Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...

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Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
Welcome to
                          Insurance Coordinator
                          Option Period Training

This publication is issued by the Office of Management and Enterprise Services as authorized by Title 62,
Section 34. Copies have not been printed but are available through the agency website. This work is
licensed under a Creative Attribution‐NonCommercial‐NoDerivs 3.0 Unported License.

 •          Option Period materials.
 •          Important dates.
 •          Option Period information.
 •          2020 plan changes.
 •          Life, health, dental and vision plans.
 •          Helpful hints.

 Option Period Material

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
Option Period Material
                                                                                                                                                                                                                  *OP 2020*
                                                                                                                                                      Employe e s Group Insura nce Division
                                                                                                                                     2020 OPTION P ERIOD ENROLLMENT/CHANGE FORM
                                                                                                                                   CURRENT EMP LOYEES
                                                                              THIS FORM MUS T BE RETURNED TO YOUR INSURANCE COORDINATOR

                                                               S ECTION A: EMP LOYEE INFORMATION                                               SECTION B:              Th e co verag e be low reflects yo ur m o s t
                                                                                                                                                                       cu rren t b en efits in ou r s ys tem .
                                                                                                                                               He a lth Aetna HMO (e nding 12/31/18)
                                                                                                                                               De nta l S un Life P re fe rred Active PP O
                                                                        ARTHUR WEASLEY                                                         Vision P rim a ry Vis ion Ca re S e rvice s
                                                                                                                                               Life   $500,000
                                                                        THE BURRO W
                                                                                                                                               Disa bility
                                                                        OTTERY S T CATCHP OLE FL 99999-9999
                                                                                                                                                                                                 HEA DEN               VIS       LIFE
                                                                                                                                                MO LLY P REWETT                        10/30/1949 X   X                 X      $20,000
                                                                                                                                                CHARLES                                12/12/1972 X             X          X   $10,000
                                                                                                                                                FRED                                      4/1/1978 X            X          X   $10,000
                                                                                                                                                G EORGE                                   4/1/1978 X            X          X   $10,000
                                                    Entity: MINIS TRY OF MAGIC MIS US E OF MUGGLE ARTIFACTS                                     G INEVRA MOLLY                           8/11/1981 X            X          X   $10,000
                                                    Me mbe r ID: 09999999                                                                       P ERCY IGNATIUS                          8/22/1976 X            X          X   $10,000
                                                    Birth Da te : 2/6/1950                                                                      RO NALD BILIUS                            3/1/1980 X            X          X   $10,000
                                                    Phone : 9999999999                                                                          WILLIAM ARTHUR                         11/29/1970 X             X          X   $10,000
                                                    Alt Phone :                                                                                 HARRY J AMES                             7/31/1980 X            X          X   $10,000
                                                    Ma rita l S ta tus : MARRIED                                                                HE RMIONE J E AN GRANGER 9/19/1979 X                            X          X   $10,000

                                                                                             S ECTIO N C: ALL CHANGES ARE EFFECTIVE J AN. 1, 2020
                                                                                 S ee b a ck o f fo rm fo r req u ired s ig n atu re s an d c h an g es to d ep en d en t co ve ra ge .
                                                    Hea lth P lan
                                                                                                        BlueLincs HMO
                                                        Ch e c k a box to ADD o r                                                                    Employee primary phys ician (HMO Only)
                                                        CHANGE pla n s :                                CommunityCare HMO
                                                                                                        GlobalHe alth HMO                                     Ne w pa tie nt   Curre nt pa tie nt
                                                               No change
                                                                                                        Hea lthChoice Bas ic* or Bas ic Alternative (re fer to Option P e riod materials )
                                                               Drop all health                          Hea lthChoice High* or High Alterna tive (re fe r to Option P eriod materials )
                                                                                                        *Req u ires c o m p le tion o f o n line To b a c c o-Fre e Atte s ta tion o r rea s o n a ble a lte rn a tive .
                                                                                                        Hea lthChoice High Deductible Hea lth P lan
                                                   Den ta l P lan                                       Cigna De ntal Care P lan (P repa id)
                                                        Che c k a b ox to ADD or                        Delta De ntal P P O
                                                        CHANGE p la ns :                                Delta De ntal P P O-Choice
                                                               No change                                Hea lthChoice Dental P lan                                                             Employe e prima ry de ntis t
                                                               Drop all de ntal                         Me tLife High Clas s ic MAC                                                                 (prepaid only)
                                                                                                        Me tLife Low Cla s s ic MAC
                                                                                                                                                                                           Ne w pa tie nt           Curre nt pa tie nt
                                                                                                        S un Life P re ferre d Active P P O
                                                   Vis io n P lan
                                                        Che c k a b ox to ADD or                        P rima ry Vis ion Ca re S ervice s (P VCS )
                                                        CHANGE p la ns :                                S uperior Vis ion
                                                               No change                                Vis ion Care Dire ct
                                                               Drop all vis ion                         VS P (Vis ion S ervice P la n)
                                                   Em p lo ye e Life P lan                                                                       Dep en d en t Life P la n (Em p lo ye e Life Req u ired )
                                                   Employe e life CANNOT be adde d or incre as e d us ing this form.                                No change
                                                   A s e parate Life Ins urance Application mus t be completed a nd                                 Drop de pendent life
                                                   a pproved to add or increas e life ins urance cove rage.                                         Add or incre as e to premier option
                                                                                                                                                    Add or incre as e /decre as e to s ta nda rd option
                                                          No cha nge
                                                                                                                                                    Add or decreas e to low option
                                                          Drop a ll life ins ura nce
                                                          Decreas e total life ins ura nce to: $
                                                          (Keep e mployee life in $20,000 units )

                                                          I h ave ad d ed o r m ad e c han ge s o n th e b ac k o f th is
                                                          form fo r my d ep en d en ts .
                                                   A1                                                                                                                        *09999999*

