choicesfor a healthy life - bidnet

CHOiCES for a HEALTHY LiFE

CITY OF PHILADELPHIA 2018 BENEFITS ENROLLMENT GUIDE

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To City Retirees,

We are so pleased to see that the City’s benefits program is helping you take better care of yourself, meaning you are also able to take better care of your family. Like a puzzle, when all the pieces come together for total health, you feel more in charge of life overall.

At times, it isn’t easy to put your own health first. But every healthy action you take is important to total wellbeing – physical, mental, and emotional. That’s why the City’s benefits program is there for you. Our whole focus is to provide you and your family with the information, tools, and activities to help you take small, but vital steps toward total wellbeing.

This year, it was exciting to see many of you take charge of your health and wellness! Over 1,000 employees participated in City-sponsored lunch and learns, wellness training, and our health fair. Spouses and life partners stepped up too. Over 40% of covered spouses/life partners completed wellness activities that helped reduce the cost of their family’s health care coverage by $500 this year. That’s higher participation than the national average. Plus, you’re learning to use benefits more wisely: we reduced non-emergency visits to the Emergency Room by 19% and increased visits to urgent care centers by 39%. Congratulations for putting healthy choices at the top of your list!

Your participation in health and wellness also helps keep the total cost of health care benefits affordable for you and the City. As a result, there will be no increase in your 2018 health plan contributions if you’re tobacco-free and return your Tobacco certification for next year.

Looking ahead to 2018, we will continue our focus on what’s important to the health and wellbeing of our members, their families, and the City. We’ll offer education on preventing and managing diabetes and other chronic diseases, as well as resources for caregiving. Most importantly, we will raise awareness of the opioid epidemic in Philadelphia and educate you about resources to help with this serious issue.

As we go into the seventh year of the City’s wellness program, please make Choices for a Healthy Life your first stop and first step to good health and wellbeing for you and your family.

Sincerely,

Marsha Greene-Jones Deputy Human Resources Director Office of Human Resources

Changes and ChoicesPages 2-3 Who's EligiblePages 4-6 City Administered (CAP) WellnessPages 7-8 ContributionsPages 9-10 Plan Comparison, Highlights, Blue Distinction and PCMHPages 11-13 Prescription -Step Therapy, Maintenance, Copays and Mail OrderPage 14 DentalPage 15 VisionPage 16 Life Insurance - LifeSuite

TABLE OF CONTENTS

Pages 17 - 21 Rights and Notices

CHOiCESfor a HEALTHY LIFE

2018

CITY-ADMINISTERED BENEFITS

WELLNESSYOU: complete 4 requirements SPOUSE: complete 2 requirements

P you must complete 4 wellness requirements and your covered spouse/

life partner must complete 2 wellness requirements S Page

MEDICALIndependence Blue Cross

: O/Keystone 65 P PPO/Medigap Security C 65

Y Tobacco users will pay more S P S

PRESCRIPTION DRUGCVS/Caremark

P P : Generic:

Formulary Brand: Non-Formulary Brand: S S

IMPORTANT:

*****NEW* **** TOBACCO CERTIFICATION

You must certify whether or not you and your spouse use (or don't use) tobacco products when you enroll. Tobacco users will pay more. See Wellness Program tobacco cessation program resources. See page 7 for 2018 health benefit contributions. There will be a non-compliance surcharge of $54.17 per month if the tobacco certification is not returned during the open enrollment period.

VISIONEyeMed

E the Keystone HMO medical E E

See t e Medical & Prescription page for your 2 ealt bene t contributions

BIG PICTURE: CHOICES FOR A HEALTHY LIFEENROLLMENT PERIOD NOVEMBER 30–DECEMBER 14, 2017

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about

your prescription drug coverage. Please see page 21 for more details.

1

>>>ALL MONETARY CHANGES TO YOUR ACCOUNT WILL REFLECT IN YOUR MARCH 2018 PENSION PAYMENT. ANY PLAN CHANGES THAT WILL RESULT IN A REFUND OR RETROACTIVE PREMIUMS DUE, WILL SHOW IN YOUR MARCH 2018 PENSION PAYMENT. <<<


2

ENROLLMENT & ELIGIBILITY

PROOF OF ELIGIBILITY REQUIREDEligibility Documents must be submitted to the Benefits HR RepresentativeExamples of documents you can provide when you add new dependents to the CAP Health Plan:

S S

O

S O

Valid proof of your dependent’s eligibility is required to be covered by the CAP Health Plan.

Please see detailed City of Philadelphia ene t Eligibility/Enrollment Guidelines City Administered ene ts Plan (CAP) in the back pocket of this guide.

Who’s Eligible?Eligible DependentsY

S marriage certificate and one other document showing marriage is current and spouse living in same location as you

S

Plan has received a Qualified Medical Child Support Order

as proved by Social Security eligibility and certified by Independence Blue Cross

IMPORTANT: Pennsylvania state law allows same-sex marriage As a result, the CAP Health Plan, no longer covers new life partners and their dependent children as of anuary , 2 NOTE: The CAP Health Plan will continue to cover current life partners enrolled in the CAP as of December 31, 2016, and their dependent children, for as long as they remain eligible However, if a life partner and his/her dependent child enrolled in the CAP as of December 31, 2016, is dropped from coverage, s/he is not eligible to be re-enrolled in the CAP on or after anuary 1, 201

Eligibility/Enrollment Guidelines City Administered enclosed with

Medicare and Non - Medicare


2018

3

Only uali ed Life Events Allow You to Change Elections

:

P P

b change your medical plan

a Benefits

IMPORTANT: Y (If you do not report the life

event in a timely manner, your dependents will not be covered by the CAP Health Plan until the next open enrollment period )

SPECIAL ENROLLMENT RIGHTS

a health and Welfare

30 days S P S P

a benefits


4

WELLNESS PROGRAM

CAP WELLNESS PROGRAM P P

Retirees

Experience Health & Wellness Your Way Y

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Wellness is a Movement and a Family AffairSpouses/Life Partners are a Part of our Wellness Team!

