5.4. ERMUSR 10-10-2006~/
Elk River
Municipal Utilities
13069 Orono Parkway
Elk River. MN 55330
October 4, 2006
To: Elk River Municipal Utilities commission
Jerry Takle
Jim Tralle
John Dietz
From: Theresa Slominski
Subject: 2007 Health Insurance
phone: 763.441.2020
Fax: 763.441.8099
Attached is a letter from Jodi Berge, our Account Executive with David Martin Agency,
regarding our 2007 health insurance rates. As I mentioned in a prior commission
meeting, the renewal is only a 7.4% increase this year. Jodi offers information regarding
the pool we participate in, rate determination, amendments for 2007, and some alternative
cost options as well.
Last year we assembled a task group together to review the insurance plan because we
had such a significant increase over the prior year and needed some cost containment
measures implemented. With only a 7.4% increase, the desire to pursue other insurance
options is not as critical as in past years, but I would still like to gather the group together
again and focus on the long term. What can we be doing now to curtail insurance costs in
the future? Do we want to start offering alternative plans (although our pool has limited
alternatives)? If it is this commission's desire to pursue this avenue of focus, I will move
forward with the task group.
Elk River Municipal Utilities
2007 Health Plan Renewal
Prepared by David Martin Agency, Inc.
October 2006
~~ ~
.Employee Benefit
Specialists
:,.
Pho 952.920.4516
1 .888.889.9013
2007 Health Plan Rates Fax 952.920.2655
The Aware (Double) Gold with $15 Copay Plan from Blue Cross Blue Shield of Minnesota
will increase by 7.39% on January 1, 2007. This is annual increase of $26,478 or $2,206.50
per month. Total 2006 annual premium will be $384,600. Average monthly rates will be as
follows: Single = $415; Single + One = $872, Family = $1,328.50. Final 2007 rates include
an actual rate increase of 11% plus an additional 0.2% due to your group's specific claim
experience. Current health insurance trend rates in the general marketplace are running 11% -
13%. The Service Cooperative pool is indicating a lower trend rate of 7.6% - 8.1%.
Health Plan Insurance Pool
The plan carrier is Blue Cross Blue Shield of Minnesota which provides plan benefits and
claims/administrative services. Renewals are distributed through Resource Training &
Solutions, the Service Cooperative and David Martin Agency, Inc. Plan rates for Elk River
are based on the MN Care small group insurance pool of 2-50 employees under the Resource
Training & Solutions umbrella. Their MN Care pool is now comprised of 16 employer
groups accountable for about 11.2% of total pool employees. (Large group employers
number eight and account for 88.8% of total pool employees.) Resource Training and BCBS
calculated 2007 renewal rates based on:
1. claim experience of the small group pool
2. claim experience of Elk River Municipal Utilities
3. demographics of Elk River Municipal Utilities
Rate History of Total Pool
Resource Training & Solutions: Insurance Pool Rate History
Year Minimum Maximum
2007 4.5% 27.0%
2006
MN Care
Lar e Grou
7%
2%
35%
30%
2005
MN Care
Lar e Grou
3.0%
2.8%
24.0%
11.6%
2004 3.0% 24.5%
2003 5.0% 20.0%
2002 4.0% 25.0%
Plan History of Elk River Municipal Utilities
Year Loss Ratio
Premiums
Claims PMPM
Claim
Amount
Avera e
Rate Change
2007 n/a n/a +7.39%
2006
Jan - A r o6 Paid to May 06
116%
$431.26
+20.6%
2005 118% $241.92 +15.91%
2004 117% $217.55 +16.9%
2003 105% $204.35 +13.4%
2002 90% $140.34 + 4.0%
Active High Cases: 2005 $93,266
2006 $37,225
Average Plan Rate History of Elk River Municipal Utilities
Year Single Rate Single + One Family Rate
2007 $415.00 $872.00 $1,328.50
2006 $386.50 $812.00 $1,237.00
2005 $258.00 n/a $ 973.00
2004 $222.50 n/a $ 839.50
2003 $205.32 n/a $ 775.12
2002 $184.39 n/a $ 696.10
How Rates are Determined
The rates given by the Service Cooperative are considered self-insured, as Elk River is solely
responsible for all claims up to $75,000 per employee per year.
