AtlantiCare Benefits Book 2020

Medical

HOME TABL OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 I E TERS AND EBSITES...................4 HOW 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

• All services provided outside of the Blue Cross/Blue Shield network will usually be paid at 50% of the cost after a $2,000 copay is met. • Visit http://atlanticare.horizonblue.com to find a participating physician, facility or other service provider. See Wellness starting on page 32 for more information about wellness activities. See Spending Accounts on page 30 for information about how spending accounts coordinate with your health plan options. ? DID YOU KNOW? There is no copay or deductible for your Annual Preventive Care Visit. You are eligible to have one covered annual Preventive Care Visit each calendar year.

The AtlantiCare Horizon Preferred Provider Plan (PPO) • Most expensive per pay period contribution • Wellness credits can reduce your contributions by up to $750 for single coverage and up to an additional $1,500 for spouse/partner or family coverage. Your earned credits are applied to the total cost of your medical contribution and divided over 26 pay periods for the following year. • Includes same benefits and provider networks as those provided in the AtlantiCare Horizon Engaged Plan, but also offers coverage for physicians and facilities outside of the national Blue Cross/Blue Shield network. • Utilizing AtlantiCare and our affiliates for service will result in the lowest out-of-pocket cost. • Services performed through a Blue Cross/Blue Shield network provider will be covered at 70% after a $1,000 copay is met.

The Plans At A Glance

GEISINGER ENGAGED HORIZON ENGAGED HORIZON PPO

Has AtlantiCare Network

Has Geisinger Network

Has BC/BS Network

Has “Out-of-Network” Providers

Has $1,000 Deductible When Using Non-AtlantiCare Facilities

Lowest Contributions

Wellness Credits Reduce Deductible

Wellness Credits Reduce Contributions

Access to Telehealth Benefit

FORMS

Healthy Rewards Gym Reimbursement Program

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