AtlantiCare 2022 Benefits Booklet
AtlantiCare 2022 Benefits Booklet
2022 Benefits Workbook
Important decisions deserve a little homework. Before you enroll, make a commitment to take the time to understand all of your options and decide what’s best for you, your family and your health. The purpose of this Benefits Workbook is to provide you with important information to help you make the right choices that fit the needs of you and your family. AtlantiCare provides employees with a comprehensive and competitive benefits package to provide coverage to you and your family. It is important for you to make informed decisions and adopt healthy habits. This workbook highlights the 2022 benefits offered to you and your family. Please review all plans offered to recognize the difference in options available so you can decide which is best for your needs. Before choosing a plan, please check with your providers to verify their participation in the plan you are considering. Many of the providers being utilized by AtlantiCare employees and their dependents participate in all plans. Our own AtlantiCare providers and affiliates continue to be the lowest option. Please visit the Human Resources portal on The Starfish for participating physicians, facilities and other services for all plans.
Dear AtlantiCare Family,
Before we can care for our patients, we must first take care of ourselves. This begins when you actively engage with your health and wellness, adopting attitudes and behaviors that benefit your mind, body and spirit. On the following pages, you will find information about the medical plans and wellness benefits available to you and your loved ones as a member of the AtlantiCare family. Please take time to carefully explore all of the options you have to choose from and select the plans that work best for you. I am proud of AtlantiCare’s continuing efforts to research and design comprehensive, affordable and meaningful wellness programs and benefits options for you and your family. Everyone’s health situation is different. That’s why we provide a wide variety of options to assist you in planning for unforeseen emergencies while offering the tools you can use to build lifelong healthy habits. As an organization, our focus is on the health and well-being of our community, and that begins at home. When you take control of your health and promote health and wellness within your family, you are playing an active role in our success. Thank you for engaging in your own health and that of your families. By modeling healthy behaviors, you help us achieve our vision of building healthy communities together.
Keep making a difference,
Lori Herndon President and CEO AtlantiCare
What’s New for 2022
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
• Adjusted Salary Bands and Contributions. Please refer to 2022 Medical Plan Biweekly Contribution Rates on page 10. • Telehealth visit copay reduced from $20 to $5 when using AtlantiCare’s Telehealth program. • Effective January 1, 2022, the medical waiver amount reduces to $12.50 per pay into your FSA/HRA account for waiving the medical benefits. You are still able to earn up to an additional $750 for completed Wellness Activities. New Voluntary Benefits Employee Purchasing Program from Purchasing Power – Get what you need now and pay over time, right from your paycheck. No credit check, down payment or hidden fees. 2022 Wellness Activity Checklist • The Wellness Activities and credit amounts have changed. Please review on page 52.
2022 Benefits Changes • Changes to Tier 2 copays and coinsurance
• Pharmacy – increased copays and coinsurance for prescriptions filled at a non-AtlantiCare pharmacy • Lower telehealth visit copay when using AtlantiCare’s Telehealth program • Changes to Out-of-Pocket Maximums • Employee Contribution Changes • Medical Waiver Changes • New Dental Carrier – Horizon Dental. Look for new ID cards to arrive via mail • Vision – reduced premium contribution rates • New Voluntary Benefit – Purchasing Power • Changes to Wellness Activity Checklist
Medical Plan Changes • Horizon Engaged Plan Tier 2 deductible increase from $2,000/$4,000 to $2,500/$5,000. Wellness Credits can reduce deductible to $500/$1,000. • Horizon Engaged Plan Tier 2 inpatient copay increases from $1,000 to $1,250. • Tier 2 High Tech imaging (ex: PET Scan, MRI, CAT Scan) increases to 30% coinsurance after deductible when services are performed at a freestanding facility or in an office. • Our prescription program will continue to afford you with low cost medications at our employee pharmacies in person or through mail order. Prescriptions filled at a non-AtlantiCare pharmacy will see an increase in copays and coinsurances. Please refer to page 14. • Changes to Out-of-Pocket Maximums – In keeping with ACA IRS limits, medical out-of-pocket maximums adjust to $6,950 for single coverage, $13,900 for family coverage.