Specific percentages of past year's claim experiences are used to calculate a full year of
experience for aself-insured rate. For the 2007 renewal, 33% of 2004 claims, 52% of 2005
claims and 15% of 2006 claims (Jan -Feb) were used.
Demographic History of Elk River Municipal Utilities
The average age of your group is about 41 years. Average age, number of employees and
dependents can impact overall rates. All plan members total 87.
Em to ee Count
Year Total S 1/ S l+ 1/ Fam
2007 31 7 / 6 / 18
2006 30 5 / 5 / 20
2005 30 7 / 0 / 23
2004 27 5 / 0 / 22
2003 26 3 / 0 / 23
2002 25 4 / 0 / 21
2
2007 Health Plan Amendments
• Office Visit Copay: The office visit copay will increase from $15 to $20.
• Emergency Room Copay: The hospital ER copay will increase from $60 to $75.
• Out of Pocket Maximums: For network medical services, the out of pocket maximum
will decrease from $2,500 to $1,500 per calendar year. The prescription drug out of
pocket maximum will change from $500/person to $500/person, $1,000/family.
• Prescription Drug Copay Change: The drug benefit will change to a three-tier copay
design. The copays are listed below. If a brand name drug is chosen when a generic is
available, the cost difference between them plus the copay amount is payable by the
member.
Copay at a Copay for
Drug Type Retail Pharmacy Mail Order/90DayRx
U to 31-da su 1 U to 90-da su 1
Generic Dru s $0 Co a $0 Co a
Brand Name Formular $35 Co a $70 Co a
Brand Name Non-formular $50 Co a $125 Co a
Over the Counter (OTC) Drugs $0 Copay Not available
Applies only to Proton Pump Inhibitor A prescription from
(Prilosec) and antihistamine drug (Clarion) your provider is
classes. Covered OTC drugs will serve as required.
replacements for some prescription drugs
that will no longer be covered in these
classes. Visit www.bluecrossmn.com for a
list o covered OTC dru s.
• Pharmacy Network Change: On January 1, 2007 your plan will use the Select Drug
Network. This network is very similar to the current one and offers a broad nationwide
access and additional cost savings.
• Specialty Drug Benefits: Some drugs used to treat complex or rare conditions (including
multiple sclerosis, rheumatoid arthritis, hepatitis C, hemophilia, and others) must be
obtained from the Specialty Pharmacy Network.
• Lifetime Benefit Maximum: The lifetime maximum benefit of your plan is increasing to
$5 million dollars from all providers.
• Minnesota Comprehensive Health Association (MCHA): Any eligible employees
currently covered under an MCHA plan may enroll in your group health plan at this time
for an effective date of January 1, 2007.
Health Plan Cost Control Options
The following options for cost reduction control are available:
A. Change plan products within the Cooperative
Option 1: BOBS CMM $25 Copay Plan (see attached benefit summary)
Avg Rates: $388.00/Single, $815.50/Single + One, $1,242.00/Family
Option 2: BCBS $300 Deductible CMM Plan (see attached benefit summary)
Avg. Rates: X274.00/Single, .$786.50/Single + One, $1,198.50/Family
Option 3: Health Savings Account (HSA) Plan Design
This type of plan was discussed as an offering in conjunction with the current Aware Gold
plan (a dual option). Premium savings could be contributed toward each participating
employee's deductible under the HSA plan design. HSAs may be a good option for
healthy members.
B. Conduct a market search for plan bids outside the Cooperative
At this time, market search results would not be fruitful due to current high claims experience
loss ratio (116% from Jan -Apr 2006) and a high on-going claim case ($37,225 in Jan -Feb
2006).
Thank you for this opportunity to present your 2007 health plan renewal! Please contact me
with any questions you may have regarding this information.
Sincerely,
Jodi L. Berge, CEBS
Account Executive
David Martin Agency, Inc.
Enc: BCBS Benefit Summaries
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}iolw this {plan aptio~~ vvork~
Alenlbers earl see any health care provider of their clu,ice
for ImOSt a,Vered SerVlceS - without reterralS. FOr SOllle
sen~ices, file best benefits are available ~a~hen nletnbers see
health rare pnn~'iders in our state~~wide Blue Cross (Aware )
network. The Blue Cress network includes priman- care
clinic,, specialists and hospitals. Nerivork providers take care
of all claims paperwork.
