2021 Logan County Employee Benefits Guide
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Logan County Employee Benefits Guide 2021
Welcome to Our Benefits
Welcome to the Logan County
Employee Benefits Guide
Logan County offers you and your eligible family members a comprehensive and valuable benefits
program.
We encourage you to take time to educate yourself about your coverage. Knowing your benefits before
you need them will help you make the best healthcare decisions for you and your family.
Be a wise health care consumer and take responsibility for your health care! Ask your doctor a few simple
questions to help you decide what treatment plan is best for both your health and your wallet such as:
• How much will my treatment cost?
• Can I be treated another way that is equally effective but less costly?
• What are the risks?
• What are the side effects?
• How long will I need to take my medication?
Other ways to be wise:
• Choose in-network providers whenever possible
• Ask your doctor if a generic equivalent is available before filling your prescription at the pharmacy
• Seek outpatient care as a reasonable alternative, instead of a hospital
• Review your bills and Explanations of Benefits (EOBs) carefully
• For non-emergency care consider a convenience clinic or urgent care if your primary care
physician isn’t available
• Remember to schedule your preventive care/routine physical each year
2
Welcome to Our Benefits
Table of Contents
Contact Information………………………………………………………………….……….….……………………………………5
Medical and Prescription Drug Coverage……………………………………………..………………………………….….6
Benefit Plan Contributions……………………………………………………………..…………………………………….….….7
Other Services Offered by Anthem……………………………………….……………………………………………..…8-22
Flexible Spending Account & Dependent Care…………………………………..…………………………….........23
Dental Benefits.……………………………………………………….………………………….…..………………………….…….24
Vision Benefits……………………………………………………………………………………...................................….25
Life & ADD Benefit………………………………………………………………………..………………………………..….…...26
How to Enroll…….……………………………………………………………………….……………………………………..…27-28
Glossary of Terms……………………………………………………………………….……………………………………….……29
Legal Notices………………………………………………………………………………………………………………........30-33
3
Welcome to Our Benefits
Who is Eligible?
Employees (other than Board of DD) are eligible on the first day of the
month following the date of hire. If hired on the first of the month,
employees are immediately eligible.
The following family members are eligible for medical, dental and vision
coverage:
• Spouses; except when they are eligible for coverage available
through their own employer’s group medical plan, or retirement
plan.
• Any child (son, daughter, stepson, stepdaughter, adopted child or
eligible foster child) up to age 26.
When to Make Changes
Unless you have a qualifying event, you cannot make changes to the
benefits you elect until the next open enrollment period.
Qualified changes in status include, for example:
• Marriage
• Divorce
• Legal separation
• Birth or adoption of a child
• Change in child’s dependent status
• Death of a spouse, child or other qualified dependent
• Commencement or termination of adoption proceedings
• Change in your employment status
• Change in your spouse’s benefits or employment status
• Gain or loss of other group coverage
• Entitlement to Medicare or Medicaid
• Change in custody, judgement, court order or decree requiring
medical coverage
If you experience a qualified status change, as noted above, it is your responsibility to notify Human Resources. Per
IRS regulations, coverage elections due to a qualified status change must be made within 30 days of the event (60
days if the event is Medicare or Medicaid entitlement).
4
Welcome to Our Benefits
Contact Information
Your first point of contact for all benefit questions, claims and billing issues, and id card replacement
is our benefits partner, Preferred Benefits Services. Preferred Benefits is a Central Ohio insurance
consultant in business for over 25 years, with a professional, experienced staff dedicated to serving as
an advocate for employers and employees. Our team is dedicated to serving your needs and will
respond to all questions or queries within 24 hours of initial contact.
Preferred Benefits Services Agency
611 S. Sandusky St., Delaware, Ohio 43015
740-363-6028 / 800-558-5658
Tammy Scott Senior Account Manager 800-558-5658 ext. 30 tammy@prefben.com
Seth Allen Senior Account Executive 800-558-5658 ext. 27 seth@prefben.com
Logan County Commissioners
Brian Dunn Commissioner’s Office 937-599-7280 bdunn@co.logan.oh.us
Medical – Anthem
Group #0033321010
Customer Service – 1-855-603-7982
Anthem Provider Network – https://www.anthem.com/health-insurance/provider-
directory/searchcriteria?brand=ABCBS
Personalized website - To set up your account, go to https://www.anthem.com/register/ . You will need your
Anthem ID number (found on your ID card); date of birth and full name.