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Service Centers and Websites
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-19 DENTAL...............20-22 VISION.....................23 LIFECENTER..............24 LIFE INSURANCE. .....25 DISABILITY...............26 VOLUNTARY OFFERINGS. ........27-30 SPENDING ACCOUNTS. ............31 RETIREMENT BENEFITS..................32 WELLNESS. .........33-36 LEGAL NOTICES..37-39 GLOSSARY..........40-41 FAQs...................42-44 CONTACTS.........45-46 FORMS................47-53
AtlantiCare Benefits Service Center 1-800-211-3252 Monday through Friday, 8:00 am – 6:00 pm Saturday, 8:00 am – 5:00 pm You can access the AtlantiCare Benefits Service/Enrollment Site to make your elections via MyOwnRecords ( www.portal.adp.com ). Navigate to the Benefits tab and click Health and Welfare. For more information, see How to Enroll on page 5. Chat and Co-browsing available Monday through Friday 8:00 AM to 8:00 PM EST, excluding all major US holidays. Access via MyOwnRecords ( www.portal.adp.com ). FSA Employee Benefits Center 1-800-307-0230 Monday through Friday, 8:30 am – 5:30 pm myflexdollars.com See Contacts on page 48 for specific benefit policies. Wellness Customer Service Team 609-677-7507 Monday through Friday, 7:30 am – 4:00 pm wellness@atlanticare.org Call the Wellness Customer Service Team for inquiries related to Wellness Credits, Wellness Activities and Wellness Program details.
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How To Enroll
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
? WHO CAN BE COVERED UNDER YOUR COVERAGE Eligible dependents include: • Your spouse or domestic partner *If you would like to add a domestic partner as a dependent, you will need to complete the online portal process, including dependent verification, to get your domestic partner verified and added. You will be required to provide documentation confirming registry of domestic partnership with a local government. Note that domestic partners are eligible for only medical, prescription drug, dental and vision insurance. • Dependent children, including adopted children, foster children in your care and stepchildren. Children are eligible until the end of the year of their 26th birthday. • Other minor children if you are a legal guardian • Children over age 26 with mental or physical impairments may be eligible – physician certifications must be provided ! QUALIFYING LIFE EVENTS (QLE) If you experience a Qualifying Life Event, you have 30 days to make the necessary changes to your benefits. You can make changes through MyOwnRecords ( www.portal.adp.com ) or call the AtlantiCare Benefits Service Center (1-800-211-3252). Documentation must be submitted to confirm the event, or your old elections will be activated. Examples of a QLE include: • Adoption • Birth of a child • Marriage • Divorce • Death of a dependent
Spend time to learn about your benefit options so you can make the best decisions for you and your family based on your needs. Make Sure You… • Read this Benefits Workbook • Review your dependent information • Use the decision tool found on the enrollment website to help you
decide which plans are best for you and your family • Consider participating in flexible spending accounts and other voluntary offerings • Review the 2022 Wellness Activity Checklist • Confirm your elections!!! Your elections will be enforced for the full plan year unless you experience a Qualifying Life Event.
The choices you make during Open Enrollment will go into effect on January 1, and remain until December 31, unless you have a qualified life event. Newly eligible employees must actively elect to either participate in or waive benefits. Those who fail to confirm enrollment within 30 days will be automatically enrolled in the Horizon Engaged Plan – ‘Employee Only,’ Tobacco surcharge and the Basic Dental Plan – ‘Employee Only.’ The choices you make as a new hire are effective the first of the month after you are hired, until December 31.
• Employee/dependent lose other coverage • Employee/dependent gain other coverage
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How To Enroll
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
u Login to MyOwnRecords ( www.portal.adp.com )
u Click Benefits on the left side. An Annual Enrollment / New Hire tile will appear, informing you how many days you have to enroll.
u Hover over Benefits tab, then click Health & Welfare .
u Click ENROLL NOW to make 2022 elections. u Confirm Your Elections. u Click Complete Enrollment . u Review Benefits Summary. Click Confirm Enrollment . A confirmation message will appear.
u Read the message and click I AGREE . u Download to save or print confirmation statement.
