ASBAIT 2021-2022 Open Enrollment Information - Santa Cruz Valley USD #35
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Arizona School Board Association Insurance Trust
ASBAIT 2021–2022
Open Enrollment Information
Santa CruzValley USD #35
Date
1 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Agenda
Provider access in and out of Arizona
Wellness programs and services
Your medical plan options
2 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Year-Round Plan Resources
Meritain Health® Customer Service
1.866.300.8449 or 1.602.789.1170
3 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Meritain Health Member Portal
Our goal is to help you find the benefits information you need, quickly and easily
Stay on top of your
benefits
Your member portal is your all-in-one tool
for managing your plan. When you visit the An overall tool for: Time-saving features Registration Instructions
portal, you’ll find:
o Claims history. Thanks to our Quick Links, the You can access your member
o Explanations of Benefits pages you need are often one portal in two easy ways:
(EOBs). click away. Plus, you can
access the member portal by Register for access from
o Plan documents. computer, tablet or smart www.meritain.com.
o Eligibility details. phone.
View your portal using our
o Wellness resources. Your member portal is
Meritain Health mobile app for
available
o ID cards (view, print or when—and where—you need Apple and Android.
request new cards). it.
https://www.meritain.com/
4 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
What’s New
ASBAIT 2021–2022
What’s NEW with What’s NEW with New ways to
your benefit plan? ASBAIT? communicate
No plan changes this year for Urgent care copays flat dollar We’ve expanded our social reach
through a YouTube channel and
the medical plans. amount for non-HDHP plans.
Instagram page.
High-Deductible Health Plan
deductibles are changing due
to IRS regulations.
5 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Early Detection is Life-Saving: SkinIO
o Early detection of skin cancer means the difference between an easy
fix and a catastrophic diagnosis.
o ASBAIT members now have access to SkinIO for early detection
and expert care:
o Easy, intuitive self-screening technology by phone or mobile device
― Guided photo-taking
― Mole-mapping
― Remote dermatologist review
― Longitudinal change tracking
― Secure results
― Connection to care
o Proactively address skin cancers among members
o Help mitigate potential health care costs
o Provide peace of mind
6 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Hinge Health for Chronic
Pain Management
o App for sensor-guided exercise therapy for chronic pain – access on the go from anywhere!
o Back and knee (hip, shoulder and neck coming soon!)
o Screening to determine if members are candidates
o Interactive 1-on-1 member coaching
o Member outcomes include 60% fewer surgeries and 50% reduction in pain and depression
o Amazon Fire tablet preloaded with Hinge Health app and Bluetooth-enabled sensors
o Exercise guidance to all enrolled members
Learn more!
Visit hingehealth.com/ASBAIT or email hello@hingehealth.com to sign up for waitlist!
7 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Follow us on
social media!
Find plan information, educational content and fun topics!
@asbait
@asbaithealth
Click arrow below to access our YouTube videos:
8 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
Doctors and Hospitals
Visit Aetna’s DocFind at:
http://www.aetna.com/docfind/custom/mymeritain
After entering your search and location information, you’ll
be asked to select your plan. Under Broad Medical Networks,
choose: Aetna Choice POS II (Open Access)
Then, follow the prompts to find a doctor or facility in the
Banner | Aetna network.
9 | Arizona School Boards Association Insurance Trust ASBAIT Confidential
National In-Network
Benefits
Aetna Choice® Point of Service (POS) II Network
within and outside of Arizona includes:
664,000+ 5,700+
participating hospitals
physicians and
ancillary providers
No referrals needed,
you choose your care providers!
10 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialPharmacy
Benefits Manager
Contact information:
Important Plan Information
CVS Caremark: 1.866.475.7589
o 90-day medications filled at any retail pharmacy or visit http://www.caremark.com
o Diabetic supplies now available through retail pharmacies CVS Specialty: 1.800.237.2767 or
visit www.CVSspecialty.com
o Your specialty pharmacy vendor is CVS Specialty
Pharmacy
11 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialID Cards
Remember to show your
ID card to your pharmacy
to be sure they have your
New ID cards were sent in March 2020. pharmacy coverage
information
You will NOT get new ID cards after open
enrollment unless you make changes for
7/1/21.