24/7 Nurseline – 1-800-337-4770
LiveHealth Online (Telemedicine) – Register at livehealthonline.com and visit with a doctor using your
smartphone, tablet or computer or call 1-844-784-8409
Dental – Superior Dental
Group #: D4986
Customer Service – 800-762-3159
Dental Provider Network https://www.superiordental.com/find-a-dentist
Personalized Website – Superior Direct Connect - https://sdc.superiordental.com/ and click on “Create an account
now” or log in if you already have an account.
Vision – VSP
Group #: 30028586
Customer Service – 1-800-877-7195
Vision Provider Network - www.vsp.com and click on “find a provider”.
Personalized Website - https://www.vsp.com, click on “Create an account”
5
Welcome to Our Benefits
Medical and Prescription Drug Coverage
We offer two PPO medical benefit plans through Anthem Blue Cross/Blue Shield. When you and your
family seek healthcare services, you have access to the largest single health plan network of healthcare
providers and facilities. Plan members can also use virtual visits and convenience care clinics as other
sources of lower-cost, quality care.
Medical and Prescription Drug Coverage Summary
Anthem
Benefits
PPO 5d PPO 4a
Deductible In-network: $2,000/$4,000 $500/$1,000
(Single/Family) Out-of-network: $4,000/$8,000 $1,000/$2,000
Out-of-Pocket Max In-network: $4,750/$9,500 $2,500/$5,000
(Single/Family) Out-of-network: $9,500/$19,000 $5,000/$10,000
In-network: 100% - no deductible 100% - no deductible
Well Care/Physicals
Out-of-network: 50%* 50%*
In-network: $25 Copay $25 Copay
Physician Office Visits
Out-of-network: 50%* 50%*
In-network: $50 Copay $35 Copay
Specialist Visits
Out-of-network: 50%* 50%*
In-network: $50 Copay $50 Copay
Urgent Care Center
Out-of-network: 50%* 50%*
Inpatient/Outpatient In-network: 50%* 70%*
Hospital and Facilities Out-of-network: 50%* 50%*
Outpatient Diagnostic In-network: 50%* 70%*
Testing, X-Ray and Lab Out-of-network: 50%* 50%*
In-network: $250 Copay $200 Copay
Emergency Treatment
Out-of-network: $250 Copay $200 Copay
30 days: $10/$30/$50 $10/$30/$50
Pharmacy Benefits Mail Order: $20/$60/$100 $20/$60/$100
Out-of-Pocket Max $2,500/$5,000 $2,500/$5,000
*After Deductible
6
Welcome to Our Benefits
Medical Plan Employee Contributions - Monthly
Rate Monthly Employee Share County Share Employee Share County Share
Health Plan With Wellness With Wellness
Tier Cost Without Wellness Without Wellness
EE $661.47 $114.00 $547.47 $64.00 $577.47
PPO Base Plan EE+Sp $1,457.17 $300.00 $1,157.17 $220.00 $1,237.17
(5d) EE+Ch $1,188.65 $242.00 $946.65 $192.00 $996.65
Family $1,984.36 $414.00 $1,570.36 $334.00 $1650.36
EE $711.13 $196.00 $515.13 $146.00 $565.13
PPO Buy-Up EE+Sp $1,566.59 $430.00 $1,136.59 $350.00 $1,216.59
Plan (4a) EE+Ch $1,277.89 $354.00 $923.89 $304.00 $973.89
Family $2,133.33 $584.00 $1,549.33 $504.00 $1,629.33
Voluntary Dental Plan Employee Costs – Per Pay
Monthly Cost Employee Cost Per Pay
Employee $26.62 $13.31
Employee/Spouse $53.22 $26.61
Employee/Child $53.22 $28.77
Employee/Children $98.86 $49.43
Family $98.86 $49.43
Voluntary Vision Plan Employee Costs – Per Pay
Monthly Cost Employee Cost Per Pay
Employee $10.86 $5.43
Employee/Spouse $16.56 $8.28
Employee/Child $16.56 $8.28
Employee/Children $29.70 $14.85
Family $29.70 $14.85
7
8
Meet Engage,
your personalized
health assistant
Engage helps you make the most of your
health plan and connect with resources
to achieve your wellness goals.
Download the
Engage Wellbeing App today!
Get peace of mind. Take charge of your wellness. Make the most of your perks.
Clearly see what's covered by your Track sleep, steps and food to create Save time and money by discovering
plan and access your digital healthy habits and hit your well additional benefits and programs.
insurance card anytime, anywhere. being goals.
9
102300ANMENABS VPOD Rev /18
Built for the real world.
All for you.
Simplify your health care experience with a personalized
health assistant that connects you to the right benefits and
programs at the right time. With Engage, you can:
See all of your medical and Access LiveHealth Online and have
pharmacy benefits in one place. face-to-face video visit with a doctor
therapist on your smartphone,
computer or mobile device.