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Medical
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
You have two choices in Medical Plan coverage: • Horizon Engaged Plan • Horizon Preferred Provider (PPO) Plan
You have two choices in medical plan options administered by Horizon Blue Cross Blue Shield: Horizon Engaged Plan and Horizon Preferred Provider (PPO). Horizon Blue Cross Blue Shield Blue Card provides access to one of the broadest networks in the country. Both options include access to AtlantiCare Inner Circle (Tier 1) physicians and you pay less when you are able to use these providers. Horizon Engaged Plan The Horizon Engaged Plan offers a lower biweekly contribution in return for your commitment to engage in your health. You will have the opportunity to complete activities to earn wellness credits that will reduce the deductible up to $2,000 for single coverage and up to $4,000 for spouse or family coverage (wellness credits do not apply to children) that will be applied the following year . For a complete description of activities, please refer to the “Wellness” section in this booklet. You will need to complete these activities by their specific due date to earn the associated wellness credits. Features • Wellness credits earned reduce the deductible. • Two-tiered network of providers – AtlantiCare Tier (Inner Circle/ Tier1) and the Blue Cross Blue Shield (Tier 2) • Providers in both tiers are considered in-network providers but pay differently. This means that the same services are covered in both tiers, but when you utilize AtlantiCare and its affiliates, you pay less out-of-pocket. • When you use the Blue Cross Blue Shield Tier you have additional costs. In some cases, the additional costs could be up to a $1,000 copay and then 30% of the cost of services. • This plan does not cover physicians and facilities who do not participate in the national Blue Cross Blue Shield network. • If services are not available at AtlantiCare, your responsibility will be at the Tier 2 level of coverage.
Horizon Preferred Provider Plan (PPO) The Horizon Preferred Provider Plan includes the same benefits and provider network as the Horizon Engaged Plan but also offers coverage for physicians and facilities outside of the national Blue Cross Blue Shield network. This plan is the most expensive when it comes to how much you contribute each pay period. However, your pay cost can be reduced if you complete wellness activities. By completing wellness activities, you can earn up to $750 for single coverage and up to $1,500 for spouse or family coverage (wellness credits do not apply to children). Earned wellness credits are applied to the total cost of your medical contribution and divided over 26 pay periods for the following year. For a complete description of activities, please refer to the “Wellness” section in this booklet. You will need to complete these activities by their specific due date to earn the associated wellness credits. Features • Wellness credits earned reduce your contributions. • Includes the same benefits and provider networks as the Horizon Engaged Plan, but also offers coverage for physicians and facilities outside of the national Blue Cross Blue Shield network.
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Medical
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
! EXTRA FACTS ABOUT YOUR HORIZON PLANS • Your medical plan offers coverage for eye exams and vision hardware • Horizon’s Blue365 discount plan offers nationwide discounts on health and wellness products and services • You can connect with Horizon’s online services to access explanation of benefits (EOBs), claim forms, health news updates and chat services
Horizon Preferred Provide Plan (PPO) continued • Utilizing AtlantiCare and its affiliates for service will result in the lowest out-of-pocket cost. • Some services performed through a Blue Cross Blue Shield network provider will be covered at 70% after the deductible is met. • When you use the Blue Cross Blue Shield network, services will usually be paid at 50% after the deductible is met. • If services are not available at AtlantiCare, your responsibility will be at the Tier 2 or Out-of-Network level of coverage. For both plans visit http://atlanticare.horizonblue.com to find a participating physician, facility or other service provider.
The Plans At A Glance
HORIZON ENGAGED HORIZON PPO
Has AtlantiCare Network
Has “Out-of-Network” Providers
Has $1,000 Copay When Using Non-AtlantiCare Facilities
Lowest Contributions
Wellness Credits Reduce Deductible
Wellness Credits Reduce Contributions
Access to Telehealth Benefit
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Medical
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
? SPOUSE & PARTNER PREFERRED CHOICE PREMIUM AtlantiCare continuously balances the need to offer meaningful and comprehensive employee benefits with the need to remain financially sound in the current healthcare environment. To achieve this balance, we require a Spouse and Partner Preferred Choice Premium. This premium will be applied to your bi-weekly contribution if your spouse/partner chooses to obtain medical coverage through AtlantiCare when they have the option of obtaining benefits through their own employer. This premium will not be applied if your spouse/partner is not offered benefits through their employer, is not currently employed or also works at AtlantiCare. The premium is $75 per paycheck if your base salary is less than $110,000, and $125 per paycheck if your base salary is $110,000 or more. AtlantiCare will conduct audits throughout the year, during which you will be asked to supply documentation (i.e., a letter from employer or tax return showing no income) if you have indicated that your spouse/partner is not eligible for medical coverage by their own employer. This acknowledgment is considered a legal process and should be treated as such. If your spouse is self-employed and not obtaining benefits through their business, they will need to supply proof of self-employment.