If you need new ID cards, please call customer
Please refer to your ID cards for:
service or visit www.meritain.com plan, provider network and billing information,
medical and prescription benefits customer service
numbers and more…
12 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialYour Wellness Journey
If you are admitted into the hospital, accept Case Management.
Get your preventive annual physical and participate in onsite
These nurses are there to help you find your way back to
biometric testing when offered at your school.
wellness.
Join or start a wellness program at your school. Wellness Save money on prescriptions and manage your condition. Ask for
campaigns are fun! Make new friends, start your journey to improved generics. Accept lower cost medication therapy if offered to you. Rx
well being. Smart Savings, we do the work for you!
Have a chronic condition? More access to care…
‒ Accept help and join Nurse Health Coaching & Earn Incentives! Teladoc®, SkinIO, Employee Assistance Program (EAP), on-
‒ Expecting? Join Maternity Management & Earn Incentives! site mammogram / flu shot clinics
‒ Chronic pain? Try the Hinge Health program!
13 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialWorking~Well Wellness Program
Impact, improve and maintain your own good health with:
Well~Connected quarterly Healthy Wellness
newsletters. recipes. campaigns.
Working~Well focuses on stress reduction, physical fitness, workplace and home safety, weight management, personal
health and community involvement.
14 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialNurse Health To reach a Nurse Health Coach, please call
Coaching Program
1.855.527.2248, select option 1, followed by option
2, and then option 5.
A personal Nurse Health Coach can help you manage:
o Asthma. o Coronary Artery Disease (CAD).
o Chronic Obstructive Pulmonary o Chronic Kidney Disease (CKD).
Disease (COPD). o Diabetes.
o Chronic pain (caused by arthritis o Hyperlipidemia.
or lower back pain). o Hypertension.
o Congestive Heart Failure (CHF).
https://www.youtube.com/watch?v=FqBEElGds0k&t=15s
We can help you control your chronic condition while setting Earn money for joining!
achievable steps and goals to assist you with living a healthy lifestyle.
If you join the Nurse Health Coaching program for help managing your
health, you will receive a $25 (per quarter) incentive for participating!
15 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialWe’re Here for You
as Life Happens
Your Employee Assistance Program (EAP) helps people like yourself cope
with life’s challenges. Employees are eligible, as well as their families. This
service is available 24/7.
.
You can register your customized EAP account at www.alliancewp.com
o Click login at top right
o Enter login email ASBAITmember and password AWP4me (case
sensitive)
Five FREE counseling sessions per incident, per year.
Call: 1.800.343.3822 to speak with an intake counselor
Teen Line 1.800.334.TEEN (8336)
Safe Ride Program 1.800.343.3822
16 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialMedical Management
Before you get care, check precertification (Medical Management)
requirements for things such as:
All Inpatient Admissions: Acute High-Cost Drugs:
Outpatient and Physician: Surgery o Injectables that cost $2,000 or
Outpatient and Physician Diagnostic Services: more per drug per month
o CT/MRI for non-orthopedic o Infusion therapy that costs $2,000
or more per drug per month
o PET scans
o Genetic testing, including BRCA
o Sleep study
Outpatient and Physician Continuing Care Services:
Questions about ASBAIT medical
o Chemotherapy (including oral)
Jake Allison management? You can contact a
o Radiation therapy
medical management nurse at
o Oncology and transplant-related injections
1.855.5ASBAIT or 1.855.527.2248
o Dialysis
17 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialThe Teladoc® Solution and Benefits
A Teladoc doctor is just a call or click away!
Contact Information:
o Teladoc gives you access to care 24 hours, 7 days a week
o U.S. board-certified doctors www.Teladoc.com
o Your dependents are eligible for Teladoc too (even if they are not 1.800.TELADOC (835.2362)
enrolled in your ASBAIT health plan!)