Learn more about our health and Participate in well-being challenges
wellness programs, like 24/7 to help keep you active and healthy
NurseLine, Condition Care and
Future Moms.
Protect yourself from overpaying by
Sync fitness and wellness data with seeing the cost of services and
your wearable fitness device. care before setting up a visit.
Using Engage, you can get
support through a mobile
device, computer or phone.
10
LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to
anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the
Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative
services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans are administered by Anthem Health Plans of
New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the
area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance
Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.Skip the ER
When it’s not an emergency, get
quick care with these options
When you need care right away and your doctor isn’t available, the emergency room (ER) might be your first choice. But did you
know how many ER visits are unnecessary? ERs aren’t the best choice in every situation, especially when you can save about
$1,100 by going somewhere else when it’s not an emergency.1, 2, 3 And you won’t have to wait as long.
Here’s what to do when you need care fast
Step 1: Call your primary care doctor or 24/7 NurseLine
Your doctor can help you decide where to get care, whether it’s a visit to his or her office, going to the ER or
somewhere else. If your doctor isn’t available, you can call the 24/7 NurseLine at the number on the back of your
ID card to help you decide what to do.
Step 2: If it’s not an emergency, choose one of these options to save you time and money
Depending on your needs, you’ve got these choices:
} Retail health clinic — Usually in a major pharmacy or retail store where you can get basic health care services
from a health care professional.
} Walk-in doctor’s office — No appointment is needed for routine care and common illnesses.
} Urgent care center — For conditions that need care right away such as stitches, lab tests or X-rays.
} LiveHealth Online — Have a video visit in minutes with a board-certified doctor 24/7 on your smartphone, tablet
or computer with a webcam. No appointment is needed. Just go to livehealthonline.com or download the free
app to register and get started.
These options are more convenient than the ER. They’re often open at night
and on weekends, so you don’t have to wait to get treated.
If you’re an HMO member, talk to your primary care doctor to understand
When to head to the ER your options for quick care. Your doctor can also help you find quick care
centers in your plan.
If you think it’s a true emergency,
call 911 or go to the nearest ER.
See the other side for examples of when to go
to the ER or if you should consider other options.
106167ANMENABS VPOD 3/18
11Where to get care quickly3
Who usually provides care Estimated average cost2 When to go
Emergency Room }Coughing up or vomiting blood
For non-emergencies: }Symptoms feel life-threatening or disabling
Doctors trained in
emergency medicine
4 hours }Chest pain or severe shortness of breath
}Major injury or broken bones
$1,404
}Sudden or unexplained loss of consciousness
Retail Health Clinic }Allergic reactions (minor)
}Bumps, cuts, scrapes, rashes
}Burning with urination
Physician assistants or 30 minutes }Burns (minor)
nurse practitioners }Cold, cough and sore throat
$72
}Sinus pain and fever (minor)
}Eye or ear pain or irritation
}Shots
Walk-in Doctor's Office Same as retail health clinic plus…
}Asthma (mild)
30 minutes
Family practice doctors }Back pain
$124 }Nausea or diarrhea
}Headache (minor)
Urgent Care Center Same as walk-in doctor’s office plus…
}Animal bites
Doctors who treat conditions that 30 minutes
}Sprains and strains
should be looked at right away $143 }Stitches
}X-rays
LiveHealth Online }Allergic reactions (minor)
}Headache (minor)
}Nausea or diarrhea
10 minutes
Board-certified doctors }Cold, cough and sore throat
$59 or less }Sinus pain and fever (minor)
}Eye or ear pain or irritation
}Burning with urination
Be prepared
} Get the right care. Whether that’s finding the right doctor, specialist, therapist or something else altogether. Just
use the Find a Doctor tool at anthem.com or call the Member Services number on your ID card and we’ll guide you
somewhere that’s part of your plan.
} Find care near you whenever you need it. Download the Anthem Anywhere app to find an urgent care center,
retail health clinic or walk-in doctor's office quickly and get driving directions. Just search for “Anthem Anywhere”
at the App Store® or Google Play.™
Watch this video on where to get care when you need it right away and how to save money.
Money-saving tip
Visit hospitals and doctors that are in your plan. If you don’t,
you’ll often pay much more out of pocket for your care.
1 If you get care from a health professional or facility that is not in your health plan, you may have much higher out-of-pocket costs.
2 National averages of the total cost, not what members paid based on Anthem members’ paid claims from January 1, 2016 through December 31, 2016.
3 If you use the ER and it’s not a true emergency, your claim could be denied and you may be responsible for the full cost of your ER care.
LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to
anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding
30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and
certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New
Hampshire, Inc.; HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia,
and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS
policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of
the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 12A HEALTHIER YOU
STARTS TODAY.
Lose weight, adopt healthy habits and significantly reduce your risk
of developing type 2 diabetes.
Take the 1-minute quiz to find
out if you qualify for a lifestyle
change program at no cost.
Visit SOLERAMECOMCEBCO
Solera4me is provided by Solera Health, an independent company.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc.
In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri
(excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO
benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada:
Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of
New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem
Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In
Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services
13
Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Company (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies.
ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.C H A N G E Y O U R L I F E IN 16 WE E KS
Introducing a new covered benefit for Anthem Blue Cross and Blue Shield Members
Anthem Blue Cross and Blue Shield is pleased to announce a new benefit for qualified members.
It’s a 16- week program, follow ed by m o n th l y se ssi o n s, th a t c a n h e l p yo u l o se w e i g h t , a d o p t
h e a l t hy habit s a n d s ign ificantly reduc e yo u r ri sk o f d e ve l o p i n g d i a b e te s. A n d i t’s a v a i l a b l e
a t n o cost t o m embers w ho qualify.
Through this benefit, you may be able to participate in a national weight loss program such as
Weight Watchers, Retrofit or HealthSlate.
Wh i l e pr ogr am s d iffer, most in clu d e the fo l l o w i n g e l e me n ts:
Access to We e k ly A s mall group Tools like a w ireles s
a pe r s o na l le ss o n s for s upport s cale or an activ ity
he a l t h c o a c h tracker
Find out if you qualify by taking a 1-minute quiz at SOLERAMECOMCEBCO
\SOLERAMECOM ©Solera Health Inc. All rights reserved.
Solera4me is provided by Solera Health, an independent company.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem
Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem
Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO
Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative
services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO O products underwritten by HMO Colorado, Inc., dba HMO Nevada.
In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc.
and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield
in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi),
underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or
Wisconsin Collaborative Insurance Company (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. ANTHEM is 14
a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks k of the Blue Cross and Blue Shield Association.
05356MUMENABSLiveHealth Online:
See a doctor 24/7
It’s easier and faster than going
to urgent care.
The next time you or someone in your family needs to
see a doctor, use LiveHealth Online. See a doctor with a
smartphone or tablet using our free app, or a computer
Sign up for LiveHealth Online today!
with a webcam.1
It’s quick and easy to sign up — just go
to livehealthonline.com or download
the mobile app. With LiveHealth Online, you get:
Immediate, 24/7 access to board-certified doctors.
Secure and private video chats with your choice of doctor.
Prescriptions that can be sent to your pharmacy, if needed.2
Your LiveHealth Online member cost share for Medical
visits will be $0 for PPO plans (NOTE: This does not apply
to HSA plans, although Medical LiveHealth Online visits
are only $59.)
apple.com play.google.com/store
1 Visit the home page at livehealthonline.com to see the latest map showing where service is available.
2 As legally permitted in certain states. 15
LiveHealth Online is the tradename of Health Management Corporation, a separate company providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.
Anthem Blue Cross and Blue Shield is the trade name of Communtiy InsruanceCompany. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue
Shield names and symobls are regsitered marks of the Blue Cross and Blue Shield Association.
53783MUMENABS VPOD 09/18LiveHealth Online
Psychiatry
What you need to know about video visits
with a psychiatrist
What is LiveHealth Online Psychiatry? For counseling sessions, contact a psychologist or therapist on
LiveHealth Online Psychology. Remember, if you’re in crisis or
Now you can see a board-certified psychiatrist to help you having suicidal thoughts, get help right away or call 911.
manage medications.1 Whether you’re at home, at work or on
the go. Just download the free LiveHealth Online app to your
How much does it cost to use LiveHealth Online Psychiatry?
mobile device or visit livehealthonline.com on a computer with
a webcam. You’ll see your cost before the visit starts. Your Anthem plan
includes benefits for video visits using LiveHealth Online, so
When is LiveHealth Online Psychiatry available? you’ll just pay your share of the costs.
You can have a video visit with a psychiatrist usually in two
Will I be charged more if I use LiveHealth Online Psychiatry
weeks.2 Appointments, which are also available on evenings
on weekends, holidays or at night?
and weekends, can be scheduled online or over the phone at
1-888-548-3432 from 8 a.m. to 8 p.m., seven days a week. No, the cost is the same.
What can psychiatrists on LiveHealth Online help me with? How do I pay for a LiveHealth Online Psychiatry visit?