! TELEHEALTH BENEFIT
You can use AtlantiCare’s Telehealth program for care such as Behavioral Health, Cardiology, OB/GYN, Primary Care and many more service lines. Your copay is $5 when you use AtlantiCare’s Telehealth program. Call 1-833-692-7436 for more information or to schedule an appointment. Scheduling can also be made at www.providers. atlanticare.org
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Medical
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
2022 Medical Plan Bi-Weekly Contribution Rates
Full-Time
Part-Time
$0-49,999k $50-109,999k $110,000-199,999k
$200k+
$0-49,999k $50-109,999k $110,000-199,999k $200k+
Horizon Engaged Plan
Employee
$38.10 $46.11
$84.99
$94.01 $76.08 $87.69
$169.97
$188.00
Employee + Spouse
$65.25 $78.96
$145.54
$160.99 $130.28 $150.16
$291.07
$321.94
Employee + Child(ren)
$52.59 $63.64
$117.34
$129.76 $105.01 $121.04
$234.61
$259.50
Family
$104.20 $126.08
$232.40
$257.08 $208.03 $239.78
$464.79
$514.10
Horizon PPO
Employee
$151.76 $167.32
$208.54
$217.27 $179.71 $198.13
$323.40
$337.97
Employee + Spouse
$259.89 $286.54
$357.12
$372.06 $307.76 $339.30
$555.54
$578.79
Employee + Child(ren)
$209.47 $230.96
$287.86
$299.92 $248.07 $273.49
$ 447.77 $466.50
Family
$415.00 $457.53
$570.27
$594.14 $491.44 $541.81
$887.10
$924.24
*$25 surcharge will be added to your bi-weekly deductions if you utilize tobacco products. A Spouse & Partner Preferred Choice Premium may also apply. See page 9 for details. ** Note, salary changes may result in changes to your contribution rate
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Medical
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
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, buy down your bi-weekly contributions or apply to your 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. 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 2021 of up to $750 will also be deposited into this account. See Wellness starting on page 36 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. ? KNOW BEFORE YOU GO Always check to see if AtlantiCare can perform the service before scheduling somewhere else. If it is a routine procedure, the AtlantiCare Access Center should be able to refer you appropriately. Never assume your provider is referring you to a Inner Circle/Tier 1 provider. Please contact Horizon Customer Service for verification of provider’s tier level.
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Medical Compare 2022 Plan Choices
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Horizon Engaged Plan
PPO Plan
Medical Services
Inner Circle/Tier 1
Tier 2
Inner Circle/Tier 1
Tier 2
Out-of-Network
Deductible (per person/per family)
$2,000/$4,000
$2,500/$5,000*
N/A
$1,000/$2,000
$2,000/$4,000
*Wellness credits can reduce deductible to $500/1,000
Out-of-Pocket Maximum after Deductible (per person/per family)
$6,950/$13,900
$6,950/$13,900
$8,800/$17,600
Facility Benefits
Covered 100% after deductible
Covered 100% after $1,250 copay/visit and deductible
Covered 100% after deductible
Covered 100% after $750 copay/visit
$2,000 copay/visit then covered 50%; no deductible
Room & Board / Ancillary
Outpatient Facility Benefits
Covered 100% after $25 copay and deductible Covered 100% after $25 copay and deductible Covered 100% after deductible Covered 100% after deductible Covered 100% after deductible
Outpatient Surgery (Hospital Based)
Covered 70% after $1,000 copay/visit and deductible
Covered 100% after $25 copay
Covered 100% after $750 copay/visit
$2,000 copay/visit then covered 50%; no deductible
Outpatient Surgery (Surgical Center)
Covered 70% after $750 copay/visit and deductible
Covered 100% after $25 copay
Covered 100% after $500 copay/visit
Covered 50% after deductible
Physician Services
Covered 70% after deductible Covered 70% after deductible Covered 70% after deductible Covered 100% after $50 copay/visit; all other services rendered in the office covered 70% after deductible Covered 100% after $65 copay/visit; all other services rendered in the office covered 70% after deductible
Covered 50% after deductible Covered 50% after deductible Covered 50% after deductible
Surgeon
Covered 70% after deductible
Covered 100%
Anesthesia
Covered 70% after deductible
Covered 100%
Inpatient Physician Visit
Covered 70% after deductible
Covered 100%
