GE Health Benefits

Transcription

GE Health Benefits

GE Health Benefits
Employee informational presentation
Imagination at work
Prepare for Annual Enrollment
Be engaged:
Be prepared:
Be ready:
Be involved:
Read the
Enrollment
Guide
Get a PIN if
you need one,
know your
SSO ID and
password to
make your
Annual
Enrollment
elections
Use the
resources and
tools available
to you by
visiting
Become an
active
consumer and
take care of
your health
Be informed:
Learn how
your health
care plan
works and
involve your
family
ge.com/healtha
head/healthcar
edecisions
This document does not create a contract of employment between the General Electric Company (also referred to as “the Company”) and any individual. This
document is not an official summary plan description and is not intended to—and does not—provide full details of the plans and programs described. Full
details are contained in the official plan documents. If any representations made in this document or by GE Human Resources differ from the plan documents,
the plan documents prevail. (For plans and programs that do not have official plan documents, the summary plan descriptions will prevail.) General Electric
Company reserves the right and discretion to amend or terminate its benefit plans and programs at any time, for any reason.
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Your health care plan options
Option 1
Option 2
Option 3
Payroll contributions
Highest
Lower
Lowest
Deductible and coinsurance maximum
Lowest
Higher
Highest
Savings accounts
GE-funded HRA
Employee-funded
FSA.
GE-funded HRA
Employee-funded
FSA
Employee-funded
HSA Employeefunded LPFSA (dental
and vision only)
Summary
You pay the most in
payroll contributions,
but you have the
lowest deductible.
You pay less in
payroll contributions
than in Option 1, but
your deductible
is slightly higher.
You pay the least in
payroll contributions
but have the highest
deductible.
All options include prescription drug and behavioral health benefits
No changes to deductible or co-insurance maximum in 2016
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Similar coverage for all three options
All three plan options offer:
• Preventive screenings at no cost to you, in-network
• Savings accounts to help you pay for medical expenses
• With a few exceptions, insurance benefits that start after your deductible
• Payment responsibility of:
– 20% in-network co-insurance
– 40% out-of-network co-insurance*
For medical expenses (including Behavioral Health) after your deductible has been
met.
*Additional out-of-network provider billed charges may apply
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How do we determine preventive screenings
and services?
Preventive screenings and services are covered based on
recommendations of the U.S. Preventive Services Task Force (USPSTF)
and are periodically updated to comply with federal health care
reform.
To view a more detailed list of covered preventive screenings (as
defined by the USPSTF) go to your GE Benefits Handbook. To ensure
coverage, call your plan administrator for more details.
No out-of-network coverage for preventive screenings
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Preventive screenings and services at no cost
Covered at 100% in-network, not subject to deductible
Some preventive screenings include:
• Cancer screenings: cervical, breast,
prostate and colon
• Adult wellness physicals, well-child
care, immunizations
• Hepatitis B screening for adults and
adolescents who are at higher risk
for infection and pregnant women.
Women’s preventive screenings:
• Low-dose aspirin use for pregnant
women who are at high risk for
preeclampsia
• Breast Cancer Susceptibility Gene
(BRCA) Genetic Testing and
Counseling, when medically
appropriate
• Routine gynecological exams
• Prescribed generic contraceptives,
contraceptive counseling and
devices when deemed medically
necessary by the prescription drug
administrator
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Summary of changes for 2016
No increase in health care payroll contributions
HSA contribution maximums increase for family. For 2016 you can contribute:
• $3,350 single and $6,750 family
• $1000 catch up contribution for age 55 and over
Ambulance services at no cost to you
Your plan will cover ambulance and air ambulance services when medically
necessary at 100%, not subject to deductible for Options 1 and 2. Option 3 is subject
to deductible.
Adding a child to your coverage is more affordable
If you add an eligible dependent child to your medical plan in the middle of a
calendar year as a result of a marriage, birth or adoption, your deductible, out-ofpocket maximum and HRA credits will not change until the next plan year for the
child(ren) (Options 1 and 2 only). This does not apply to Option 3.
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Additional 2016 changes
Individual out-of-pocket limits
In accordance with new requirements under the Affordable Care Act (ACA), in 2016 no
individual family member can pay more out-of-pocket than $6,850 (Options 1 and 2), $6,550
(Option 3) or the combined family out-of-pocket maximum for the plan option in which they are
enrolled, whichever is less. Once the combined family out-of-pocket maximum is met, the plan
will pay 100% of eligible expenses for the remainder of the year (including for a family member
who has not met the deductible.)
Coverage rule change for same-sex domestic partnership
In June of 2015, the United States Supreme Court ruled that all U.S. states must now allow and
recognize same-sex marriage. Therefore, coverage under the Company’s health plans for
same-sex domestic partners will end December 31, 2016. An employee and his/her same-sex
domestic partner must marry by that date for the same-sex domestic partner to continue to
be covered under the GE plan.