Option Period Material
                                                EGID Life Premium Chart for Current Employees
                                              Jan. 1 through Dec. 31, 2020
 The coverage levels and monthly premiums listed below include Basic Life.
    Amount/Age*                  > 30          30 - 34                35 - 39                 40 - 44                   45 - 49                      50 - 54                     55 - 59                       60 - 64                   65 - 69     70 - 74   75 +
  Basic $     20,000**              4.20             4.20                    4.20                    4.20                       4.20                       4.20                         4.20                          4.20                    4.20      4.20     4.20
  $            40,000               8.40             8.40                    8.40                    8.40                       8.40                       8.40                         8.40                          8.40                    8.40      8.40     8.40
  $            60,000               9.60             9.60                    9.60                   10.00                      11.20                      13.60                        16.40                         17.60                   23.20     34.00    47.60
  $            80,000              10.80            10.80                   10.80                   11.60                      14.00                      18.80                        24.40                         26.80                   38.00     59.60    86.80
  $           100,000              12.00            12.00                   12.00                   13.20                      16.80                      24.00                        32.40                         36.00                   52.80     85.20   126.00
  $           120,000              13.20            13.20                   13.20                   14.80                      19.60                      29.20                        40.40                         45.20                   67.60    110.80   165.20
  $           140,000              14.40            14.40                   14.40                   16.40                      22.40                      34.40                        48.40                         54.40                   82.40    136.40   204.40
  $           160,000              15.60            15.60                   15.60                   18.00                      25.20                      39.60                        56.40                         63.60                   97.20    162.00   243.60
  $           180,000              16.80            16.80                   16.80                   19.60                      28.00                      44.80                        64.40                         72.80                  112.00    187.60   282.80
  $           200,000              18.00            18.00                   18.00                   21.20                      30.80                      50.00                        72.40                         82.00                  126.80    213.20   322.00
  $           220,000              19.20            19.20                   19.20                   22.80                      33.60                      55.20                        80.40                         91.20                  141.60    238.80   361.20
  $           240,000              20.40            20.40                   20.40                   24.40                      36.40                      60.40                        88.40                        100.40                  156.40    264.40   400.40
  $           260,000              21.60            21.60                   21.60                   26.00                      39.20                      65.60                        96.40                        109.60                  171.20    290.00   439.60
  $           280,000              22.80            22.80                   22.80                   27.60                      42.00                      70.80                       104.40                        118.80                  186.00    315.60   478.80
  $           300,000              24.00            24.00                   24.00                   29.20                      44.80                      76.00                       112.40                        128.00                  200.80    341.20   518.00
  $           320,000              25.20            25.20                   25.20                   30.80                      47.60                      81.20                       120.40                        137.20                  215.60    366.80   557.20
  $           340,000              26.40            26.40                   26.40                   32.40                      50.40                      86.40                       128.40                        146.40                  230.40    392.40   596.40
  $           360,000              27.60            27.60                   27.60                   34.00                      53.20                      91.60                       136.40                        155.60                  245.20    418.00   635.60
  $           380,000              28.80            28.80                   28.80                   35.60                      56.00                      96.80                       144.40                        164.80                  260.00    443.60   674.80
  $           400,000              30.00            30.00                   30.00                   37.20                      58.80                     102.00                       152.40                        174.00                  274.80    469.20   714.00
  $           420,000              31.20            31.20                   31.20                   38.80                      61.60                     107.20                       160.40                        183.20                  289.60    494.80   753.20
  $           440,000              32.40            32.40                   32.40                   40.40                      64.40                     112.40                       168.40                        192.40                  304.40    520.40   792.40
  $           460,000              33.60            33.60                   33.60                   42.00                      67.20                     117.60                       176.40                        201.60                  319.20    546.00   831.60
  $           480,000              34.80            34.80                   34.80                   43.60                      70.00                     122.80                       184.40                        210.80                  334.00    571.60   870.80
  $           500,000              36.00            36.00                   36.00                   45.20                      72.80                     128.00                       192.40                        220.00                  348.80    597.20   910.00
  $           520,000              37.20            37.20                   37.20                   46.80                      75.60                     133.20                       200.40                        229.20                  363.60    622.80   949.20
 *Chart based on member's age as of Jan. 1, 2020.
 **Basic Life must be purchased before Supplemental Life coverage is available.
 This publication was printed by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. 500 copies have been printed at a cost of $2.30. A copy has been submitted to
 Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62 O.S. 2012, § 34.11.3). This work is licensed under a Creative Attribution‐NonCommercial‐NoDerivs 3.0
 Unported License.

Option Period Material

                                                              Annual Option Period
                                                            During the annual Option Period, you
                                                            may change or enroll in:
                                                                                   Health coverage.
                                                                                   Dental coverage.
                                                                                   Vision coverage.
                                                                                   Life insurance coverage.
                                                                                   (A life insurance application is required.)

                                                                        Please contact your insurance coordinator for
                                                                        procedures, deadlines and forms.

                                                            Your IC is:
                                                            Phone number:
                                                            Complete forms and
                                                            return to the IC by:

                                                                   PRESENTATION DATES                                                                     ENROLLMENT DATES

                                                         This publication was printed by the Offic of M
                                                                                                      a nageme nt and En t er pr ise Se r vi ces as aut hor ized by Title 62, Section 34. 1,000 copies have been printed
                                                         at a cost of $39.60. A copy has been submitted to Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62
                                                         O.S. 2012, § 34.11.3). This work is licensed under a Creative Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
Important Dates
                                   Start     Stop
    Web enrollment                Sept. 19   Nov. 8

    Life insurance applications   Sept. 19   Oct. 31

    Paper forms                     —        Oct. 31

    Employee meetings             Sept. 27   Oct. 31

                      Option Period

OMES Website
•   Find us on our website – it’s easy.
•   Go to omes.ok.gov.
•   Select Services from the top menu.
•   Select Employees Group Insurance Division.

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
IC Responsibilities
• Set your Option Period deadline.
• Schedule employee Option Period meetings.
• Know the benefits available to your employees.
• Communicate Option Period deadlines with your
• Send the Summary of Benefits and coverage
• Generate pre‐bill for 2020.

Option Period Reminders
• This is the time when eligible employees can
  enroll, add or drop family members, and
  change or drop coverage.
• Employees receive Option Period
  Enrollment/Change Forms.
• If no changes are made, EGID does not need the
  form. You may keep a copy for your records.
• Take time to verify your mailing and email

Confirmation Statement
• Employees are mailed a confirmation
  statement when they enroll or make
• Includes:
    — Coverage changes.
    — Effective date.
    — Premium amounts.
• Employees who do not make changes are not
  mailed a statement.
• Employees should verify coverage and contact
  you if their statement is incorrect.

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
Life, Health, Dental
            and Vision Plans

Life Insurance
• Employees can enroll.                      Oct. 31
  — During Option Period.
  — Within 30 days of a midyear qualifying event.
  — Within 30 days of the loss of other group life coverage.
• Employees can apply to increase Supplemental
  Life up to a maximum of $500,000 with a life
  insurance application.
• Employees can add or increase Dependent Life
• Encourage employees to update their
  beneficiary designation.

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
Health Plans

Health Carriers Offered for 2020
•   BlueCross BlueShield of Oklahoma.
•   CommunityCare.
•   GlobalHealth.
•   HealthChoice.
•   Selman & Company (TRICARE Supplement).

Note: Aetna will not be available for 2020.

Plan Changes
                                             Selected            Premium
                                              Benefit            Changes
     BCBSOK – BlueLincs HMO                     Yes                 Yes
     CommunityCare HMO                          No                  Yes
     GlobalHealth HMO                           Yes                 Yes
     HealthChoice                               Yes                 Yes
     TRICARE Supplement                         No                   No

     Value‐added benefits (required for PY2021): CDC‐Recognized National
     Diabetes Prevention Program and bariatric surgery.

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
Plan Changes
               Selected Benefit Changes
BCBSOK –       • Diabetes Prevention Program – Covered at 100%.
BlueLincs      • Bariatric Surgery – $250 per day, $750 maximum
HMO              per admission.
GlobalHealth   • There is no longer a separate physician cost‐share
                 for inpatient, outpatient and emergency room
               • Hospital inpatient, mental health and substance
                 abuse inpatient – $300/day up to $900/stay.
               • Hospital outpatient – $300 preferred/$800 non‐
               • Emergency room – $400/visit.
               • Maternity postnatal care – $0.
               • Pharmacy Benefits – specialty: $200 preferred;
                 $400 non‐preferred.
               • Diabetes Prevention Program – $0.
               • Bariatric surgery – $300/day up to $900/stay.
HealthChoice   • Addition of nationally recognized CDC‐approved
                 Diabetes Prevention Program.

