AtlantiCare 2022 Benefits Booklet

Medical Plan FAQs

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

What if AtlantiCare does not provide the service I require? AtlantiCare is able to provide you with enhanced benefits when you utilize our services because the dollars spent for these services stay within AtlantiCare. While AtlantiCare offers most services, not all services are provided at the AtlantiCare Tier 1 level. If you require services outside of AtlantiCare you will still have access to these services. However, depending on the plan you choose, you will be required to pay for them at the Horizon (Tier Two) benefit level. If the service can only be provided through an out- of-network provider, please contact your insurance carrier, Horizon, to file an appeal prior to receiving the service. Helpful Tip: If you know that you will need services performed at another facility, utilize your FSA account to help you budget for the expense and reduce your taxable income at the same time. No, personal medical information is not part of your HR file. Neither HR staff nor your management team have access to your personal medical information. AtlantiCare Health Engagement, a separate company within AtlantiCare, collects data and administers the wellness program. Health Engagement is accountable under a number of federal and state laws to maintain any employee health information it obtains in separate, confidential files. Can I have my annual preventive care visit certification performed by a specialist such as an OB/GYN? No. All preventive care visits must be performed by a primary care provider. If I enroll in the Horizon Engaged Plan, does that mean my personal medical information will become part of my HR file?

If I receive care at an AtlantiCare facility, are the doctors who treat me automatically considered AtlantiCare providers? No. For example, an anesthesiologist may not be covered even if they administer anesthesia at an AtlantiCare facility. Likewise, a physician who treats you at an AtlantiCare facility and then in another location, should not be automatically considered in- network. You are responsible for confirming network participation.

What should I do if I disagree with how a claim was paid? Contact Horizon directly at 1-800-355-2583 .

What should I do if 10-14 business days have passed and I have not yet received my medical plan ID card? You can obtain a temporary card online. For assistance with this, please contact Horizon at 1-800-355-2583 to obtain your member ID to register online.

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