Psychiatrists on LiveHealth Online can help you manage some You can use PayPal, American Express, Visa, MasterCard and
of your medications. Keep in mind, though, they can’t prescribe Discover cards to pay for an online visit.
medications that are controlled substances.
16
59965MUMENABS_PS VPOD 06/17How can I make an appointment?
For your first visit, set up a time by going online, using the
mobile app or calling LiveHealth Online:
Online: Visit livehealthonline.com and sign up or log in.
Once you’ve logged in, select LiveHealth Online
Psychiatry to schedule an appointment with the board
certified doctor you would like to see.
Mobile app: Download the free LiveHealth Online mobile
app from theApp Store® or on Google PlayTM and then sign
up or log in. Once you’ve logged in, choose LiveHealth
Online Psychiatry. Next, select from available doctor’s
after checking out their qualifications and arrange a visit.
Phone: You can also call 1-888-548-3432 from 8 a.m. to
8 p.m., seven days a week.
In most cases, you can make an appointment to see a
psychiatrist in two weeks.2 This may be sooner than waiting
for an office visit. LiveHealth Online will send you an email
confirming your appointment.
What type of computer do I need to use LiveHealth Online?
You’ll need high-speed Internet access, a webcam or a built-
in camera with audio. To learn what computer hardware and
software you need, go to livehealthonline.com and select
Frequently asked questions under the How it works tab.
How do I know if a psychiatrist is in my plan?
When you log into livehealthonline.com, the psychiatrists
you see on the website are part of your plan. Make sure you
select the state where you are to see the most current list of
psychiatrists.
How old do I have to be to see a psychiatrist?
You must be 18 years old or older to schedule a visit. If you send us an email, please be sure to include:
Your name
What if I still have questions about using LiveHealth Online?
Your email
Send an email to customersupport@livehealthonline.com A phone number where you can be reached
or call toll free at 1-888-548-3432.
1 Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online. Psychiatrists on LiveHealth Online will not offer counseling or talk therapy.
2 Appointments subject to availability.
Online counseling is not appropriate for all kinds of problems. If you are in crisis or have suicidal thoughts, it’s important that you seek help immediately. Please call 1-800-784-2433 (National Suicide Prevention Lifeline) or 911 and ask for help. If your issue is an emergency, call 911 or go to
your nearest emergency room. LiveHealth Online does not offer emergency services.
LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of .
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to
anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In
Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO
Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem
Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and
17
Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of
network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies.
Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.Sydney Health makes
health care easier
See your benefits. Find a doctor. Track
your fitness. It’s personalized and easy!
With Sydney Health, you can find everything you need to know about your
medical, pharmacy, dental, vision, life insurance, and disability insurance
benefits all in one place. Sydney Health makes it easier to get things done, so
you can spend more time focused on your health.
Get started with Sydney Health
Download the app today!
Simple experience My Health Dashboard Personalized Match
Our simple experience makes it easy to My Health Dashboard is your hub for Personalized Match helps you find a
find what you need — with one-click personalized health and wellness. Find doctor in your plan who’s right for you.
access to benefits info, Member programs that interest you, build an You’ll get results carefully matched with
Services, LiveHealth Online and wellness action plan to help you meet your health your unique needs, preferences and plan
resources. And you can use the goals, sync your fitness tracker and earn details.
interactive chat to get answers quickly. points for your progress.
My Family Health Record With just one click, you can:
My Family Health Record gives you the full Find care and check costs View and use digital ID cards
picture of your family’s health — all in one See all benefits Use the interactive chat feature
place. It includes health history and electronic to get answers quickly
View claims
medical records. View, download and share Sync your favorite fitness tracker
the info right from the app.
Life and Disability products underwritten by Anthem Life Insurance Company. In Georgia: Life and Disability products are underwritten by Greater Georgia Life Insurance Company using the trade name Anthem Life. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky
Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of
Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits
underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO
Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem
Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or
administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies;
WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Sydney and Sydney Health are service marks of CareMarket, Inc. 18
116947MUMENABS VPOD Rev. 11/19Meet your new health champion
Enhanced Personal Health Care doctors go above and beyond for you
Whether you go to the doctor rarely or often, you should find a primary care physician (PCP) you like and trust. Checking
out Enhanced Personal Health Care (EPHC) doctors is a great way to start your search. Enhanced Personal Health Care
professionals (including primary care doctors and other medical staff) have agreed to provide high-quality care and focus
on your whole health — not just your symptoms. In fact, Anthem Blue Cross and Blue Shield members who choose an EPHC
doctor are happier with their doctors and their overall health.*
Your Enhanced Personal Health Care doctor has agreed to go above and beyond and:
Focus
}} on preventing illnesses and helping you get healthy faster and stay healthy longer.