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IMPORTANT: In order for retirees to save $500 on 2019 medical contributions, covered spouses/life partners must also participate in the 2018 CAP Wellness Program Details are on page 8

Quitting Tobacco is Hard - We KnowWhen You and/or your Covered Spouse/Life Partner are Ready, We are Here to HelpThe City Rewards a Tobacco-free Lifestyle

P P s retiree s s s m

six months O E m O s s m s s s P P ss ss s 54.17 month s retiree s s

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Make a Successful Attempt to Quit and be Rewarded too

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IMPORTANT: The tobacco cessation program will help you quit smoking; however, you can complete the program and meet the CAP Wellness Program requirement, regardless of whether you actually stop tobacco use You can also involve your personal physician in designing an alternative program to meet the CAP Wellness Program requirement

NOTE: If you and/or your spouse/life partner successfully complete the tobacco cessation program through ActiveHealth on or before May 1, 2018, the following will occur:

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For members of the City-Administered Health Plan

TOBACCO CESSATION PROGRAM

866.795.2970www MyActiveHealth com/city

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Non - Medicare


2018

5

COMPLETE THE 2018 CAP WELLNESS PROGRAM Earn 100 points Save $500 Save $500 on the cost of your 2019 medical coverage by earning 100 wellness points on or before the October 31, 2018 deadline Retirees in the City's Non- Medicare health plans must complete 4 activities – and covered spouses/life partners must complete 2 activities – to save $500 on the cost of medical coverage The Wellness Program runs for 10 months ( anuary 1, 2018 through October 31, 2018)

To begin, go to www myactivehealth com/city to log in or register for a new account RETIREE & COVERED SPOUSE/LIFE PARTNER MUST COMPLETE THE 2 REQUIRED ACTIVITIES BELOWP O I N T S

25 Complete a 2018 Health Assessment

Y s s m s m ss ssm s

25 Complete a 2018 Biometric Screening

Y s s m s m s s s s : P ss s s

RETIREE ONLY MUST COMPLETE 2 OF THE 6 ACTIVITIES BELOW

25

Complete a 2018 Eye Exam

And/Or

a 2018 Dental Cleaning/Exam

IMPORTANT: You will earn a maximum of 25 points for completing both dental and eye exams You may only use your CAP Health Plan for the dental or eye exams ms s S m

ss s ms s s m m m U E

25 Work with a

Lifestyle Coach or a Condition Management

Nurse

Complete 3 telephonic sessions by working with:

s ss s m ss ss s

m m s ss s s s s s s Call 1 866 95 29 0 to speak with a Lifestyle Coach or Nurse Practitioner

25 or

50Enjoy the

Mobile App experience!

WHAT'S NEW: The amount of ’s you earn will change, but your level of e ort will stay the same You now have 2 paths to earn wellness points using Digital Coaching:

Health Education: Earn s arn n a n ss an nan r a m s ss Y r a E a n s a a a n r m a a m

Health Goals: Earn s n s a a an ra arn s m a a s am s an s s n m r a O E: a ss Y r a

a s s n a a n s a a a n s n m a an s m a a m

Earn enough “hearts” or “ ’s” to reach Level 3 and earn 25 wellness points Earn enough “hearts” or “ ’s” to reach Level 4 and earn 50 wellness points

Y an a ss Your Health Education an Your Health Goals s ns n n r a a n r m a a m

25 Track Physical Fitness

Log 60 days of physical tness ma n an n n a s a n r s n an a ma a ra r s s n a r a

25 Visit Registered Dietician (RD)

Complete 2 in-person visits with an in-network Registered Dietician s s r ans s a a a n a s En r s s n a r a

25 Complete

Tobacco Cessation Program

Par a n s ss ns n n a ns a n n s s r n n a s m an n s a r ns s Call 1 866 95 29 0 Note: If this activity is completed

on or before May 1, 2018, you may also be eligible for a refund of the $25 per pay tobacco surcharge, retroactive to anuary 1, 2018 See the next page for additional options working with your physician

Complete Online Digital Coaching

SEE TH

IS STAMP?

E A RN W ELLNE SS P

OINT

S!

Non - Medicare

6

CHOiCESfor a HEALTHY LIFEFAQS:WELLNESS PROGRAM: SPECIAL DATES & DEADLINES

What is the deadline for completing the tobacco cessation program and getting a refund of the surcharge this year?

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What are the early deadlines I should know so that I get wellness points this year? EyeMed – Submit eye exam claim by September 30

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United Concordia – Submit dental exam claim by September 30

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Fax Dental Exam Claim Form To: United Concordia Dental Fax number (412) 544-2094

If I am newly retired and enrolling in the CAP Health Plan, how do I know if I must complete the Wellness Program to save on medical coverage for 2019? When your CAP Health Plan bene ts become e ecti e between: anuary 1 - une 1 2018

r Retiree benefits effective s ar date is n an ar an n 1 ar

r s ns r m n a n ss r r m n s n r r O r sa n

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When your CAP Health Plan bene ts become e ecti e between: uly 1 - December 1 2018

r Retiree n s effective start date is n r a r ar m n P

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WELLNESS PROGRAM

866.795.2970www MyActiveHealthcom/city

O Y Y: : a m m E

S U Y: a m m E

For members of the City-Administered Health Plan

SEE TH

IS STAMP?

E A RN W ELLNE SS P

OINT

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Non - Medicare


7

MEDICAL & PRESCRIPTION

2018 MEDICAL PLANS AND HEALTH BENEFIT CONTRIBUTIONS Y an s n n n n r ss m a ans s n O r P rs na PPO

On a m a n a ma a nr n r s r n r ra

On n a s an r a n s m ar n s n O an P rs na PPO Un rs an n n s s s as m r an as n rs an n s ans

Health Plan Contributions Based on Wellness and Tobacco UseMaintaining and improving health not only reduces health risks, but also reduces your health plan payroll contributions!