All Health Plans Include:
•   Out‐of‐pocket maximums.
•   Prescription drug benefits.
•   Designated provider networks.
•   Preventive services.
•   No pre‐existing condition exclusions.
•   Coordination of benefits.
•   Coverage of emergency care.

Some Health Plans Have:
• Calendar‐year deductibles.
• Referral process for specialist visits.
• Preauthorization requirement for certain
  medical services.

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
All HMO Plans Have:
            • No deductibles.
            • No coinsurance.
            • No balance billing.
            • A requirement that a primary care physician
              be selected.
            • ZIP code service area – live or work.

              Health Plan Presentations

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
BlueLincs HMO

                                                                                             $0 Copay For

 ZERO                    Deductible
                                                       Home Health Visits
                                                       Routine Lab & X-Rays
                                                                                      Preventive Health Services
                                                                                      Preferred Generic Drugs
       Cost For          Primary Care Physician Visits Diabetes Prevention Program    Maternity Care

                                                                                        At least
                                                                               20% lower
      Network                   Customer             Health & Wellness
 Largest HMO network                                  Diabetic prevention
     in Oklahoma
                               24/7 Availability
                                                       and management
                                                                                      than other
    Coverage in all                                   Health and nutrition
     77 counties               Blue Access for          management                   HMO Options
                                Members SM
 No referrals required                                 Fitness program
 within HMO network                                        discounts
                                                        Well onTarget®

More Information About
BlueLincs HMOSM

Customer Service:

Operating Hours:
24 hours a day, 7 days per week

State of Oklahoma Employees Website:
 - Find a doctor
 - Check prescription drug coverage
 - Log into Blue Access for MembersSM (BAMSM)

             State, Education & Local Government
                             2020 Active & Pre-Medicare Benefits

Welcome to Insurance Coordinator Option Period Training 2020 - Office of ...
2020 Provider Network
The State network includes Saint Francis and St. John Health Systems in Tulsa,
Broken Arrow, Owasso, Sapulpa, Bartlesville, Nowata, Muskogee and Vinita.
There are other network providers that are affiliated with 12 other hospitals
throughout northeastern Oklahoma.

                                        Premier facilities that offer full
                                             continuum of care.

        Multifaceted coordination with focus on compliance and control of complex high risk conditions.

      Owner systems EMR (Electronic Medical Record) accessible to providers across the spectrum of care.

2020 Health Plan Overview

  No Deductible

  Out‐of‐Pocket Maximum: $4,000 Individual /$8,000 Family

  Office Visit: $35 PCP / $50 Specialist Copay (no referral)

  Preventive Care: $0 Copay

  Diagnostic Lab & X-ray: $0 Copay

  Emergency Room: $200 Copay

  Urgent Care: $50 Copay

  Outpatient Surgery: $300 Copay

  Inpatient Hospital: $350 Copay/Day (max $1,750 per admit)

2020 Pharmacy Benefit Overview

  Prescription Copays:                            $15       Preferred Generic
   * If generic equivalent is available,         *$40        Preferred Name Brand
   you’ll pay the copayment plus the
   difference in cost between the brand          *$70        Non‐Preferred
   name drug and its generic equivalent.
   The difference in cost will not count       *$160         Specialty
   toward your annual out‐of‐pocket

  Mail Order: CVS Caremark & AllianceRx Walgreens Prime
  –    (90 day supply)

  $0 Copay Program: Select Generic Medications
                Blood Pressure
                Cholesterol
                Anti‐Depressants
                Anti‐Inflammatory

Value Added Services
                 CommunityCare continues to maintain a custom website just for
               State, Education & Local Government employees! state.ccok.com

                        • View benefits, providers & formulary guide
                        • Log in to the Member Connection
                                View and print your EOB’s
                                View claim history & out‐of‐pocket
                                Print temporary ID cards
                                Order replacement ID cards

  2020 Reminders
            The pharmacy network includes CVS, Target, Walgreens,
             Walmart, Sams Club, Costco, Reasor’s and other local

            24/7 Nurse Line
                Including weekends and major holidays. Registered nurses are
                 standing by on the telephone with confidential medical advice.

            COB (Coordination of Benefits) Notices
                Sent around March 1st.

            Every Member of the family can choose a different PCP.
                Call Customer Service to change primary care doctors.

            All members will receive new ID cards.


 Fewer expenses. Greater care. Less worry.

             Your Health Plan Should Cover What Matters

       16              Continuous years

            serving State of Oklahoma
                                                                  Offered in all   77
                                                                      counties in Oklahoma
             employees and educators

MPP 2020                                                                                     MLGMH20-ST

We help you stay ahead of whatever
                           life throws your way with:

 Unlimited $0           Zero               $25 Urgent            $500 Maternity            $10 Tier 1               GlobalFit®
 Primary Care        Deductibles           Care Copay            Delivery Copay             Generics             Gym Membership
Physician Visits                                                                        for a 30 day supply         Discounts

                                                                                      Three-month prescription
                                                                                        for 2 copays for most

         Specialty Scans:                                                     $50   Specialist Visits
             • $250 each in a preferred facility
             • $750 each in a non-preferred facility

         Outpatient Surgery:                                                  $10 X-Rays & Lab Copay
             • $300 each in a preferred facility
             • $800 each in a non-preferred facility

          Inpatient Hospital:                                                 $35 Physical Therapy Copay
               • $300 per day;
                 $900 maximum per admission

                         For complete listing of plan benefits and administration go to our website

            Choose a plan that puts its members first

“I recently called GlobalHealth to speak to someone about my behavioral health benefits. I was very
pleased with how kind, compassionate and knowledgeable she was in helping me with my benefits. I
love how GlobalHealth takes care of and values their members!”
Brenda R. GlobalHealth Member

“When I learned I was diagnosed with Ovarian Cancer, the last thing I wanted was to go through it
alone. My GlobalHealth case manager was by my side from the very beginning till the end of all my
treatments. And I still talk to her weekly! GlobalHealth provided me with the peace of mind
knowing that all I need to do is focus on healing.”
Cynthia B. GlobalHealth Member

“I am blessed to know the sweet people at GlobalHealth. It’s like a gift from heaven. I love the whole
GlobalHealth team. GlobalHealth is the best insurance I’ve had in my 8 decades of life, and so are all
the sweet workers. I LOVE GLOBALHEALTH!”
Ruth O. GlobalHealth Member


                           Provider Network        as of August 2019

                   Tulsa Area                                                Oklahoma City Area
    ●   Harvard Family Physicians.                           ●      Centennial Health.
    ●   Utica Park Clinic Physician Group.                   ●      Mercy Hospital.
    ●   Hillcrest Medical Center.                            ●      Mercy Primary Clinics.
    ●   Hillcrest South Hospital.                            ●      Integris Baptist Medical Center.
    ●   Hillcrest Hospital Claremore.                        ●      Integris Health Edmond.
    ●   Hillcrest Hospital Pryor.                            ●      Integris Southwest Medical Center.
    ●   Tulsa Spine & Specialty Hospital.                    ●      Integris Primary and Specialty Care
    ●   Oklahoma Heart Institute.                                   Clinics.
    ●   Oklahoma Surgical Hospital.                          ●      Integris Deaconess Hospital.
    ●   OSU Medical Center.                                  ●      Oklahoma Heart Hospitals (North &
    ●   OSU Physicians.                                             South).
    ●   Bailey Medical Center, Owasso.                       ●      Bone and Joint Hospital at St. Anthony.
    ●   Oklahoma Spine and Brain                             ●      St. Anthony Hospital.
        Institute.                                           ●      Variety Care Clinic.
    ●   McAlester Regional Health Center.                    ●      Lakeside Women’s Center of Oklahoma.

