Current and Prospective Employers 2019

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1 Current and Prospective Employers 2019

2 A Quick History of PHBP PHBP is an employer funded group insurance plan providing health coverage for eligible production freelancers and, staff employees of all AICP General Members and eligible associate members. The Plan s Trust was first funded by Participating Employers in 2007 and began offering coverage to non-union commercial freelance employees in the Production department in In 2013, the Plan expanded to offer Participating Employers two Staff Coverage package options.

3 2019 Medical Benefits Staff Employees You may now choose from the following Anthem Blue Cross medical and prescription drug benefits for your staff employees. All plans utilize the most extensive networks offered by Anthem Blue Cross and its affiliated Blue Card Blue Cross Blue Shield networks where available PHBP Classic Premier PPO. With the highest annual premiums and lowest member out-of-pocket costs, this is the richest of all our medical options. PHBP Classic Plus PPO. With lower annual premiums but higher out-of-pocket medical costs than the PHBP Premier PPO, this option offers employees meaningful coverage while costing employers less. PHBP California Classic HMO. With lower annual premiums and out-of-pocket medical costs than the Premier and Select PPOs, this is a valuable option available to employees in California only. PHBP HSA. This high-deductible PPO with an attached Health Savings Account (HSA) option brings our menu of medical benefits in line with current healthcare trends. While annual premiums are the lowest of all the options, out-of-pocket costs are the highest but employees and employers can make pre-tax contributions to a rolling savings account. And use the funds to meet the deductible.

4 Benefits Options If you join the PHBP, you may also purchase each of the following benefits bundles for your employees (benefits within each bundle cannot be purchased separately). Anthem Dental and MetLife Vision: Both plans offer vast networks of providers and coverage for preventive and supplemental care. Short and Long-Term Disability and Life Insurance: PHBP is creating a disability package that will be available on April 1, If you are interested, we will need your employee census data by February 1, Stay tuned for more information.

5 2019 Policy and Structural Enhancements Post Production freelance job categories are being phased out and will no longer require freelance contributions. The cost-sharing ceiling that you may elect your employees to contribute will increase from 25% to 50% of the cost of coverage. The cost of dependent coverage remains at the employer s discretion. The Plan will no longer charge scaled administrative or freelance assessment fees. The costs of each plan are consistent for all. Covered Production Freelancer contributions will remain unchanged at 9%. With the nationwide legalization of same sex marriage, eligible dependents are the same-sex and opposite-sex legally married spouses and their children.

6 PHBP CLASSIC PREMIER PPO

7 PHBP Classic Premier PPO With the highest annual premiums and lowest member out-of-pocket costs, this is the richest of all our medical options.

8 PHBP Classic Premier PPO Deductibles and Out-of-Pocket Max DEDUCTIBLE IN-NETWORK NON-NETWORK INDIVIDUAL $500 $1,500 FAMILY $1,000 $3,000 OUT-OF-POCKET MAX IN-NETWORK NON-NETWORK INDIVIDUAL OOP $2,500 $5,000 FAMILY OOP $5,000 $10,000

9 PHBP Classic Premier PPO Physician Services PHYSICIAN SERVICES IN-NETWORK NON-NETWORK OFFICE VISIT COPAY $25 50% COINSURANCE PREVENTIVE CARE $0 50% COINSURANCE DIAGNOSTIC LAB/X-RAY 20% COINSURANCE 50% COINSURANCE IMAGING (CT/PET SCANS, MRI S) 20% COINSURANCE 50% COINSURANCE REHABILITATION/HABILITATION 20% COINSURANCE 50% COINSURANCE CHIROPRACTIC CARE $20 COPAY PER VISIT 50% COINSURANCE ACUPUNCTURE $25 COPAY PER VISIT 50% COINSURANCE

10 PHBP Classic Premier PPO Prescription Drugs PRESCRIPTION DRUGS IN-NETWORK NON-NETWORK TIER 1 (GENERIC FORMULARY) $10 $10+50% COINSURANCE TIER 2 (PREFERRED BRAND) $30 $30+50% COINSURANCE TIER 3 (NON-PREFERRED BRAND) $50 $50+50% COINSURANCE TIER 4 (SPECIALTY DRUGS) $500 DEDUCTIBLE 50% COINSURANCE 30% UP TO $150 T1: $10 T2: $60 MAIL ORDER T3: $100 50% COINSURANCE T4: 30% UP TO $300