P~etvvork hroviders n~ivan sa~rin~s
By using the e-tensive net~a~ork of health care providers,
nletnbers avoid hidden costs. All those providers have agreed
to acceptthe"allowed amount" specified intheir contracts as
frill payment for covered sen-ices. The BlueCard` program
ea-tends that protection across file United States atld even
worldwide tllrou~h the"Traditional" net~«,rk.
If a member sees a health care provider ~vho doesn't have a
contract ~~~th Blue Cross (a nonparticipating provider), the
member is responsible for any deductible, the coinsurulce
amount applied to the allowed amount, and the difference
between the actual bill and file allowed amount
~xp~ct ~~~ore with E31uzPrint f~f~ Health`'
Take advantage of programs designed to improve health
atld pCOdilctlvlty: htneSS d1SCOL1ntS • EAp • .'.4-hour I1L1CSe
advice line • prenatal support •stop-smoking program •
ease'-to-use health information at our online wwellness center
• Blueprint for Health care support, our groundbreaking
progr:un for members ~~~itll chronic conditions. These
programms are offered at no additional charge to groups.
r
14' 1 f ~I i= t? ~ r1 }' ~? i tt !I Please note: r"a'?efir~?:~=u~y~ad t\? :^3~t,da'a'1 ?,?,\: ~,l,ij
Annual deductible none x_ 00+'parson - $900+'fan7ily
Out-of-pocket ma~nnun7 $1, SOOiperson $S,000lpersun
4 separate out of-Pocket maximum
of $500 per pesos or $1,000 per tamil~ applies
10 pre SCllpt1011 drLl Q~
klfatltlle RIBYInIUnI `~S nlllO~l fOr SBfVICe. frOlll 311 prOl'Ide15
Offlia VIS Its Or ill gent Lc71C VISItS
• Illness or injury 100"o after X20 copay SO°~o after deductible
• Behavnora health care (mental health, 100°~b atter $20 eopay~ i~ea m ~.+~ bal~)w~' 80Sro after deductible
substance abuse. e3tincY disorders
and autisml
• Lhll-Op ra ~~IC 17lanlPUatlOn I1~~"L after x'17 0.np ~1'* I~Oe 7. 3!S 1)elOln;=I kl~o,U after dedU ctl k~ e; ,'70 b c fOi
~ ~ ,
S orb rC~J i~~)i?? ii:~-~.i-:, °i4Vpri; ~ Oyc7erS
• In-office surges^•'allerav-related selti~lces 1004~o SOni~ after dedudlLle
Preventive earn
• 1rl~e-cI71d Sarl+ilt'S and IlYllllLin1~3t10n5 ~ 1717"~L Sly°~L 3ftel dedlll~lbe
• Prenatal care 1011°:0 ~0".i after deducrtible
• RoUUne physicals and e1'e a\anll I1~1~`~b til~`)ro after dPdLI CtI bP
• <_3llcal SCrZZI7111Q5 I1704~b X17°ro 8ttel dedLldlbe
Lab and X-ray san~ Ices 100°-b 8056 after deductible
In- and outpatient hospital services
• Facility services iindudes behavioral 100"{ * i'~ee ae~ ~, k, lovr;? 80°i after deductible
health care?
• Professional services (includes behavioral 100"ot j's r ",au's k ievl;! SO Si after deductible
health caret
EI?iaraanc~ Tara
• l~Ut~?dti2nt fall it\•' SL•IV IOc.= I l~l~o after" $-S ~Opa~~ 11717 o~t 3ftZC $~S ~Op3~`
• l~utpatient professional services 100 u.5 SO St after deductlLle
,4mbu lama sarv Ices 0°6 SO4i
~:'ledlccel supplies SO4~u 80°~i,
Therap\' serv leas
• L_hlrOpradlc th er3pl' 100°~L aftal X00 cOp 91t I~°' c7. a ~S Jd1i~Vl! SO 4b after dedll ctl be, 1'O ~?8!' J
~tbri..j '~ Ji?? C ~~i-~.r-, ~ °tbVOiY L i)Y? T~rS
• OccU paUOn d and ph1'slCa theca py 1171~`~~ti d1YPl $20 cOp34' ~l~°0 3fler i~2dll ctl bleu i=)?"~' Y. 8~h k?: !i)L9~'I
• SpeeclY therapy 1170 `'L after ~~17 cOp31' SO"L after declll Crtl b.e*; j'S'Z YP. a'lt belOVl~;I
Prescription drugs-?1 -dsy supph~
• -~~'de supply of oral oontraoepti\resfcr $0 aanenc'~= 5 fom?Mary brand+' ~0 aaneri~r'f=5furmular~• brandr~50 nonfomnllar~~
copaYS $50 nonformulary brand br3nd~ member pa4s the pharmacy and tile, a Balm.