1 2 3 4 5 6
Talk to a doctor Receive quality Prompt treatment A network of doctors Prescriptions sent Teladoc is less
anytime, anywhere care via phone, median call back in that can treat every to pharmacy of expensive than the
you happen to be. video or mobile ten minutes. member of the choice if medically ER or urgent care.
app. family. necessary.
18 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialGet Ready
to Enroll
19 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialBenefits Terminology
Before you get started, it’s important to understand these key phrases:
Your DEDUCTIBLE After you meet your Your The amount you pay PARTICIPATING
is the amount you deductible, your plan OUT-OF-POCKET at the time of PROVIDERS
pay before your plan will share the cost of MAXIMUM is the service—like include those in the
shares the cost of services—up to your total amount you’ll doctor’s visits or Aetna Choice® POS
services. Note: out-of-pocket pay before the plan filling prescriptions— II network. Any
preventive care is maximum. begins covering the is called a COPAY. doctors or facilities
not subject to your This is called full cost of services. outside of this
deductible. COINSURANCE. network are NON-
PARTICIPATING.
20 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialPicking Your Medical Plan—Option 1
Classic Gold ~ At-a-Glance
Does not include Health Savings Account (HSA)
Your prescription drug benefits are
CLASSIC GOLD CLASSIC GOLD Prescription drug copays administered by Meritain Health
Participating Providers Non-Participating Providers
30-day 90-day mail Pharmacy Solutions and your
Calendar-year deductible Calendar-year deductible retail order** Pharmacy Benefit Manager is
Mandatory generic $15 $30 CVS Caremark. ***
Individual $300 Individual $1,200
Preferred 20% 20%
Family $900 Family $3,600 brand-name* (no generic ($25min; ($50 min;
Coinsurance after available) $80 max) $175 max)
Coinsurance after
deductible or copays deductible or copays
Non-preferred 40% 40%
50% brand-name* (no generic ($40 min; ($80 min;
15% available) $110 max) $225 max)
Calendar- year Calendar- year
out-of-pocket max Specialty drug 20%
out-of-pocket max (CVS Specialty ($100 min; N/A
Individual No Limit Pharmacy) $150 max)
Individual $4,000
Family $8,000 Family No Limit *Please note: If you purchase a brand-name drug while a generic is available, you will be charged the brand-
Office visits name copay PLUS the cost difference between the generic and the brand-name drug.
Office visits
Primary 50% 90-Day Supply – Maintenance Medications
Primary $25 copay; care
care no deductible after deductible
This Plan will allow maintenance medications to be filled at any retail pharmacy and mail order in 90 day
quantities, Covered Persons benefit from paying only 2 Copays for a 3 month (90-day) supply.
$35 copay; Specialist 50%
Specialist after deductible
no deductible
Copays in Other 50% after deductible ***Specialty drugs are administered through CVS Specialty Pharmacy.
Other 26 categories: copays with some copays
copays deductible waived for
24 of those
21 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialPicking Your Medical Plan—Option 2
Classic Silver ~ At-a-Glance
Does not include Health Savings Account (HSA)
Your prescription drug benefits are
CLASSIC SILVER CLASSIC SILVER Prescription drug copays administered by Meritain Health
Participating Providers Non-Participating Providers
30-day 90-day mail Pharmacy Solutions and your
Calendar-year deductible Calendar-year deductible retail order** Pharmacy Benefit Manager is
Mandatory generic $15 $30 CVS Caremark. ***
Individual $500 Individual $1,400
Preferred 20% 20%
Family $1,100 Family $4,200 brand-name* (no generic ($25min; ($50 min;
Coinsurance after available) $80 max) $175 max)
Coinsurance after
deductible or copays deductible or copays
Non-preferred 40% 40%
50% brand-name* (no generic ($40 min; ($80 min;
20% available) $110 max) $225 max)
Calendar- year Calendar- year
out-of-pocket max Specialty drug 20%
out-of-pocket max (CVS Specialty ($100 min; N/A
Individual No Limit Pharmacy) $150 max)
Individual $4,500
Family $9,000 Family No Limit *Please note: If you purchase a brand-name drug while a generic is available, you will be charged the brand-
Office visits name copay PLUS the cost difference between the generic and the brand-name drug.
Office visits
Primary 50% 90-Day Supply – Maintenance Medications
Primary $30 copay; care
care no deductible after deductible
This Plan will allow maintenance medications to be filled at any retail pharmacy and mail order in 90 day
quantities, Covered Persons benefit from paying only 2 Copays for a 3 month (90-day) supply.
$40 copay; Specialist 50%
Specialist after deductible
no deductible
Copays in Other 50% after deductible ***Specialty drugs are administered through CVS Specialty Pharmacy.
Other 26 categories: copays with some copays
copays deductible waived for
24 of those
22 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialPicking Your Medical Plan—Option 3
HDHP A ~ At-a-Glance
Includes Health Savings Account (HSA)
Your prescription drug benefits are
HDHP A HDHP A administered by Meritain Health
Prescription drug copays
Participating Providers Non-Participating Providers
Pharmacy Solutions and your
Calendar-year deductible Calendar-year deductible 30-day 90-day mail Pharmacy Benefit Manager is
retail order** CVS Caremark. ****
Individual $1,500 Individual $2,000
HDHP plans 20% 20%
Family $3,000*** Family $5,000*** after deductible after deductible
Coinsurance after Coinsurance after
deductible or copays deductible or copays *Please note: If you purchase a brand-name drug while a generic is available, you will be charged the brand-
name copay PLUS the cost difference between the generic and the brand-name drug.
20% 20%
Calendar- year This Plan will allow maintenance medications to be filled at any retail pharmacy and mail order in 90 day
Calendar- year
out-of-pocket max quantities. Covered Persons are responsible for 20% after the deductible has been met.
out-of-pocket max
Individual $5,500 Individual $18,000 ***If you have Family coverage, The Family Deductible must be satisfied before the Plan will pay any benefits.
Family $11,000 Family $28,000 ****Specialty drugs are administered through CVS Specialty Pharmacy.
Office visits Office visits
Primary 80% Primary 50%
care after deductible care after deductible
80% Specialist 50%
Specialist
after deductible after deductible
23 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialWhy Choose an HDHP
with HSA Plan?
HSAs are an easy way to win in today’s complex
health care system
Health Savings Accounts (HSAs) empower health savings
Visit healthequity.com/ed/asbait to
As an HSA user, you save in several ways: learn more about the HSA option.
o Lower monthly health insurance premiums Video: Health savings account
(HSA) | HealthEquity
o HSA contributions are not taxed
o You earn tax-free interest on HSA balances
You own the account and all contributions—
o HSA funds used for qualified medical expenses are not taxed
the entire balance rolls over each year and
remains yours even if you change health plans,
retire or leave the ASBAIT program.
24 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialMaximum Annual
Contribution Limits
on HSAs
HSA 55+
HSA
additional
maximum
maximum
contribution
contribution
limit
amount
Single $3,600 $1,000
Family $7,200 $1,000
The entire balance for your HSA rolls over each year.
Remember, you own the account and all
contributions forever.
25 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialUsing Your HSA
HSA funds can be used for qualified medical expenses:
How it works…
o Acupuncture o Medical supplies
o Birth control o Physical exams
o Chiropractor o Prescriptions
At the doctor’s office
o Contact lenses o Orthodontia
o Dental treatment o Radiology 1. Receive services
o Prescription eyeglasses o Stop-smoking programs 2. Provider bills Meritain Health
o Fertility enhancement o Surgery (non-cosmetic) 3. Meritain Health sends EOB
o Hearing aids o Therapy 4. Provider sends invoice
o Lab work o And more!
5. Pay invoice with HSA
For a complete list, visit: www.HealthEquity.com/qme
At the pharmacy
1. Obtain prescription
2. Pharmacy verifies coverage
Easily access 3. Pay for your prescription
your HSA funds Over-the-Counter (OTC) medication
with a debit card The IRS does not allow HSA funds to be
used for OTC medicines without a
prescription.
