Take a close look at your medical coverage!

Transcription

1 Take a close look at your medical coverage! 4 O P E N E N R O L L M E N T Thanks to your employer, you have valuable health plans to choose from. So compare your options and choose the plan that s best for you. Plus, we re introducing critical benefits for preventive care. For a preview, review your Preventive Services summary. And then if you want to change your coverage for 2015, simply let us know! Review these brief summaries of the plans available to you. And for information about Deseret Mutual contracted providers in your area, visit DESERET CHOICE The hospital and physician networks cover the entire state of Utah and portions of Southeast Idaho. You can receive care from any Deseret Choice contracted provider. If you receive care from a non-deseret Choice provider, you re still covered but your benefits are less. When you receive services from Deseret Choice contracted providers, certain preventive services benefits will be covered at 100%! To be eligible for benefits, you or your physician must preauthorize some services with Deseret Mutual. DESERET VALUE Deseret Value is a low-cost alternative to both Deseret Choice and Deseret Select. You pay a lower premium for reduced benefits. Deseret Value focuses on preventive medicine and primary care, but it also covers prescription drugs, hospital stays, surgery, and other specialty services, as well as catastrophe coverage. You can receive care from any Deseret Value contracted provider. If you receive care from a non-deseret Value provider, you re still covered but your benefits are less. When you receive services from Deseret Value contracted providers, certain preventive services benefits will be covered at 100%! For some services, you must satisfy an annual deductible if you receive care from non-deseret Value providers ($300 per person or $600 per family). To be eligible for benefits, you or your physician must preauthorize some services with Deseret Mutual. DESERET SELECT Deseret Select includes all Intermountain Healthcare hospitals, plus many other facilities and a broad physician network. You can receive care from any Deseret Select contracted provider. But if you receive care from a non-deseret Select provider, you will not be covered unless it s a bona fide emergency. When you receive services from Deseret Select contracted providers, certain preventive services benefits will be covered at 100%! To be eligible for benefits, you or your physician must preauthorize some services with Deseret Mutual. C1A

2 Financial Protection When you receive care from Deseret Mutual contracted providers for your specific plan, you re financially protected. How? Contracted providers accept what you pay (your copayments and coinsurance) and what Deseret Mutual pays as payment in full for eligible services. They won t bill you for amounts that exceed the maximum allowable limits. For example, say you re enrolled in either Deseret Choice or Deseret Value and you see your physician for an office visit. She charges $100 for the visit. But the maximum allowable amount we ll cover is $80. And because your physician is a contracted provider for your specific plan, she writes off the $20 difference. That s financial protection. When you receive care from providers who are not contracted with Deseret Mutual for your specific plan, you don t have the same protection. These providers can bill you for the difference. Keep in mind if you re enrolled in Deseret Select and you receive services from a provider who is not contracted specifically for Deseret Select, you re responsible for 100% of the charges (unless it s a bona fide emergency). Based on plan guidelines, we cannot make exceptions! So you bear the cost for services from non-deseret Select contracted providers even if your contracted physician refers you to a non-contracted facility! Always call Customer Service if you re unsure! All Deseret Choice, Deseret Value, and Deseret Select benefits are subject to the maximum allowable limits determined by Deseret Mutual. Wasatch Front Hospital Networks Deseret Mutual offers the most comprehensive access to contracted hospitals of any health insurance organization along the Wasatch Front. This includes multiple hospital networks such as Intermountain Healthcare (like Intermountain Medical Center), University of Utah (like University Hospital), Iasis (like Salt Lake Regional and Jordan Valley Hospitals), and MountainStar (like St. Mark s and Ogden Regional Hospitals). And remember, the provider networks vary from plan to plan. So in choosing your coverage, make sure to check providers who are contracted for the plan you re most interested in. Again, use our website for information about contracted providers in your area. National Provider Network We re contracted nationally with UnitedHealthcare s Options PPO network. So if you re enrolled in Deseret Choice or Deseret Value and you travel out of the service area and need medical care, you can take advantage of UnitedHealthcare s discounts and be protected from paying charges that exceed our maximum allowable limits. Administrative Philosophy Deseret Mutual s administrative philosophy is to pay your claims whenever possible within plan guidelines, of course. Because we re a non-profit trust, the assets we manage belong to you and your employer. For commercial organizations, on the other hand, making a profit is often the bottom line. Patient Protection & Affordable Care Act As part of the Patient Protection and Affordable Care Act (health-care reform), health plans are classified as either grandfathered or non-grandfathered. At Deseret Mutual, we ve decided to maintain the benefit structure that was in place at the time the law passed. So our health plans are considered grandfathered.

