Current and Prospective Employers 2019

Similar documents
2019 Staff Medical Plan Options

2019 California Freelance Employee

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

Highmark Health Insurance Company: Alliance Flex Blue PPO 1000 ONX (Base Plan)

Your Plan: Anthem Platinum Select PPO 20/10%/4000 Plus Your Network: Select PPO

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

$500 Individual/$1,500 Family for participating providers. $1,000 Individual/$3,000 Family for non-participating providers.

You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.

Blue Cross Blue Shield Blue Options ~ HSA (Health Savings Account)

Michigan Conference of Teamsters Welfare Fund: Benefit Package 1199 Coverage Period: 04/01/ /31/2018

Not applicable because there s no out-of-pocket limit on your expenses. The plan does not require a referral to see a specialist.

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

Important Questions Answers Why this Matters: For in-network providers AND out-of-network providers combined: $1,750 Individual; $4,250 Family

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

Anthem BCBS BlueCard PPO 90. Anthem BCBS CDHP 15/HSA

$20,000 Family for nonparticipating. Important Questions Answers Why this Matters:

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

Anthem: Self-Funded PPO Plan Coverage Period: 01/01/ /31/2015

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

Anthem BCBS BlueCard PPO 80

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: Network: $500 Individual $1,000 Family Non-Network: $1,500 Individual $3,000 Family

Anthem BCBS CDHP 15/HSA. Anthem BCBS BlueCard PPO 90. Anthem BCBS BlueCard PPO 80

Important Questions Answers Why this Matters:

limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.

Important Questions Answers Why this Matters:

BlueCard PPO % coinsurance 50% coinsurance 10% coinsurance 50% coinsurance 20% coinsurance $100 per day copay to maximum of $600

PreferredOne. Are there other deductibles for specific services? Is there an out-ofpocket. There are no other specific deductibles.

Important Questions Answers Why this Matters: $100 Member/$200 Family for PCP Benefit level. $250 Member/$500 Family for Self-Referred Benefit level.

Important Questions Answers Why this Matters: In-network: $200/Individual; $400/Family Out-of-network: $1,000/Individual; $2,000/Family

Anthem Blue Cross and Blue Shield East Central College Blue Access Choice PPO and Blue Preferred Select - Base Plan

Important Questions Answers Why this Matters: For in-network providers, $2,600 individual / $5,000 family For out-of-network providers,

Important Questions Answers Why this Matters: In-network: $4,100 person /

You don t have to meet deductibles for specific services.

Important Questions Answers Why this Matters:

Regence BlueCross BlueShield of Oregon: Regence Oregon Standard Silver Plan Coverage Period: Beginning on or after 01/01/2014

Important Questions Answers. Why this Matters:

Even though you pay these expenses, they don t count toward the out-ofpocket limit.

limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.

You don't have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers.

PreferredOne. Are there other deductibles for specific services? Is there an out-ofpocket. There are no other specific deductibles.

Important Questions Answers Why this Matters: In-Network: $500 Individual $1,000 Family Out-of-Network:

Galesburg CUSD #205 Medical Reimbursement Plan (MRP) & Affordable Care Plan ACP Coverage Period: 09/01/ /31/2018

Best Buy HSA PPO FLEX Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services

You don t have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers.

Important Questions Answers Why this Matters:

HC Capital Group, Inc. Coverage Period: Beginning on or after 1/1/14 High Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs

HEALTH PLAN BENEFIT SUMMARIES

Educators Health Alliance Coverage Period: 09/01/ /31/2017

HealthPartners. Are there other deductibles for specific services? Is there an out-ofpocket. There are no other specific deductibles.

Ohio University: Blue Access PPO Package 007 AFSMCE Bargaining Unit Coverage Period: 07/01/ /30/2015 Summary of Benefits and Coverage:

Important Questions Answers Why this Matters: $2,850 individual / $5,650. providers

Important Questions Answers Why this Matters:

Blue Cross Blue Shield PPO2 Medical Plan CVS Caremark 10/20/30 Prescription Plan

Important Questions Answers Why this Matters:

Medtronic HRA Plan Coverage Period: Beginning on or after

Important Questions Answers Why this Matters:

limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.

