© 2010 Wittenberg University Springfield, Ohio 45501 New Health Care Plan For Retirees Under 65 Effective Oct. 1, 2010

© 2010 Wittenberg University Springfield, Ohio 45501

New Health Care Plan For Retirees Under 65

Effective Oct. 1, 2010


Agenda

I. Medical/Dental Insurance Plan Design Review Employee Contributions

II. Anthem Resources Anthem.com Look up providers, manage prescriptions etc.

General Information


General Information

• New Plan is Effective 10/1/2010

• Self-Funded Plan subject to ERISA and plan document

• Partnering with Anthem Blue Cross & Blue Shield

Blue Access PPO network – national network

• 4 Plan Types: Employee plan, Employee + spouse plan,

Employee +children plan, & Family plan


General Information

• Dental continues to be a part of the Medical Plan

• Your deductible accrual that started on January 1, 2010 will remain intact. In other words, plan members will not need to restart their deductible accumulations with the Oct. 1 onset of the Anthem plan.

• The healthcare plan will continue to operate on a calendar year. Deductibles, out-of-pocket maximums etc. will be calculated based on the calendar year.


Glossary of Terms• Co-pay – a flat dollar amount that is paid at the time of service. Co-pay

does not apply to the deductible

• Deductible – annual amount of money a member must pay before benefits are paid at the co-insurance % .

• Co-insurance – a percentage that a member pays for services received after they have met their deductible.

Member pays in full until deductible is met.

• Out-of- pocket limit – the most an employee would pay in deductible and co-insurance during a

plan year (Jan-Dec) for healthcare services excluding prescription drugs.

Services with a % = Co-insurance .

Services with a $ = Co-pay .


Wittenberg’s Blue Access PPO Health Plan

MEMBER PAYS

Deductible $400 individual /$800 family

Emergency Room Services 10% after deductible

In-Network BenefitOut-of-Pocket Limit $1,200 individual /$2,000

familyPhysician Office visits $20 co-payPreventive Care visits Covered at 100%Urgent Care $20 co-payInpatient/Outpatient Services 10% after deductible


Wittenberg’s PPO Health PlanOut-of-network benefit

Out-of- Pocket Limit $1,300 individual /$2,200 family

Physician Office visits 30% after deductiblePreventive Care visitsUrgent CareInpatient/Outpatient Services

Balance billing: Providers and hospitals who are out-of-network will bill you for the difference between the amount the plan pays and the usual and customary amount.


Deductibles and Out-of-Pocket Limit

Deductible The $400/$800 deductible simultaneously applies to both in and out-of-network services. In other words, there is not a separate deductible for out-of-network.

Out-of-Pocket Limit (“OOP”) There is a separate out-of-pocket limit for in-network and out-of-network co-insurance expenses.

Co-insurance costs for services received in-network only apply tothe in-network OOP. Co-insurance costs for services received out-of- network only apply to the out-of-network OOP.

In-network - $1,200/$2,000Out-of-network - $1,300/$2,200



Three Possible Scenarios

Illustration: OOP costs based on an Individual Member

1. Member receives all services from in-network providers

= $1,200 per individual OOP limit. ($400 deductible + $800 additional co-insurance expenses)

2. Member receives all services from out-of-network provider

= $1,300 per individual OOP limit plus any balance billing. ($400 deductible + $900 additional co-insurance expenses…plus balance billing)



3. Individual Member receives in-network AND out-of -network services.

Member must satisfy OOP limit under each benefit.

OOP limit = $1,200-$2,100 depending on the cost of the out-of-network service.

$1,200 in-network OOP limit plus the cost of the out-of-network service up to a maximum of $900 additional cost. Plus any balance billing.


Tiered Prescription Benefit

Prescription Drug Retail $10/$25/$40

Express Scripts Prescription Drug Mail Order $20/$50/$80

3-month supply Anthem Tiered Drug List

You will need a new script to initiate the new mail order service

Prescription co-pay OOP limit: $1,200 single/$2,000 family

Note: This OOP limit is completely separate and unrelated to the OOP for medical.

http://www.anthem.com/health-insurance/customer-care/forms-library


Wittenberg Dental Plan MEMBER PAYS

Deductible $25 single /$75 family

Annual Maximum (per covered member) $1,500

Diagnostic and Preventive No Charge to member

Minor Restorative 20% after deductible

Oral Surgery 20% after deductible

Endodontic Services 20% after deductible

Periodontal Services 20% after deductible

Prosthodontic Services 50% after deductible

Orthodontic Services 50% no deductible

Orthodontic Lifetime Maximum $1,000

Orthodontic Age Limit Child to age 19


80/20 Contribution Medical/Dental Plan


80/20 Contribution Medical/Dental Plan

Nationally, Healthcare Costs will continue to trend up.

Expect Future Rate Increases


Anthem.com website

• Your Personal Account Summary

• Manage your Prescription Benefit – Express Scripts

• Information about the plan benefits and PPO providers

• Valuable Tools

• Health and Wellness Discounts and Special Offers

• You must Register to have access to the website

Anthem

http://www.anthem.com/health-insurance/home/overview


RegistrationRegistering for anthem.com is quick and easy and designed to ensurethat your personal information is kept safe and secure.

1

1

1

First, go to anthem.com.

Click on the Register link.

http://www.anthem.com/health-insurance/home/overview


How to Find a Provider

• www.anthem.com

• Click on “Find a Doctor” on the right side of the page• Choose the state that you want to search• Choose the Blue Access PPO for the Medical Plan network• Choose the type of Provider you want to find • You can then search by provider name, address, zip code etc.

http://www.anthem.com/


New Health Care Cards

Anthem will mail your new cards directly to your home before the end of September.

Note: You can register on Anthem.com as soon as you have your new benefit card. There is information you can access without registering such as the list of PPO providers and tiered drug formulary information.

Documents

© 2010 Wittenberg University Springfield, Ohio 45501 New Health Care Plan For Retirees Under 65 Effective Oct. 1, 2010