11 PHBP Classic Premier PPO Hospital Facility Service HOSPITAL FACILITY SERVICES IN-NETWORK NON-NETWORK INPATIENT HOSPITAL SERVICES 20% COINSURANCE 50% COINSURANCE OUTPATIENT SURGERY 20% COINSURANCE 50% COINSURANCE AMBULATORY SURGICAL CENTER 20% COINSURANCE 50% COINSURANCE

12 PHBP Classic Premier PPO Emergency Services EMERGENCY SERVICES IN-NETWORK NON-NETWORK EMERGENCY ROOM $150 COPAY PER ADMIT $150 COPAY PER ADMIT THEN 20% COINSURANCE THEN 20% COINSURANCE EMERGENCY 20% COINSURANCE 20% COINSURANCE URGENT CARE $25 COPAY PER VISIT 50% COINSURANCE

13 PHBP Classic Premier PPO Mental Health/ Substance Use Disorder MENTAL HEALTH/ IN-NETWORK NON-NETWOK SUBSTANCE USE DISORDER OUTPATIENT SERVICES $20 COPAY PER VISIT 50% COINSURANCE INPATIENT SERVICES 20% COINSURANCE 50% COINSURANCE

14 PHBP Classic Premier PPO Maternity MATERNITY IN-NETWORK NON-NETWORK PRENATAL & POSTNATAL CARE $25 COPAY PER VISIT 50% COINSURANCE DELIVERY & ALL INPATIENT SERVICES 20% COINSURANCE 50% COINSURANCE

15 PHBP Classic Premier PPO Medical Rates MEDICAL RATES EE $ EE+SP $1, EE+CH $1, FAM $1,912.93

16 PHBP CLASSIC PLUS PPO

17 PHB Classic Plus PPO With lower annual premiums but higher out-of-pocket medical costs than the PHBP Premier PPO, this option offers employees meaningful coverage while costing employers less.

18 PHBP Classic Plus PPO- Deductibles and Out-of-Pocket Max DEDUCTIBLE IN-NETWORK NON-NETWORK INDIVIDUAL $500 $1,500 FAMILY $1,000 $3,000 OUT-OF-POCKET MAX IN-NETWORK NON-NETWORK INDIVIDUAL OOP $4,000 $12,000 FAMILY OOP $8,000 $24,000

19 PHBP Classic Plus PPO- Anthem Classic PPO Physician Services PHYSICIAN SERVICES IN-NETWORK NON-NETWORK OFFICE VISIT COPAY $30 COPAY 50% COINSURANCE PREVENTIVE CARE $0 50% COINSURANCE DIAGNOSTIC LAB/X-RAY 20% COINSURANCE 50% COINSURANCE IMAGING (CT/PET SCANS, MRI S) 20% COINSURANCE 50% COINSURANCE REHABILITATION/HABILITATION 20% COINSURANCE 50% COINSURANCE CHIROPRACTIC CARE $30 COPAY PER VISIT 50% COINSURANCE ACUPUNCTURE $30 COPAY PER VISIT 50% COINSURANCE

20 PHBP Classic Plus PPO- Anthem Classic PPO Prescription Drugs PRESCRIPTION DRUGS IN-NETWORK NON-NETWORK TIER 1 (GENERIC FORMULARY) $5/20 50% UP TO $250 TIER 2 (PREFERRED BRAND) $40 50% UP TO $250 TIER 3 (NON-PREFERRED BRAND) $65 50% UP TO $250 TIER 4 (SPECIALTY DRUGS) 30% UP TO $250 50% UP TO $250 T1: $12.50 T2: $120 MAIL ORDER T3: $165 50% UP TO $250 T4: 30% UP TO $250

21 PHBP Classic Plus PPO- Anthem Classic Hospital Facility Services HOSPITAL FACILITY SERVICES IN-NETWORK NON-NETWORK INPATIENT HOSPITAL SERVICES 20% COINSURANCE 50% COINSURANCE OUTPATIENT SURGERY 20% COINSURANCE 50% COINSURANCE AMBULATORY SURGICAL CENTER 20% COINSURANCE 50% COINSURANCE