Ill ai"1d1110r7 tip cOp31'S, rYYalllbc'YLVI k~e lespO~lslba
(1:1alnta178 r7ce preS%r IptIOI7S - ~l)-d a4' yU~.?F)1' fOr" 31ll OLl tits In ZYOc'SS Of aObV2d 3nlOllllt.
• ?OdayRx retell nehroork or by mail order $0 generic/$?0 formulate` brand:
$ I ~ 5 nonformulaly brand
ifd ~,9L: ~i1T.l: . \,i 1: i1~.. 'ti4 ^L'~~Il. hL.O`±.?~~2'llti''1:'~L ~~TA:.'T L9,~'C1:/~C:Ilcll*.~'i~~~L 7:L~9'?2:11~3'~i7-'1 l-?.1^ 1~..'~d C~~L CI'L .1~~C'`?i.1 '. _1'Cl .~i .. .~~.!, _t'?ti'Od'~~C:h^G.
..~..~i.~., ,J f,'t fi: ~I~~ i~^S! OI ;~ 5:~7?~7-71: fJt ~Y2.C:.
61uaFr int for Health pro~Prams Employee assistance • stop-smoking prograr77 • ~~-hour nurse advice line • prenatal alppolrt
Included lroith plan • onlinevvellness center • care support for chro nic condrtlons • fitne~ discount
Ho\n~ ecst shdrin4 is cskulated
CO(kiy5 dre 1130 f2p51OU tdV aL Yhp bR1p Vc~LI reCelti2 d Sefvic2
t.ofnSUCanCe L Ch2 pprC2nC3lp o1 clldlge5 vOLI ~.:3V tJl d 521VICP. ICs I?. dsed Jn Cllp dlloeV2d dmOUnC.
t)edUCtl ~le ~Il3r l2= d12 5Uk CI3 c22d frORl the 311 ~t~pd 3R10UI?C.
Allowed amount IS flip 1121i,43C2~ aRl JLlllt t~ldC netvv i?rk 1:ri,Vli~2 r5 I1 34~2 3]rp2i~ LO 3CC2F t d5 CLlll 1,31 R1Pnt dC CIl2 LIR1P yOLlr IIdIRI I~ ~ I~,C2=52 t1 11 1~OL1522 3 I?I O1~I ~Pr ~Vll t~ i1 i~2511 2 Fdf biIP3C2
4Rrltll BLIe Cr'ow', flip 311 ~)4tlpd 3n10U n215 21th2r flip billed CllafQe i,r d p?I~2n Cdg2 01 the rip t4ti i~r l; doNl2d aRlOLlII C, Yt+lllch 2Ver IS p\
For highe~7 level of coverage, uce Select Network provides for outpatient chiropractic and behavioral health .cervices.
For a!! other services use the Blue Cro` Network.
` f`~-°~;~ 't Phydcal, occupational and spc~ch Urerapyservic~s?united to a 8300 maximum per calendar yEar
Yit ~~
This Is only do outline of plan l2nehC The conitdct dnd c2r tillcate Indud2 complete detdlls of ~vhdt a and isn't a~v2red. 52nnc2_ not covered in lode
~U!l~JJ53~$itl~*,~fi~*#~ e~~2~la`2shearin~dl~it2m5primarih~us2dioranon-m2di~alturpese,o\21-the-counterdrLr<ti~nuUitl.~ndlSUpplemen~ser~~i.PStf~d[dre~~m2ti`
<7~ ~I(1f`I@~C€~~ exp2rim2ntal not medically ne-2s`dry or covered bs ',~oll:er_.' cemperzation or no-1aLJt auto Irzurdnlp Bre-21~ona conditions mdse not he covertd }or
d limited period of time This limit ~ redu~2d by pnor eonOnuaLC cov2ra~p and doesi t dpph~ R~ pre~ndnv n2evborrz, adopted children or handlcdpp2d
dppend2nts 1A+'e t2ahlre a large n2l4t+erk ~f h2ait!) care plaviders Each praaider Is an indep2ndpnt a~nUactor dnd is not our dClpnt Nanpdrbcipatina
F5ge5~? t:0t? prwlder~ do not hdv2 contra.C v+rith Blue Croce and Biu2 Shield of Nlinn25ota. Blue G ~ and Elul ~hipld e(h'llnnesota ~ an Ind 2p2ndent hcert2e
(etas numter4? of die Blue Qo and But Shield +hxiation. E2n2hLs are p112e0vp luh~ 1 ?OOo.