    This is not a full list of providers. Other providers are available in our network. The provider network may
    change at any time. You will receive notice when necessary. To see if your local provider or hospital is in
    network, visit www.GlobalHealth.com/search or call Customer Care at 1-877-280-5600.
    Out-of-network care is not covered except for emergency or urgent care.


                         Connect With Us
                    Call 844-299-6999 (TTY: 711)

         GlobalHealth Insurance                  Download our Mobile App

              We offer a Medicare Advantage plan for State of Oklahoma
         retirees. If you are a state of Oklahoma Retiree, call us today or visit
              www.GlobalHealth.com/osr to learn more about this plan.

Fewer expenses. Greater care. Less worry.

  A Variety of Plans
  for Everyone's Needs.
  •   HealthChoice High – Lowest deductible and out-of-pocket maximum
      and simple office visit copays.
  •   HealthChoice Basic – First-dollar benefit and no office visit copays.
  •   High and Basic members who cannot attest as tobacco free or meet one
      of the reasonable alternatives will automatically be enrolled in the High
      Alternative or Basic Alternative plans. The Alternative plans have a
      deductible that is $250 higher.
  •   High Deductible Health Plan – Lowest premium, combined medical and
      pharmacy expenses apply to deductible and it works with an HSA.

  Network pharmacy benefits available on all plans with simple copays after

HealthChoice Key
High                             Basic                      HDHP
•  Deductible:                   •  $500 first-dollar       •   Deductible:
    • $750 individual.              coverage.                    • $1,750 individual.
    • $2,000 family.             • Deductible:                   • $3,500 family.
• Coinsurance:                       • $1,000 individual.        • Combined medical
    • 80/20.                         • $1,500 family.                and pharmacy.
• Out-of-pocket maximum:         • Coinsurance:             •   Out-of-pocket:
    • $3,300 individual.             • 50/50.                    • $6,000 individual.
    • $8,400 family.             • Out-of-pocket:                • $12,000 family.
• Copays:                            • $4,000 individual.   •   After deductible, plan
    • $30 primary care and           • $9,000 family.           mirrors HealthChoice
        urgent care.             • No copays for network        High plan.
High Alternative                    services.
• Deductible:                    Basic Alternative
    • $1,000 individual.         • $250 first-dollar
    • $2,750 family.                coverage.

       Easy to Use Benefits

       •   No referrals needed.
       •   10,000 network providers and facilities.
       •   Access to Select networks.
       •   Non-network services available.
       •   Value-added services.

       Value-added Services

       •   Bariatric services.
       •   HealthChoice Select.
       •   Care Management.
       •   Telemedicine.
       •   Complex Care Program.

Bariatric Surgery

•      Several procedures available.
•      Must be on HealthChoice for 12 months.
•      Five convenient locations.
•      Subject to deductible and copays.

Select Program

    Select is available to all HealthChoice plans.
    • 100% of certain services and procedures.
    • No out-of-pocket costs for members of the
       HealthChoice High, High Alternative, Basic
       and Basic Alternative Plans.
    • No out-of-pocket costs for members of the
       HealthChoice High Deductible Health Plan
       after deductible is met.
    • Learn what procedures are covered at
       100% by going to the Select webpage on

Care Management Program

Care Management and Care Coordination are available to all HealthChoice
members. A dedicated care coordination team is waiting to provide assistance
in coordinating health care needs of members and will:

•     Assist with where and when to seek medical care.
•     Assist with understanding medications.
•     Assist when transitioning home.
•     Identify and contact members with care gaps – preventive care and
      medication adherence.
•     Ensure members are comfortable in their understanding of directions given
      at doctor’s office or hospital.

Complex Care Program

•   Program provides treatment and care of serious, rare or complicated
•   You will be contacted directly if identified with:
     • Multiple health issues.
     • Rare medical issues.
     • Health problems that remain unresolved.


COMING in 2020!
•   Available 24/7/365.
•   Basic physician services.
•   Secure.
•   User-friendly.
•   Unlimited, immediate and
    easy access.

HealthChoice Connect:
Member Self-service Portal
Your online source for:
•   Access to claims history.
•   Benefit information.
•   Update annual Verification of Other Insurance Coverage.
•   Ability to order ID cards.
•   Review out-of-pocket amounts.

  •   Must complete online HealthChoice
      Tobacco-Free Attestation for Plan Year
      2020 to remain in High or Basic plan.
  •   HealthChoice waives the attestation the
      first year of enrollment in High or Basic
      plan but requires it each year thereafter.
  •   Does not apply to HealthChoice High
      Deductible Health Plan.
  •   Deadline to complete the attestation is
      Nov. 8, 2019.

New for 2020: Complete the HealthChoice Tobacco-
Free Attestation and update the annual Verification of
Other Insurance Coverage at the same time!

                           Dental Plans

      Dental Carriers for 2020
      •   Cigna.
      •   Delta Dental.
      •   HealthChoice.
      •   MetLife.
      •   Sun Life.

Plan Renewals
                                                           Premium Changes

Cigna Dental Care Plan (Prepaid)                                    No
Delta Dental PPO                                                    Yes
Delta Dental PPO – Choice                                           No
HealthChoice Dental                                                 Yes
MetLife High Classic MAC                                            Yes
MetLife Low Classic MAC                                             Yes
Sun Life Preferred Active PPO                                       Yes
Note: There were no changes in suppliers, plans or benefits from 2019.

All Dental Plans Include:
•   Preventive care.
•   Basic care.
•   Major care.
•   Orthodontic care.

    Dental Plan Presentations


Plan year: Jan. 1, 2020 –
              Dec. 31, 2020

Offered by Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.