3 As a grandfathered plan, your coverage may not include certain consumer protections included in the law that apply to other plans. For example, health-care reform says preventive health services must be covered at no cost to you, the employee. And for 2015, we re pleased to introduce these critical benefits for preventive services! Keep in mind, grandfathered plans must comply with other consumer protections included in the Affordable Care Act like eliminating lifetime limits on essential benefits. We re happy to report we ve already done that. For questions about which protections apply and do not apply, as well as information about what could cause a plan to change from grandfathered to non-grandfathered status, please contact us. Or you re welcome to contact the Employee Benefits Security Administration, U.S. Department of Labor, at or For More Information Remember, this comparison points out highlights and important differences you should consider when choosing your coverage. It does not describe each plan in detail. If you have any questions about this information, please call the appropriate telephone number: Deseret Mutual Salt Lake City Area Toll Free

4 Plan Benefits Deseret Choice Member Pays: Deseret Value Member Pays: Physician Services: Office Visits Deseret Choice PCP: $15 per visit Deseret Choice specialist: $25 per visit Non-Deseret Choice PCP: $25 per visit Non-Deseret Choice specialist: $35 per visit Deseret Value PCP: $15 per visit Deseret Value specialist: $25 per visit Non-Deseret Value PCP: $20 per visit Non-Deseret Value specialist: $30 per visit Physician Services: Routine Adult Physicals Well Child Care Routine Eye Exams Outpatient Mental Health Therapy Deseret Choice PCP: NOTHING Deseret Choice specialist: NOTHING Non-Deseret Choice PCP: $25 per visit Non-Deseret Choice specialist: $35 per visit Deseret Choice provider: $25 per visit Non-Deseret Choice provider: $35 per visit One exam is covered every calendar year Deseret Choice provider: $15 for individual and group therapy. Non-Deseret Choice provider: $25 for individual and group therapy Deseret Value PCP: NOTHING Deseret Value specialist: NOTHING Non-Deseret Value PCP: $20 per visit Non-Deseret Value specialist: $30 per visit Deseret Value provider: $25 per visit Non-Deseret Value provider: $30 per visit One exam is covered every calendar year Deseret Value provider: $15 for individual and group therapy. Non-Deseret Value provider: $20 for individual and group therapy Outpatient Laboratory Nothing (the plan pays 100%) Nothing (the plan pays 100%) Prescription Drugs Basic Radiology NEW! Retail formulary drugs: 30% for 30-day supply Mail-order formulary drugs: 25% for 90-day supply; up to $85 per prescription All non-formulary drugs: 100% (not covered) Retail formulary drugs: 50% for 30-day supply. Mail-order formulary drugs: 45% for 90-day supply; up to $140 per prescription All non-formulary drugs: 100% (not covered) Hospital Emergency Room $75 per visit plus 10% $75 per visit plus 30% ANNUAL DEDUCTIBLE DOES NOT APPLY Inpatient Hospital Services * Inpatient Maternity Services Inpatient Mental Health Services* Major Radiology Services * Surgery * Maternity (Physician) Physical Therapy Chiropractic Therapy Deseret Choice provider: 10% Non-Deseret Choice provider: 40% Deseret Choice provider: 10% Non-Deseret Choice provider: 40% Deseret Choice provider: $25 per visit Non-Deseret Choice provider: $35 per visit Up to 25 visits per calendar year CHP provider: $25 per visit; no visit limit when preauthorized and medically necessary Non-CHP provider: $35 per visit for up to five visits when preauthorized and medically necessary ANNUAL DEDUCTIBLE APPLIES TO SERVICES FROM NON-NETWORK PROVIDERS ($300 PER MEMBER OR $600 PER FAMILY) Deseret Value provider: 30% Non-Deseret Value provider: 40% Deseret Value provider: 30% Non-Deseret Value provider: 40% Deseret Value provider: $25 per visit Non-Deseret Value provider: $30 per visit Up to 25 visits per calendar year Deseret Value provider: $25 per visit Non-Deseret Value provider: $30 per visit Up to 25 visits per calendar year Medical Equipment * Deseret Choice provider: 10% Non-Deseret Choice provider: 40% Deseret Value provider: 30% Non-Deseret Value provider: 40% * Your Annual Maximum Out-of-Pocket Cost $2,000 per person or $4,000 per family for services from Deseret Choice providers. Then the plan pays 100% of eligible charges. $4,000 per person or $6,000 per family. Then the plan pays 100% of eligible charges. The annual deductible does not apply. Preauthorization may be required for these services. If you do not preauthorize with Deseret Mutual, you must pay up to the first $200 per service.

5 Plan Benefits Physician Services: Office Visits Deseret Select PCP: $15 per visit Deseret Select specialist: $25 per visit Deseret Select Member Pays: Physician Services: Routine Adult Physicals Well Child Care Routine Eye Exams NEW! Deseret Select provider: NOTHING Deseret Select provider: $25 per visit One exam is covered every calendar year Outpatient Mental Health Therapy Deseret Select provider: $15 for individual and group therapy Outpatient Laboratory Nothing (the plan pays 100%) Prescription Drugs Basic Radiology Retail formulary drugs: 30% for 30-day supply Mail-order formulary drugs: 25% for 90-day supply; up to $85 per prescription All non-formulary drugs: 100% (not covered) Hospital Emergency Room $75 per visit plus 10% Inpatient Hospital Services * Inpatient Maternity Services Inpatient Mental Health Services * Major Radiology Services* Surgery * Maternity (Physician) Deseret Select provider: 10% Deseret Select provider: 10% Physical Therapy Chiropractic Therapy Medical Equipment * Your Annual Maximum Out-of-Pocket Cost Deseret Select provider: $25 per visit; up to 25 visits per calendar year CHP provider: $25 per visit; no visit limit when preauthorized and medically necessary Non-CHP provider: 100% (not covered) Deseret Select provider: 10% $2,000 per person or $4,000 per family for services from Deseret Select providers. Then the plan pays 100% of eligible charges. Preauthorization may be required for these services. If you do not preauthorize with Deseret Mutual, you must pay up to the first $200 per * service. For information about the preauthorization requirements for Altius, please review the material you receive from Altius.