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Hot~j this plan option 4vorks
Members can see any health care proc-ider of their chore
for most covered serviies -without referrals. For some
sen-ices, the best benefits are available ~~~hen members see
health rare providers in our statewide Blue Cross (Aware`}
network. The Blue Cross net~•vork includes priman~ care
clinics, specialists and hospitals. Net~~vork providers take care
of all claims paperwork.
Net~~~ork providers mean savings
By using the et-tensive net~•vork of health rare pro~~iders,
members avoid hidden costs. All those providers ha~~~e agreed
to accept the "allu~ved amount' specified in their contracts as
hill payment for covered senzces. The BlueCard`~ program
extends that protection across the United States and even
worldwide through the "Traditional" network.
If a member sees a health care provider ~vho doesn't have a
a~ntract ~~ith Blue Cross (a nonparticipating provider), the
member is responsible for any deductible, the coinsurance
amount applied to the allowed amount, and the difference
bet<•veen the actual bill and the allowed amount
Expert more vt~ith EiueFrint for Health`"~'
Take ad~•atttage of pro~ratns designed to improve health
and productivity: fitness discounts • ELF • ?4-hour nurse
advice line • prenatal support •stop-smoking program •
easv-to-use health infonnation at our online ~•velh~ess center
• BlueFrint for Health care support, our groundbreaking
program for members ~aid~ chronic a~nditions. These
programs are offered at no additional charge to groups.
~~.
1v i t 1t cop ;~ v p 1 ,~ !t ~'easenute:Ba',"+;[,a~,~'~'e~ ;o:^a~.u=r~~~~a,~~l:~„ci+
Annual deductible none $Z00%person-$r00;'falllily
Out-of-F?otket lll8xm7um ~ ~ 1, 100?peron- $S ~l~l~lrf3llllly s 4_.SOOrperson
ASEparatEOUt-Ot-pOckdtnlaXlnlllRl ~1,=110~'p!er=ill-~5,l1Lll+'famlll' i. ~~,5001'perSOrl
of $500 per person ~?r $1, 000 per tanlil~'
applias to prescnption drug=
Lifetime rllaaimulll $5 million far sen'ICes from al l pro~'iders
Office visits or Urgent gar e vi,its
• Illness or injury '100°~b suer 3?O copav or ~ ;-$25 copav ~ t0°,o alter dedudiLle
• Eehavfioral health care lnlental health, 1004~i after $'_0 eopay or ~,~ ~$~5 copav *
~ ~ OS~t after dedudlble
substance abusE, Eatnlg disorLiers uxL-+et~'ls ~I~ovs
and autisllll
• ~hiropradlc nlanlpulation 100°o after :~ ~> $20 copal of .~n~ $~5 copav * ~ 0°n after dedur~lble ; ~~ L», ~ f~~,
ire ~^?aI_ balaaa ~ r-tes f o;l~ c~,~ ~ trva+-~ 17da•S
• n-pf11CE CLIrQErV`~~BEfC~y-related Sell'ICeS ``;~"~L Ltd"~u BttErdedLlL~Ib12
pr c'.V c'.ntlVC' carE
• 1~1+EI1-child Sefl+lce$ and llllfllLUlIZ3UOlls t lll~°.~L t~~"b after dedULrtlbl2
• Fl Enatal care 100`rL b0°b after deduc~lble
• ~QLltint physicals arld Eye e\3111= I I~~~°,~i, C.S~°.~6 aftEl dedUitlbe
• Latl CEr CC12ell In i7_ ~ 00 `lb ll~".L effel dedLl Bible
La k? and ~-ra\' ?ErVI%eS 1 L~L~`~b; 0"L tL?i IllFiatlEnt Serl!1cE5 L.0°L after dedUCtlL,le
In- and outpatient hospital servieEs
• Facility sen.ices jindudES behal ioral 80".L * isee Bets 1. ~~eloLro;? o0".t after deducrtibla
health carE)
• Professional senlices ~lndudas behatrioral 30°i' icee de ? ~ ',~iev>;? c0°t altar deductible
health care?
