Welcome to benefits orientation for Vidant Medical Center Residents. In this presentation we will provide you with a brief overview of the benefits offered to Vidant Medical Center Residents and their eligible dependents. The information provided to you today will help prepare you in making your enrollment decisions. For your convenience you can find this presentation posted on the Vidant Medical Center and Vidant Health internet at www.vidanthealth.com, click on “For Employees” “Benefits” “Welcome to Our Family” and then “Benefits”. 0
You can read and review detailed information about any of the benefits topics shown on this slide 2 different ways: • From home (internet), go to www.vidanthealth.com. Once at the website click on the tab For Employees , then click on Benefits Information . • From work (intranet), go to the Vidant Health homepage. Follow this path – Click on Employee Central . You can browse this section for more information on our benefits or scroll down to “New to Our Family” for an overview about Employee Central and what is available. 1
• Medical, dental and vision coverage becomes effective on your first day of employment and deductions for benefits are taken every two weeks. • You can cover yourself only, yourself and your child(ren), yourself and your spouse/domestic partner, or family. Family coverage includes yourself, your spouse/domestic partner and your eligible child(ren). • Your eligible dependents include your spouse/domestic partner, and your children up to the day they turn age 26. If you enroll your dependents you must provide their social security numbers and date of birth in order for claims to be processed and paid. Proof of dependent eligibility may be requested. • You will be asked to attest that the named dependents on your medical, dental, and/or vision plans are qualified participants under the policy guidelines for Vidant Health. You will be asked to attest that you understand if documentation is ever requested to prove a dependent meets the plan(s) eligibility requirements that you have 30 calendar days to produce the requested documents. • Proof documents include: • State issued marriage certificate/license • State issued birth certificate or adoption certificate • Adoption placement agreement and petition for adoption • Qualified medical child support order • Proof of legal guardianship • State issued civil union and/or domestic partnership certificate/license • A copy of the Registration of your registered domestic partnership, or • Proof of financial interdependence, provide any three of the following that were issued within last 12 months: •Copy of your and your domestic partner’s driver’s license showing your current address • Joint mortgage or joint tenancy on a residential lease • Bank account in both names, or • Credit card in both names, or • Power of attorney for health care, or • Designation of each other as authorized signatures on safe deposit boxes, or 2
• Joint wills 2
• MedCost is our third party administrator and is the company that processes all medical claims. Your out of pocket costs are determined by whether you seek care from an in-network provider or an out of network provider. A list of providers can be found on the MedCost website at the website address shown on the slide. Once at the site click on “locate a provider” and select MedCost Ultra as the network. • You pay less out of pocket by seeing your PCP (primary care physician) or other in network providers. Seeing a doctor outside the network means you pay a higher share of the bill. • Participating network physicians outside of North Carolina, South Carolina and Virginia can be viewed on the MedCost website by selecting American Healthcare Alliance. • Insurance identification cards are mailed to your home address within 5- 10 business days. For enrollments made during our annual Open Enrollment, new cards, if applicable will be mailed prior to 1/1 • You should immediately access the MedCost website to register and create a username and password. Registering will allow you to check on the status of a medical claim for yourself and dependent and print explanation of benefits statements. You will also find information about 3
fitness, nutrition and other wellness links. • There are three basic parts to the health plan as shown on the slide that we will cover in a little more detail. 3
This slide shows the dollar amounts of the plan deductibles, out of pocket max and various co-pays. For more detailed information, refer to the summary plan description booklet posted on the Vidant Health website under the benefits section. 4
• The Vidant Employee Clinic is part of the Vidant Health family and provides screenings and services to keep you healthy. They can connect you with programs and resources that help you manage your and your dependents (age 16 & older) health. Your visit to the clinic requires a $5 co-payment if you are in the Vidant Health Medical plan and they are located at 600 Medical Dr. across from Doctors Park. The Vidant Employee Clinic is by appointment only. Office hours are Monday – Friday, 7am – 5 pm. Hours may vary during holidays. 5
• Employees may choose between a 70/30 plan or an 80/20 plan. With the 70/30 plan, insurance covers 70 percent of the claim and the employee pays the remaining 30 percent. With the 80/20 plan, insurance covers 80 percent of the claim and the employee pays the remaining 20 percent. • Employees enrolled in the medical plan are eligible to receive medical premium credits to help offset what you pay in medical premiums. Medical plan premium credits will be discussed later in this presentation. • This slide shows the in and out of network levels of coverage for both plans. • The family deductible is cumulative in that as each family member incurs cost it is added together to help you meet the family deductible. However, one person must meet the individual deductible. • The plan includes an annual deductible and coinsurance for all hospital services (inpatient and outpatient) and certain physician services that are not included in the office co-pay. 6
• The examples shown on this slide are subject to a one time annual deductible and then the plan will begin paying. • Hospital services such as inpatient visits are subject to the annual deductible. • In addition, some inpatient and outpatient services must be pre-certified. Consult the summary plan description for more details. • The examples on this slide are the more common items that fall under the deductible and is not all inclusive. Consult the summary plan description for more details. Please also note that pre-certifications will be required for all in-patient and out-patient MRI, CT and Pet Scans for domestic and non-domestic facilities. It is your responsibility as a plan participant to ensure that your/your covered dependents provider has completed the pre- certification process for these services. 7
• Minor Emergency Department is located on Arlington Blvd next to the hospital’s emergency room entrance. • We want to make sure you are aware that the Minor Emergency Department is part of the hospital’s emergency room and is not an urgent care center. • You should visit your primary care physician, urgent care center, or Vidant Employee Clinic for non-emergency services especially during the hours of Monday through Friday, 7am -5pm as this will help save you money. 8
• The prescription drug coverage is organized in tiers. There is no deductible associated with the purchase of your prescriptions. • Your cost will vary depending on the type of prescription drug you purchase. • You will pay between $5 and $10 for prescriptions at the employee pharmacy and $25 for a brand name prescription when a generic is available. • Retail pharmacy purchases are based on a three tier formulary guide as shown on the slide. • The annual out of pocket maximum is $2500 individual and $5000 family. • Co-pays from the purchase of prescription drugs are not applied to your medical deductible or out of pocket maximum. • Please also note that our plan utilizes step therapy and prior authorizations as a cost saving feature for both the employee and the plan. These features are discussed in detail on the following slides. 9
Utilization versus direct costs. Our health choices result in increased costs. Better health choices result in better overall health and reduced costs. What is Step Therapy? Program for people who take prescription drugs regularly for an ongoing condition. This program is an approach to getting you the prescription drugs you need, with safety, cost and – most importantly – your good health in mind. It allows you and your family to receive the treatment you need while making prescription drugs more affordable for you . A generic front-line medication will cost, on average, between 30% and 80% less than the equivalent brand-name drug . What is a Prior Authorization? • A cost -savings feature of your prescription benefit plan that helps ensure the appropriate use of selected prescription drugs • Designed to prevent improper prescribing or use of certain drugs that may not be the best choice for a health condition • Prior Authorizations may be obtained by working with your physician and pharmacy benefit manager (MedImpact) For additional information please contact MedImpact at 1.844.513.6009.
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