Coordinate
}} your overall health care to avoid any gaps in care. This entails things like setting up appointments
with specialists to ensuring you’re following your prescription plan and getting the right tests and screenings regularly.
Help
}} you avoid unnecessary medical services and tests, saving you money and reducing stress.
Use
}} specialized health information to help them better coordinate and manage your care.
Be
}} available to you 24/7 through extended office hours, after-hours call coverage and sometimes even online.
Spend
}} extra time with you to get to know you and your health goals.
Contact
}} you when you’re due for a preventive exam or screening.
108075MUMENABS VPOD 09/18
19Choose the kind of professional who’s right for you
Family
}} practice/general practice — These doctors offer a
wide range of care, from check-ups to pregnancy care. This
type of doctor might be a good choice if you want to keep
all of your family members under the same doctor’s care.
A doctor who treats everyone in a family can sometimes
get a better view of each person’s health.
Internal
}} medicine — Internal medicine doctors mainly
treat adults and offer a range of care, including
preventive care. But they may have special knowledge
about certain health problems. So if you have a long-term
health problem, an internist who also focuses
on that particular problem may be a good fit for you.
Pediatricians
}} care for infants, children, and adolescents.
Nurse
}} practitioners and physician assistants aren’t
doctors, but they’ve had lots of training. They can do
many of the same things that doctors do.
Ready to find your Enhanced Personal Health Care doctor?
1. Log in or register at anthem.com.
2. Under Find a Doctor, enter your location and search distance.
Be sure to select the boxes for Able to serve as primary care
physician (PCP) and Enhanced Personal Health Care.
3. Choose Search and you’ll see a list of available doctors near you.
* AEPHC Patient Experience Survey Results. In 2015, 2,751 EPHC patient interviews were conducted across four distinct EPHC patient populations. 746 interviews for non-EPHC Group. Analyses conducted across patient experience domains to identify performance of EPHC providers
over time, and, comparative performance to non-EPHC providers.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by
going to anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area):
RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide
administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc.; HMO plans
are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area
is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies
offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of
the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
20Take care of yourself
Use your preventive care benefits
Regular checkups and exams can help you stay healthy and catch problems early — when they are easier to treat.
That is why our health plans offer all the preventive care services and immunizations below at no cost to you.1 As long as you use a
plan doctor, pharmacy or lab, you will not have to pay anything. If you go outside the plan, you may have out-of-pocket costs.
If you are not sure which services make sense for you, talk to your doctor.
Preventive vs. diagnostic care
Preventive care helps protect you from becoming sick. If your doctor recommends services even though you have no symptoms, that
JTQSFWFOUJWFDBSF%JBHOPTUJDDBSFJTXIFOZPVIBWFTZNQUPNTBOEZPVSEPDUPSSFDPNNFOETTFSWJDFTUPȍOEPVUXIBUJTDBVTJOH
those symptoms.
Adult preventive care
Preventive physical exams
Screening tests
}Alcohol misuse: related screening and behavioral counseling }Hearing screening
}Aortic aneurysm screening (for men who have smoked) })FJHIU XFJHIUBOECPEZNBTTJOEFY #.*
}Behavioral counseling to promote a healthy diet })VNBOJNNVOPEFȍDJFODZWJSVT )*7 TDSFFOJOHBOEDPVOTFMJOH
}Blood pressure }Lung cancer screening for those ages 55 to 80 who have a
}Bone density test to screen for osteoporosis history of smoking 30 packs per year and still smoke, or quit
}Cholesterol and lipid (fat) levels within the past 15 years2
}Colorectal cancer, including fecal occult blood test, barium }Obesity: related screening and counseling3
FOFNB ȎFYJCMFTJHNPJEPTDPQZ TDSFFOJOHDPMPOPTDPQZBOE }1SPTUBUFDBODFS JODMVEJOHEJHJUBMSFDUBMFYBNBOE
related prep kit, and computed tomography (CT) QSPTUBUFTQFDJȍDBOUJHFO 14" UFTU
colonography (as appropriate)2 }4FYVBMMZUSBOTNJUUFEJOGFDUJPOTSFMBUFETDSFFOJOHBOEDPVOTFMJOH