Covered 100% after $50 copay/visit and wellness deductible; all other services rendered in the office covered 70% after deductible
Covered 100% after $10 copay and deductible
Physician Office Visits - Primary Care
Covered 100% after $10 copay/visit
Covered 50% after deductible
Covered 100% after $65 copay/visit and wellness deductible; all other services rendered in the office covered 70% after deductible
Covered 100% after $10 copay and deductible
Physician Office Visits - Specialist
Covered 100% after $10 copay/visit
Covered 50% after deductible
Covered 50% after deductible
Physician Office Visits - Routine Well Care
Covered 100%
Covered 100%
Covered 100% Covered 100%
This chart is meant as an overview only. For detailed information, please refer to the Summary Plan Description posted under “Benefit Information” on the HR Portal: Benefits Tab. * For Engaged Plan only, the deductible can be reduced through wellness credits ** AtlantiCare also covers some services for gender assignment. Check the plan document for more information.
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Medical
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Compare 2022 Plan Choices
Horizon Engaged Plan
PPO Plan
Medical Services
Inner Circle/Tier 1
Tier 2
Inner Circle/Tier 1
Tier 2
Out-of-Network
Supplemental Services
Covered 100% after $5 copay/visit
Covered 100% after $20 copay/visit
Covered 100% after $5 copay/visit
Covered 100% after $20 copay/visit Covered 100% after $50 copay/visit and deductible; all other services rendered in the office covered 70% after deductible Office and freestanding clinic: Covered 100% after $50 copay/visit and deductible Facility: Covered 70% after deductible Office and freestanding clinic: Covered at 70% after deductible for services performed at a freestanding facility or in an Office Facility: Covered 70% after deductible Covered 100% after $150 copay
Covered 100% after $20 copay/visit
Telemedicine
Covered 100% after $20 copay and deductible
Covered 100% after $50 copay/visit and deductible; all other services rendered in the office covered 70% after deductible
Covered 100% after $20 copay and deductible
Urgent Care
Covered 100% after $60 copay
Covered 100% after $150 copay and deductible
Covered 100% after $150 copay and deductible
Covered 100% after $150 copay
Emergency Services
Covered 100% after $150 copay
Office and freestanding clinic: Covered 100% after $50 copay/visit and deductible
Covered 100% after $10 copay and deductible
Covered 100% after $10 copay/visit
Covered 50% after deductible
Diagnostic X-ray
Facility: Covered 70% after deductible
Covered at 70% after deductible for services performed at a freestanding facility or in an Office Facility: Covered 70% after deductible
Covered 100% after $10 copay and deductible
Diagnostic hi-tech imaging
Covered 100% after $10 copay/visit
Covered 50% after deductible
Covered 100% after $10 copay/visit and deductible
Covered 100% after $50 copay/visit and deductible
Covered 100% after $10 copay/visit
Covered 70% after deductible
Covered 50% after deductible
Diagnostic Tests
This chart is meant as an overview only. For detailed information, please refer to the Summary Plan Description posted under “Benefit Information” on the HR Portal: Benefits tab.
Vision care expense benefit for all plans (no network limitations) Routine Vision Exam annually $70 Eyeglasses and/or Contact Lenses every two years $60 Must submit a claim form for reimbursement.
*For Engaged Plan only, the deductible can be reduced through wellness credits **AtlantiCare also covers some services for gender assignment. Check the plan document for more information.
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Prescription Drug
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Regardless of which medical plan option you choose, you automatically receive prescription drug coverage through MedImpact. You do not need to enroll separately in the prescription plan. Prescription coverage is included as part of the Medical plan enrollment. Your prescription plan information can be found on your prescription ID card. Refer to the table below for the copay amounts you will pay under the Prescription Drug plan. The maximum amount that you will pay for prescriptions per year: Single $1,750/Family $3,500. For more information about prescription benefits, see Prescription Plan FAQs on page 47.