862420 b

A plan where one dentist coordinates your care within a network
that provides general and specialty dental care

                                               • You choose a primary care dentist in the DHMO network
                                                 where you can receive all your care
     Cigna Dental
                                               • By using dentists in the DHMO network you may pay less
     Care® Dental                                than you would with other types of dental plans
     Health                                    • You pay an office visit fee and the charge listed on your
     Maintenance                                 Patient Charge Schedule
     Organization                              • There is no out-of-network coverage (except in
     (DHMO*)                                     emergencies)**

                                               • There are no deductibles and no annual dollar maximums

Coverage with no deductibles or waiting periods                                                                        DENTAL:

Examples of covered services*

   Preventive care, such as cleanings and exams, at no added or low cost

   Additional cleanings, fluoride, and fluoride varnish available for a copay

   Temporomandibular joint (TMJ) diagnosis

   General anesthesia/IV sedation when medically necessary

   Coverage for brush biopsy, a noninvasive diagnostic procedure for detecting oral cancer

   Coverage for teeth whitening (take-home bleaching gel with trays) and athletic mouth guards

   No age limit on sealants

   Coverage for advanced procedures like crowns and bridges over implants

   Second opinions covered

   Emergency care

   Orthodontic coverage for children AND adults

Cigna Dental Oral Health Integration Program®
                                                                                                                                                                              & SERVICES

 More programs                                                  More wellness                                                     More discounts
 Available to ALL Cigna Dental                                  Articles on behavioral                                            40% off* average retail prices on
 customers with qualifying condition(s)                         issues linked to oral health                                      certain prescription dental products*

                                                                                                                                    Chronic                      Head and
                                                           Heart                                                                                     Organ
  Dental Services                                         Disease
                                                                            Stroke       Diabetes            Maternity              Kidney
                                                                                                                                                                neck cancer
                                                                                                                                    Disease                      radiation

  Periodontal treatment and maintenance
                                                                                                                                                               
  (D4341, D4342, D49101)

  Periodontal evaluation (D0180)                                                                                    
  Oral evaluation (D01202, D01402, D01502)                                                                          
  Cleaning (D11103)                                                                                                 
  Emergency palliative treatment (D91104)                                                                           

  Topical application of fluoride and topical
  application of fluoride varnish (D12065)
                                                                                                                                                                   

  Topical application of fluoride – excluding
                                                                                                                                                                   
  varnish (D12085)

  Sealants (D13515)                                                                                                                                                
  Sealant repair – per tooth (D13535)                                                                                                                              
 1. Four times per year.                                                                  4. No limitations.
 2. One additional evaluation.                                                            5. Age limits removed, all other limitations apply.
 3. One additional cleaning

We’re here 24/7/365
                                                                                                                                                                              TOOLS &

By phone – 800.244.6224
• Call anytime day or night for live customer service
• Ask for a Spanish-speaking representative or speak with us in your preferred language – interpreter service is
  available in over 200 languages
• Get help finding a dental office
• Check your eligibility
myCigna – online or through the mobile app
• Review your plan information and check a claim status                                                                                         Download the myCigna
• Find network dentists                                                                                                                         Mobile App*** for easy
• Print temporary ID cards                                                                                                                      access on the go!
• Change your DHMO dental office*
• View year-to-date dental costs and estimate approximate costs prior to treatment
• Take oral health assessments that you can share with your dentist

Dentists who participate in Cigna’s network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. The information in this
presentation summarizes the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see your
employer’s plan booklet, evidence of coverage, insurance certificate, or summary plan description – the official plan documents. If there are any differences between the
information in this presentation and the plan documents, the information in the plan documents takes precedence.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Cigna Dental Care (DHMO) plans are insured by Cigna
Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health
of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NB), Cigna
Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental
Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of
Virginia, Inc. In other states, Cigna Dental Care plans are insured by Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company
(CGLIC), or Cigna HealthCare of Connecticut, Inc., and administered by Cigna Dental Health, Inc. Cigna Dental PPO plans are insured or administered by CHLIC or CGLIC,
with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice,
and this plan uses the national Cigna DPPO network. Policy forms: OK - Dental Indemnity/PPO: HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); DHMO: HP-POL115
(CHLIC), GM6000 DEN201V1 (CGLIC); TN – Dental Indemnity/PPO: HP-POL69/HC-CER2V1 et al, DHMO: HP-POL134/HC-CER17V1 et al (CHLIC). The Cigna name, logo,
and other Cigna marks are owned by Cigna Intellectual Property, Inc.
862420 b 05/16         © 2016 Cigna. Some content provided under license.

Appendix A
DHMO for residents of Minnesota and Oklahoma

Minnesota Residents: When enrolling in a DHMO plan, you must visit your selected network dentist in order
for the charges on the Patient Charge Schedule to apply. You may also visit other dentists that participate in
our network or you may visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the
Patient Charge Schedule will not apply. You will be responsible for the dentist’s usual fee. We will pay 50% of
the value of your network benefit for those services. You’ll pay less if you visit your selected Cigna Dental
Care network dentist. Call Customer Service for more information.

Oklahoma Residents: DHMO for Oklahoma is an Employer Group Pre-Paid Dental Plan. You may also visit
dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will
not apply. You will be responsible for the dentist’s usual fee. We pay non-network dentists the same amount
we’d pay network dentists for covered services. You’ll pay less if you visit a network dentist in the Cigna
Dental Care network. Call Customer Service for more information.

   2020 Dental Benefits Options
   for State, Education & Local Government Employees

We Deliver a Superior Customer Experience

                               DDOK does not deny                                     No waiting periods before
                               coverage due to                                        you can begin receiving
                               pre-existing conditions                                treatment

   Our coverage includes                     We allow benefits for                 Overall member satisfaction
 replacement of a missing                 comprehensive orthodontic                 rating – and percentage of
tooth, even if it was lost prior          cases, even if treatment was              inquiries (calls) resolved
  to your DDOK coverage                      started prior to DDOK                      during initial contact

We Deliver the Largest Network of Dentists

                             Largest Dental

Our unmatched network strength means                                                                       Nearly 1,800 dentists practice in the state,
your dentist likely participates with Delta Dental –                                                       and more than 1,100 of those dentists
ask if your dentist is a Delta Dental PPO provider                                                         participate in Delta Dental’s PPO network.
to enjoy maximum savings!


Option 1: Delta Dental PPO*

   you receive treatment from a Delta Dental Premier provider, you will be responsible for the difference between the
 PPO allowable and Premier allowable amounts. If you are treated by a dentist who does not participate with Delta Dental
 (out‐of‐network), you will be responsible for the difference between the dentist charge and the PPO allowable amount.     **DEPENDENTS ELIGIBLE TO AGE 26

Option 1: Delta Dental PPO
This plan option provides access to both the Delta Dental PPO and the Delta Dental Premier
networks. Subscribers of this plan are welcome to receive treatment from the licensed dentist of
their choice, but will have lower out-of-pocket expenses when they visit a Delta Dental PPO
participating dentist.

Payment of a covered Class II dental service**

       **Assumes deductible is satisfied

Option 2: Delta Dental PPO – Choice**
Members who select this low-cost program have access to the Delta Dental PPO network and will be responsible for the
amounts reflected in the Delta Dental PPO – Choice Description of Covered Services and Enrollee Co-payments table along
with any deductible. Their out-of-pocket expenses will be lower if they use a Delta Dental PPO provider.


       *Assumes deductible is satisfied                                             **DEPENDENTS ELIGIBLE TO AGE 26

Visit Our Custom Website for State Employees
To learn more about the plans and services available
to you with Oklahoma’s leading dental benefits
provider, please visit DeltaDentalOK.org/client/OK

 Review Plan Information
 Search for Participating Dentists
 Access Monthly Health Tip
 Learn Answers to FAQs
 Register for Spotlight to access:
   ‒ electronic ID card
   ‒ plan information,
     including Explanation of Benefits (EOBs)
   ‒ claim status and history, and more!

