Coverage Comparison Chart
Transcription
Coverage Comparison Chart
Coverage Comparison Chart Premera Blue Cross $500 Deductible/$1000 Deductible/CDHP Deductible PPO Plans $500-Deductible PPO Provider Non-PPO Provider Alaska Plan $1,000-Deductible PPO Provider Non-PPO Provider Alaska Plan CDHP $1,500-Deductible HSA-qualifed plan PPO Provider Non-PPO Provider Medical Plan Annual Deductible Annual Out-ofPocket Maximum* $500 Per Person $1,000 Per Person $1,500 Individual $3,000 Individual $1,500 Per Family $3,000 Per Family $3,000 ** Aggregate Family $6,000 ** Aggregate Family $2,500 Per Person None $2,500 Per Person $5,000 Per Person None $5,000 Per Person $4,000 Individual $7,750 Individual $7,500 Per Family None $7,500 Per Family $10,000 Per Family None $10,000 Per Family $9,000 ** Aggregate Family $17,750 ** Aggregate Family Lifetime Maximum Unlimited *Co-pays and benefits with a coinsurance level below 80% do not apply to the out-of-pocket maximum. ** Aggregate Family = Individual plus one or more family members. Services for all family members covered under this CDHP HSA-quaified plan apply to the family deductible. You must meet the family deductible before the plan will cover services for any enrolled family members. Similar for the Out-ofPocket Maximum. You will receive better rates and avoid balance billing by using PPO providers. Note: Residents of Alaska will find their coverage information for the $500 and $1,000 Deductible in the “Alaska Plan” column, regardless of provider status. You are also eligible for the CDHP $1,500 Deductible plan. continued on inside 7.0_CCC Premera Blue Cross $500 Deductible/$1000 Deductible/CDHP Deductible PPO Plans $500-Deductible $1,000-Deductible CDHP $1,500-Deductible HSA-qualifed plan PPO Provider Non-PPO Provider Alaska Plan PPO Provider Non-PPO Provider Alaska Plan PPO Provider Non-PPO Provider Office Visit 100% after $30 co-pay 60% after deductible 80% after deductible 100% after $30 co-pay 60% after deductible 80% after deductible 80% after deductible 60% after deductible Specialist Visit 100% after $30 co-pay 60% after deductible 80% after deductible 100% after $30 co-pay 60% after deductible 80% after deductible 80% after deductible 60% after deductible Outpatient Hospital Care > Facility Services > Physician Services 80% after deductible 60% after deductible 80% after deductible if PPO; 60% after deductible if Non-PPO 80% after deductible 60% after deductible 80% after deductible if PPO; 60% after deductible if Non-PPO 80% after deductible 60% after deductible Preventive Care * >R outine GYN > Routine Mammograms >P SA Tests > CDL Exam 100% 60%; deductible waived 100% if PPO; 80% if Non-PPO deductible waived 100% 60%; deductible waived 100% if PPO; 80% if Non-PPO deductible waived 100% 60%; deductible waived Preventive Care * Adults and children >R outine Physical > Well Child > Immunizations >X -ray/Lab services 100% 60%; deductible waived 100% if PPO; 80% if Non-PPO deductible waived 100% 60%; deductible waived 100% if PPO; 80% if Non-PPO deductible waived 100% 60%; deductible waived 100% after $30 co-pay 60% after deductible 80% after deductible 100% after $30 co-pay 60% after deductible 80% after deductible 80% after deductible 60% after deductible Laboratory Services 100% 60% after deductible 80%; deductible waived 100% 60% after deductible 80%; deductible waived 80% after deductible 60% after deductible X-Ray Services 100% 60% after deductible 80% after deductible 100% 60% after deductible 80% after deductible 80% after deductible 60% after deductible 100% after $30 co-pay 60% after deductible 80% after deductible 100% after $30 co-pay 60% after deductible 80% after deductible 80% after deductible 60% after deductible OUTPATIENT SERVICES Allergy Injections and Serum Chiropractic Care (limited to 16 visits per calendar year) Hearing Aids (limited to 2 devices every 36 months) Outpatient Physical, Speech and Occupational Therapy Alternative Medicine (limited to 16 visits per calendar year) 80% after deductible 80% after deductible 60% after deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible 60% after deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible 60% after deductible 80% after deductible You will receive better rates and avoid balance billing by using PPO providers. Note: Residents of Alaska will find their coverage information for the $500 and $1,000 Deductible in the “Alaska Plan” column, regardless of provider status. You are also eligible for the