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s an m P n ss Pr ram r r m n s an r s s ma

a s P rs r r n n s an a r s n ss Pr ram a

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NON-TOBACCO USER RATES SINGLE RETIREE + 1 FAMILY

n ss r m n ss n O 40.67 81.66 132 67

P rs na PPO 81.73 155.85 252 44

n ss r m n s

s n O 82.34 123.33 174.34

P rs na PPO 124.40 197.52 294 11

TOBACCO USER /NON-COMPLIANCE RATES SINGLE RETIREE + 1 FAMILY

a Us r n m an n ss r m n s

s n O 94.84 135.83 1 84

P rs na PPO 135.90 210.02 306.61

a Us r n m an n ss

r m n s

s n O 136.51 177.50 228.51

P rs na PPO 177.57 251 69 348 28

Tobacco user rates are assessed n retiree an r s s as r s

a r s a s r ra ma an n n a s r ra

retiree an r s s m s a a ssa n r ram n r

r a s 54.17 r month s r ar ass a a ra r n r r a an ar

Non-compliance rates are assessed a 54.17 r month n a retiree s n submit a Tobacco Certification r n O n Enr m n r

m r m r n m an ra s ann an r n ar

INDEPENDENCE BLUE CROSS

1.800.ASKBLUE1.800.275.2583http://www ibx com

Text IBXWire to 73529

s r ar a m ssa s

n r smar n

GET URGENT CARE FOR $40 COPAY PER VISIT AND SAVE HOURS OF WAIT TIMEFind an Urgent Care Center near you

1.800.ASKBLUE1.800.275.2583

n www ibxpress coman r n ar n n rs an

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2018 Health Benefit Contributions Per Month City-Administered Bene ts

Non- Medicare

>>>ALL MONETARY CHANGES TO YOUR ACCOUNT WILL REFLECT IN YOUR MARCH 2018 PENSION PAYMENT. ANY PLAN CHANGES THAT WILL RESULT IN A REFUND OR RETROACTIVE PREMIUMS DUE, WILL SHOW IN YOUR MARCH 2018 PENSION PAYMENT.<<<

CITY ADMINISTERED MEDICAL BENEFIT COMPARISON

(MEDICARE PLANS)

HEALTH MAINTENANCE ORGANIZATION PLANS

PREFERRED PROVIDER ORGANIZATION PLANS

KEYSTONE 65 MEDIGAP

SECURITY C

DEDUCTION RETIREE

RETIREE + 1 (Both Medicare)

RETIREE + 1 (1 Med./1 Reg.)

FAMILY (1Med./1 Reg./1Dep.)

$0

$0

$0

$0

DEDUCTIBLE NONE NONE CO-PAY $15 PRIMARY PHYSICIAN

$25 SPECIALIST $50 EMERG. ROOM

N/A

INPATIENT HOSPITAL

OUTPATIENT SURGERY

EMERGENCY CARE

DENTAL $10 VALUE DENTAL

N/A

VISION $100 REIMBURSEMENT EVERY 2 YRS

N/A

**MEDICARE RECIPIENTS WITH MEDICARE PARTS A & B AND ARE ENROLLED HAVE NO DEDUCTION FOR CAP HEALTH COVERAGE . HOWEVER, THERE IS A DEDUCTION FOR SPOUSES AND/OR DEPENDENTS ENROLLED IN NON-MEDICARE PLANS. USE THE RATE CHART ON PAGE 7 TO FIND THE CORRECT RATE FOR YOUR SPOUSE OR DEPENDENTS.**

$100 INPATIENT PER ADMISSION

$100 COPAY

$50 COPAYNOT WAIVED IF ADMITTED

$0

$0

$0

<<<<<<**<<<<<<

8

Medicare

888

2018


9

GET FREE FLU SHOTS WITHOUT FILING CLAIMS S r n n n

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GET IBX APPManage your health on the go

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2018

How the HMO and PPO Compare IMPORTANT: sa m an ass if you’re adding or changing dependent or bene ciary information

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FEATURE KEYSTONE HMO PERSONAL CHOICE PPO Pension n r n r an PPO r an O

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e s me a era e ns are m re ens e an mee a r a e are re remen s

Patient-Centered Medical Home: Lower Copay, Faster Access, Coordinated Care

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BLUE DISTINCTION FOR HEALTHIER OUTCOMESThe hospital choices you make directly impact your care. Blue Cross can help you find hospitals, called Blue Distinction Centers and Blue Distinction + centers, which have a proven track record for delivering better results-including fewer complications and readmissions than hospitals without these recognitions. Every patient, condition, and treatment is different. By seeking care at a facility that meets the Blue Distinction high standard of quality, you should experience fewer re-admissions, complications, and post treatment expenses.Consider experienced Blue Distinction Centers for the following conditions:*Bariatric Surgery * Knee and Hip Replacement *Spine Surgery*Cardiac Care *Maternity Care *Transplants*Complex and Rare cancers

Non- Medicare

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I


10


HIGHLIGHTS: KEYSTONE HMO AND PERSONAL CHOICE PPO 1.800.ASKBLUE

MEDICAL SERVICESKEYSTONE HMO PERSONAL CHOICE PPO*

E O E O OU O E O

Deductible (Individual/Family)

Coinsurance

Preventive Care ( including child immunizations, Flu shots provided by pharmacies covered when showing Independence Blue Cross ID card)

Patient-Centered Medical Home ( Primary Care doctor and care team coordinates all patient care, treatment, specialists)

a a e a e

Primary Care Visit a a n e e a er e e

Specialist O ce Visit a a n e e a er e e

Routine Annual GYN Exam n re erra n e e n e e

Mammography n re erra n e e n e e

Registered Dietician n re erra n e e n e e

Routine Eye Exam a n e e er ears ere ere

Urgent Care Center a a n e e a er e e

Emergency Room a a m e Emer en are ere n ne r

an ne r

a a m e

Inpatient Hospital Services a er a ma m m a s er a m ss n

a er e e a er e e

Outpatient Hospital Services a a er e e a er e e

Outpatient Laboratory n e e a er e e

Outpatient Radiology a a er e e a er e e

Therapy Services s e s m s (Physical, Occupational, Cardiac)

a a n e e a er e e

Outpatient Mental Health and Substance Abuse ( including treatment for eating disorders)

a a n e e a er e e

Use Magellan Behavioral Health providers (800.688.1911) for ongoing outpatient mental health and substance abuse care,

Individual Out-of-Pocket Maximum (includes deductible and coinsurance)

er n a

Family Out-of-Pocket Maximum (includes deductible and coinsurance)

er n a

Lifetime Maximum Un m e Un m e

*Coinsurance s e er en a e ar es a a a er e e e s me r e am e a ar es a er a e e e en s n n ne rs a ser es n er e PPO