If you choose to switch your plan administrator or are impacted by a change: Visit the
Provider Search tool on the GE Health Benefits Web site at ge.com/healthahead/healthbenefits
to verify your plan administrator and confirm your providers are in the new network.
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Additional 2016 changes
Simplified process to manage medical savings accounts
For those enrolled in Options 1 and 2, GE is introducing two new features ― the GE
Pharmacy Card and Auto-Reimbursement for your medical claims ― to improve
your experience and eliminate most steps in the process. Reimbursements will come
from FSA funds first, then HRA.
Specialty Drug co-pay increases
For conditions such as rheumatoid arthritis and multiple sclerosis — typically
including injectable, infused, oral, or inhaled drugs that generally require special
storage or handling and close monitoring. These drugs are often, but not always,
high-cost. Don’t forget, these drugs are not subject to a deductible under Options 1
and 2. Option 3 is subject to a deductible. Beginning in 2016, the cost for Specialty
Drugs will be $90 for a 30 day supply and $270 for a 90 day supply via mail order.
Targeted Drugs: Keeping copays the same, adding cholesterol drugs
Most generic cholesterol medications will be added to the targeted drug list, saving
you money. To view a list visit Caremark.com/ge.
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Prescription drug coverage
With a few exceptions, insurance benefits start after your deductible. This refers
only to drugs you have paid for at a network retail pharmacy or CVS Caremark mail
order. Drugs provided by your physician in their office may be subject to the
deductible and co-insurance.
Prescription drug coverage after your deductible
Generic
Brand name
Retail: $12 co-pay (30 day supply)
Retail: 30% co-insurance (30 day supply)
Mail order: $24 co-pay (up to a 90 day
supply)
Mail order: 20% co-insurance (up to a 90
day supply)
Prior authorization and brand/ generic
drug differences apply
CVS Pharmacies offer certain generic prescriptions at low prices:
$4 for a 30-day supply at retail pharmacy and $10 for a 90-day supply through
mail order
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Targeted , specialty drugs and diabetic supplies
Specialty drugs: Major
illnesses such as Multiple
Sclerosis, cancer,
Rheumatoid Arthritis
• Retail: $90 for 30 days,
• Mail order: $270 for up to
90 days
Targeted drugs: Diabetes,
cholesterol and Nicotrol®
management medications
• $12 for 30 days, $24 for
up to 90 days
Diabetic Supplies
Options 1 and 2
Option 3
You do not have to meet
your deductible for co-pays
to apply for Specialty or
Targeted drugs
You have to meet your
deductible for co-pays to
apply for Specialty or
Targeted drugs
Diabetes supplies are
Diabetes supplies are
covered at 100%, not subject covered at 100% once you
to deductible
have met your deductible
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Exclusive Choice Network (ECN)
expansion for 2016
The Exclusive Choice retail prescription drug network, which includes CVS,
Walmart, Sam’s Club and select independent pharmacies will now be
available in all states* starting January 1, 2016. This retail network may help
you reduce your pharmacy costs. If impacted, you’ll received a
communication mailed to your home in mid October.
If you don’t live within 25 miles of an in-network Exclusive Choice pharmacy,
there are options for you. Please call CVS Caremark at 1-800-509-9891.
*Excludes Kansas
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Vision and dental coverage changes for 2016
Enhanced vision coverage
Enhanced dental coverage
• For you and your covered adult
dependents, GE’s Vision Standard
Option will provide eye exams every
calendar year at no cost in-network.
• Children can stay on the dental plan
longer. As with the medical plan, you
can now keep or add your dependents
enrolled in a GE dental plan until age
26 without verification.
• GE’s Vision Standard and Vision
Premium Options will make glasses
more affordable by reducing or
eliminating co-pays for certain
lenses.
• GE's Dental Standard and Premium
Option will now cover services on any
teeth that were missing before your GE
coverage took effect.
• In addition, GE’s Dental Premium
Option will cover fillings at 100% of
reasonable and customary charges.
Maximums still apply.
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Introducing the GE Pharmacy Card and
Auto-Reimbursement for Options 1 & 2
It’s simpler when you go to the doctor
After your visit, your in-network doctor
will submit a claim. You’ll automatically
receive funds from any balance in your
medical account – by direct deposit or
check – in the amount that you owe
your doctor. Pay your doctor directly
when you receive the bill.
It’s simpler when you go to the pharmacy
Present your new GE Pharmacy Card,
which is now a combined CVS Caremark
ID card and debit card, to pay for
pharmacy or mail-order prescriptions.
Funds will be automatically withdrawn
from any balance in your medical
account.
No additional
action is needed
The new GE Pharmacy card does
not apply for those in Option 3 or
waived GE medical coverage.