CDHP $1,500 Deductible plan. * Your preventive benefits offer full coverage for many tests, screenings and immunizations. During the exam, your physician may discover an issue or problem that requires further testing or screening for an accurate diagnosis. These additional diagnostic tests often require you to pay a share of the costs. Coverage Comparison Chart $500-Deductible $1,000-Deductible PPO Provider Non-PPO Provider Alaska Plan PPO Provider Non-PPO Provider Alaska Plan 80% after $250 co-pay plus deductible 60% after $250 co-pay plus deductible 80% after $250 co-pay plus deductible if PPO; 60% after $250 co-pay plus deductible if Non-PPO 80% after $250 co-pay plus deductible 60% after $250 co-pay plus deductible 80% after $250 co-pay plus deductible if PPO; 60% after $250 co-pay plus deductible if Non-PPO CDHP $1,500-Deductible HSA-qualifed plan PPO Provider Non-PPO Provider 80% after deductible 60% after deductible INPATIENT CARE Inpatient Hospital Care > Facility Services > Physician Services Home Health Care (limited to 120 visits per year) 80% after deductible 80% after deductible 80% after deductible Hospice Care 80% after deductible 80% after deductible 80% after deductible Skilled Nursing Facility (limited to 120 days) 80% after deductible 80% after deductible 80% after deductible EMERGENCY SERVICES Emergency Room (Co-pay waived if admitted) Ambulance 80% after $100 co-pay plus deductible 80% after $100 co-pay plus deductible 80% after deductible Non-emergent care may be paid at 60%. Non-emergent care may be paid at 60% Non-emergent care may be paid at 60% 80% after deductible 80% after deductible 80% after deductible BEHAVIORAL HEALTH Mental Health – Outpatient 80% after deductible 60% after deductible 80% after deductible if PPO; 60% after deductible if Non-PPO 80% after deductible 60% after deductible 80% after deductible if PPO; 60% after deductible if Non-PPO 80% after deductible 60% after deductible Mental Health – Inpatient 80% after $250 co-pay plus deductible 60% after $250 co-pay plus deductible 80% after $250 co-pay plus deductible if PPO; 60% after $250 co-pay plus deductible if Non-PPO 80% after $250 co-pay plus deductible 60% after $250 co-pay plus deductible 80% after $250 co-pay plus deductible if PPO; 60% after $250 co-pay plus deductible if Non-PPO 80% after deductible 60% after deductible Substance Abuse – Outpatient 80% after deductible 60% after deductible 80% after deductible if PPO; 60% after deductible if Non-PPO 80% after deductible 60% after deductible 80% after deductible if PPO; 60% after deductible if Non-PPO 80% after deductible 60% after deductible Substance Abuse – Inpatient 80% after $250 co-pay plus deductible 60% after $250 co-pay plus deductible 80% after $250 co-pay plus deductible if PPO; 60% after $250 co-pay plus deductible if Non-PP 80% after $250 co-pay plus deductible 60% after $250 co-pay plus deductible 80% after $250 co-pay plus deductible if PPO; 60% after $250 co-pay plus deductible if Non-PPO 80% deductible 60% after deductible continued on back 7.0_CCC Coverage Comparison Chart Premera Blue Cross $500 Deductible/$1000 Deductible/CDHP Deductible PPO Plans $500-Deductible $1,000-Deductible CDHP $1,500-Deductible HSA-qualifed plan Retail (30 day supply) > Generic > Preferred Brand > Non-Preferred Brand $15 Co-pay $40 Co-pay $65 Co-pay 50% Coinsurance 50% Coinsurance 50% Coinsurance $10 Co-pay after deductible $25 Co-pay after deductible $40 Co-pay after deductible Mail Order (90 day supply) > Generic > Preferred Brand > Non-Preferred Brand $30 Co-pay $80 Co-pay $130 Co-pay 20% Coinsurance 20% Coinsurance 20% Coinsurance $20 Co-pay after deductible $50 Co-pay after deductible $80 Co-pay after deductible $75 co-pay $75 co-pay $75 co-pay after deductible Plan pays 60% after deductible Plan pays 60% after deductible Plan pays 60% after deductible Covered in full Covered in full Covered in full n/a n/a Generic covered in full PRESCRIPTION DRUGS Specialty Rx (Self-Injectable) Rx from Non-PPO Preventive Drug Coverage under Health Care Reform * Preventive Drug Coverage for CDHP (to treat heart disease and diabetes) * * Visit www.premera.com pharmacy section to learn more. Note: Maintentance drugs (drugs that are taken on a regular basis or for more than 90 days) are available through the mail order program. You will save money by using mail order and your prescriptions are conveniently shipped directly to you. IMPORTANT DISCLOSURE: As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options. The