En7era2ncv care
• Outpatient facillt~' services I00°6 after $'S copav I00°i after ~'S copav
OLIt(JatlEllt F?ltesslOlla SEn+I~ES till"b l~~"•L aftEl dedLlCtlbE
.ambulance sErvice+ SO"o 80°.t
I~'Ied Ila I $UF?F?I12i ~~~`~L l C~`~L, attC'r lledLlLrtlblE
T ll er ~1F?y SerV Ii.25
• Uhiro?Tactic thera,l
{- (-' 80`~6* ':ee e a l~ bejovl,!
I- 1 , , ~,~;, ` rte.,
ll`~b after dEilU Ertl L.E;
~~f7l~~~ .. Ji?? OUi-pi-;'uttrt/i?;~~ P ~01'iiY y'~.
• l~!QUpatlOna and ph)!slca th Er"8pV :Ll°~u ll~`}i 31t2r ~iz~lU dib2~~ l~°e T 47-~'elOVia
• tipeEcll th Erapl' ~l ".'u l l~".'b after dedLl LEI bEt ~ jJ" il'Oi3!!J ~`~'!CVI~;I
Prescription dru~~s- 31-day +upF?ly
• ~-~ydE supph' of oral a?ntracepti~,es for $0 generid$_ 5 formulary brandy $Ogenerivx5 fornlularv brand/x50 nonfonllulan'
~opays $50 nonfonllularybrand brand: n7Erllber paysthE pharnla~y,andtilES adaim
In addition to cx,pags, I~lernber ~roill be responsible
ft,laintenance prescriptions - ~0-day supph' for amounts m excESS of allowed arllount
• a0dayRx retail nehroork or by rllail ordEr $0 Generic, ~?0 forrllularv brand-+
$ 1?5 nonforlllulanl L?ran Li
ill ~-Cl'~~ ~ t7 T.V ~ ..1~d .. il~ ? c7 ~,la'?~~11 ~ LJ~ 3 il.~'7cY-•l3 •lL ~Cf '~.1;. 'lL^ IL'tti :1t Y~~ i7 k.9q ~2' it'~'16 X3'7? Y~`L ill d-^2'^L nl^~~ ,.'?7',`L ~'
_ L^L v Ll ;. 1' «. ~~.. ,. ~ I'l ,Jf~L G?tea C~h. G. .
..,,,~i,~,~,Jtho >`i.C1 c0+Y J?',IL i43 RQ'-n:?nt ~'i.V.
Blueprint for Health proararns ErllploveE assistance • stop-smoking program • 2-1-hour nurse advice line • prenatal ~Ippurt
Indudad \rolth plan • onlinE \wEllness center • care support for chronic conditions • fltnes, discounts
HO\~\~ ii?St sll 3f lrl _} IS c3cU3tzd
CO[kiy5 3fe tat }PT ti1111 pay 3t the tl Rle \'OU t2~eIV2 3 sPI'VI~2.
Coinsurance I~ ale f121t211C312 O} il131Q2= VJLI pal' t01' 3 X21 VI~2 . ICS I?3-+2i~ ilrl 1}lP 311;^Y112 t'~ 3nlt L1tlC
fed UCtl~Jle ill3r 125 31 P Lib b a~Ced irOm the 311 ~Ve ~ 3RleLlllt.
Allowed amount Is flip I1270b3ted 3R10Utlt t}l3t ietLtrillk pl ilvl d2r~ have 3gle2d t0 3Ciept 35 }Lill ~: 3Vn1211t 32 the bn1P VJUI 0131 R1 h plOi 2`2 ~ I} VOLI fee 3 }?IOVIi1dl 4M hi? i10 P=n't }?3f 0~I}: 3t? btllto
BLIe Lr0`, dlP 311011+e ~ 3mi?Urli IS 212I1er the billed dl3re7P Jr 3 pPri2nt3 7e i`t dlc' n2MliX li 31114113 i1 3R1 i, tin( 4VhICIIPVPf IS 2i~
For highest level of coverage, use Select !L'etwork provlden for outpak'ent chiroprac6'cand behavioralhealth .cervices.
For ali other services use the Blue Croce Network.