Highmark Blue Cross Blue Shield: BLUECARE CUSTOM PPO EXP Coverage Period: 01/01/ /31/2017

Important Questions Answers Why this Matters:

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

Ultimate PPO Coverage Period: Beginning on or after 1/1/2014

$0 See the chart starting on page 2 for your costs for services this plan covers.

Important Questions Answers Why this Matters:

Primary care visit to treat an injury or illness 10% coinsurance 30% coinsurance. Specialist care visit 10% coinsurance 30% coinsurance

Important Questions Answers Why this Matters:

01/01/ /31/2018 UMR: COLE COUNTY COMMISSION:

You can see the specialist you choose without permission from this plan.

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services

Land O Lakes, Inc.: $3,500/$7,000 HRA Plan Coverage Period: Beginning on or after

Blue Care Elect Preferred The MathWorks - PPO Plan Coverage Period: on or after 01/01/2017

Anthem BlueCross BlueShield Premier Plus POS / Optional Maternity Coverage 20% Summary of Benefits and Coverage:

Important Questions Answers Why this Matters:

Why This Matters: You don t have to meet deductibles for specific services.

limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.

Highmark West Virginia: Shared Cost Blue PPO 1000 Coverage Period: 01/01/ /31/2016

BlueCross BlueShield of North Carolina: Blue Cross Blue Shield 200, a Multi-State Plan

The Jay School Corp. Plan C

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters:

Maine's Choice Pemaquid Silver HMO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services

Important Questions Answers Why this Matters:

Administered by Capital BlueCross 1

You don t have to meet deductibles for specific services.

You don t have to meet deductibles for specific services.

Anthem Blue Cross Your Plan: Custom Lumenos HSA 2600/ /50 Embedded (LHSA500) Your Network: Prudent Buyer PPO

Oscar Silver Plan Coverage Period: 01/01/ /31/2015

deductible? This plan covers some items and services even if you haven't yet met the deductible amount. But a copayment or coinsurance may apply.

Important Questions Answers Why this Matters:

You don t have to meet deductibles for specific services, but see the chart starting

You don t have to meet deductibles for specific services.

Important Questions Answers Why this Matters: $2,000 person/$4,000 family for in-network; $4,000

HealthKeepers Anthem HealthKeepers 20/20/500 POS / $10/$30/$50 or 20% with $150 Ded Coverage Period: 11/01/ /31/2014

Important Questions Answers Why this Matters: What is the overall deductible?

Transcription:

Current and Prospective Employers 2019

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 2008. In 2013, the Plan expanded to offer Participating Employers two Staff Coverage package options.

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.

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, 2019. If you are interested, we will need your employee census data by February 1, 2018. Stay tuned for more information.

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.

PHBP CLASSIC PREMIER PPO

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 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

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

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

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

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

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

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

PHBP Classic Premier PPO Medical Rates MEDICAL RATES EE $612.13 EE+SP $1,359.63 EE+CH $1,112.42 FAM $1,912.93

PHBP CLASSIC PLUS PPO

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.

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

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

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

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

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

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

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

PHBP Classic Plus PPO- Anthem Classic Medical Rates MEDICAL RATES EE $576.35 EE+SP $1,280.20 EE+CH $1,047.44 FAM $1,801.18

PHBP CALIFORNIA CLASSIC HMO

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.

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.

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

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

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

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

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

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

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

PHBP California Classic HMO MEDICAL RATES EE $441.26 EE+SP $980.12 EE+CH $801.92 FAM $1,378.98

PHBP HEALTH SAVINGS ACCOUNT (HSA)

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.

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

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

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

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

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

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

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

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.

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

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

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.

PHBP Health Savings Account (HSA) Medical Rates MEDICAL RATES EE $408.19 EE+SP $906.67 EE+CH $741.83 FAM $1,275.65

2019 Ancillary Plan Options

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

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

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

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 $612.13 $576.35 $441.26 $408.19 EE + SP $1,359.63 $1,280.20 $980.12 $906.67 EE + CH $1,112.42 $1,047.44 $801.92 $741.83 FAM $1,912.93 $1,801.18 $1,378.98 $1,275.65

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, 2019. Signed 2019 Participation Agreements are due by January 1 and will be available online soon.