SBC is available on the web at: http://office.asrc.com/office/SBC/ A paper copy is also available, free of charge, by calling 1-877-339-6850. This document is neither a summary plan description nor an employee handbook. If a discrepancy arises between this document and the provisions of the plan documents, the plan documents govern. ASRC reserves the right to modify, amend or terminate its plans and programs at any time. 7.0_CCC Medical, Dental, and Vision Benefits (500/1000/CDHP) COMMITTED TO OUR SHARED VISION. COMMITTED TO YOU. Medical, Dental, Vision ASRC Employee Benefits Coverage Tiers Being a part of ASRC means having a shared When you enroll for medical, dental and/or mission, and also having talented, dedicated vision benefits, you have four coverage tiers people who live that mission every day. To that to choose from to meet the needs of you and end, the benefits program offered to our your family: employees must live up to the same principles and standards of excellence. Our goal is to provide top-quality, people-focused programs that will support the needs of every employee. The ASRC benefits program will provide you > Employee only > Employee + Spouse > Employee + Child(ren) > Employee + Family the choice and flexibility to select appropriate The coverage tier you elect can be different benefits for you and your family. for medical, dental and vision. For example, This ASRC benefits program guide is designed to help you understand the benefit options available to you and help you make informed benefit selections. The guide includes helpful information about: you can elect medical for your entire family and dental only for yourself. Remember, for each plan that you choose, you need to elect your coverage tier separately. The contribution rates for each coverage tier are shown on the Rate Sheet included in the enrollment packet. > Coverage Tiers > Eligibility Information > Medical Plan > Dental Plan > Vision Plan > Contact information for all plan administrators Please contact your ASRC Benefits Specialist if you have any questions about your benefits or the enrollment process. Eligibility ASRC offers health and welfare benefits to all eligible employees who have met their waiting period. Eligible employees include all regular, full-time employees normally scheduled to work 30 or more hours in a work week. You may also enroll your eligible dependents; eligible dependents include your legal opposite-sex spouse and your natural, step or legally adopted children under age 26. Enrolling disabled children requires prior approval. A copy of your marriage certificate is required to enroll your spouse, birth certificates are required to enroll children; marriage & birth certificates are required to enroll a stepchild. ASRC and the plan administrators will conduct periodic audits to ensure eligibility of enrolled dependents. Medical, Dental, and Vision Medical 24-Hour NurseLine Premera Blue Cross Online Resources and Customer Service Premera Blue Cross offers all Premera Blue Cross is the plan administrator Premera Blue Cross also offers a wide range 24-Hour NurseLine. These for the ASRC medical plans. Premera of resources to help you with health-related nurses have access to high- will provide ASRC employees access to issues. Through the Premera website at quality health resources and care through comprehensive national and www.premera.com, you can: will listen to your health worldwide provider networks. The Blue Cross Blue Shield medical ID card is one of the most widely recognized and accepted ID cards in the world. Premera offers national health plan coverage. In order to facilitate provider recognition in Washington and Alaska, the Premera Blue Cross Blue Shield of Alaska logo will appear on your medical > Look up claims and benefits > Search for a network doctor or hospital > Get medical and prescription drug cost estimates > Search the Preferred Drug list > Download claim and prescription drug reimbursement forms > Get information to help you live healthier plan members access to a concerns, answer questions and offer advice about many health-related topics. In addition, NurseLine nurses are trained to ask the right questions, enabling them to make a recommendation about when and where you should seek treatment for an injury or illness. Nurses base their IDs. For plan members living in other Customer Service: Get help finding a recommendations on your states, you will see the Blue Cross