, or to 25 re-enrolled in the vision plan if they are full-time students. for 2009. Your Vision Plan At-a-Glance Confirmations will be mailed mid-December confirming your Here’s a look at the services and coverage under the vision plan. Please refer to the enclosed elections. VSP brochure for complete details of the Contact Care Program. Vision Out-of-Network In-Network (Reimbursement Amount) Eye Exam $10 co-pay $35 (one per calendar year) Lenses $25 co-pay • Single: up to $25 / pair (one per calendar year) • Bifocal: up to $40 / pair • Trifocal: up to $55 / pair Special Note: • Lenticular: up to $80 / pair Polycarbonate lenses for children under 19 are covered in full at an in-network provider Frames Up to $130 retail Up to $45 / pair (one per calendar year) or: Soft Contact Lenses $120 benefit provides full None Program coverage for the simple exam current soft contact wearers: (fitting & evaluation) and (one per calendar year) contact lenses Contact Lenses • Elective: up to $120 Elective: up to $105 1st time contact wearers, or current • 15% discount off the cost wearers with special needs or materials, of contact exam evaluation fees and fitting costs (fitting & evaluation) (one per calendar year) LASIk / PRk Discount is available None Associate Monthly Vision Contribution Associate Only: $8 Associate +1: $12 Associate +2: $16 18 Applied Choices
  19. 19. Flexible Spending Accounts (FSAs) Flexible Spending Accounts are an excellent Highlights of Your way to save money. Any money you contribute to an FSA is deducted from your Flexible Spending gross income, before your Federal taxes, Accounts FICA, and state taxes are calculated. Once you open an FSA, you can use your contributions to reimburse yourself or an • The accounts – the healthcare eligible dependent for: reimbursement account • Healthcare Expenses and the dependent care reimbursement account save • Dependent Care Expenses you money on eligible You must open a separate FSA for each of expenses because your these two expense categories. You cannot taxable income is reduced combine both expense categories into one by the amount of money you IRS Rules for FSAs FSA. put aside in the account. Both types of FSAs are discussed in further The IRS has established certain rules for • You decide how much you detail below: FSAs, which must be followed: want to set aside for each account (up to the annual • FSAs do not automatically renew from one How the FSA Process Works limits). year to the next. You must enroll to create • Determine what you believe your 2009 out- a new FSA for 2009, even if you had an • When you contribute to of-pocket expenses will be for one of the FSA in 2008. an FSA, you decrease your expense categories above. taxable income because • If you do not use the entire amount you the contributions are taken • The on-line enrollment system allows contributed to your FSA, you must forfeit before Federal, state and FICA you to open an FSA account for the total any money remaining in your account. taxes that are calculated. amount you wish to contribute during However, you have until March 31, 2010 to 2009. submit expenses incurred in 2009. Helpful • FSA contributions are deducted Hint: Carefully estimate your expenses for from every paycheck. • During 2009, equal payroll deductions will the coming year and do not set aside more be taken from each paycheck until the total • Refer to the enclosed brochure money than you are certain you will use. amount is accumulated in your FSA. for additional information. • If you open two FSAs, one for Healthcare • As you incur out-of-pocket expenses and one for Dependent Care, you cannot during 2009, submit the receipts for eligible transfer money between your two expenses to the FSA administrator. You do accounts. not have to wait until the end of 2009 to be reimbursed. You may submit expense • You cannot use a Dependent Care Account receipts throughout the year. for healthcare expenses. Nor can you use a Healthcare Account for dependent care • The FSA administrator will send you a expenses. reimbursement check each month for the eligible expenses you submitted. • Changes to both the healthcare and dependent care can be made in the event of • You have until March 31, 2010, to submit an IRS approved qualifying event. receipts for reimbursement for expenses incurred during 2009. Healthcare Reimbursement • Minimum annual amount $100. Accounts You may set aside up to $3,600 each year for eligible healthcare expenses, for yourself and all eligible dependents, that are not covered by any other healthcare plan. Further, if an- other healthcare plan does not reimburse the full amount of a medical expense (example: the co-pay for an office visit), you may submit this expense for reimbursement from your FSA. You do not have to participate in the health plan in order to participate in the FSA. 19 Applied Choices