Non-Specialty Medications
AtlantiCare Pharmacy (Retail & Mail Order) Generic Brand Preferred Brand Non-Preferred
Copays for 30/90-day supply $10/$20 $20/$40 $50/$100
Non-AtlantiCare Retail Pharmacy Generic Brand Preferred Brand Non-Preferred Specialty Medications AtlantiCare Retail Pharmacy Generic Brand Preferred Brand Non-Preferred
Copays for 30-day supply 15% 30% 100%
Minimum $15 $35 N/A
Copays (up to 30-day supply) $10 $20 $50
*Other Specialty Pharmacy Generic Brand Preferred Brand Non-Preferred
Copays (up to 30-day supply) 10% 20% 30%
Maximum $150 $150 $150
*If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact MedImpact Customer Service for assistance in obtaining your medication.
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Prescription Drug
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Always consider using the AtlantiCare Pharmacy first, because it typically provides the least out-of-pocket cost.
AtlantiCare Pharmacy (Retail and Mail Order) The AtlantiCare Pharmacy offers AtlantiCare employees and their covered dependents the opportunity to fill prescriptions at a reduced cost. Medications can be filled for as little as $10 (generic) or $20 (brand name preferred) for a 30-day supply. Medication copay costs will double for a 90-day supply. There are three AtlantiCare Pharmacy locations:
? DID YOU KNOW?
AtlantiCare Pharmacy provides an online site to manage your prescription needs, order refills, transfer prescriptions from other pharmacies and much more. Visit https://atlanticare.refillmyrx.com to register and start managing your prescriptions today.
Atlantic City AtlantiCare HealthPlex, 1401 Atlantic Avenue Tel: 1-609-441-7088 Fax: 1-609-441-7089 Hours of Operation: Monday through Friday, 8:00 am to 6:00 pm
Galloway 54 West Jimmie Leeds Road
Tel: 1-609-404-7444 Fax: 1-609-404-7445 Hours of Operation: Monday through Friday, 8:00 am to 6:00 pm Saturday, 9:00 am to 4:00 pm
Manahawkin 517 Route 72W
Tel: 1-609-704-6800 Fax: 1-609-704-6801 Hours of Operation: Monday through Friday, 9:00 am to 5:00 pm
In the case of an emergency, you may use the AtlantiCare Community Pharmacy located inside ARMC City and Mainland Campuses. Hours of operation are Monday through Friday, 8:00 am to 8:00 pm and Saturday and Sunday, 9:00 am to 6:00 pm. Please note, you may utilize these pharmacies for emergencies only. They do not carry enough supply for employees’ daily usage.
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Prescription Drug
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Retail Pharmacies (non-AtlantiCare) You can utilize your MedImpact prescription card to access retail pharmacies nationwide. While most large chains participate in the network, we do have some exclusions. To find a participating pharmacy or to see if your medication is covered, visit the MedImpact Member portal at https://www.medimpact.com/web/login When you utilize these pharmacies, please consider the following: • Your copay may be higher than what you would pay at your AtlantiCare pharmacy. • If your medications are not categorized as generic or preferred brand, you may be responsible for the full cost of the prescription. • Any medication obtained from a non-AtlantiCare Pharmacy will only be filled for up to a 30-day supply (90-day supply not available). • Maintenance medications can only be refilled one time at a non-AtlantiCare pharmacy. • AtlantiCare pharmacy offers mail order service for all active employees and their dependents at no additional cost. Medications are delivered within 2-3 days. Mail order forms can be found on the HR Portal: Benefits tab on The Starfish or by calling the Galloway pharmacy at 609-404-7444 .
Specialty Medications AtlantiCare Pharmacy will process your specialty medications. Please note, specialty medications may require prior authorization, so please plan accordingly. If the AtlantiCare Pharmacy is unable to fill your request, they will direct you to contact MedImpact Customer Service for assistance in obtaining your medication.
? DID YOU KNOW
Members can request ID cards via MedImpact Customer Service ( 1-833-229-3595 ) and have the option to print a temporary ID card from the member website by logging onto www.medimpact.com until their new ID card is mailed to them.