Out-of-pocket limit s e ma m m am n e e an ns ran e r r am a r e n a a en ar ear

NO DEDUCTIBLE a es ese PPO n e r ser es

Non - Medicare


2018

11

GO TOBACCO-FREE FOR YOUR HEALTH AND YOUR WALLETUse tobacco-free pharmacies in the City’s Preferred Health Network to avoid an extra $15 copay.

e er o e Pre erre ea n e en en

ne or oo arma s n or a S

s omer ser e o n Pre erre ea e or arma es n o r area

800.309.5013

8/10 PRESCRIPTIONS FILLED IN THE U.S. ARE FOR GENERIC MEDICINES

HOW YOUR PRESCRIPTION PLAN WORKSe n o n a s o sa e on res r on

me a ons s a r or e m n s ere ea P an n es a

om re ens e res r on an es ne o ee o r o a e o es en o :

Use er or Pre erre ea o a o ree arma es or s or erm res r ons

res r ons s n ener me a ons

Use S on ma or re a arma es o on erm ma n enan e me a ons n a

a s

Tier 1 Pharmacies/Tobacco-free Preferred Health Network vs. Tier 2 Pharmacies

e rea e a o a o ree Pre erre ea arma ne or s e rs o s n

n e na on The Preferred Health pharmacy network includes more than , 00 CVS and other pharmacies that have agreed not to sell tobacco products ese o a o ree arma es are a so no n as er arma es

n arma an o n e er Pre erre ea ne or as on as e es a s men a rees no se o a o ro s oo or a s n o Pre erre ea arma es n e a o e o s e o a ona o a ar es

s n er P arma es

Tier 2 pharmacies sell tobacco products When you ll a prescription at a Tier 2 pharmacy you will incur an additional $15 copay towards the cost of your medications

Pay Less When You Choose Generic Medications or Try Step Therapy Go generic for short-term medication: Yo

a ess en o a n n ener s or erm res r ons rom a Pre erre ea o a o ree

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FDA Approvede re res ener me nes o

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12


UNLOCK SPECIAL SAVINGS! USE CVS EXTRACARE HEALTH CARD

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ar s e a ro ram rom S aremar

an e e ar a o s o o sa e on o san s o S P arma ran eare a e ems ro o

e s ore s earn re ar s an more

TWO EASY WAYS TO GET STARTED SAVING ON LONG-TERM MEDICATIONS

VISIT ONLINE Caremark.com/90day

CALL

1.800.309.5013

e on a o r o or or a ne res r on an an e

a e e a s

Step Therapy: Start with Generic Medication as the First Step to Better Health and a Lower Copay

ma es sense o r a ener me ne as a rs s e n rea men or man eo e ener

me ne or s s as e as o er me ne an os o ess (source: Generic

Pharmaceutical Association).

Step Therapy Process Begins with Generic MedicationSTEP 1 e res r on r an en o ra es

o o se a ener me ne as e S S EP n rea men a o o r

o or o n o o er os ener o ons ma e r or o

STEP 2 s o r o or o a n or a o r res r on o a S arma or

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STEP 3 o r ener res r on an rea o r ea on on or ess an e ran o a

IMPORTANT: o a ran name res r on as e rs s e n rea men o a e o a

e r e n ess o r o or on a s S an S a or es e ran me a on

Sign up for MaintenanceChoice™ and Save 33% on Long-term Medications at CVSUse e a n enan e o e ro ram or onerm me nes: a n enan e me a ons are res r e or on erm or ron on ons

an m s e a en on a re ar re rr n as s o nee ma n enan e me a on s n or a n enan e o e

Save Money e a se one a s a os s ess an ree a s es o an e s re o re

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Save Time E m na e e nee or mon r s o e

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Choose delivery by mail or pick up

S e er o r a s es an ere o e no os s n an s a s a er s or

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2018

13

T I P S T O H E L P YO U $AV E Retail for Short-term and Mail for Long-term Prescriptions

For medications taken for a short time(like an antibiotic)

a an S P arma or an arma n e o a o ree e or

IMPORTANT: o a res r on a a arma a se s o a o ro s o e ar e an a ona o a er res r on

For medications taken regularly(such as high blood pressure or diabetes medicine)Yo a e a o e a an S P arma or e o r me a on e ere o o r oor or ma ser e a

IMPORTANT: en o re e e a s or erm o a s o a ma n enan e me a on ere e an a e s r ar e o e re a o a o a res r on a a arma a se s

o a o ro s o e ar e an a ona o a er res r on

For medications taken for complex conditions(such as rheumatoid arthritis, hepatitis, or cancer)

O r s e a arma an e s Ss e a om or a o e s ar e

Prescription Copays at a Glance

FEATURE

NON MAINTENANCE MEDICATION MAINTENANCE MEDICATION*TIER 1

Pre erre ea P arma

o a o ree

Tier 2 on Pre erre P arma

Se s o a o

TIER 1 S P arma On

Pre erre ea P arma

TIER 1 on S P arma Pre erre ea

P arma

TIER 2 on S P arma

on Pre erre P arma

Se s o a o

Generic Drug

Formulary Brand Drug

Non-Formulary Brand Drug

Dispensing Limit U o a s U o a s U o a s U o a s U o a s

Year o o o e ma m m or o ere res r on r os s: er erson er ear er am

DIGITAL TOOLS FOR YOUR CONVENIENCE

S a oo s ma e eas o n a s o

sa e mone on o r me a ons an sa e

me mana n em or o an o r am

So e s re o re s er a aremar om an

o n oa e S aremar mo e a a a o on

m ss o on an sa n s o or n es

SHORT-TERM AND MAIL ORDER PRESCRIPTIONS

1.800.309.5013

SPECIALTY PHARMACY FOR COMPLEX CONDITIONS

1.800.237.2767



14

DENTAL BENEFITS CHOICES FOR TOTAL HEALTHYo r en a ea a e s o r o a ea o e a e are o o r an o r am s en a ea o an se e one o o en a ro rams rom Un e on or a on or a e PPO or on or a P s O Yo m s e e a me a an o e e e or en a ene s

Option 1: Concordia Flex - PPOs s a en a PPO an means o an

s an ense en s r mar are or s e a so a re erra o e er o an sa e more

mone see n a en s n e Advantage Plus Network s s e a se n ne or en s s anno o more an Un e on or a s

ne o a e ees o o ne or en s s an o ar e o or e es or ser es a

e ee an m a ons

Services Covered at 100%Preventive services n n

ean n s e ams an ra s

Basic services s as roo ana s an m sease are

Services Covered at 80%Major services s as ro ns ne en res an r es

Basic restorative services n s

Orthodontic services or e en en s n er a e on

Deductibles, Maximums & LimitationsAnnual deductible er erson or

er am m s e a o o o e e ore e an ro e o era e

or ser es e n re en e an or o on ser es

Annual maximum e an a o er erson o ar e os

o en a ser es er orme n e n or o on s

Orthodontic maximum or e e me o ea e en en n er a e e an

a o o ar e os o or o on ser es

Frequency limitations ean n s ro ne e ams an e n ra s are o ere a a re en o o er erson er a en ar ear or a om e e s o m a ons on a s omer Ser e

Option 2: Concordia Plus - DHMO a O an o m s se e a r mar

en s rom e DHMO Concordia Plus Network o oor na e a o o r en a are nee s n n

re erra s o s e a s s Ea am mem er an oose e r o n r mar en s e e

ne or o en s s a a a e n er s an s m sma er o an sa e mone e a se ere are no e es or ene m a ons os ser es are one a no os o e er o a men s ma e re re or some ser es Yo a a s

no a o e ar e ro a ro e o a men s e e o ene s

Plan FeaturesSa n s ro re e o o o e e enses

Pre en e ser es o ere a no or o os

Pr mar en s s oor na e a are

Same o a men s or s e a s s as enera en s s

o ann a ma m m or e e

IMPORTANT: The DHMO plan does not cover out-of-network dentists Make sure your preferred primary dentist is in the DHMO Concordia Plus Network before you enroll

MANAGING YOUR UNITED CONCORDIA DENTAL BENEFITSMy Dental Bene ts

U on re e n o r ar s

UnitedConcordia com/MDB rom o r om er or

smar one o rea e o r on ne a o n

en a ene s o an:

Pr n or e r a ar s

n en s s n o r ne or

See a o r an o ers

e a ms s a s

S n or e ema s

Customer Service

or s e es ons a o o r a o n a

s omer Ser e r n s an ar s ness o rs or om e e e se re re es orm on ne

By phone or online:

866.851.7568UnitedConcordia com/ContactForm

Find YOUR dentist

UnitedConcordia com/Find-a-dentist

Be sure to select your network from the dropdown menu:

PPO: an a e P s e or

O: on or a P s e or

FEATURE CONCORDIA FLEX (PPO) CONCORDIA PLUS (DHMO)e or s e o n P a area ar a n en s s r mar are en s s

O o ne or o era e Yes o

Pr mar en s re re o Yes

Se re erra s a o e Yes o r mar en s m s ma e a re erra s

Pre nan ene n e Yes o

nn a e es erson or am one or re en e an or o on ser es

one

nn a a m m erson a en ar ear Or o on s a e a se ara e e me ma m m o

or ea e en en n er a e

one

Medicare and Non -Medicare

Retiree dental benefits are available through COBRA continuation coverage only for a periodof 18 months starting from the date your retiree health benefits take effect. Only available at the onset of retirement.


2018

15

How Vision Benefits WorkVISION CARE SERVICES IN-NETWORK MEMBER COST OUT-OF-NETWORK REIMBURSEMENTRoutine Eye Exam with dilation as necessary Once every 12 months

o a U o IMPORTANT:

en o se an o o ne or

ro er o e res ons e o a

e ro er n a e me o ser e

o e re m rse o e a o a e

amo n o m s s m an o o ne or

a m o E e e

e er o e ar o see e e

re m rsemen amo n s

Eye exam claims must be submitted to EyeMed by September 30, 2018 to be eligible for wellness points

Retinal Imaging U o

Frames Once every 24 months

o a a o an e o re a r e o er

U o

Standard Plastic Lenses Choose plastic lenses OR contact lenses once every 12 months

S n e s on o a U o

o a o a U o

r o a o a U o

S an ar Pro ress e ens o a U o

Prem m Pro ress e ens o ar e ess a o an e U o

en ar o a U o

Lens Options Paid by the member and added to the base price of the lens

U rea men n so an ra en

S an ar P as S ra oa n U o

S an ar Po ar ona e

S an ar Po ar ona e s n er U o

S an ar n e e e oa n

Po ar e O er Ons an Ser es o re a r e

Contact Lens Fit and Follow Up Contact lens t and two follow up visits are available after a comprehensive eye exam has been completed Choose plastic lenses OR contact lenses once every 12 months

S an ar on a ens U o

Prem m on a ens o re a

on en ona o a a o an e o re a r e o er U o

s osa e o a a o an e s a an e o er U o

e a e essar o a a n U o

NOTES: em ers o r ase on a enses on ne an a e r on a ens ene s a on a s re om

For prescription contact lenses for only 1 eye: e an a one a o e amo n a o a e or on a enses or o e es on e e er mon s

Laser Vision Correction: E e e mem ers are e e o re e e o re a r e or o a romo ona r e or as or P ro U S aser e or o ne an o era e s on or as ro ers a SE

There are additional discounts available once you have used your in-network EyeMed bene ts They include: 40% o a complete pair of glasses 20 % o non-prescription sunglasses 15% o conventional contact lenses

VISION BENEFITS: SEE THE VALUEs on ene s ro E e e s on are are n e en

o enro n e P ea P an a n a n n o r s on ea s m or an o o a ea ron seases s as a e es an

oo ress re an e e e e ear e e e ams

E e e o ers mem ers e o on o s n E e e n ne or or o o ne or non ar a n o ors o O ome r anO a mo o

e E e e s on are ne or n es r a e ra oners as e as o re a ers ens ra ers Sears O a ar e O a Penne O a an mos Pear e s on o a ons

EYEMEDwww.eyemed.com

866.393.3401(post-enrollment)

Medicare and Non - MedicareRetiree vision benefits are available through COBRA continuation coverage only for a periodof 18 months starting from the date your retiree health benefits take effect. Only available at the onset of retirement.

16

2018

LifeSuite Services — To Meet YOUR LIFE NEEDSLife happens When it does – turn to your LifeSuite services These services are designed to help you in times of need and are only a click or a call away

Legal, Financial and Grief – LifeWorks comess one or a o mee o r nee s:

Un m e e e on an e an ons a on ro ess ona s n ea area

Com re ens e e an mo e reso r es

r m n e a e o a e ons a on an a orne or ea n e e a ss e

Travel Assistance – LifeBene ts com/travela a e or ersona or s ness ra e

en m es rom ome:

e a ro ess ona o a or ser es

ss s an e re a n os or s o en a e me a on or o er r a ems

e a or se r e a a on

e a ne essar re a r a on

e a r a on o mor a rema ns

Legacy Planning – LegacyPlanningResources comess o a ar e o n orma on an reso r es o or ro en o e ss es:

En o e ann n

na arran emen s

m or an re es

E ress ss nmen or e e e nera ome ass nmen s

Bene ciary Financial Counselingn e en en nan a o nse n reso r es ro e Pr e a er o seCoo ers P P C are es ne o e ene ar es ma e so n nan a e s ons a a me

ene ar re eren e e

ess o a nan a o nse n e s e or mon s

nan a ness assessmen

S e s e ass s an e n om e n a ersona e nan a an

mon ne s e er

ona ersona e reso r es are a a a e o ose ene ar es ma n

e s ons a o er ro ee amo n s

ene ar es m s o n o s ser e e sen a ess ns r ons o a ene ar es re e n ns ran e ro ee s o or more

e e a nan a an r e ser es are ro e Cer an C n e ser es are no a a e nneso a e Se r an e or s ro on ra s an ma e s on n e a an me Cer a n erms on ons an res r ons ma a

en n e ser es

e ra e ass s an e ser es are ro e e o n P C e ser es are no a a e nneso a e Se r an e or s ro on ra s an ma e s on n e a an me Cer a n erms on ons an res r ons ma a en n

e ser es

Ser es ro e Pr e a er o seCoo ers P are e r so e res ons e ser es are no a a e nneso a e Se r an e or s ro on ra s an ma e s on n e a an me Cer a n erms on ons an res r ons ma a

en n e ser es

e er P C nor s em o ees are n o e n e sa e or en orsemen o n es men or ns ran e ro s

ns ran e ro s are ss e nneso a e ns ran e Com an or Se r an e ns ran e Com an a e Yor a or e ns rer o om an es are ea ar ere n Sa n Pa Pro a a a an ea res ma ar s a e Ea ns rer s so e res ons e or e nan a o a ons n er e o es or on ra s ss es

e Se r an nan a ro n an s a a es nneso a e an Se r an e ro e a e ran e o nan a ro s an ser es a mee e nee s o n a s am es s ness o ners nan a ns ons an em o ers


user name: lfg password: resources

1-877-849-6034

U.S./CANADA

1-855-516-5433all other locations

+1 415-484-4677

M e d i c a r e a n d N o n - M e d i c a r e


17

AFFORDABLE CARE ACT (ACA) Healthcare Marketplace, Information, Tools, and Resources

www healthcare gov

IMMUNIZATION VACCINESor a s an ren

as a e a ro r a eoses re ommen e

a es an re ommen e o a ons ar :

e a s

e a s

er es os er

man Pa oma r s

n en a S o

eas es m s e a

en n o o a

Pne mo o a

e an s er a Per ss s

ar e a

RIGHTS & NOTICESAffordable Care Act (ACA): Preventive Care Services

e o o n re en e ser es m s e o ere en o se an n ne or ro er s

means e m s e o ere o a o a e e or o ns ran e e C s ene ro ram om es s s an ar or a om re ens e s ease on a e C ene s e ar men

Covered Preventive and Drug Services (Partial List)

o e a o ere r s am ns an on ra e es o a ne a a arma re re a res r on n n o er e o n er r s an ro s

Abdominal Aortic Aneurysm one me s reen n or men o s e e a es o a e e er smo e

Alcohol Misuse s reen n an o nse n

Aspirin se or men an omen o er a n a es

Blood Pressure s reen n or a a s

Cholesterol s reen n or a s o er a n a es or a er r s

Colorectal Cancer s reen n or a s o er

Contraceptives ora emer en n e a es m an a e e es a na r n s rans erma a an arr er me o s

Depression s reen n or a s

Type 2 Diabetes s reen n or a s oo ress re

Diet o nse n or a s a er r s or ron sease

HIV s reen n or a a s a er r s

Immunization a nes or a s an ren as a e a ro r a e oses

re ommen e a es an re ommen e o a ons ar

Obesity s reen n an o nse n or a a s

Sexually Transmitted Infection (STI) re en on o nse n or a s a er r s

Tobacco Use s reen n or a a s an essa on n er en ons or o a o sers

Syphilis s reen n or a a s a er r s

Vitamins and supplements n n ron s emen s or e s emen s o a an am n

COBRA Continuation Coverageen C ea o era e en s e o a

erm na on o em o men o an o r o ere e en en s ma e e e o on n e o era e or o mon s a n e os o o era e n er CO on n a on

r es CO s e e era s a e a erm s o ere em o ees an e en en s o on n e ea o era e em orar a e r o n e ense er a n a n E en s o r a o

or nar res n e oss o o era e O er a n E en s n o r e en en s ma

on n e o era e or o mon s n e em o ee or e or ea en emen o

e are an a e en en os n e or ea o era e

Required Notice about Your Wellness Program Information

e C o P a e a e ness Pro ram s a o n ar e ness ro ram a a a e o a

ene s e e retirees e ro ram s a m n s ere a or n o e era r es erm n em o er s onsore e ness ro rams a see o m ro e retiree ea or re en sease n n e mer ans sa es o

e ene n orma on on s r m na on o an e ea ns ran e Por a

an o n a as a a e amon o ers o oose o ar a e n e e ness

ro ram o e as e o om e e a o n area r s assessmen or a as s a ser es

o es ons a o o r ea re a e a es an e a ors an e er o a e or a er a n me a on ons e an er a e es or

ear sease Yo a so e as e o om e e a ome r s reen n n e a oo es or oo ose oo ress re an o a

o es ero an Yo are no re re o om e e e or o ar a e n e oo es or o er me a e am na ons

RIGHTS & NOTICES



2018

18

o e er retirees o oose o ar a e n e e ness ro ram an om e e o r re re

a es re e e an n en e o o n s e a o a s o n on e os o ea o era e n e o o n ear o o are

no re re o om e e e or ar a e n e ome r s reen n on retirees o o so

e e e o re e e o n s o ar e o a o n s re remen

ona n en es o o n s are a a a e or retirees o ar a e n er a n ea re a e a es an om e e o o se era a es

n n ea oa n on on mana emen s a ness an or re s ere e an s s

o are na e o ar a e n an o e ea re a e a es re re o earn an n en e o ma e en e o a reasona e a ommo a on or an a erna e s an ar Yo ma re es a reasona e a ommo a on or an a erna e s an ar on a n ars a reene ones a

mars a reene ones a o

e n orma on rom o r an e res s rom o r ome r s reen n e se o ro e o n orma on o e o n ers an o r rren ea an o en a

r s s an ma a so e se o o er o ser es ro e e ness ro ram s as n r on

o nse n Yo a so are en o ra e o s are o r res s or on erns o r o n o or

Protections from Disclosure of Medical Information

e are re re a o ma n a n e r a an se r o o r ersona en a e ea n orma on o e e ness ro ram an e C o P a e a ma se a re a e n orma on o e s o es n a ro ram ase on en e ea r s s n e or a e e C o P a e a e ness Pro ram ne er

s ose an o o r ersona n orma on e er or o e C as em o er e e as

ne essar o res on o a re es rom o or a reasona e a ommo a on nee e o ar a e n e e ness ro ram or as e ress erm e

a e a n orma on a ersona en es o a s ro e n onne on e e ness ro ram no e ro e o

anyone an ma ne er e se o ma e e s ons re ar n o r em o men

Yo r ea n orma on no e so e an e rans erre or o er se s ose e e o e e en erm e a o arr o s e a es re a e o e e ness ro ram an o no e as e or re re o a e

e on en a o o r ea n orma on as a on on o ar a n n e e ness

ro ram or re e n an n en e n one o re e es o r n orma on or r oses o

ro n o ser es as ar o e e ness ro ram a e e same on en a

re remen s e on n a s o re e e o r ersona en a e ea n orma on are

e ea ana emen e C s r ar e ness ro ram ro er an a m n s ra or

an e ea s ea oa es on on mana emen n rses o ors an ense ea are ro ess ona s n or er o ro e o

ser es n er e e ness ro ram

n a on a me a n orma on o a ne ro e e ness ro ram e ma n a ne

se ara e rom o r ersonne re or s n orma on s ore e e ron a e en r e an no n orma on o ro e as ar o e e ness ro ram e se n ma n an em o men e s on ro r a e re a ons e a en o a o an a a rea an n e e en a a a rea o rs n o n n orma on o ro e

n onne on e e ness ro ram e no o mme a e

Yo ma no e s r m na e a a ns n retirement e a se o e me a n orma on o ro e as ar o ar a n n e e ness ro ram nor ma o e s e e o re a a on o oose no o ar a e

o a e es ons or on erns re ar n s no e or a o ro e ons a a ns s r m na on an re a a on ease on a ars a reene ones a mars a reene ones a o

Women’s Health Coveragee C s me a an res r on r ans

n e re en e o era e or omen as re re e or a e Care a so no n as e era ea are re orm Co era e or e o o n ser es r s an s es or omen

e o ere a en o or o r o ere am mem er s s an n ne or ro er:

e oman s s

reas ee n s or s es an o nse n



19

PENNSYLVANIA MEDICAIDhttp://www dhs pa gov/hipp

1-800-692-7462o see an o er s a es a e a e a rem m

ass s an e ro ram s n e or or more n orma on on

s e a enro men r s on a e er:

U.S. DEPARTMENT OF LABORretiree Bene ts Security Administration

www dol gov/ebsa

1-866-444-EBSA(3272)

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICESCenters for Medicare & Medicaid Services

www cms hhs gov

1-877-267-2323en O on

E

RIGHTS & NOTICES

a ro e on ra e on me o s s er a on an re ro on re a e a en e a on an o nse n

Co nse n or se a ransm e n e ons

S reen n an o nse n

P es n

es a ona a e es s reen n s

omes an n er ersona o en e s reen n an o nse n

n a on e C s ea an as re re e omen s ea an Can er s o

ro es ene s or mas e om re a e ser es n n a s a es o re ons r on an s r er o a e e s mme r e een e

reas s ros eses an om a ons res n rom a mas e om n n m e ema Ca n e en en e e Cross a or more n orma on

Maternity and Newborn Infant CoverageCo era e n er e C s me a ans ro es

a ma ern or ne orn o era e ma no n er e era a res r ene s or an os a

en o s a n onne on r or e mo er or ne orn o ess an o rs

o o n a a na e er or ess an o rs o o n a esarean se on o e er e era a enera oes no ro e mo er s or ne orn s a en n ro er a er ons n

e mo er rom s ar n e mo er or er ne orn ear er an o rs or o rs

as a a e n an ase ea are ans an ns ran e ss ers ma no n er e era a re re a a ro er o a n a or a on rom

e an or e ss er or res r n a en o s a no n e ess o o rs or o rs

HIPAA Privacy Notice Remindere r a r es n er e ea ns ran e

Por a an o n a P re re e ro ea ans s onsore e C o

P a e a o er o a sen a rem n er o ar an s a o e a a a o e ans

Pr a o e an o o o a n a no e e Pr a o e e a ns ar an s r s an e

ans e a es res e o ro e e ea n orma on P an o e ans ma se an

s ose P om e e P Pr a o e s

n e n e a o e o s e or more n orma on on e ans r a o es or o r r s n er P a o r ene s m n s ra or a 215 686 2325