                                          Visit DeltaDentalOK.org/client/OK today!

     We would welcome the opportunity to serve you and your family in 2020.
            Please do not hesitate to contact us with any questions.

                                Live Answer Customer Service
                           Monday – Thursday, 7:00 a.m. – 6:00 p.m.
                                  Friday, 7:00 a.m. – 5:00 p.m.
                        405-607-2100 (OKC Metro) 800-522-0188 (Toll Free)

The Plan of Choice
                                            Dental Plan

Dental Plan

When using a network provider:
• Preventive care is covered at 100%.
• A $25 deductible applies to basic and major
• After the deductible, you pay:
   — 15% for basic care.
   — 40% for major care.
• Orthodontic care is covered at 50%.
   — No calendar year or lifetime maximum.
   — A 12-month waiting period applies.
• $2,500 calendar year maximum benefit for
   all other services.

Dental Plan Providers

• You have the option to see any dental provider you choose,
  network or non-network.
• Using a network provider will provide you a higher level of
• Network providers will not balance bill.
• Find a network provider on healthchoiceok.com under Find a

Preventive Services

Covered services include:
•   Cleanings.
•   Bitewing X-rays, routine oral examinations (2 times per year).
•   Full mouth X-rays (1 time per 36 months).
•   Topical fluoride treatments (2 times per year).
•   For more covered services refer to the HealthChoice Dental
    Plan handbook.

Basic Restorative
Covered services include:
•   Extractions, including wisdom teeth.
•   Oral surgeries.
•   Composite filling restorations.
•   Endodontic treatments.
•   For more covered services refer to the HealthChoice Dental
    Plan handbook.

Major Restorative
Covered services include:
•   Initial placement of dentures.
•   Dental implant systems.
•   Inlays.
•   Onlays.
•   Restorations.
•   For more covered services refer to the HealthChoice Dental
    Plan handbook.

       Covered services include:
       • Orthodontic services for members under age 19.
       • Orthodontic services for treatment of TMD for members at any
         age (certification required).
       • Molar uprighting.
       • For more information on orthodontic services refer to the
         HealthChoice Dental Plan handbook.

MetLife Dental Insurance
Prepared for : State of Oklahoma

                                                                       Metropolitan Life Insurance Company, New York, NY 10166
                                                          © 2019 METLIFE Services and Solutions, LLC L0819517372[exp0820][OK]

State of Oklahoma employees and educators

                                Dental Network

 There are thousands of general dentist and specialists to choose from
  nationwide – So you are sure to find one that meets your needs.

                                                           Best Access areas in Oklahoma
                                                                                                                                      MetLife PDP PLUS
                                                 City or Area Associated with                 MetLife Estimated   MetLife PDP Plus
                        State         Zip Code                                All Dentists1                                           Network % of All
                                                        3‐digit Zip Code                        Participants1     Network Dentists1
                          OK            730        Oklahoma City Vicinity          875             40,313               729                83.3%
                          OK            731            Oklahoma City              1,871            35,721              1,507               80.5%
                          OK            737                  Enid                  145              3,071               137                94.5%
                          OK            740             Tulsa Vicinity             823             31,552               823               100.0%
                          OK            741                  Tulsa                 810             17,580               790                97.5%
                          OK            743                 Vinita                 136              2,906               136               100.0%
                          OK            744               Muskogee                 239              6,224               235                98.3%
                          OK            746               Ponca City                46              3,102                41                89.1%
                          OK            748                Shawnee                 211              7,135               189                89.6%
                          OK            749         Fort Smith (AR) West            89              2,803                75                84.3%

   1   MetLife data as of July 2019

                                                                       Metropolitan Life Insurance Company, New York, NY 10166
                                                          © 2019 METLIFE Services and Solutions, LLC L0819517372[exp0820][OK]

State of Oklahoma employees and educators
                                   Dental Benefits

 Choice of the dental plan that’s right for you based on your needs and budget:
          High Classic MAC Plan – Highest PPO benefit levels ($5,000 annual maximum and
                  lifetime adult orthodontia of $2,000)
          Low Classic MAC Plan – Competitive premiums (less than $340/year for EE only)

 No cost for in-network cleanings, x-rays and exams1

 No waiting periods, including for Orthodontia
   * Savings from a MetLife Dental plan near Oklahoma City and Tulsa as compared to the cost of not having insurance
   ** These are hypothetical examples only. Actual costs and savings may vary

                                                        In‐Network                                                                                                                                  In‐Network
                                                                        High Out‐of‐                                                                                                                                         Out‐of‐
 Dental Service in Cost if not                              Dentist                                                                       Dental Service in Cost if not                                 Dentist High Classic
                                                                      Classic Pocket Savings3                                                                                                                                Pocket Savings3
  Oklahoma City enrolled                                Negotiated                                                                                   Tulsa enrolled                                 Negotiated MAC pays
                                                                    MAC pays    Cost                                                                                                                                           Cost
                                                              Fee2                                                                                                                                        Fee2
Cleaning                               $101                    $55     100%       $0    $101                                           Cleaning                                      $94                   $52        100%       $0     $94
Cavity Filling                         $245                   $113      85%      $17    $228                                           Cavity Filling                              $255                   $107         85%      $16    $239
Root Canal                            $1,303                  $663      85%      $99 $1204                                             Root Canal                                 $1,112                  $626         85%      $94 $1,018
Porcelain Crown                       $1,269                  $705      60%     $282 $1,187                                            Porcelain Crown                            $1,237                  $667         60% $267        $970
Dental Implant                        $2,386                $1,352      60%     $541 $1,845                                            Dental Implant                             $2,043                $1,694         60% $678 $1,365
   1 Subject to frequency limitations
   2 Based on MetLife data. Negotiated fees refers to the fees that in‐network dentists have agreed to accept as payment in full for covered services, subject to any co‐payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.
   3 Savings from enrolling in a MetLife Dental Plan featuring the Preferred Dentist Program will depend on various factors, including the cost of the plan, how often participants visit the dentist and the cost of services rendered.
   * Savings calculations based on analysis of 2019 claims information, comparing participating dentists’ reported usual charges for services to negotiated fees for those same services

   **Please note: These are hypothetical examples. They assume services are performed by an in‐network dentist, that the annual deductible has been met and annual maximums have not been reached. Fees and savings in your area may be different.

                                                                                      Metropolitan Life Insurance Company, New York, NY 10166
                                                                         © 2019 METLIFE Services and Solutions, LLC L0819517372[exp0820][OK]

State of Oklahoma employees and educators
              MetLife Dental Mobile App

 To use the MetLife mobile app, employees can choose to register
    at metlife.com/mybenefits from a computer or directly through
    the app. (Certain features of the MetLife Mobile App are not
    available for all MetLife Dental Plans)

                                                                  Get estimates for                                                                     View your                                                           View your
      Find a Dentist
                                                                 most procedure fees                                                                     claims                                                              ID Card
                                                                                      Metropolitan Life Insurance Company, New York, NY 10166
                                                                         © 2019 METLIFE Services and Solutions, LLC L0819517372[exp0820][OK]

                                                               Thank you!

  Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, limitations, reductions, waiting periods and terms for keeping them in
  force. Please contact MetLife or your plan administrator for costs and complete details.

                                                                                      Metropolitan Life Insurance Company, New York, NY 10166
                                                                         © 2019 METLIFE Services and Solutions, LLC L0819517372[exp0820][OK]

SLPC 27622

Dental Coverage Overview

    Procedure Type                                                 In-Network                               Out-of-Network
    I - Preventive Services                                             100%                                           100%
    II - Basic Services                                                    85%                                           70%
    III - Major Services                                                   60%                                           50%
    IV - Ortho Services                                                    60%                                           50%

       • Calendar Year Maximum (type I, II, and III) = $2,000
         per person

       • Ortho Maximum = $2,000 lifetime per child under age

                                                                                                                      DENTAL INSURANCE
GVMPPPT-EE-4496B                                                                                                                     SLPC 27622

Network dentists can save you* $$

    Example                                                    Network dentist                         Non-Network dentist
    Average charge for crown**                                          $1,145                                       $1,145
    Minus network discount                                                  30%                                             NA
    Actual Fee                                                             $802                                      $1,145
    Insurance pays 50%                                                     $401                                         $573
    Claimant pays                                                          $401                                         $572

  You could save $171 by going to a network dentist!!

*This example is for illustrative purposes only. Cost of dental procedures may differ depending on location or dental provider. Savings may also differ in
cases when deductibles apply or if the dentist’s discount differs from 30%
**Based on 2017 Sun Life claims data. Figures have been rounded to the nearest dollar.

                                                                                                                      DENTAL INSURANCE
GVMPPPT-EE-4496B                                                                                                                     SLPC 27622

How to find a dentist

• Visit www.sunlife.com/findadentist
  – Select Sun Life Dental Network®, the PPO network
    for your plan
  – Enter your search criteria and a list of participating
    dentists will be provided
• Call customer service at 800-442-7742 for
  assistance in locating a network dentist
• Use the Provider nomination card if your dentist is
  not in our network of dentists

                                                                                                                 DENTAL INSURANCE
GVMPPPT-EE-4496B                                                                                                               SLPC 27622



 The Sun Life Financial group of companies operates under the “Sun Life Financial” name. In the United States and elsewhere, insurance
 products are offered by members of the Sun Life Financial group that are insurance companies. Sun Life Financial, Inc., the publicly traded
 holding company for the Sun Life Financial group of companies, is not an insurance company and does not guarantee the obligations of these
 insurance companies. Each insurance company relies on its own financial strength and claims-paying ability.

 Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under
 Policy Form Series 93P-LH, 98P-ADD, 07-SL REV 7-12, 07P-LH-PT/07C-LH-PT, 01P-ADD-PT/01C-ADD-PT, GP-A, GC-A, 12-GP-01, 15-GP-
 01, 12-DI-C-01, 16-DI-C-01, 13-SD-C-01, 13-SDPort-C-01, 12-AC-C-01, 12-ACPort-C-01, 16-AC-C-01, 16-ACPort-C-01, 13-ADD-C-01, 13-
 ADDPort-C-01, 15-ADD-C-01, 12- GPPort-P-01, 12-STDPort-C-01, 16-SD-C-01, 16-SDPort-C-01, 16-CAN-C-01, 16-CANPort-C-01, 15-LF-C-01,
 15- LFPort-C-01, 16-DEN-C-01, 16-VIS-C-01, TDBPOLICY-2006, and TDI-POLICY. In New York, group insurance policies are underwritten by
 Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 15-GP-01, 13-GP-LF-01, 13-LF-C-01, 13-GP-LH-01, 13-
 ADD-C-01, 12-DI-C-01, 16-DI-C-01, 13-LTD-C-01, 13-STD-C-01, 06P-NY-DBL, 07-NYSL REV 7-12, GC-A, GP-A, 12-GP-SD-01, 13-SD-C-01,
 13-SDPort-C-01, 12-GP-01, 12- AC-C-01, 12-ACPort-C-01, 12-GPPort-01, 13-LFPort-C-01, 13-ADDPort-C-01, 15-LF-GP-01, 15-SD-GP-01, and
 12- STDPort-C-01. Product offerings may not be available in all states and may vary depending on state laws and regulations. The group
 insurance policies described in this advertisement do NOT provide basic hospital, basic medical, or major medical insurance.

 © 2018 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are
 registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

 3/17 (exp. 3/19)


Vision Plans

Vision Carriers Offered for 2020
• Primary Vision Care Services
• Superior Vision.
• Vision Care Direct.
• VSP (Vision Service Plan).

Plan Renewals
      PVCS                               Yes
      Superior Vision                     No
      Vision Care Direct                  No
      VSP                                 No

Note: There were no changes in suppliers, plans or benefits from 2019.

All Vision Plans Include:
     • Coverage for exams, lenses, frames, contact
       lenses and more.
     • Designated provider networks.
     • Limited coverage for services by non‐
       network providers.

 Comprehensive Continuous Coverage with PVCS

                                                          Laser Vision Correction

                                           An Oklahoma Vision Care Company
                                                     www.pvcs-usa.com | 888-357-6912

• $0 COPAY
• Not limited to once
  a year
• Member pays “Wholesale
  Cost*” for prescription
  lenses and lens options
FRAMES                                                           CONTACT LENSES
• Member pays                                                    • Member pays “Wholesale
  “Wholesale Cost*”                                                Cost*” for Contact lenses
  for Frames                                                     • Copay for 1st time fittings
    *Wholesale cost is the manufacturers published list price plus tax and shipping rounded up to the nearest
    $5. It is roughly 50% less than retail prices.

Network Benefits
                                                           •   No ID Cards required
                                                           •   Simply select a PVCS Provider and identify
                                                               yourself as a PVCS Member
                                                           •   Eye Exams are covered 100% and not limited
                                                               to once a year
                                                           •   Members are eligible for Glasses and Contact
                                                               lenses in the same plan year
                                                           •   Get as many pairs of Prescription Glasses as
    Our Network                                            •
                                                               you want or need
                                                               Prescription Glasses and Contact lenses are
    •    Over 350 Independent Optometrists and                 provided at “Wholesale Cost”
    •    All Providers dispense glasses and contacts
    •    Glasses can be made at the lab of their
         choice, including their own lab resulting in
         quick delivery

                                          An Oklahoma Vision Care Company
                                                  www.pvcs-usa.com | 888-357-6912

                                                   •    Save up to $1000 on Lasik with PVCS
                                                        and nJoy Vision in Oklahoma City and

                                                   •    Non‐Network reimbursement up to
                                                        $40 for an eye exam and up to $60 for
                                                        prescription glasses or contact lenses
Questions?                                              in lieu of Network Benefits.
•       Customer Service: 888‐357‐6912
•       Website: www.pvcs‐usa.com
•       Email: email@pvcs‐usa.com