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Auto-Reimbursement or Pick & Process?
Auto-Reimbursement
Pick & Process
• Automatic reimbursement via
direct deposit or check from any
balance in your account
• No additional documentation
needed
• You select which claims to
reimburse yourself for or can
pay a provider directly
• Those who like the experience
today can stick with it
• Reimbursements will come from
FSA funds first, then HRA.
• Reimbursements will come from
FSA funds first, then HRA.
• More control to use funds now
or save for future expenses
• Applicable to those who elect an
FSA and LPFSA
Important! Employees will be defaulted into Auto-Reimbursement . If you want to opt
out and continue using Pick & Process, take action during Annual Enrollment
• You choose your preference each year during Annual Enrollment
• Reminder the new GE Pharmacy Card applies only to Option 1 and 2 participants
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Savings accounts: Options 1 & 2
Help to pay your share of eligible health care expenses
Health Reimbursement Account (HRA)
• Credit between $600 and $1,200;
full amount available on January 1
• Credit is tax-free
Health Care Flexible Spending Account
(FSA)
• Pre-tax contributions from your
paycheck
• Unused credits roll over to following
year
• Contribute up to $2,500; full amount
available on January 1
• If you switch to Option 3, waive
coverage or if you don’t retire directly
from GE, the balance in your account
will be forfeited
• Can carry over up to $500 a year,
anything above $500 will be forfeited
• Can’t be used for dental/vision
• Includes dental and vision
• Reimbursements will come from FSA
funds first, then HRA.
Key advantage:
• GE opens and funds the HRA for you
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Savings Accounts: Options 1 & 2
Health Reimbursement Account (HRA) and Health
Care Flexible Spending Account (FSA)
If you have an HRA and FSA, you will receive one GE
pharmacy card for both accounts
When using the card at point of service, funds will be
deducted from your FSA first
If you plan to use FSA money for vision or dental
expenses, you may not want to use the debit card for
your medical and pharmacy expenses
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Savings accounts: Option 3
Help to pay your share of eligible health care expenses
Health Savings Account (HSA)
Key advantage
• Bank account you open and contribute to
save money tax free
• You own your HSA even if you change health
plans or jobs—your HSA will follow you
• You can open an account through your
medical plan’s partner bank or on your own
• Unused funds rollover into next year
• Subject to IRS rules
• Same as FSA, but used only for dental and
vision
• Contributions; not pre-funded
– Up to $3,350 for single coverage
– Up to $6,750 for 2 or more persons
• Additional $1,000 if 55 or older
• Account earns interest; investment options
are available
• Can be used for dental and vision
NOTE: States can choose to follow the federal tax guidelines or establish their own.
Consult a financial advisor or State Department of Revenue for applicable tax
information.
Limited Purpose FSA (LPFSA)
• Contribute up to $2,500, full amount
available January 1
• Can carry over up to $500 a year, anything
above $500 will be forfeited
• Auto-reimbursement election available
during Annual Enrollment
You should contribute to an LPFSA if you have
significant dental or vision expenses
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Annual Enrollment is October 12 – November 6
You must take action if:
• You wish to change your medical,
vision or dental plans in 2016
• You wish to contribute to a flexible
spending account (FSA) in 2016
• You wish to contribute to a health
savings account (HSA) in 2016
• You need to make a change in your
covered dependents
• You wish to add a dependent under
the age of 26 to your dental plan in
2016
• You want to select Pick & Process
rather than Auto-Reimbursement to
process your HRA and FSA claims. If
no choice is made, you will be
defaulted to Auto-Reimbursement.
• You need to change your working
spouse status
• You are a tobacco user, or you
certify that you will complete a
tobacco cessation program in 2016
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Points to remember about your 2016 elections
Your plan option will remain the same unless you choose to change during
the 2016 Annual Enrollment period, however, your health plan administrator
may change. Participation in an FSA, LPFSA, DCFSA or HSA will require
action.
If you are only carrying over funds (up to $500) from an FSA or LPFSA, funds
will roll over automatically. New election is not required if you choose to
only roll over funds. New 2016 elections require action.
Active employees not enrolled in a health plan are still eligible to enroll in an
HCFSA and/or DCFSA.
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Switching implications
1
2
3
Options 1 or 2 to Option 3
• Lower employee payroll contribution and higher deductible and co-insurance
maximum. You will pay less in payroll contributions, but more when receiving care.
• Loss of any remaining HRA funds and may choose self funded HSA.
• You are no longer eligible for a standard Health Care FSA. Instead, you can choose
to fund an LPFSA for dental and/or vision only.
• Up to $500 of remaining Health Care FSA funds will be automatically enrolled into
a Limited Purpose FSA. Amounts above $500 on December 31 will be forfeited.