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Additional Medical Plan Resources
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
AtlantiCare Health Services - FQHC*
If you have a medical condition such as diabetes, rheumatoid arthritis, congestive heart failure, cardiovascular disease or chronic obstructive pulmonary disease (COPD), you know how difficult it is to manage and coordinate all of the providers and finances involved in your care. Our staff is ready to help improve your health, simplify your life and reduce your out-of-pocket medical expenses.
The resources described here are available to you and your family regardless of which medical plan you elect. • Your physician copays will be waived and most of your medications will be completely free. Medications include Levemir, Humira, Lantus, Novolog, Januvia, Enbrel and others. What’s different about receiving care at these locations? • You will be at the center of a team working together to coordinate and manage your care. • Your personal health coach will be by your side every step of the way, and will also keep the care team informed of your care plan and progress. • The sites listed feature a convenient, on-site pharmacy where you can fill your prescriptions right after your appointment.
There are two convenient locations to provide and coordinate care for you:
Health Services
1401 Atlantic Avenue Suite 2500 and Suite 2600 Atlantic City, NJ 08401 Hours: Monday through Friday: 8:30 am to 6:30 pm 1-609-572-8800
54 Jimmie Leeds Road Suite 8 Galloway, NJ 08205 Hours: Monday through Thursday: 8:00 am to 6:00 pm 1-609-404-7300
*(Federally Qualified Health Center)
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Additional Medical Plan Resources
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
? DID YOU KNOW?
AtlantiCare Access Center Nurse Triage AtlantiCare offers telephonic nurse triage when your AtlantiCare Physician Group (APG) primary care provider practice is not available. After hours, a nurse is available to answer any questions related to your medical care. The hours vary by practice. However, they are typically available from 4:00 pm – 8:30 pm daily, including holidays and weekends. When you call you will speak with a registered nurse (with an average of 30 years experience) who will assess and evaluate your symptoms or injury over the phone, provide physician- approved medical information so you can make an informed decision about where and when to seek treatment, recommend next steps and, if necessary, refer you to the appropriate care and resources. Care Management As part of your benefits, our Nurse Care Managers are available to help you understand your healthcare options by: • Coordinating your healthcare services • Helping you understand and use your benefits in the most efficient way • Directing you to community resources, support groups, and health and wellness programs when appropriate • Navigating the healthcare system when dealing with a complex medical illness This is a free benefit as part of your affiliation with our APG primary care practices.
Medical Nutrition Therapy/Counseling with a registered dietitian is a covered benefit, offering six visits per calendar year. Nutritional Counseling is an important part of prevention and treatment of many diseases and conditions. Confirm network providers with your plan prior to scheduling an appointment. Call the AtlantiCare Access Center 1-888-569-1000 to schedule your appointment with an AtlantiCare Registered Dietitian.
You may speak to a Care Manager by calling 1-609-272-6297 .
Both Nurse Triage and Care Management are offered as free benefits . All medical and personal information is confidential and may only be shared with those involved in your care.
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Additional Medical Plan Resources
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
EMPLOYEE ASSISTANCE PROGRAM Feeling stressed, overwhelmed, need to talk?
There are many reasons to call the Employee Assistance Program. There is no need to enroll as this is offered as a benefit for all full, part-time and per diem employees and their immediate family members 18 and older. The Employee Assistance Program (EAP) is a wellness benefit that helps people cope with problems that affect your quality of life. This is a free and CONFIDENTIAL benefit to help you when you are experiencing problems that may affect your ability to function, both on the job and at home. EAP offers confidential, brief intervention services both over the phone and in person, seminars, conflict resolution, employee wellness trainings and support. In addition, EAP is able to help with treatment needs and any referrals that are needed for treatment.
The EAP services are provided by Master’s Level Counselors: • 24/7 toll-free EAP telephone line providing easy access to professional assistance • Free and Confidential
• Work/Life Balance • Anxiety and Stress • Depression • Substance Use • Communication Issues • Grief and Loss • Relationship Issues • Anger Management • Trainings and Seminars
Several convenient locations throughout Atlantic County. 24 hours a day, 7 days a week for support Service’s offered telephonically, virtually or in person.
WE ARE HERE TO HELP!