                                         An Oklahoma Vision Care Company
                                                 www.pvcs-usa.com | 888-357-6912

Join us online or give us a call

                     •   Website: superiorvision.com

                     •   Phone: 1 (800) 507-3800

                     •   Live support:

                         Monday – Friday: 8 a.m. to 9 p.m. CST

                         Saturday: 10 a.m. to 4:30 p.m. CST

                     •   Benefit information

                     •   Eligibility status

Have questions?      •   Claims information
We have answers!     •   Provider listings

                     •   Assistance with issues and special requests

Members can easily find a provider online

                                                                                 Members can:

                                                                                 •   Get directions

                                                                                 •   Call the provider

                                                                                 •   Determine services offered

                                                                                 •   See languages available


Your mobile app is also ready to help
It’s easy to use and highly rated

Create an online      View vision          Locate a vision         Display member
account               benefits             provider                ID card
Log in with the       Review your vision   Find a vision           View your member
same username         benefits and         provider in your        ID card full screen,
and password as       eligibility          network, call the       print and email it.
superiorvision.com,   information for      provider, visit their
or create a new       yourself and for     website and even
account in the app.   any dependents.      get directions



                                        2020 VISION PLAN OFFERING


  Local Customer Service
  Tax Revenue Stays Local
  Supports Teachers                                  Proud
  Doctor Controlled Care
  Patient Focused

                           FOCUSED ON YOU

  EYE EXAMS                     GLASSES                 CONTACTS

Comprehensive Eye Health          ANY Frame              $130 Allowance
 Early Disease Detection        $130 Allowance

   $15 MEMBER FEE              $15 MEMBER FEE           $0 MEMBER FEE

2020 Plan Improvements

    • Over 100 New Plus Plan Providers
    • Eyemart Express, Pearl Vision and more
    • No Premium Increase
    • Conquering Out-of-Pocket costs

Supercharge Your VCD Plan
Get access to PLUS Plan FREE Upgrades by visiting any       Look for this logo when searching for a provider!!
one of our VCD PLUS doctors!

                           BENEFITS             INCLUDED

                            Up to $130
                           Single Vision

       LENSES                 Bifocal


                        HD Polycarbonate

                      Anti-Reflective Coating

                        Scratch Resistance
                          UV Protection

                       Oil & Water Repellent
                       Progressive (No-Line)
                                                                                             Don’t break the bank!

                                                           CONTACT US
                                                                   Customer Support
                                                                   (855) 918-2020

                                                                   Dedicated Website

                                                                   Email Address

Your VSP
              Vision Benefits
              Members First,
              Members for Life

       Effective Jan. 1, 2020


            Low out of pocket costs                               Quality care.                                   More choices.
                                                            64 years of helping people                        Nationwide network of
                                                             see well and stay healthy                       more than 38,000 providers

                 88 million                           Providing no-cost eye care through                             Great value!
              members nationwide                                Eyes of Hope®                                    VSP® is consumers’ #1
                                                                                                                 choice In vision care2

       1. VSP insurance plans have exclusions and limitations. For costs and complete details
       of the coverage, contact VSP at 800.877.7195.
       2. National Vision Plan Member Study, 2017.

                                                 VSP Plan at a glance

Exam                            •    WellVision Exam covered every calendar year $10 Copay

Frame Allowance                 $170 Frame allowance every calendar year + extra $50 allowance for featured frame brands.

Lenses                          • Single vision, lined bifocal or lined trifocal lenses for adults. $25 Copay included in glasses.
(every calendar year)           • Single vision, lined bifocal or lined trifocal polycarbonate lenses for children. $25 Copay included in glasses.

                                • Standard Progressive lenses covered with $0 copay
Lens Enhancements
                                • 20‐25% savings on lens enhancements–Scratch‐resistant, UV, Anti‐reflective coating
Contact Lens Allowance
                                $120 allowance for contacts lenses and copay up to $60 for contacts lens exam (fitting and evaluation)
(in lieu of glasses)
Diabetic Eyecare
                                Services related to diabetic eye disease glaucoma, and age‐related macular degeneration. $20 Copay
Plus Program

Retinal Screening               No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam.

                                $8.72 Member only, $14.50 Member + spouse, $14.42 Member + child,
Your Monthly Contribution       $20.20 Member + spouse + child, $21.20 Member + 2 or more children,
                                $26.98 Member + spouse + 2 or more children

Premier Program Savings

Save even more and get more through extra offers,
like additional savings on frames, lenses, and contacts
that are exclusive to Premier Program locations.
Access to exclusive Bonus Offers
A wide selection of featured frame brands¹
Eyewear protection warranty
The latest in performance lenses
An advanced eye exam
Participation in the VSP preventive
eye health and wellness program


Eyeconic is the only place where
VSP members can shop online for contacts and
eyewear with their
VSP insurance in-network.
Personalized: As a VSP-owned company, Eyeconic seamlessly
connects VSP vision benefits to your account.
Simple: Save time and money on quality eyewear with a few
easy clicks.
1. Connect your vision insurance.
2. Select your product.
3. Upload your prescription or provide your doctors contact
   information and we’ll take care of the rest.
Choice: Eyeconic offers a variety of well-known brands and
contact lenses. Choose from over 35 eyewear brands and over
1600 styles.

  Exclusive Member Extras

Big Value. More Saving with VSP Vision Care.
With Exclusive Member Extras, savings never looked so good.
VSP puts members first by providing you with exclusive special
offers. Discover great deals on glasses, sunglasses, contact
lenses, and more.

                        Special Deal on Glasses —
                        Extra $50 on Featured Frame Brands

                        Save 25-40% on popular lens enhancements

                        Save Up to $50 on Non-prescription Sunglasses
*Offers vary based on benefit plan.

Participating Retail Chains
Over 8,000 participating retail locations
in the VSP network:
Retail Chains include:
     • Walmart Vision Center.
     • Pearle Vision.
     • Visionworks.®
     • MyEyeDr.
     • Clarkson Eyecare.
     • RxOptical.®
     • Optyx.
     • Costco® Optical.
     • And More!

                                                                 Using your benefit is easy

                                                             Once you’re enrolled …
                                                             • Create an account at vsp.com and review your
                                                               benefit information
                                                             • Find a VSP in-network doctor by visiting
                                                               vsp.com or calling 800.877.7195
                                                             • No ID card needed, at your appointment, simply
                                                               tell them you have VSP

           9/19/19 – 11/08/19

           Enjoy the complete coverage
           and quality care you deserve.
           To learn more contact us
           at 800.877.7195 or www.vsp.com.

                                                                                                ©2019 Vision Service Plan. All rights reserved.
                           VSP, Eyeconic, eyeconic.com, Eyes of Hope, and WellVision Exam are registered trademarks of Vision Service Plan. All other brands are the property of their respective owners. 40152 VCCL

Helpful Hints
•   Utilize your resources.
•   Reach out to your employees.
•   Complete and submit forms by the deadlines.
•   Verify all signatures.
•   Keep your employees informed.


     Please complete the seminar evaluation.
             Fax it to 405‐717‐8949 or
          Email it to me at [MSR EMAIL].

     Thank you for attending.

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