• Specialty and Targeted Drugs will now be subject to deductible. Make sure to
consider which medications you take and how much they will cost under Option 3.
• Other Centers of Excellence benefits will also be subject to deductible.
• Health Plan Administrator may change
– Check to ensure your providers are participating
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Switching Implications
3
2
1
Option 3 to Options 1 or 2
• Increased employee payroll contribution but reduced deductible and co-insurance
maximum. You will pay more in payroll contributions, but less when receiving care.
• Eligible for a GE-funded HRA and an employee-funded FSA.
• Up to $500 of remaining Limited Purpose FSA funds will be automatically enrolled into a
Health Care FSA. Amounts above $500 on December 31 will be forfeited.
• May keep current HSA, but responsible for any banking fees associated with the account.
Qualified medical expenses may be reimbursed from HSA, however you can’t contribute.
• Specialty and Targeted Drugs will no longer be subject to deductible.
• Certain Centers of Excellence (COE) benefits will no longer be subject to deductible.
• Health Plan Administrator may change (check to ensure your providers are participating).
• Special IRS rules apply to mid-year enrollees (e.g. new hires) with less than 13 months in an
HSA. See OneHR.ge.com, your Benefits Handbook or IRS.gov for detailed information.
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Health Care Hub App – Coming soon!
One-stop shop for health care tools and resources
New app and desktop website guides you to your:
– Plan administrators … CVS Caremark, UHC, Aetna,
MetLife, etc.
– Key contact information
– Health care websites and apps … Treatment Cost
Calculator, Health Coach from GE, HRA/FSA/HSA
resources
– Quick links and detailed plan information on the
HealthAhead portal
Key features:
– Email Health Coach from GE and upload documents
– “Favorite” your most used resources
– Click to call functionality
search: “GE Health Care Hub”
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New! Annual Enrollment Elections on the Web
Simpler Annual Enrollment Web and mobile experience
– Anytime, anywhere; tablet and mobile
friendly
– Quick and easy experience
– Confirmation statement available as
soon as you complete your elections
to print or save for your records
• Email it to yourself and/or text a
confirmation that your elections were
submitted
– We want to know what you think!
Feedback tool and survey available
within the web experience
– Not compatible with Internet Explorer
8. Please use a newer version of IE,
Chrome or FireFox
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Treatment Cost Calculator (TCC) mobile app
Before you get the care, get the cost
We used employee feedback to design an improved mobile
app that helps members:
• Find physicians, hospitals and clinics in their area and compare
those providers by quality, cost and location
• Get GPS based turn-by-turn directions
• Click to call a provider
• Search for a medical treatment, service or condition
To add the TCC to a mobile device … Search for “GE TCC” in
the app store for your operating system
Save time and money! Use the TCC mobile app to locate
urgent care facilities
Visit treatmentcostcalculator.com/ge
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Health Coach from GE
Dedicated nurses,
supported by doctors
• Find high quality providers and
facilities
• Learn about your diagnosis and
treatment options
• Call 24/7 for urgent after-hours
care questions and options
Benefit and claims support
• Understand your plan, financial
responsibilities and coverage
• Resolve claim issues, both
simple and complex
• Single point of contact between
your medical carrier and
provider
A free confidential and voluntary resource for plan members
Call Health Coach from GE at 1-866-272-6007 Option 2, or via secure email on
OneHR.ge.com. Available 24/7 for urgent after-hours care questions and options.
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Expert Medical
Opinion (EMO)
Program
1 out of 4 GE members who get a second
opinion from a Cleveland Clinic doctor find
that their initial diagnosis or treatment plan
is not appropriate
A second opinion through the
Cleveland Clinic is confidential
and voluntary
• GE pays the entire cost
• Health Coach from GE will help
you collect and submit the
required medical records
Commonly used for the following
services:
• Back surgery
Visit eclevelandclinic.org/ge or learn more at
ge.com/healthahead/healthcaredecisions
• Joint replacement
• Cancer treatment
• Heart surgery
Call 1-866-272-6007
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NowClinic® from GE
Exclusively for members in certain states*
Benefits to our members
• Connect with a doctor on the web via
secure online chat or phone
• Open 24 hours, 7 days a week, no
appointment needed
Get help with minor
illnesses including:
• Allergies
• Pink eye
• Bladder infection • Rash
• Price decrease for 2016 - $40 per visit
• Bronchitis
• Seasonal flu
• Doctors can diagnose and prescribe most
drugs**
• Cough/cold
• Sinus infection
• All doctors are licensed, credentialed and
in-network
• Fever
• Sore throat
• Insomnia
• Viral illness
• Available in 45 states plus the District of
Columbia
Visit myNowClinic.com/GE or search
“NowClinic” in your mobile app store
• Nausea
*NowClinic® is not available in Arkansas, Alabama, Alaska, Louisiana, and Texas at
this time (February 10, 2015).
