arkansas public school health plan comparing plans copyright © 2012 five points ict, inc. all...
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Arkansas Public School Health Plan
Comparing Plans
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
DisclaimerThe content of this communication is for informational purposes only and is not intended as any form of professional advice. This communication is not intended to outline every benefit, limitation, or exclusion of the State-sponsored benefit plans.
For questions or advice about your benefits, please contact your human resources representative or the Arkansas Department of Finance and Administration Employee Benefits Division.
Five Points ICT, Inc. and its affiliate companies are not responsible for errors or omissions in this communication.
Copyright © Five Points ICT, Inc. All rights reserved.
Important Information
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
• The information in this video may not apply to all employees in all situations
• Always refer to your Summary Plan Description (SPD) for more details about your plan options
• You can find more info at www.ARBenefits.org
Why Compare?
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
• There are some important differences between your plan options, including:– Type of plan– Premium cost– Deductibles/Co-insurance/Co-pays– Out-of-pocket limits– Networks
Total Cost of Healthcare
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
Premium
+ Deductible
+ Co-payments
+ Co-insurance
=
Total Cost of Healthcare
Bronze Plan
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• High-Deductible Health Plan (HDHP) – Health Advantage Network– Must meet calendar year deductible before
plan pays for any service, other than preventive care, screenings or immunizations
• Health Savings Account (HSA) eligible– Use pre-tax dollars for qualified medical
expenses, like deductibles, co-insurance, and more
Bronze PlanPremiums
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Level of CoverageTotal Monthly Employee Cost
Employee Only Current Renewal
$ 0.00 $ 0.00
Employee & Spouse $108.70 $255.02
Employee & Child(ren) $ 0.00 $50.94
Employee & Family $111.22 $258.76
Bronze PlanDeductibles & Co-insurance
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• Deductible amounts:– $2,000 in-network (IN)/$4,000 out-of-
network (OON) for individuals– $3,000 IN/$8,000 OON for families
• Once deductible is met, plan pays 80% of maximum allowable charge (MAC) for covered in-network services
• No co-pays, except for vision/hearing screenings
Bronze PlanOut-of-pocket Limits
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• Out-of-pocket limits– $4,350 IN/$8,700 OON for individuals– $6,525 IN/$13,000 OON for families– After deductible is met– Co-payments, premiums, balance-billed
charges, and non-covered services not included
Silver Plan
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• Point-of-service plan: – QualChoice Network– Deductible, then combination of co-
payments and co-insurance– Premiums higher than Bronze Plan, but
lower than Gold Plan– Preventive care, screenings, immunizations
covered at no out-of-pocket cost
Silver PlanPremiums
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Level of CoverageTotal Monthly Employee Cost
Employee Only Current Renewal
$23.78 $ 124.00
Employee & Spouse $580.08 $ 745.04
Employee & Child(ren) $270.32 $ 489.82
Employee & Family $582.00 $957.30
Silver PlanDeductibles/Co-pays/Co-ins.
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• Deductible amounts:– $1,000 IN for individuals– $2,000 IN for families
• Once deductible is met, plan pays for covered in-network services according to the SPD
• You will have to pay co-pays and co-insurance for most services until your out-of-pocket limit is met
Silver PlanCo-Pays
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CoverageTotal Monthly Employee Cost
Physician Office Visit PCP Current Renewal
$ 25 $ 35
Office Visit – Specialist $ 50 $ 70
Rx Tier 1 – Generic $ 10 $ 15
Rx Tier 2 – Preferred $ 35 $ 40
Rx Tier 3 – non-preferred $ 70 $ 80
Rx – Specialty w/tier $ 100
Silver PlanOut-of-pocket Limits
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• Out-of-pocket limits– $3,000 in-network (IN)/$6,000 out-of-
network (OON) for individuals– $6,000 IN/$12,000 OON for families– After deductible is met– Co-payments, premiums, balance-billed
charges, and non-covered services not included
Gold Plan
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• Point-of-service plan –Blue Cross Network– Deductible, then combination of co-
payments and co-insurance– “Richest” plan– Preventive care, screenings, immunizations
covered at no out-of-pocket cost
Gold PlanPremiums
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Level of CoverageTotal Monthly Employee Cost
Employee OnlyCurrent Renewal
$ 92.92 $ 226.60
Employee & Spouse $893.42 $1,095.28
Employee & Child(ren) $ 447.70 $ 753.02
Employee & Family $896.18 $1,423.48
Gold PlanDeductibles/Co-pays/Co-ins.
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• No deductibles for individuals or families• Plan pays for covered in-network
services according to the SPD• You will have to pay co-pays and co-
insurance for most services until your out-of-pocket limit is met
Gold PlanCo-Pays
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
CoverageTotal Monthly Employee Cost
Physician Office Visit PCP Current Renewal
$ 25 $ 35
Office Visit – Specialist $ 35 $ 70
Rx Tier 1 – Generic $ 10 $ 15
Rx Tier 2 – Preferred $ 30 $ 40
Rx Tier 3 – non-preferred $ 60 $ 80
Rx – Specialty w/tier $ 100
Gold Plan
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• Out-of-pocket limits– $2,500 in-network (IN)/$5,000 out-of-
network (OON) for individuals– $5,000 IN/$10,000 OON for families– Co-payments, premiums, balance-billed
charges, and non-covered services not included
How to Decide
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
• All plans cover the same services• To decide which plan may be
best for you and your family, think about:– How many claims did you have the
last year? How many do you expect this year?
– How each type of plan works– Compare the cost of premiums
Proposed Premium Cost -2014
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
Level of CoverageTotal Monthly Employee Cost
Gold Silver Bronze
Employee Only $226.60 $124.00 $0.00
Employee & Spouse $1,095.28 745.04 $255.02
Employee & Child(ren) $753.02 $489.82 $50.94
Employee & Family $1,423.48 $957.30 $258.76
Deductibles for 2014
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Type of DeductibleAnnual Deductible
Gold Silver Bronze
Individual In-Network $0 $1000 $2000
Family In-Network $0 $2000 $3,000
Out-of-Pocket Limits for 2014
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
Type of OOP LimitAnnual OOP Limit
Gold Silver Bronze
Individual In-Network $2,500 $3,000 $4,350
Family In-Network $5,000 $6,000 $6,525
Total Premium Cost, Deductibles & Out-of-Pocket Limits for 2014
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
Total CostTotal Monthly Employee Cost
Gold Silver Bronze
Employee Only $5,219.20 $5,488.00 $6,350.00
Employee & Spouse $18,143.36 $16,940.48 $12,585.24
Employee & Child(ren) $14,036.24 $13,877.84 10,136.28
Employee & Family $22,081.76 $19,487.60 $12,630.12
Learn More
Copyright © 2012 Five Points ICT, Inc. All rights reserved.
• Contact Employee Benefits Division– 1-877-815-1017 “Just Press One”
• Additional info online– www.MyBenefitsChannel.com– www.ARBenefits.org
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