26 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialParticipating Provider Medical Plan Comparison
Aetna Choice POS II─ Tier 1 Benefits Listed below
CLASSIC GOLD CLASSIC SILVER HDHP A
Participating Providers Participating Providers Participating Providers
Calendar-year deductible Calendar-year deductible Calendar-year deductible
Individual $300 Individual $500 Individual $1,500
Family $900 Family $1,100 Family $3,000***
Coinsurance after Coinsurance after Coinsurance after
deductible or copays deductible or copays deductible or copays
15% 20% 20%
Calendar- year Calendar- year Calendar- year
out-of-pocket max out-of-pocket max out-of-pocket max
Individual $4,000 Individual $4,500 Individual $5,500
Family $8,000 Family $9,000 Family $11,000
Office visits Office visits Office visits
Primary $25 copay; Primary $30 copay; Primary 80%
care no deductible care no deductible care after deductible
Specialist $35 copay; Specialist $40 copay; Specialist
80%
no deductible no deductible after deductible
Copays in Copays in
Other 26 categories: Other 26 categories:
copays deductible waived for copays deductible waived for
24 of those 24 of those
27 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialCovering Your
Dependents
Your eligible dependents may include:
o Your spouse or domestic partner (varies by plan).
o Your children, natural or adopted.
o Your stepchildren.
Dependent coverage is available for any child (regardless of marital
status, residency, student status, etc.) of an employee who is deemed to
be the employee’s biological, step, foster or adopted child (including a
child placed for adoption) until such child reaches age 26.
28 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialOpen Enrollment and
Qualifying Events
If you enroll or decline coverage now, you may be able to add, delete or
change your benefit choices within 30 days of the qualifying event:
During your employer’s next open enrollment period
If you have a qualifying event:
o Involuntary loss of o Birth o Placement of
benefits o Adoption a child in your home
for adoption
o Marriage
29 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialWhen You’re
Ready to Enroll 6
Is there a change in your life insurance beneficiary?
5
Double check every paper form.
4
Make sure you choose the benefits that fit your needs.
3
Estimate annual health care expenses for you and your dependents.
2
Consider your personal health and that of your family members.
1
Gather all information for you and any dependents you wish to enroll.
30 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialImportant Plan Contacts
Important plan contacts
What do you need help with? Who to contact How to contact
Call: 1.866.300.8449 or
My ASBAIT benefits Meritain Health Customer Service 1.602.789.1170
Visit: http://www.meritain.com
Call: 1.866.475.7589
My prescription drug benefits CVS Caremark
Visit: http://www.caremark.com
Call: 1.855.5ASBAIT or
Precertification ASBAIT Medical Management
1.855.527.2248
Employee Assistance Program (EAP) Call: 1.800.343.3822
Alliance Work Partners (AWP)
Visit: http://www.alliancewp.com
Working–Well Wellness Program Edwards Risk Management Call: 1.800.575.2657
Nurse Health Coaching Meritain Health Call: 1.855.527.2248
Call: 1.877.694.3948
Health Savings Account (HSA) Information Health Equity
Visit: healthequity.com/ed/asbait
Call: 1.800.237.2767
Specialty Pharmacy CVS Specialty Pharmacy
Visit: www.CVSspecialty.com
Email: help@skinio.com
Skin health questions SkinIO
Call: 1.847.331.2238
Visit: Hingehealth.com/ASBAIT
Therapy for chronic pain HINGE Health Email: hello@hingehealth.com
Call: 1.855.902.2777
31 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialThank You!
PROPRIETARY NOTICE
IMPORTANT CONFIDENTIALITY NOTICE - PLEASE READ! This Confidential Information, provided by Meritain Health, is
intended only for the use of the addressee and only for the purpose that it is being provided. The Confidential information
shall not be distributed, disclosed or conveyed to any consultant, subcontractor, vendor or other third party. The addressee
is required to use appropriate safeguards to protect the Confidential information from unauthorized disclosure. If you are
not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on
the contents of these documents is strictly prohibited. If you have received these documents in error, please notify the
Meritain Health Privacy Officer immediately to arrange for their return at 800.831.1166.
32 | Arizona School Boards Association Insurance Trust ASBAIT ConfidentialYou can also read