**No controlled substances may be prescribed. Other prescriptions may be available
where clinically appropriate and permitted by law and can be transmitted to a CVS
Caremark participating pharmacy of your choice.
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Coverage for full hip and knee replacements
GE has partnered with four Centers of Excellence to offer services to employees,
retirees or their enrolled dependents who need hip or knee replacement surgery,
even if they live outside the region.
All facilities are nationally ranked best hospitals with a rating of ‘high performing’ or
better in Orthopedics according to US News and World Reports
Chicago - Northwestern Memorial Hospital
Cincinnati - The Christ Hospital
Charlotte - Carolina Medical Center
New York City - Hospital for Special Surgery
Program benefits include:
• 100% coverage of consultation and surgery costs for Options 1 and 2. Not subject
to deductible and co-insurance
• 100% coverage, after meeting deductible for Option 3
• Up to a $2,000 total allowance to use toward eligible travel expenses to and from
the appropriate facility, depending on where you live*
• Pre- and post-op care coordination via Health Coach from GE
*Call Health Coach from GE at 1-866-272-6007 to verify if you are eligible for the $2,000 allowance and to understand expenses that qualify for reimbursement.
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CVS Caremark
Find savings and opportunities
• Confidential and proactive messaging tailored to the user
• Refill, check order status, locate pharmacy, cost savings opportunities
• Search for lower-cost medications and delivery options
• Ask a pharmacist
• Available via mobile app and toll-free service number
Learn more at Caremark.com
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Tobacco cessation resources
Quitnet Tobacco Cessation Program
www.quitnet .com/ge
• Nicotine Replacement Therapy (NRT)* products are available through QuitNet and
delivered to your home at no cost to you. (Nicoderm Patch, Nicorette Gum and
Commit Lozenges)
• Provides access to expert resources and online support communities
Your GE medical benefits plan
Counseling for tobacco use and smoking cessation drugs for adults are covered at
100% in-network. This includes Chantix and other NRT products when prescribed by
a physician. For more details, call CVS Caremark at 1-800-509-9891 or visit
Caremark.com
Offers lifestyle coaching programs including tobacco cessation coaching. Call 1-866272-6007 to get started, weekdays from 9:00 a.m. – 7:00 p.m., Eastern time.
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Be an active health care consumer
You never know when you will need medical care, but certain factors are
under your control.
Helpful tips:
To minimize expenses:
• Choose a Primary Care Physician
(PCP)
• Use generic drugs whenever
possible
• Use network providers
• Seek care from high quality
doctors and hospitals
• Use free-standing diagnostic
imaging centers when possible
• Get your preventive screenings at
no cost to you … catch any
medical issues early
• Eat well, exercise, get fit—and
stay fit
• Avoid unnecessary ER visits by
using non-hospital based urgent
care centers when available
• Consider enrolling in an FSA to
take advantage of pre-tax dollar
savings
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Annual Enrollment Quick Start page
In one convenient location,
you’ll find links to all the
tools and information you
need to make your 2016
elections
ge.com/gotoAE-gehb
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Where to go for questions
Visit the Web to learn more
about GE Health Benefits:
• Plan option descriptions
• Decision profiles
• Comparison charts
• Tips for making the most
of GE Health Benefits
ge.com/healthahead/healthbenefits
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Important phone numbers
For questions on your savings accounts, auto-reimbursement or
savings account changes for 2016
WageWorks
1-888-303-3006
Find high quality doctors and treatment options, understand your treatment
options, resources to live a healthier lifestyle
1-866-272-6007
Learn how GE Health Benefits works, verify dependent eligibility, enrollment,
employee contributions and general plan information
GE Benefits Center
1-800-252-5259
Drug costs and plan design information
CVS Caremark
1-800-509-9891
Treatment Cost Calculator (User support, technical/data questions)
Product Support Team
1-800-441-5592
Learn about covered services, doctors and hospital participation and plan design questions
UnitedHealthcare
Aetna
CDPHP
BCBS of Alabama
1-866-756-4792
1-800-433-6796
1-877-754-5064
1-800-321-4392
Health Savings Accounts
PayFlex– Aetna
1-888-678-8242
Optum Bank – UnitedHealthcare
BenefitWallet – Blue Cross Blue Shield of Alabama
BenefitWallet – Capital District Physician Health Plan
1-800-791-9361
1-866-274-8494
1-866-274-8494
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Appendix
Key terms for you to know
Payroll contributions
Savings accounts
• The amount deducted from your paycheck for the health • Accounts to help you pay for your share of eligible health
care plan you select
care expenses.