6 Compare the Idaho hospital and facility networks and know the right answers... County Deseret Choice & Deseret Value Deseret Select Bannock Portneuf Medical Center Portneuf Medical Center Rocky Mountain Surgical Center Endoscopy Center Rocky Mountain Surgical Center Endoscopy Center Bear Lake Bear Lake Memorial Hospital Bear Lake Memorial Hospital Bingham Bingham Memorial Hospital Bingham Memorial Hospital Idaho Doctors Hospital Idaho Doctors Hospital Bonneville Eastern Idaho Regional Medical Center Eastern Idaho Regional Medical Center Grand Teton Surgical Center Gem State Regional Dialysis Center Gem State Regional Dialysis Center Caribou Caribou Memorial Hospital Caribou Memorial Hospital Cassia Cassia Regional Medical Center Cassia Regional Medical Center Franklin Franklin County Medical Center Franklin County Medical Center Madison Madison Memorial Hospital Madison Memorial Hospital Madison Memorial Surgery Center Yellowstone Dialysis Center Madison Memorial Surgery Center Yellowstone Dialysis Center Oneida Oneida County Hospital Oneida County Hospital Power Harms Memorial Harms Memorial Teton Teton Valley Hospital Teton Valley Hospital Deseret Choice Deseret Value Deseret Select What happens if I receive care from a noncontracted provider? What if I don t preauthorize care when necessary? Will my medical care be covered if I m out of the plan service area? What if I m out of the service area for more than 90 days? Will dependent children be covered while serving as missionaries? What about coverage for full-time college student dependents who are outside the plan service area? You pay 30% more You pay first $200; reviewed for medical necessity Yes Must switch to another plan You pay 10% more. Deductible may apply You pay first $200; reviewed for medical necessity Yes Covered anywhere in the world No benefits You pay first $200; reviewed for medical necessity Only emergency and authorized urgent care is covered Must switch to another plan Yes Yes Yes Yes Yes Yes

7 Compare the Utah hospital networks... County Deseret Choice Deseret Value Deseret Select Box Elder Bear River Valley Hospital Bear River Valley Hospital Brigham City Community Hospital Davis Davis Hospital & Medical Center Davis Hospital & Medical Center Lakeview Hospital Juab Central Valley Medical Center Central Valley Medical Center Salt Lake Alta View Hospital Alta View Hospital Intermountain Medical Center Orthopedic Specialty Hospital LDS Hospital Intermountain Medical Center Orthopedic Specialty Hospital LDS Hospital Lone Peak Hospital Riverton Hospital Primary Children s Medical Center Riverton Hospital Primary Children s Medical Center Huntsman Cancer Hospital Jordan Valley Hospital Pioneer Valley Hospital Salt Lake Regional Medical Center St. Mark s Hospital University Hospital Sanpete Gunnison Valley Hospital Gunnison Valley Hospital Sanpete Valley Hospital Sanpete Valley Hospital Summit Park City Medical Center Park City Medical Center Tooele Mountain West Medical Center Mountain West Medical Center Utah American Fork Hospital American Fork Hospital Orem Community Hospital Utah Valley Regional Medical Ctr. Orem Community Hospital Utah Valley Regional Medical Ctr. Mountain View Hospital Timpanogos Regional Hospital Wasatch Heber Valley Medical Center Heber Valley Medical Center Weber McKay-Dee Hospital McKay-Dee Hospital Ogden Regional Medical Center

8 Review your monthly premium rates... The monthly rates shown here include the cost for all four of your core insurance benefits, including: Medical insurance (plus Living Healthy, our Wellness Program) Group Term Life insurance Occupational Accidental Death & Dismemberment insurance (for the employee only) Disability insurance (for the employee only) In other words, when you choose one of the medical plans shown below (like Deseret Choice, Deseret Value, etc.), the rates shown include your Group Term Life, OAD&D, and Disability coverage. You choose dental coverage separately, so the monthly dental premiums are shown on your Dental Comparison. Deseret Choice Deseret Value Deseret Select YOU PAY Single $ Two Party $ Family $ YOU PAY Single $ Two Party $ Family $ YOU PAY Single $ Two Party $ Family $ YOUR EMPLOYER PAYS Single $ Two Party $ 1, Family $ 1, YOUR EMPLOYER PAYS Single $ Two Party $ Family $ 1, YOUR EMPLOYER PAYS Single $ Two Party $ Family $ 1, These premium rates apply to active employees and their dependents. Your open enrollment summary shows your personal rates. NOTES: