arkansas public school health plan comparing plans copyright © 2012 five points ict, inc. all...

Arkansas Public School Health Plan

Comparing Plans

Copyright © 2012 Five Points ICT, Inc. All rights reserved.

DisclaimerThe content of this communication is for informational purposes only and is not intended as any form of professional advice. This communication is not intended to outline every benefit, limitation, or exclusion of the State-sponsored benefit plans.

For questions or advice about your benefits, please contact your human resources representative or the Arkansas Department of Finance and Administration Employee Benefits Division.

Five Points ICT, Inc. and its affiliate companies are not responsible for errors or omissions in this communication.

Copyright © Five Points ICT, Inc. All rights reserved.

Important Information


• The information in this video may not apply to all employees in all situations

• Always refer to your Summary Plan Description (SPD) for more details about your plan options

• You can find more info at www.ARBenefits.org

http://www.arbenefits.org/

Why Compare?


• There are some important differences between your plan options, including:– Type of plan– Premium cost– Deductibles/Co-insurance/Co-pays– Out-of-pocket limits– Networks

Total Cost of Healthcare


Premium

+ Deductible

+ Co-payments

+ Co-insurance

=

Total Cost of Healthcare

Bronze Plan


• High-Deductible Health Plan (HDHP) – Health Advantage Network– Must meet calendar year deductible before

plan pays for any service, other than preventive care, screenings or immunizations

• Health Savings Account (HSA) eligible– Use pre-tax dollars for qualified medical

expenses, like deductibles, co-insurance, and more

Bronze PlanPremiums


Level of CoverageTotal Monthly Employee Cost

Employee Only Current Renewal

$ 0.00 $ 0.00

Employee & Spouse $108.70 $255.02

Employee & Child(ren) $ 0.00 $50.94

Employee & Family $111.22 $258.76

Bronze PlanDeductibles & Co-insurance


• Deductible amounts:– $2,000 in-network (IN)/$4,000 out-of-

network (OON) for individuals– $3,000 IN/$8,000 OON for families

• Once deductible is met, plan pays 80% of maximum allowable charge (MAC) for covered in-network services

• No co-pays, except for vision/hearing screenings

Bronze PlanOut-of-pocket Limits


• Out-of-pocket limits– $4,350 IN/$8,700 OON for individuals– $6,525 IN/$13,000 OON for families– After deductible is met– Co-payments, premiums, balance-billed

charges, and non-covered services not included

Silver Plan


• Point-of-service plan: – QualChoice Network– Deductible, then combination of co-

payments and co-insurance– Premiums higher than Bronze Plan, but

lower than Gold Plan– Preventive care, screenings, immunizations

covered at no out-of-pocket cost

Silver PlanPremiums



Employee Only Current Renewal

$23.78 $ 124.00

Employee & Spouse $580.08 $ 745.04

Employee & Child(ren) $270.32 $ 489.82

Employee & Family $582.00 $957.30

Silver PlanDeductibles/Co-pays/Co-ins.


• Deductible amounts:– $1,000 IN for individuals– $2,000 IN for families

• Once deductible is met, plan pays for covered in-network services according to the SPD

• You will have to pay co-pays and co-insurance for most services until your out-of-pocket limit is met

Silver PlanCo-Pays


CoverageTotal Monthly Employee Cost

Physician Office Visit PCP Current Renewal

$ 25 $ 35

Office Visit – Specialist $ 50 $ 70

Rx Tier 1 – Generic $ 10 $ 15

Rx Tier 2 – Preferred $ 35 $ 40

Rx Tier 3 – non-preferred $ 70 $ 80

Rx – Specialty w/tier $ 100

Silver PlanOut-of-pocket Limits


• Out-of-pocket limits– $3,000 in-network (IN)/$6,000 out-of-

network (OON) for individuals– $6,000 IN/$12,000 OON for families– After deductible is met– Co-payments, premiums, balance-billed


Gold Plan


• Point-of-service plan –Blue Cross Network– Deductible, then combination of co-

payments and co-insurance– “Richest” plan– Preventive care, screenings, immunizations

covered at no out-of-pocket cost

Gold PlanPremiums



Employee OnlyCurrent Renewal

$ 92.92 $ 226.60

Employee & Spouse $893.42 $1,095.28

Employee & Child(ren) $ 447.70 $ 753.02

Employee & Family $896.18 $1,423.48

Gold PlanDeductibles/Co-pays/Co-ins.


• No deductibles for individuals or families• Plan pays for covered in-network

services according to the SPD• You will have to pay co-pays and co-

insurance for most services until your out-of-pocket limit is met

Gold PlanCo-Pays


CoverageTotal Monthly Employee Cost

Physician Office Visit PCP Current Renewal

$ 25 $ 35

Office Visit – Specialist $ 35 $ 70

Rx Tier 1 – Generic $ 10 $ 15

Rx Tier 2 – Preferred $ 30 $ 40

Rx Tier 3 – non-preferred $ 60 $ 80

Rx – Specialty w/tier $ 100

Gold Plan


• Out-of-pocket limits– $2,500 in-network (IN)/$5,000 out-of-

network (OON) for individuals– $5,000 IN/$10,000 OON for families– Co-payments, premiums, balance-billed


How to Decide


• All plans cover the same services• To decide which plan may be

best for you and your family, think about:– How many claims did you have the

last year? How many do you expect this year?

– How each type of plan works– Compare the cost of premiums

Proposed Premium Cost -2014



Gold Silver Bronze

Employee Only $226.60 $124.00 $0.00

Employee & Spouse $1,095.28 745.04 $255.02

Employee & Child(ren) $753.02 $489.82 $50.94

Employee & Family $1,423.48 $957.30 $258.76

Deductibles for 2014


Type of DeductibleAnnual Deductible

Gold Silver Bronze

Individual In-Network $0 $1000 $2000

Family In-Network $0 $2000 $3,000

Out-of-Pocket Limits for 2014


Type of OOP LimitAnnual OOP Limit

Gold Silver Bronze

Individual In-Network $2,500 $3,000 $4,350

Family In-Network $5,000 $6,000 $6,525

Total Premium Cost, Deductibles & Out-of-Pocket Limits for 2014


Total CostTotal Monthly Employee Cost

Gold Silver Bronze

Employee Only $5,219.20 $5,488.00 $6,350.00

Employee & Spouse $18,143.36 $16,940.48 $12,585.24

Employee & Child(ren) $14,036.24 $13,877.84 10,136.28

Employee & Family $22,081.76 $19,487.60 $12,630.12

Learn More


• Contact Employee Benefits Division– 1-877-815-1017 “Just Press One”

• Additional info online– www.MyBenefitsChannel.com– www.ARBenefits.org

http://www.mybenefitschannel.com/

http://www.arbenefits.org/

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