22 PHBP Classic Plus PPO- Anthem Classic Emergency Services EMERGENCY SERVICES IN-NETWORK NON-NETWORK EMERGENCY ROOM $150 COPAY PER ADMIT $150 COPAY PER ADMIT THEN 20% COINSURANCE THEN 20% COINSURANCE EMERGENCY 20% COINSURANCE 20% COINSURANCE URGENT CARE $30 COPAY PER VISIT 50% COINSURANCE

23 PHBP Classic Plus PPO- Anthem Classic MENTAL HEALTH/ IN-NETWORK NON-NETWORK SUBSTANCE USE DISORDER OUTPATIENT SERVICES $30 COPAY PER VISIT 50% COINSURANCE INPATIENT SERVICES 20% COINSURANCE 50% COINSURANCE

24 PHBP Classic Plus PPO- Anthem Classic Maternity MATERNITY IN-NETWORK NON-NETWORK PRENATAL & POSTNATAL CARE $30 COPAY PER VISIT 50% COINSURANCE DELIVERY & ALL INPATIENT SERVICES 20% CO INSURANCE 50% COINSURANCE

25 PHBP Classic Plus PPO- Anthem Classic Medical Rates MEDICAL RATES EE $ EE+SP $1, EE+CH $1, FAM $1,801.18

26 PHBP CALIFORNIA CLASSIC HMO

27 PHBP California Classic HMO With lower annual premiums and out-ofpocket medical costs than the Premier and Select PPOs, this is a valuable option available to employees in California only.

28 HMO Enrollment All Participants and their covered dependents MUST select an In-Network Primary Care Physician (PCP) Medical Group prior to receiving care. If you do not select a PCP by January 1, Anthem Blue Cross will pick one for you. You may change your PCP as often as you would like.

29 PHBP California Classic HMO Deductibles and Out-of-Pocket Max DEDUCTIBLE IN-NETWORK NON-NETWORK INDIVIDUAL $0 NOT APPLICABLE FAMILY $0 NOT APPLICABLE OUT-OF-POCKET MAX IN-NETWORK NON-NETWORK INDIVIDUAL OOP $2,000 NOT APPLICABLE FAMILY OOP $4,000 NOT APPLICABLE

30 PHBP California Classic HMO Physician Services PHYSICIAN SERVICES IN-NETWORK NON-NETWORK OFFICE VISIT COPAY $10 NOT COVERED PREVENTIVE CARE $0 NOT COVERED DIAGNOSTIC LAB/X-RAY $0 NOT COVERED IMAGING (CT/PET SCANS, MRI S) $100 COPAY PER TEST NOT COVERED REHABILITATION/HABILITATION $10 COPAY PER VISIT NOT COVERED CHIROPRACTIC CARE $10 COPAY PER VISIT NOT COVERED ACUPUNCTURE $10 COPAY PER VISIT NOT COVERED

31 PHBP California Classic HMO Prescription Drugs PRESCRIPTION DRUGS IN-NETWORK NON-NETWORK TIER 1 (GENERIC FORMULARY) $5/20 50% UP TO $250 TIER 2 (PREFERRED BRAND) $40 50% UP TO $250 TIER 3 (NON-PREFERRED BRAND) $65 50% UP TO $250 TIER 4 (SPECIALTY DRUGS) 30% UP TO $250 50% UP TO $250 T1: $12.50 T2: $120 MAIL ORDER T3: $165 50% UP TO $250 T4: 30% UP TO $250

32 PHBP California Classic HMO Hospital Facility Services HOSPITAL FACILITY SERVICES IN-NETWORK NON-NETWORK INPATIENT HOSPITAL SERVICES $250 COPAY PER ADMIT NOT COVERED OUTPATIENT SURGERY $125 COPAY PER ADMIT NOT COVERED AMBULATORY SURGICAL CENTER $125 COPAY PER ADMIT NOT COVERED

33 PHBP California Classic HMO Emergency Services EMERGENCY SERVICES IN-NETWORK NON-NETWORK EMERGENCY ROOM $100 COPAY PER VISIT COVERED AS IN NETWORK EMERGENCY $100 COPAY PER VISIT COVERED AS IN NETWORK URGENT CARE $10 COPAY PER VISIT COVERED AS IN NETWORK

34 PHBP California Classic HMO Mental Health/ Substance Use Disorder MENTAL HEALTH/ IN-NETWORK NON-NETWORK SUBSTANCE USE DISORDER OUTPATIENT SERVICES $10 COPAY PER VISIT NOT COVERED INPATIENT SERVICES $250 COPAY PER VISIT NOT COVERED