Blue doctor and your other health care questions symptoms and other relevant Shield logo on your medical ID card. answered via a toll-free telephone number at health conditions or history. (877) 370-2772 (ASRC) between 6:00 AM and 6:00 PM (Pacific Time). All calls to the NurseLine are You can find out if your doctor is in the free and confidential – 24 hours network by visiting www.premera.com a day, 7 days a week. Just call and clicking the Find a Doctor link. (877) 370-2772 (ASRC). While using this directory, you can search for providers by name, location, gender, specialty, and language. When searching for a provider, please make sure to select the correct network based on your geographical region. > Alaska: AK Heritage Select > Washington: Heritage and Heritage Plus 1 > All other states: BlueCard® PPO If you don’t have access to a computer, Premera’s customer service team can help you find a doctor. Just call (877) 370-2772 (ASRC) between 6:00 AM and 6:00 PM (Pacific Time). 1.0_MDV5001000CDHP Medical Plan Options Prescription Drugs With the ASRC benefits program, eligible Prescription drug benefits are included in the employees have the choice of medical plan ASRC medical plan. When you fill a options that include both medical and prescription, you will pay a co-pay or pharmacy benefits: coinsurance. The cost varies based on the type of drug (generic, preferred brand, non- > $500-Deductible PPO preferred brand, or specialty) and whether you > $1,000-Deductible PPO > CDHP $1,500-Deductible PPO - HSA qualified plan Each plan offers employees a broad range of health care services. Deductibles, out-ofpocket maximums and coverage levels will vary by plan. To elect the plan that best meets the needs of you and your family, be sure to carefully evaluate each medical plan by looking at the information below and the purchase medications at a retail pharmacy or through mail order. Prescription costs under the Premera Blue Cross medical plans are shown below. Premera offers members access to a nationwide network of retail pharmacies. Retail versus Mail-Order Pharmacy Coverage Comparison Chart, located in your Retail Pharmacy: For immediate drug needs enrollment packet. or short-term (less than 90 days) medications, If you choose to visit in-network providers, you will be able to take advantage of deeper discounts and lower costs offered by Premera’s contracted providers and facilities. You will you should use a retail pharmacy. You can fill your 30-day prescriptions at any of more than 60,000 retail pharmacies in the pharmacy network. also avoid balance billing. Medical: Plan Options $500-DEDUCTIBLE PPO Provider Annual Deductible Annual Out-of-Pocket Maximum* Lifetime Maximum $2,500 Per Person $7,500 Per Family Non-PPO Provider Alaska Plan $1,000-DEDUCTIBLE PPO Provider Non-PPO Provider Alaska Plan CDHP $1,500-DEDUCTIBLE HSA-qualified plan PPO Provider Non-PPO Provider $500 Per Person $1,000 Per Person $1,500 Individual $3,000 Individual $1,500 Per Family $3,000 Per Family $3,000 ** Aggregate Family $6,000 ** Aggregate Family $4,000 Individual $7,750 Individual $9,000 ** Aggregate Family $17,750 ** Aggregate Family None None Unlimited $2,500 Per Person $7,500 Per Family $5,000 Per Person $10,000 Per Family None None $5,000 Per Person $10,000 Per Family Unlimited Unlimited * Co-pays and benefits with a coinsurance level below 80% do not apply to the out-of-pocket maximum. ** Aggregate Family = Individual plus one or more family members. Services for all family members covered under this CDHP HSA-qualified plan apply to the family deductible. You must meet the family deductible before the plan will cover services for any enrolled family members. This requirement also applies to the Out-of-Pocket Maximum. Note: Residents of Alaska will find their coverage information for the $500 and $1,000 Deductible in the “Alaska Plan” column, regardless of provider status. You are also eligible for the CDHP $1,500 Deductible plan. Medical, Dental, and Vision Generic versus Brand-Name Drugs Mail Order: Maintenance drugs (drugs that are taken on a regular basis or for more than 90 days) are available through the mail order ASRC encourages the use of generic drugs versus brand-name drugs program. You will save money by using the because generic drugs cost less and are virtually identical to brand-name mail order pharmacy service and your drugs in safety and effectiveness. When filling a prescription, here are some prescriptions are conveniently shipped directly reasons to select a generic: to your home. 1. FDA monitored. Generic drugs are regulated by the Food and Drug It will take approximately two weeks for you to Administration (FDA) just like brand-name drugs and provide the same receive your prescriptions by Mail Order. To level of quality, strength and purity at less cost. avoid any delay in starting your medicine, ask 2.Dollar savings. Using a generic version of a brand-name drug can help you your doctor to write two separate prescriptions control your healthcare costs. Ask your doctor to prescribe a generic drug – one for a 30-day supply which you can fill at when available and appropriate. a local network pharmacy right away, and one 3.Same ingredients. Generic drugs must contain the same active ingredients for a 90-day supply that you can fill through and produce the same effect on the body as their brand-name equivalents. the Mail Order Pharmacy. You can order refills by phone at (888) 327-9791 or register through the pharmacy section at www.premera.com. Medical: Prescription Drugs* Premera Blue Cross $500 Deductible/ $1000 Deductible/CDHP Deductible PPO Plans $500-Deductible $1,000-Deductible CDHP $1,500-Deductible HSA-qualified plan Retail (30 day supply) > Generic > Preferred Brand > Non-Preferred Brand $15 Co-pay $40 Co-pay $65 Co-pay 50% Coinsurance 50% Coinsurance 50% Coinsurance $10 Co-pay after deductible $25 Co-pay after deductible $40 Co-pay after deductible Mail Order (90 day supply) > Generic > Preferred Brand > Non-Preferred Brand $30 Co-pay $80 Co-pay $130 Co-pay 20% Coinsurance 20% Coinsurance 20% Coinsurance $20 Co-pay after deductible $50 Co-pay after deductible $80 Co-pay after deductible PRESCRIPTION DRUGS Specialty Rx (Self-Injectable) Rx from Non-PPO Preventive - Health Care Reform * Preventive for CDHP (to treat heart disease & diabetes) * $75 co-pay $75 co-pay $75 co-pay Plan pays 60% after deductible Plan pays 60% after deductible Plan pays 60% after deductible Covered in full Covered in full Covered in full n/a n/a Generic covered in full * Visit www.premera.com pharmacy section to learn more. 1.0_MDV5001000CDHP Is My Dentist In the Network? You can access the provider directory by calling (877) 370-2772 (ASRC), toll-free, or by visiting United Concordia’s website at www.ucci.com. 1.Click on the Find a Dental Concordia Flex: Dental benefits are offered separately from the medical plan through United Concordia. With over 35 years of experience in dental insurance, United Concordia offers flexible dental benefits backed by excellent customer service. The two dental plan options available to ASRC employees are: Dentist link 2.Select the Advantage Plus The Concordia Flex plan provides the same level of coverage for preferred and nonpreferred providers. This may be the best plan for you if there are no preferred providers in your area or if you want to see a non-preferred provider. Remember, if you choose to see a non-preferred provider, you will be responsible > Concordia Preferred for any charges above reasonable and > Concordia Flex customary limits. network option 3.You can search for network dentists by specialty, city, last name, zip code, distance to a certain zip code, or county. Register for My Dental Benefits allowing secure access to benefits, claim Concordia Preferred: Predetermination The Concordia Preferred plan provides the When the amount of a proposed treatment is most coverage when you see a preferred more than $500, we encourage you to request a provider. Make sure to check for preferred predetermination from your Dentist. This lets providers in your area before selecting this you know if the procedure will be covered; the plan. Dental benefits are limited and amount you will owe and notifies you of any orthodontia is not covered if you see a alternate treatment options covered by the non-PPO provider. dental plan prior to receiving services. details, procedure history, deductible accumulations, printable ID cards and more. Dental: Concordia Preferred / Concordia Flex CONCORDIA PREFERRED CONCORDIA FLEX PPO Provider Non-PPO Provider PPO or Non-PPO Provider > Per Person $50 $50 $50 > Per Family $150 $150 $150 Annual Limit (per person)* $2,000 $1,250 $2,000 Orthodontia Limit $4,000 N/A $4,000 Preventive and Diagnostic Services (routine cleanings, exams, and most x-rays) 100% 80% 100% Basic Services (extractions, space maintainers, nonsurgical periodontics, endodontics, complex oral surgery, general anesthesia, repairs of