AtlantiCare Benefits Book 2020

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HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND EBSITES...................4 HO TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOU TS. ............30 RETIREMENT B NEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56 WHAT’S NEW SERVICE CENTERS AND WEBSITES HOW TO ENROLL MEDICAL PRESCRIPTION DRUG ADDITIONAL MEDICAL PLAN RESOURCES DENTAL VISION LIFE INSURANCE LONG TERM DISABILITY VOLUNTARY OFFERINGS SPENDING ACCOUNTS RETIREMENT BENEFITS WELLNESS LEGAL NOTICES CONTACTS GLOSSARY

• Discounts on vision services through EyeMed Vision Care – Eyewear, mail order contact lenses, and eye exams (can be used separately but not in combination with benefits under the plan) • Discounts on LASIK vision correction through US Laser Network – 15% discount off regular price or 5% off promotional price for LASIK and PRK treatments • Discounts on child safety products through Safe Beginnings – 15% discount • Local discounts for amusement/attractions, and fitness centers (not available in all areas; primarily in Central, Northeastern and Southern Pennsylvania) The AtlantiCare Engaged Plan Powered by Horizon • Second lowest per pay period contribution • Wellness credits reduce the wellness deductible by up to $2,000 for single coverage and up to $4,000 for spouse/partner or family coverage • Two-tiered network of providers – the AtlantiCare Tier and the Blue Cross/Blue Shield Tier • Same services are covered in both tiers, but when you utilize AtlantiCare and its affiliates, you pay less out of pocket • When you utilize the Blue Cross/Blue Shield national network (Blue Card), you have some additional costs. In most cases, the additional costs are a $1,000 copay and then 30% of the cost of services. This applies even when AtlantiCare does not offer a comparable service. • Visit http://atlanticare.horizonblue.com to find a participating physician, facility or other service provider. Little Known Benefits About The Horizon Plans • Eye Exams – one eye exam per year, $70 maximum reimbursement • Vision hardware – one pair of eyeglasses or contacts every 2 years, $60 maximum reimbursement • The Horizon Plan Discounts through Blue 365 – weight loss programs, gym discounts, hearing aid discounts, vision discounts, travel, wellness discounts. • Fitness Your Way program offers special pricing on Fitbits. • Free identity theft protection • CareOnline telemedicine program • To access log on to www.Atlanticare.horizonblue.com

You have three choices in Medical Plan coverage: • Engaged Plan Powered by Geisinger • Engaged Plan Powered by Horizon • Horizon Preferred Provider (PPO) Plan

All three options include access to AtlantiCare Tier 1 physicians, facilities and services, and you pay less when you use these providers. Each plan was designed to meet your family’s healthcare needs. However, access to physicians and facilities varies with each plan. The amount you pay toward the cost of the plan also varies. As you review your medical plan option, be mindful of how often you visit the doctor, the flexibility you want when choosing a doctor for your care and the cost of coverage. The AtlantiCare Engaged Plan Powered by Geisinger • Lowest per pay period contribution • Wellness credits reduce the wellness deductible by up to $2,000 for single coverage and up to $4,000 for spouse/partner or family coverage • Two-tiered network of providers – the AtlantiCare Tier and the Geisinger Tier • Same services are covered in both tiers, but when you utilize AtlantiCare and its affiliates, you pay less out of pocket • When you utilize the Geisinger network, you have some additional costs. In most cases, the additional costs are a $1,000 deductible and then 20% of the cost of services. This applies even when AtlantiCare does not offer a comparable service. • Visit http://www.thehealthplan.com/atlanticare to find a participating physician, facility or other service provider. Little Known Benefits About The Geisinger Engaged Plan • Eye Exams – one eye exam per year, $70 maximum reimbursement • Vision hardware – one pair of eyeglasses or contacts every 2 years, $60 maximum reimbursement • Discounts on massage therapy through ASHN – 25% discount • Discounts on chiropractic care and acupuncture through ASHN – 25% discount (can be used separately but not in combination with benefits under the plan)

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