To learn more or to make an appointment, call 1-800-260-0808
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Additional Medical Plan Resources
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Health & Wellbeing Resources AtlantiCare and our community have many organizations dedicated to the health and well-being of you and your family. Below you will find information on many resources available at AtlantiCare and in the community. For additional resources, please visit NJ211.org , call the AtlantiCare Family Success Center 609 567-2900 , or the AtlantiCare Access Center at 1-888-569-1000 for more information.
Application Assistance Available*
AtlantiCare Resource
Community Resource
Category
Provider
Description
For More Information
Housing/Financial
Prudential
AtlantiCare’s retirement benefits partner offers monthly webinars on a variety of financial wellness topics including Buying/Selling a Home, Creating a Budget, the Basics of Savings & Investing, and much more. Credit counseling and homeowner education, and down payment assistance for employees looking to buy a primary residence in Atlantic City. Short term housing support such as past due rent, first month’s rent, security deposits, late payments, and furniture available for qualifying individuals. Funds are issued on a Families First Electronic Benefits Transfer (EBT) card that works like a debit card. This card can be used in person and online at most grocery stores and some participating farmers markets. AtlantiCare employees may be eligible for further discounted membership rate based on income and household size. Support for clothing related needs vary depending on agencies and availability.
Visit myatlanticare.org or the Human Resources page located on the Starfish for more information
Housing
AtlantiCare/ NJCC
Visit myatlanticare.org or the Human Resources page located on the Starfish. You can also contact 609-272-6324 .
Housing
NJ TANF/ General Assistance (GA)
Visit www.njhelps.org for more information.
Healthy Eating
SNAP Benefits
Visit www.njhelps.org for more information.
Physical Activity
LifeCenter
Email the Lifecenter@atlanticare.org for more information.
Clothing
Varies
Contact NJ211.org or the AtlantiCare Family Success Center at 609-567-2900 .
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Additional Medical Plan Resources
TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-13 PRESCRIPTION DRUG. ................14-16 ADDITIONAL MEDICAL PLAN RESOURCES........17-22 DENTAL...............24-25 VISION.....................26 LIFECENTER..............27 LIFE INSURANCE. .....28 DISABILITY...............29 VOLUNTARY OFFERINGS. ........30-33 SPENDING ACCOUNTS. ............34 RETIREMENT BENEFITS..................35 WELLNESS. .........36-39 LEGAL NOTICES...40-42 GLOSSARY..........43-44 FAQs...................45-47 CONTACTS.........48-49 FORMS................50-56
Application Assistance Available*
AtlantiCare Resource
Community Resource
Category
Provider
Description
For More Information
AtlantiCare offers tuition support/ reimbursement for qualifying staff including upfront payment for hard to fill positions. Helps with home heating costs and medically necessary cooling costs.
Education
Education Investment Program (EIP)
Visit the HR page on the Starfish and click on Education Investment Program to learn more. Visit www.nj.gov/dca/divisions/dhcr/ offices/hea.html for more information. Contact Hammonton Family Success Center for application assistance. Visit www.njpoweron.com for more information. Contact Hammonton Family Success Center for application assistance. Visit www.njshares.org for more information. Contact Hammonton Family Success Center for application assistance. Visit www.njhelps.org for more information.
Utilities
LIHEAP
Utilities
PAGE
Annual program provides assistance to low to moderate income NJ residents struggling to pay their electric/gas bills.
Utilities
NJ SHARES Energy assistance for middle income who do not qualify for other assistance programs; maximum grant is $700 for heating.
Child Care
NJ HELPS
Childcare assistance is available for qualifying individuals. Provides free or low-cost health care that may help pay for medical bills, doctor visits and prescriptions for qualifying individuals and families. AtlantiCare RN Care Managers are available to: • Coordinate your healthcare services • Help you understand and use your benefits in the most efficient way • Direct you to community resources, support groups and health and wellness programs when appropriate • Navigate the healthcare system when dealing with a complex medical illness
NJ Family Care/ Medicaid
Medicine or Any Health Care (Medical, Dental, Mental Health, Vision) Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)
Visit www.njhelps.org for more information.
AtlantiCare Care Managers
Contact AtlantiCare Care Management Department at 609-272-6294 .
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