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

2020 Medical Plan Bi-Weekly Contribution Rates

Full-Time

Part-Time

$0-49,999k $50-99,999k $100k-149,999k

$150k+

$0-49,999k $50-99,999k $100k-149,999k $150k+

Engaged Plan Powered by Geisinger

Employee

$32.37 $37.47

$65.75

$67.29 $64.64 $71.26 $131.51 $134.56

Employee + Spouse

$55.41 $64.15 $112.58

$115.20 $116.36 $128.29 $225.15 $230.39

Employee + Child(ren)

$44.67 $51.71

$90.75

$92.86 $93.80 $103.41 $181.48 $185.72

Family

$88.52 $102.47 $179.76

$183.92 $185.78 $204.82 $359.49 $367.86

Engaged Plan Powered by Horizon

Employee

$46.88 $51.69

$77.56

$79.36 $93.77 $103.38 $155.14 $158.75

Employee + Spouse

$80.29 $88.51 $133.75

$136.87 $160.54 $177.00 $230.55 $235.90

Employee + Child(ren)

$64.71 $71.34 $122.35

$125.20 $129.42 $142.68 $244.69 $250.38

Family

$128.18 $141.32 $218.63

$223.72 $256.35 $282.62 $437.28 $447.45

Horizon PPO

Employee

$135.08 $148.92 $180.55

$184.75 $159.95 $176.35 $280.86 $287.39

Employee + Spouse

$231.32 $255.04 $309.19

$316.38 $273.93 $302.00 $480.99 $492.17

Employee + Child(ren)

$186.45 $205.57 $249.23

$255.04 $220.80 $243.43 $387.68 $396.69

Family

$369.38 $407.24 $493.74

$505.22 $437.42 $482.25 $768.05 $785.91

*$25 surcharge will be added to your bi-weekly contribution if you utilize tobacco products. A Spouse & Partner Preferred Choice Premium may also apply. See page 8 for details.

FORMS

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