}Depression screening }Tobacco use: related screening and behavioral counseling
}Hepatitis C virus (HCV) for people at high risk for infection, and }Tuberculosis screening
a one-time screening for adults born between 1945 and 1965 }Violence, interpersonal and domestic: related screening
}Type 2 diabetes screening3 and counseling
}Eye chart test for vision4
Immunizations
}Diphtheria, tetanus and pertussis (whooping cough) }.FOJOHPDPDDBM NFOJOHJUJT
}Hepatitis A and hepatitis B }Pneumococcal (pneumonia)
}Human papillomavirus (HPV) }7BSJDFMMB DIJDLFOQPY
}*OȎVFO[B ȎV }Zoster (shingles)
}.FBTMFT NVNQTBOESVCFMMB ..3
Women’s preventive care
}Well-woman visits }Counseling related to genetic testing for those with a
}#SFBTUDBODFS JODMVEJOHFYBN NBNNPHSBN BOEHFOFUJD family history of ovarian or breast cancer
UFTUJOHGPS#3$"BOE#3$"XIFODFSUBJODSJUFSJBBSFNFU4 }HPV screening
}Breastfeeding: primary care intervention to promote }4DSFFOJOHBOEDPVOTFMJOHGPSJOUFSQFSTPOBMBOE
breastfeeding support, supplies and counseling6,7,8 domestic violence
}Contraceptive (birth control) counseling }Pregnancy screenings, including gestational diabetes,
}Food and Drug Administration (FDA)-approved contraceptive IFQBUJUJT# BTZNQUPNBUJDCBDUFSJVSJB 3IJODPNQBUJCJMJUZ
NFEJDBMTFSWJDFT JODMVEJOHTUFSJMJ[BUJPO QSPWJEFECZBEPDUPS TZQIJMJT )*7BOEEFQSFTTJPO7
}Counseling related to chemoprevention for those at high risk }1FMWJDFYBNBOE1BQUFTU JODMVEJOHTDSFFOJOHGPS
for breast cancer cervical cancer
These preventive care services are recommendations of the Affordable Care Act (ACA or health care reform law). They may not be right for every person, so ask your doctor what is right for you. 21
26between this sheet and the group policy, the provisions of the group policy will rule. Please see
This sheet is not a contract or policy with Anthem Blue Cross and Blue Shield. If there is any difference
your combined Evidence of Coverage and Disclosure Form or Certificate for exclusions and limitations.
43199MUMENABS VPOD Rev. 5/20 4FFOFYUQBHFGPSNPSFQSFWFOUJWFDBSFCFOFȍUTChild preventive care
Preventive physical exams
Screening tests
} Behavioral counseling to promote a healthy diet } Lead testing
} Blood pressure } Newborn screening
} Cervical dysplasia screening } 4DSFFOJOHBOEDPVOTFMJOHGPSPCFTJUZ
} Cholesterol and lipid levels } 4LJODBODFSDPVOTFMJOHGPSUIPTFBHFTUPXJUIGBJSTLJO
} Depression screening } Oral (dental health) assessment, when done as part of a
} Development and behavior screening preventive care visit
} Type 2 diabetes screening } 4DSFFOJOHBOEDPVOTFMJOHGPSTFYVBMMZUSBOTNJUUFEJOGFDUJPOT
} Hearing screening } Tobacco use: related screening and behavioral counseling
} )FJHIU XFJHIUBOE#.* } Vision screening, when done as part of a preventive care visit4
} Hemoglobin or hematocrit (blood count)
Immunizations
}$IJDLFOQPY }..3
}Flu }Pneumonia
})BFNPQIJMVTJOȎVFO[BUZQFC )JC }Polio
}Hepatitis A and hepatitis B }3PUBWJSVT
}HPV }Whooping cough
}.FOJOHJUJT
A word about pharmacy items
For 100% coverage of your over-the-counter (OTC) drugs Child preventive drugs and other pharmacy items —
and the following pharmacy items, you must: age appropriate
}.FFUDFSUBJOBHFSFRVJSFNFOUTBOEPUIFSSVMFT }%FOUBMȎVPSJEFWBSOJTIUPQSFWFOUUIFUPPUIEFDBZPGQSJNBSZ
}3FDFJWFQSFTDSJQUJPOTGSPNQMBOEPDUPSTBOEȍMMUIFNBU teeth for children ages 0 to 5 years
QMBOQIBSNBDJFT }Fluoride supplements for children ages 6 months to
})BWFQSFTDSJQUJPOT FWFOGPSUIF05$JUFNT 16 years
Adult preventive drugs and other pharmacy items — Women’s preventive drugs and other pharmacy items —
age appropriate age appropriate
}Aspirin use (81 mg and 325 mg) for the prevention of }Contraceptives, including generic prescription drugs,
cardiovascular disease (CVD), preeclampsia and colorectal brand-name drugs with no generic equivalent and OTC
cancer in adults younger than 70 years of age items like female condoms and spermicides7
}Colonoscopy prep kit (generic or OTC only) when }Low-dose aspirin (81 mg) for pregnant women who are at
prescribed for preventive colon screening increased risk of preeclampsia
} Generic low-to-moderate dose statins for members ages 40 }Folic acid for women ages 55 or younger who are planning
to 75 who have one or more CVD risk factors (dyslipidemia, and able to become pregnant
diabetes, hypertension or smoking) }Breast cancer risk-reducing medications, such as tamoxifen,
}Tobacco-cessation products, including all FDA-approved raloxifene and aromatase inhibitors, that follow the U.S.