• Working Spouse contributions and tobacco surcharge
– Health Reimbursement Account (HRA):
may apply
Tax-free account funded by GE
• The amount you need to pay each year for eligible health
care expenses before most insurance payments begin
– Flexible Spending Account (FSA): Account
opened on your behalf by GE that you fund through pretax payroll deductions
Co-insurance
– Health Savings Account (HSA): Bank account that you
open and contribute to with tax-free money
Deductible
• The amount you pay for eligible health care
expenses after you reach your deductible
• In-network services are generally covered at 80%. In most
cases you pay the remaining 20%
Co-insurance maximum
• The maximum amount you pay each year for
eligible health care expenses after your deductible
Out-of-pocket maximum
• Your deductible plus your co-insurance maximum
• Once you meet your out-of-pocket maximum in a
given year, GE pays 100% of eligible health care
expenses
– Limited Purpose Flexible Spending Account (LPFSA):
Same as FSA, but can be used only for dental/vision
expenses
– Dependent Day Care Flexible Spending Account:
(DCFSA): An account that can be used to pay for
childcare or adult care for a qualified dependent so that
you and your spouse, if you are married, can work
Network
• Doctors, hospitals, pharmacies and other health care
providers who meet quality standards and have agreed to
accept negotiated rates
37
Using your plan
You pay 100% of health care costs until you reach your deductible, then you pay
20% and GE pays 80% (in-network). Once you’ve met your deductible and coinsurance maximum, GE pays 100% of remaining eligible expenses in-network.
Here’s a closer look
Your deductible
The dollar amount you’ll need to
spend before most insurance
payments begin. You’ll pay all
health costs until the amount is
reached.
Your deductible is made up of
eligible medical, pharmacy and
behavioral health claims for you
and your covered dependents.
Dental, vision, over-the-counter
purchases, and non-covered
services do not count toward
your deductible.
+
Your co-insurance
maximum
Once your deductible is met,
co-insurance begins.
Co-insurance means you pay
20% of the cost and GE pays
80% (in-network).
=
Your out-of-pocket
maximum
After you reach your coinsurance maximum (your
deductible plus co-insurance
maximum) GE pays 100% of
covered expenses in-network..
The amount of co-insurance
you pay is capped. Your
co-insurance maximum is the
most you will pay each year for
covered benefits after your
deductible.
Exclusive Choice retail pharmacy network (ECN)
Retail network to help reduce prescription drug costs for members
• Exclusive Choice Network includes CVS, Walmart, and Sam’s Club and
select independent pharmacies and is available in all states.*
• You must use an Exclusive Choice Network pharmacy, or mail order for
your prescription to be covered
• Exclusive Choice network reduces the amount you pay at the pharmacy
in many cases
• If you do not currently have the ECN, this change does not affect the
availability of medications you may currently take. Also, there is no
change to mail order service.
• CVS Caremark website, mobile app and customer service will provide
network pharmacies in your area
*The Exclusive Choice retail network in all states except Kansas.
39
Preventive screenings and services at no cost to you
Covered at 100% in-network, not subject to deductible
Pediatric Prevention through age 21
Well Child Care visits
Annual Adult Physicals and Annual
Routine Gynecological Care
Physical Examinations
Screening tests
Routine Gynecologic Examinations
- Newborn Hearing
Primary Preventive Counseling
- Annual vision
Electrocardiogram
- Developmental Screening
(condition restrictions apply)
Obesity Screening
- Major depressive disorder screening
Women’s Preventive Care
Contraception – Sterilization procedures
Prescribed generic contraceptives and
contraceptive counseling, over-the-counter drugs,
non-oral brand contraceptives without a generic
equivalent, and oral brand drugs when deemed
medically necessary by the prescription drug
administrator
Breast feeding supplies (breast pump), support and
lactation counseling
Prenatal care office visits
FDA approved contraception devices – including
Insertion/removal
Breast cancer preventive medication for women
with increased risk. Includes Tamoxifen
Low dose aspirin for those at risk for preeclampsia
Age, gender, condition and medical necessity
restrictions may apply. See benefit
administrator for details
Osteoporosis Screening
Cancer Screenings
Breast Cancer: Mammography
Cervical Cancer: Laboratory Testing
Colon Cancer: Colonoscopy, Sigmoidoscopy and
associated laboratory tests, e.g. biopsy
Prostate Cancer: Digital Rectal Exam and
Antigen (PSA) test
Breast Cancer Susceptibility Gene (BRCA)
Counseling
Abdominal Aortic Aneurysm Screening
Breast Cancer Susceptibility Gene (BRCA)
Genetic Testing, when medically appropriate
Immunizations and tobacco cessation
Annual lung cancer screening for age 55 – 80
who have smoked for over 30 years
Influenza (i.e. H1N1)
DTaP (Diphtheria, tetanus, pertussis)
Hepatitis A
Hepatitis B
Hib (Haemophilus Influenzae Type b)
Human Papilloma-virus (HPV)
Meningococcal Conjugate (MCV) or
Polysaccharide (MPSV)
MMR (Measles, mumps and rubella)
Pneumococcal polysaccharide (PPSV)
Polio
Rotavirus (RV)
Tetanus
Varicella (Chickenpox)
Zoster (Shingles)
Counseling for tobacco use and prescribed
generic (including OTC) tobacco cessation
products for adults. Chantix included
Blood/urine and other laboratory
tests to screen for the following:
Rh Incompatibility
Lipid Disorder – Cholesterol, lipoprotein,
and triglycerides
Bacteruria (For pregnant women only)
Chlamydial Infection
Gonorrhea
HIV
Syphilis Infection
HPV Detection
Diabetes Type II
Iron Deficiency Anemia
Sickle Cell Disease
Lead
Hepatitis C virus screenings for adults born in US
from 1945–1965 and those at high risk.
Hepatitis B screening for adults and adolescents
This document does not create a contract of employment between the General Electric Company (also referred to as
“the
Company”)
any
who
are
at higherand
risk
forindividual.
infectionThis
and pregnant
document is not an official summary plan description and is not intended to—and does not—provide full details of the
plans and programs described. Full
women.
Savings account comparison
Option 1 and Option 2
HRA
Option 3
HC FSA
HSA
LP FSA
Action To Take
Elect Option 1 or 2
Annual election during
enrollment
Elect Option 3; then
Open an account
 Optum, Payflex,
BenefitWallet; or
 Your own bank
Annual election during
enrollment
Contribution
$600–$1,200 deposited
on January 1
Up to $2,500
Full amount available 1/1
Can change only with a
qualifying event (family
status change)
Single: up to $3,350
Two +: up to $6,750
Over 55: + $1,000
Optum, Payflex, BenefitWallet
(Mellon Bank), HealthEquity
 Pre tax payroll contributions
 Can change anytime
Your own bank
 You decide how/when
Up to $2,500
Full amount available
1/1
Can change only with a
qualifying event (family
status change)
Tax Benefits
Tax-free account
Pre-tax payroll deduction
Money goes in tax-free
Pre-tax payroll deduction
Medical expenses
Yes
Yes
Yes
No
Dental and vision
expenses
No
Yes
Yes
Yes
Maintenance fees
None
None
Depends on bank
None
If you don’t use it
Rolls over to next year
Can carry over up to $500
per year
Rolls over to next year
Can carry over up to
$500 per/year
If you leave GE
Balance forfeited
Balance forfeited
Account stays with you
Balance forfeited
41
Behavioral health coverage
Employee Assistance Program (EAP)
•
Personal, confidential assessment, counseling and referral services
•
Contact Health Coach from GE line at 1-866-272-6007, Option 1, 24-hours-a-day,
7-days a week
Behavioral Health and Substance Abuse Treatment Network
•
Network of psychiatrists, psychologists, certified addiction counselors, social
workers, hospitals and treatment centers
•
Contact Health Coach from GE line at 1-866-272-6007, Option 1, 24-hours-a-day,
7-days a week for approval and referral
•
In-patient hospitalizations – covered at 80% after deductible has been met
network)
•
Centers of Excellence benefit for substance abuse available
(in-
GE Vision Care options
Provides a broad range of services to maintain healthy eyesight
Choose from two GE Vision Care Options
GE Vision Standard/Basic Option
• Provided at no cost. All eligible full-time employees
enrolled in Options 1, 2 or 3 are automatically enrolled.
• Provides a schedule of benefits for eye exams, corrective
prescription lenses and eyeglass frames, and low vision
services.
GE Vision Premium/Plus Option
• Participants must pay a premium, and eligible employees
can choose to enroll in this plan.
• Provides a schedule of benefits for eye exams, corrective
prescription lenses, eyeglass frames, low vision services,
and laser vision surgery.
1. Go to
davisvision.com
2. Click the
Members tab
and select Open
Enrollment
3. Control Code:
7540 – Standard
or Basic
7541 – Premium
or Plus
4. Select Find a
Provider
43
GE Dental Care options
Provides a broad range of services to maintain healthy teeth and gums
Choose from two GE Dental Care Options
GE Dental Schedule Option:
• Eligible full-time employees are automatically enrolled at no cost.
• Most benefits paid according to a schedule
GE Dental Premium Option:
• Eligible employees can choose to enroll in this plan.
• Participants must pay a premium
• Benefits are paid as a percentage of reasonable and customary
Employee and dependents must be enrolled in the same option.