the following: Inlays, onlays, bridges, and dentures) 80% 60% 80% Major Services (inlays, onlays, crowns, prosthetics (bridges & dentures), surgical periodontics) 80% 60% 80% Orthodontia Services 80% Not Covered 80% Deductible * Preventive, basic and major services combined Medical, Dental, and Vision Vision Glasses and Sunglasses > The name of the organization that offers > Average 20-25% savings on all non- Vision benefits for you and your eligible dependents are offered through Vision Services covered lens options Regional Corporation > 20% off additional glasses and > The patient’s name, date of birth, address Plan (VSP), one of the nation’s most complete sunglasses, including lens options, from eye-care health plans. Using your VSP benefit any VSP doctor within 12 months of is easy. ID cards aren’t required for VSP. your last WellVision® Exam To use your VSP benefits: >F ind a VSP doctor at www.VSP.com or call (877) 370-2772 (ASRC) >M ake an appointment and tell the doctor you are a VSP member >P rovide your doctor with your Social Security Number >Y our doctor and VSP will handle the rest You get the best value from your vision benefit when you visit a VSP network doctor. When you visit an in-network doctor, you are often able to take advantage of greater benefits and your VSP coverage – Arctic Slope and phone number > The patient’s relationship to the covered member (such as “self,” “spouse,” “child”) Laser Vision Correction Discounts Out-of-network claims must be submitted to > Average 15% off the regular price or VSP within six months. Keep a copy of the 5% off the promotional price claims information for your files and send a > Discounts only available from copy to VSP, P.O. Box 997105, Sacramento, contracted facilities CA 95899-7105. Contact Lenses > 15% off cost of contact lens exam (fitting and evaluation) For additional questions regarding your eye-care coverage, contact VSP’s Member Services department at (877) 370-2772 (ASRC) If you do obtain services from an out-of- or register at www.VSP.com to view benefits, network doctor, please send VSP the access rebates & special offers or printable following materials: member vision card. > An itemized receipt listing the pay less out-of-pocket. Extra Discounts and Savings As a VSP member, you can take advantage of additional discounts and savings on: services received > The name, address and phone number of the out-of-network provider > The covered member’s name, date of birth, address and phone number YOUR VISION COVERAGE – VSP CHOICE VSP Provider Non-VSP Provider WellVision® Annual Exam Covered in full after $20 co-pay; once every calendar year Covered up to $43; once every calendar year Lenses Single, lined bi-focal, tri-focal, and progressive lenses are covered after co-pay; once every calendar year Single vision lenses covered up to $26; lined bifocal lenses covered up to $43; lined trifocal lenses and progressive lenses covered up to $60; once every calendar year Frames Covered up to $175; once every twenty-four months Covered up to $40; once every twenty-four months Contact Lens Exam Fitting & Evaluation Standard and Premium fit: Covered in full after never to exceed $60 co-pay. Combined with Elective Contact allowance noted below. Elective Contacts (in lieu of glasses) Covered up to $130; once every calendar year Covered up to $100; once every calendar year 1.0_MDV5001000CDHP Medical, Dental, and Vision Contact Information For your convenience, you can call one number for assistance with most of your benefit needs. Dial (877) 370-2772 (ASRC) and select from the following options: This document is neither a summary plan description nor an employee handbook. If a discrepancy arises between this document and the provisions of the plan documents, the plan documents govern. ASRC reserves the right to modify, amend or terminate its plans and programs at any time. > Option 1: Premera (Medical and Rx) >O ption 2: NurseLine > Option 3: Flexible Spending and Transportation Accounts >O ption 4: COBRA > Option 5: United Concordia (Dental) >O ption 6: VSP (Vision) >O ption 7: Additional Options > 1. Employee Assistance Program > 2. Unum (Life and Disability) > 3. 401K > 4. ASRC Benefits Team IMPORTANT DISCLOSURE: As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format to help you compare across options. The SBC is available on the web at http://office.asrc.com/office/SBC/ A paper copy is also available, free of charge, by calling (877) 339-6850. 1.0_MDV5001000CDHP