2023 AtlantiCare Benefits Booklet

Medical

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-14 PRESCRIPTION DRUG. ................15-17 ADDITIONAL MEDICAL PLAN RESOURCES........18-22 DENTAL...............23-24 VISION.....................25 LIFECENTER..............26 LIFE INSURANCE. .....27 DISABILITY...............28 VOLUNTARY OFFERINGS. ........29-32 SPENDING ACCOUNTS. ............33 RETIREMENT BENEFITS..................34 WELLNESS. .........35-38 LEGAL NOTICES...39-41 GLOSSARY..........42-43 FAQs...................44-46 CONTACTS.........47-48 FORMS................49-58

Make The Most Of Your Medical Benefits • Consider the “Engaged Plan.” The contributions are low cost, and unless you have many physicians who are out of network, the Horizon Engaged Plan’s Blue Card network should meet your needs. • Preventive Care at No Cost – Preventive care is comprised of a variety of clinical services and programs, including annual doctor’s checkups, annual immunizations and screenings. Make sure your provider codes all eligible claims as preventive care in order to be eligible for 100% coverage. • Out-of-Pocket Maximums – You are protected from catastrophic medical expenses by the annual out-of-pocket maximum. When your out-of-pocket expenses (deductibles, copays and coinsurances) reach the out-of-pocket maximum, the plan pays the full cost for any covered care you receive for the rest of the year. • Contact Horizon before a procedure to determine what you can expect to pay and to ensure any pre-authorizations have been completed. • Consider participating in Flexible Spending Accounts to supplement your out-of-pocket expenses. • Complete wellness activities to earn credits to reduce your deductible if your enrolled in the Horizon Engaged plan, buy down your bi-weekly contributions if you are enrolled in the Horizon PPO plan. or if you waive, it will be applied a Health Reimbursement Account (HRA) paid on an FSA card. • Utilize an AtlantiCare Primary Care Plus provider. In both medical plans, these providers are only a $10 copay for office visits, compared to a $50 copay for primary care providers that are not AtlantiCare Primary Care Plus designated. Wellness credits will be earned for using one of these providers for your Annual Preventative Care Visit. To earn this designation, our providers have taken meaningful steps toward the patient-centered medical home model, which means offering same- or next-day urgent appointments, implementing a common electronic medical record, collaborating with AtlantiCare Care Managers for complex patients and allowing hospitalists to care for patients admitted to ARMC. To find an AtlantiCare Primary Care Plus provider, call the AtlantiCare Access Center at 1-888-569-1000 or visit www.atlanticare.org .

Waiving Benefits If you waive your medical benefits, $12.50 per pay* will be deposited into a Healthcare Reimbursement Account (HRA). See Spending Accounts on page 34 for more information. In addition, your earned wellness credits from 2022 of up to $750 will also be deposited into this account that will be applied the following year . See Wellness starting on page 33 for a list of wellness activities and their values. Please visit https://myatlanticare.org to view your online wellness activity checklist or call Health Engagement at 1-609-677-7507 if you have questions about your wellness activities. *If you are covered by another AtlantiCare employee and you waive medical coverage, you will not be eligible for the waiver benefit.

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