35 PHBP California Classic HMO Maternity MATERNITY IN-NETWORK NON-NETWORK PRENATAL & POSTNATAL CARE $10 COPAY PER VISIT NOT COVERED DELIVERY & ALL INPATIENT SERVICES $250 COPAY PER ADMIT NOT COVERED

36 PHBP California Classic HMO MEDICAL RATES EE $ EE+SP $ EE+CH $ FAM $1,378.98

37 PHBP HEALTH SAVINGS ACCOUNT (HSA)

38 PHBP Health Savings Account (HSA) This high-deductible PPO with an attached Health Savings Account (HSA) option brings our menu of medical benefits in line with current healthcare trends. While annual premiums are the lowest of all the options, out-of-pocket costs are the highest but employees and employers can make pre-tax contributions to a rolling savings account and use the funds to pay the deductible.

39 PHBP Health Savings Account (HSA) Deductibles and Out-of-Pocket Max DEDUCTIBLE IN-NETWORK NON-NETWORK INDIVIDUAL $2,700 $8,100 FAMILY $5,400 $16,200 OUT-OF-POCKET MAX IN-NETWORK NON-NETWORK INDIVIDUAL OOP $5,000 $15,000 FAMILY OOP $10,000 $30,000

40 PHBP Health Savings Account (HSA) Physician Services PHYSICIAN SERVICES IN-NETWORK NON-NETWORK OFFICE VISIT COPAY 20% COINSURANCE 50% COINSURANCE PREVENTIVE CARE $0 50% COINSURANCE DIAGNOSTIC LAB/X-RAY 20% COINSURANCE 50% COINSURANCE IMAGING (CT/PET SCANS, MRI S) 20% COINSURANCE 50% COINSURANCE REHABILITATION/HABILITATION 20% COINSURANCE 50% COINSURANCE CHIROPRACTIC CARE 20% COINSURANCE 50% COINSURANCE ACUPUNCTURE 20% COINSURANCE 50% COINSURANCE

41 PHBP Health Savings Account (HSA) Prescription Drugs PRESCRIPTION DRUGS IN-NETWORK NON-NETWORK TIER 1 (GENERIC FORMULARY) $5/$15 50% UP TO $250 TIER 2 (PREFERRED BRAND) $40 50% UP TO $250 TIER 3 (NON-PREFERRED BRAND) $60 50% UP TO $250 TIER 4 (SPECIALTY DRUGS) 30% UP TO $250 50% UP TO $250 T1: $12.50 T2: $120 MAIL ORDER T3: $180 50% UP TO $250 T4: 30% UP TO $250

42 PHBP Health Savings Account (HSA) Hospital Facility Services HOSPITAL FACILITY SERVICES IN-NETWORK NON-NETWORK INPATIENT HOSPITAL SERVICES 20% COINSURANCE 50% COINSURANCE OUTPATIENT SURGERY 20% COINSURANCE 50% COINSURANCE AMBULATORY SURGICAL CENTER 20% COINSURANCE 50% COINSURANCE

43 PHBP Health Savings Account (HSA) Emergency Services EMERGENCY SERVICES IN-NETWORK NON-NETWORK EMERGENCY ROOM 20% COINSURANCE 50% COINSURANCE EMERGENCY 20% COINSURANCE 50% COINSURANCE URGENT CARE 20% COINSURANCE 50% COINSURANCE

44 PHBP Health Savings Account (HSA) Mental Health/Substance Use Disorder MENTAL HEALTH/ IN-NETWORK NON-NETWORK SUBSTANCE USE DISORDER OUTPATIENT SERVICES 20% COINSURANCE 50% COINSURANCE INPATIENT SERVICES 20% COINSURANCE 50% COINSURANCE

45 PHBP Health Savings Account (HSA) Maternity MATERNITY IN-NETWORK NON-NETWORK PRENATAL & POSTNATAL CARE 20% COINSURANCE 50% COINSURANCE DELIVERY & ALL INPATIENT SERVICES 20% COINSURANCE 50% COINSURANCE

46 Health Savings Account (HSA) ACCOUNT OWNERSHIP: EMPLOYEE/ INDIVIDUAL DEPOSITS MADE BY: EMPLOYER, EMPLOYEE, OR BOTH EXPENSES COVERED: MEDICAL, DENTAL, VISION, PRESCRIPTION, AND SOME OVER-THE-COUNTER EXPENSES.