Find a participating dentist at metlife.com/dental. Select PDP network
44
GE Vision Care options
Comparison
GE Vision Standard /Basic Option
19 and Over
Under 19
GE Vision Premium/Plus Option
All Members
Once every calendar year
Spectacle lenses
Once every other calendar year / Once every calendar year
Frame
Contact lenses (in lieu of spectacle lenses)
Eye examination (including dilation)
Included
Included
Spectacle lenses: All ranges of prescriptions and sizes
Included
Included
$120
$150
Fashion (up to $100 retail value)
Included
Included
Designer (up to $160 retail value)
Included
Included
Premier (up to $195 retail value)
$25 co-pay
Included
$130
$175
$200
$200
Disposable
Included (up to 4 boxes)
Planned replacement
Laser vision surgery
Laser vision discount program participation
Laser vision discount program participation, plus up
to $250 lifetime allowance per eye
Eye examination (including dilation)
IN-NETWORK BENEFITS
FRAME
In-Network retail allowance
EXCLUSIVE COLLECTION OF FRAMES (IN LIEU OF FRAME ALLOWANCE)
CONTACT LENSES (IN LIEU OF SPECTACLE LENSES)
Elective allowance up to: Single Vision
Bifocal
FORMULARY WITH FITTING/FOLLOW UP CARE (IN LIEU OF ELECTIVE ALLOWANCE
45
GE Dental Care Options
Services
GE Dental Schedule Option
GE Dental Premium Option
Diagnostic and preventive coverage
Benefit schedule (benefits paid up to
scheduled amounts)
100% of reasonable and customary fees
Crowns and inlays
scheduled amounts)
Fillings
scheduled amounts)
Dentures and fixed bridges
scheduled amounts)
Benefit maximum for fillings, crowns,
inlays, dentures and fixed bridges and
dental implants
$2,500 over two consecutive calendar
years
$2,500 annually
Root canals, gum treatment and oral
surgery
Dental implants
Orthodontia
- Lifetime maximum
$2,500 per child up to age 19
$2,500 per child up to age 19
46
HealthAhead
A one-stop-shop for employees and their families! Externally accessible by
spouses through the Internet. Access and share today!
Front Door
Live Healthier
You and your family’s
journey into
HealthAhead begins
here
Lifestyle and wellness
tips and tools to
inspire positive,
practical changes
Health Care Decisions
Health Resources
U.S. benefits related
tools and resources
(health resources for
non-U.S.)
Lead the Way
Apps and Resources
Leadership stories to
inspire involvement in
HealthAhead
Information and tools to
help educate employees
and their family members
to make smart health
care decisions
ge.com/healthahead
47
How does the plan work?
HRA, deductible and co-insurance
Employee example – Meet Joe
The following example
shows how an HRA and a
deductible work,
and what happens when an
employee reaches the
co-insurance portion of
coverage
Joe
Age 39
Married, with two children:
• Son, age 11
• Daughter, age 13
Option 1, family coverage
$55,000 salary
Active and healthy
Son broke leg in October
Benefits Detail
Deductible: $2,000
Health Reimbursement Account:
$1,200
80% co-insurance (in-network)
Co-insurance maximum:
$2,500 (in-network)
Joe – January to September
Before his son breaks his leg
Expense
$2,000
Deductible
HRA: $600 remaining
Preventive care: 100%
In-network coverage
80% co-insurance
HRA: $600 paid
$300
Deductible:
$1,400 left to
pay
Deductible:
$2,000
Doctors visit (sore
throat)
$200
Prescription medicine
$400
$600
Joe pays from his HRA
Preventive screening
$0
$300
$0
The plan pays
Total
Joe Pays Plan Pays
$900
$300
$600 $300
With no further needs, Joe could
roll over $600 in his HRA
Joe’s son breaks a leg in October
$5,175 Medical Expenses
$5,175
Expenses
Deductible:
Deductible:
Joe pays $800; he has
$800 left to pay
now met his deductible
Preventive care: 100%
$2,000
Deductible
HRA: $600 paid
HRA: $600 paid
Expense
Hospital
$5,000
X-ray
Co-insurance:
GE Pays 80%: $3,020
Co-insurance:
Joe Pays 20%: $755
Total Health Care Cost
$300
Joe Pays Plan Pays
$175
Joe pays from his HRA
$600
Joe pays the rest of
deductible
$800
Co-insurance
Joe Pays 20%
$755
GE Pays 80%
Total
$3,020
$5175
$2,155
$3,020
For Joe’s $2,155, he pays:
- $600 from his HRA
$1,555 from his own funds
Joe has $1,745 in Out of Pocket (OOP) to pay if
necessary (but all at 80%/20%), GE will then pay 100%
Health Savings Account (HSA) Partner Banks
If you are enrolled with:
That bank is:
Phone:
United Healthcare
Optum Bank
1-800-791-9361
Aetna
Payflex
1-888-678-8242
Capital District
Physicians’ Health Plan
(CDPHP) or Blue Cross
Blue Shield of Alabama
BenefitWallet
1-866-274-8494
52

GE Health Benefits

Transcription

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