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

o or o r ren are e e or e a or C P an o re e e or ea o era e rom o r em o er o r s a e ma a e a rem m

ass s an e ro ram a an e a or o era e s n n s rom e r e a or C P ro rams o or o r ren aren e e or e a

or C P o on e e e or ese rem m ass s an e ro rams o ma e a e o n a ns ran e o era e ro e ea ns ran e ar e a e or more n orma on s

ea are o

o or o r e en en s are a rea enro e n e a or C P an o e n Penns an a

on a o r S a e e a or C P o e o n o rem m ass s an e s a a a e

o or o r e en en s are O rren enro e n e a or C P an o n o or an o o r e en en s m e e e or e er o ese ro rams on a o r S a e e a or C P o e or a 1-8 -KIDS NOW or wwwinsurekidsnow gov o n o o o a o a as o r s a e as a ro ram a

m e o a e rem ms or an em o ers onsore an

o or o r e en en s are e e or rem m ass s an e n er e a or C P as e as e e n er o r em o er an o r em o er m s a o o o enro n o r em o er an o aren a rea enro e s s a e a s e a

enro men o or n an you must request coverage within 60 days of being determined eligible for premium assistance o a e

es ons a o enro n n o r em o er an on a e e ar men o a or a as e sao o or a E S

If you live in Pennsylvania, see sidebar information; you may be eligible for assistance paying your employer health plan premiums This information is current as of uly 31, 201 Contact your State for more information on eligibility



2018

20

Important Notice from the City of Philadelphia About Your Prescription Drug Coverage and Medicare (Medicare Part D Notice)To Retired retirees Eligible for Medicare Coverage as of anuary 1, 2018 o are e are e e or o or o r e en en s are e are e e or e

r n an o ar a e n e C o P a e a Pres r on r Co era e s no e a es o o Keep this Creditable Coverage notice where you can nd it P ease sre ar s n orma on oes no a o o

Creditable Coverage NoticeP ease rea s no e are an ee ere o an n e no e as n orma on a o o r rren res r on r o era e e C o P a e a an a o o r o ons

n er e are s res r on r o era e s n orma on an e o e e e er or no o an o o n a e are r an

o are ons er n o n n o s o om are o r rren o era e n n r s are o ere a a os e o era e an os s

o e ans o er n e are res r on r o era e n o r area n orma on a o ere o an e e o ma e e s ons a o o r res r on r o era e s a e en o s

no e

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1 Medicare prescription drug coverage became available in 2006 to everyone with Medicare Yo an e s o era e o o n a e are Pres r on r P an or a

e are an a e P an e an O or PPO a o ers res r on r o era e e are r ans ro e a eas a s an ar

e e o o era e se e are Some ans ma o er more o era e or a er mon

rem m

e C o P a e a as e erm ne a e res r on r o era e o ere e

C o P a e a or retirees s on a era e or a an ar an s e e e o a o as

m as s an ar e are res r on r o era e a s an s ere ore ons ere

Cre a eCo era e

e a se o r e s n o era e s Cre a e Co era e o an ee s o era e an no a a er rem m a ena o a er e e o o n a e are r an

When Can You oin a Medicare Drug Plan?Yo an o n a e are r an en o rs

e ome e e or e are an ea ear rom O o er o e em er o e er o ose o r rren re a e res r on r o era e ro no a o o r o n o a so ma o n a e are r an r n a o mon S e a

Enro men Per o SEP

What Happens to Your Current Coverage If You oin a Medicare Drug Plan?

o e e o o n a e are r an o r C o P a e a Pres r on r o era e no e a e e e C o P a e a an oor na e e are The City of Philadelphia

Medicare-eligible retirees have the same drug coverage as they did as an active member

When Will You Pay a Higher Premium (Penalty) to oin a Medicare Drug Plan?Yo s o a so no a o ro or ose o r

rren o era e e C o P a e a an on o n a e are r an n on n o s a s a er o r rren o era e en s o ma a a er rem m a ena o o n a e are r an a er o o on n o s

a s or on er o re a e res r on r o era e o r mon rem m ma o a

eas o e e are ase ene ar rem m er mon or e er mon a o no a e a o era e

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o a s er rem m a ena as on as o a e e are res r on r o era e n

a on o ma a e o a n e o o n O o er o o n

Medicare and Non- Medicare


21

RIGHTS & NOTICES

For More Information about This Notice or Your Current Prescription Drug Coverageor more n orma on a o o r C a m n s ere

Pres r on r o era e on a o r ene s m n s ra or e o NOTE: Yo e s no e

ea ear Yo a so e e ore e ne er o o an o n a e are r an an e o era e ro e C o P a e a an es Yo a so ma re es a o o s

no e a an me

For More Information about Your Options under Medicare Prescription Drug Coverage

ore e a e n orma on a o e are ans a o er res r on r o era e s n e e are Yo an oo o are e e

or e are o e a o o e an oo n e ma e er ear rom e are Yo ma a so

e on a e re e are r ans or more n orma on a o e are res r on

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e are Yo an oo or e r e e one n m er or ersona e e

Ca E C E Y sers s o a

o a e m e n ome an reso r es e ra e a n or e are res r on r o era e s a a a e or n orma on a o s e s So a Se r on e e a

so a se r o or a em a Y

Remember: Keep this Creditable Coverage notice o e e o o n one o e e are

r ans o ma e re re o ro e a o o s no e en o o n o s o e er or no o a e ma n a ne re a e o era e an

ere ore e er or no o are re re o a a er rem m a ena

Date:

Title:

O o er

Benefits Adminstrator

Contact: [email protected]

Address: o Penn Cen er P a a Boulvard

Philadelphia, PA 19102

About This Enrollment Guide: Disclaimers enro men e s a s mmar o ene s o ons an no n en e o e a om e e es r on o e

C s ene ans ro rams ere are an s re an es e een s ene s enro men e an an C a m n s ere ene an or o e a a e an o men s or o s a o ern s oo e

oes no re resen a aran ee o ene s e n a on e C reser es e r o an e or s o ene s a an me or an reason as erm e a a e a s r es an re a ons Retirees

o are re resen e one o e C m n a a or n ons ma or ma no e e e or e ro rams es r e n s o men e e o n on re resen e em o ees or ese ro rams e o erne e a a e o e e ar a n n a reemen s an or e s e o o e e ar a n n


NOTES

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22

O CO E : Summer Kaleidoscope ra r s P a e a ess e Un er a er a e r n Ea ns O a en am n ran n Par a P o o a e a an