47 HSA CONTRIBUTION LIMITS FOR 2019: - $3,500 SELF ONLY -$7,000 FAMILY - $1,000 CATCH UP

48 HSA FULL PORTABILITY FULL ROLLOVER REQUIRED FUNDS BECOME AVAILABLE AS DEPOSITS ARE CREDITED

49 HSA EMPLOYER CONTRIBUTIONS CAN BE MADE ON BEHALF OF CURRENT EMPLOYEES (ACCOUNTS EXTENDS TO SPOUSE AND DEPENDENTS) RETIREES CAN BE COVERED DEBIT CARD USAGE IS ALLOWED CONTRIBUTIONS FOR MEDICAL PARTICIPANTS CANNOT BE MADE ONCE AN INDIVIDUAL HAS COVERAGE USAGE OF INELIGIBLE EXPENSES IS ALLOWED. AMOUNTS INCLUDED IN INCOME; SUBJECT TO 20% PENALTY, UNLESS AFTER ACCOUNT BENEFICIARY S DEATH, DISABILITY OR ATTAINING THE AGE OF 65 DISTRIBUTIONS FOR EXPENSES INCURRED AFTER INDIVIDUAL IS NO LONGER ELIGIBLE CAN BE MADE WHEN USING HSA YOU MAY BANK AT ANY BANK THAT OFFERS HSA, OR UTILIZE ANTHEM S ACTWISE BANKING SYSTEM.

50 PHBP Health Savings Account (HSA) Medical Rates MEDICAL RATES EE $ EE+SP $ EE+CH $ FAM $1,275.65

51 2019 Ancillary Plan Options

52 Dental- Anthem Blue Cross DEDUCTIBLE IN NETWORK NON-NETWORK INDIVIDUAL $50 $50 FAMILY 3X INDIVIDUAL DED 3X INDIVIDUAL DED WAIVED TIER FOR DEDUCTIBLE TIER 1 TIER 1 TIER COPAYS IN NETWORK NON-NETWORK TIER 1 DIAGNOSTIC & CLEANING 100% 100% TIER 2 BASIC SERVICES 80% 80% TIER 3 MAJOR SERVICES 50% 50% TIER 4 ORTHODONTIA 50% 50% TIER 1-3 BENEFIT MAXIMUM $1,500 $1,500 TIER 4 BENEFIT MAXIMUM $1,500 $1,500

53 Vision-MetLife DEDUCTIBLE IN NETWORK COPAY FREQUENCY EXAMS $10 12 MONTHS FRAMES $200 ALLOWANCE 12 MONTHS FRAME ALLOWANCES IN NETWORK COPAY FREQUENCY SINGLE VISION $25 12 MONTHS BIFOCAL $25 12 MONTHS TRIFOCAL $25 12 MONTHS POLYCARBONATE $25 12 MONTHS ANTI-REFLECTIVE COATING UP TO $41-$85 COPAY 12 MONTHS PROGRESSIVE LENSES UP TO $55 COPAY 12 MONTHS

54 Dental and Vision Bundle Rates EE $42.36 EE + SP $85.52 EE + CH $93.86 FAM $132.83

55 Staff Medical Options PHBP Staff Plan Options PHBP Classic Premier PPO PHBP Classic Plus PPO PHBP California Classic HMO PHBP Health Savings Account (HSA) EE $ $ $ $ EE + SP $1, $1, $ $ EE + CH $1, $1, $ $ FAM $1, $1, $1, $1,275.65

56 What s Next You have until December 1, 2018 to select your medical coverage and submit your staff and dependent enrollment forms. HMO Enrollments: All Participants and their covered dependents MUST select an In- Network Primary Care Physician (PCP) Medical Group prior to receiving care. You can also Check to see if your current doctor is in the HMO Network. It is strongly recommended that you enroll with your PCP immediately. All HMO enrollments that do not designate a PCP Medical Group will have one automatically assigned by Anthem Blue Cross. PCP selections can be changed at any time directly with Anthem Blue Cross. Payment is Due December 15th for coverage effective January 1, Signed 2019 Participation Agreements are due by January 1 and will be available online soon.

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