brand-name and generic OTC and prescription products, Preventive Services Task Force criteria2,9
for those ages 18 and older
} Pre-exposure prophylaxis (PrEP) for the prevention of HIV
For a complete list of covered preventive drugs under the Affordable Care Act, view the Preventive ACA Drug List flyer at
anthem.com/pharmacyinformation.
1 The range of preventive care services covered at no cost share when provided by plan doctors is designed to meet state and federal requirements. The Department of Health and Human Services decided which services to include for full coverage based on U.S. Preventive Services Task Force A and B recommendations, the Advisory
Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents and women supported by Health Resources and Services Administration (HRSA) Guidelines. You may have additional coverage under your insurance policy. To learn more about
what your plan covers, see your Certificate of Coverage or call the Member Services number on your ID card.
2 You may be required to receive preapproval for these services.
3 The Centers for Disease Control and Prevention (CDC)-recognized diabetes prevention programs are available for overweight or obese adults with abnormal blood glucose or who have abnormal CVD risk factors.
4 Some plans cover additional vision services. Please see your contract or Certificate of Coverage for details.
5 Check your medical policy for details.
6 Breast pumps and supplies must be purchased from plan providers for 100% coverage. We recommend using plan durable medical equipment (DME) suppliers.
7 This benefit also applies to those younger than age 19. A cost share may apply for other prescription contraceptives, based on your drug benefits. Your cost share may be waived if your doctor decides that using the multisource brand is medically necessary.
8 Counseling services for breastfeeding (lactation) can be provided or supported by a plan doctor or hospital provider, such as a pediatrician, obstetrician/gynecologist or family medicine doctor, and hospitals with no member cost share (deductible, copay or coinsurance). Contact the provider to see if such services are available.
9 Aromatase inhibitors are included, effective October 1, 2020.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Copies of Colorado network access plans are available on request from member services or can be obtained by going to
anthem.com/co/networkaccess. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri
27
(excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT
and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire,
Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service
area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by 22
Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue
Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.Welcome to Our Benefits
FSA Medical Expense and Dependent Care Reimbursement Plans
Medical Expense Reimbursement Plan: The Medical Expense Reimbursement Plan can be used by employees
interested in paying less taxes by using pre-tax income to reimburse medical, dental, vision and certain Over-the-
Counter expenses not covered by insurance. You elect a dollar amount each year to be withheld from your
paycheck, on a per pay basis, and then submit eligible expenses to be reimbursed from these funds.
FOR EXAMPLE: $20 per pay deduction x 26 pays = $520 per year into your Medical Reimbursement Account. This
amount will be deducted from your payroll prior to withholding applicable taxes. You can submit receipts for
copays, medical, prescription, dental, eligible Over-the-Counter and vision expenses, not covered by any insurance,
to be reimbursed up to the $520.
Minimum annual contribution is $260 / Maximum annual contribution $2,750
Dependent Care Reimbursement Plan: Depending on your tax filing status, you can elect up to $5,000 per year to
reimburse your eligible child-care expense with pre-tax income. Dependent Care expenses reimbursed under this
program may not be eligible for a tax credit on your IRS return. For more information, contact your accountant or
financial advisor.
Any monies left in your FSA account, whether medical or dependent care, after the end of the plan
year for which you have no expenses for reimbursement, will be forfeited per IRS guidelines.
Once enrolled, you cannot change or discontinue your deductions during the plan year unless you have a change in
family status, i.e. marriage, birth or adoption, divorce, etc. You then must notify your Human Resources
department, in writing, within 30 days of the change of status.
How do I enroll?
You can enroll through American Fidelity https://www.afenroll.com/enroll
What expenses are eligible under my Medical Expense account for reimbursement?
Examples of eligible expenses are office visit copays, prescription copays, amounts applied to your deductible, out-
of-pocket dental and vision expenses and certain Over-the-Counter expenses. Eligible expenses are amounts you
pay that are not covered by insurance. Eligible expenses also cannot be reimbursed by any other reimbursement
plan. A complete list of IRS approved expenses can be found at www.irs.gov Publication 502
23You can also read