~" ?hy~ical, occupational and spEech therapy :ervicesllmrted to a $500 maximum per calendar year
~. .
brmT• ~,,~ ~1J Thl_ is my 3n outline of plan ben2}i~ The ~onb3ct 3n i ;artiii~ate in line L nlplate detail, of mh3t i. and inn t covered ~2n1 ~ not avared indudr
~,'~' evr_ll3.e., h23nn t 31 ~ Items primarily u.ed for anon-mediLal F Llrpo.e. ol2r Jl2-counter dI Li t nutrltlonal suppl2m2nb- ter\ Ire= tl 73t are c ~meGc
~~~.i2S'~[~TS'~ ~~:lR+~a'fIN~C" e~p2rim2nt31. not medically n2-2~ary. cr covered by elork2n' comp2lraben ;~r no~f3ult auto ir2ur3nc2. Fre-et~bna condlbum may net b2 <evered feI
Oi Allir~fla~a[3 a limited period o(bme Thi_ Ilmit c reduced ly prier continuoLS ccvrra_72 and do2snt 3pph~ to pregnanZ~ neyuborlr, adopted dlildren ar h3ndlcapp2d
d2p2rld2rl~ 1A72 teaRlre 313r ~e Il2LLVJII: ci I1231th L3'2 (:IJYIdel~ E3 ill pli^41d21 IS 3n In d2pelld2110 ~Ollb3il01 3f'd I= nOt OUt 312nt Nullp3l bilp3tlrl7
FS l5~ R?? i=Or1 providers do net have cantracts evnt}l Blue Gam and Blue tihl2ld ai R!linnr.ota. Blue G ~ and Elul shield of NIInn2sota ~ an rnd2pendent licer~2e
iFlan numb2n a 11=. b 1111 0(~e BIu2 Crate and Blue tihi2ld ~~aaation Benefit are atfecOve.'.uly 1, _00
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Ho~~v this plan option works
1\Iembers can see qtly health care provider of their dloice
tOr mOSt COVered SerV1CeS - 4Vlthollt retefC;11S. FOr Silllle
Seri'1CeS, the hest benetltS art' a~'allable b1'hen IIle11]berS See
health Care provlderS In Ollr Statewlde BIUe ~,rll$S {t14V1re~}
nerivork. The Rhie Cross network includes primary care
clinics, specialists and hospitals. Network providers take care
of all claims papena~orl:.
Network pra~,riders mean savings
Bc- using the ei'tensive network of health rare providers,
members avoid hidden costs. :111 dlose providers have agreed
to accept the "allinved amount' specified in their contrails as
hill payment for covered sen7ces. The BlueCard`° program
ei-tends that protection across the United States and even
world~~~~ide through the "Traditional" net<~vork.
If a member sees a health care provider who doesn't have a
contract ~~1th Rlue Cross (a nonpartlapaUng provider), the
IIleIIlbeC 1S reSpOllSlble toC ally dedLlctlble, the coinsuratlce
amount applied to the allo~~~~ed amount, and the difference
between the actual bill and the allowed :unount
Expect mare vt~iti~ Bluerririt for Health'
Take adv;urtage of programs designed to improve health
alld productivity: hUless discounts • E~1F • 24-hour nurse
advice line • prenatal support • stop-smoking progr:un
easy-to-use health information at our online ~velhless center
• B1ueFrint for Health care support, our groundbreaking
progrun for members ~~vith chronic conditions. These
programs are offered at no additional charge to groups.
~~~
1'h 1 ~- ( 1 id l' it 11~ l4 t '1 L~ !~ C; ~ !- f~ ll >7(0d Cenote:Be'?e+l's ar~si'iPed 20 "~1'Ti.ll?'vl~'1•?C'q,iJ 1':3?
~,nnualdeduaik~leoptions ~ =OOrper son-$ 900~family
Employers choosz onz of four options $ 500%pzr son - $ 1.000+'fanllh
One dzdudlblz applizsto sen,lczs from ~1 0001; pzr ;on - 32,OOOOfanllly
all pro~~iders $?,000lper son - $4 000+'falllily
O Ut-C~t-pOCI:et nI~XIIIIUl11 ~~,f $ 1,500)pefsOn -$S,OOOrfafllllV $~,5L1 L}1per50n
Theseeptionscorrz=pond tothzdzductible $1,800ipzrson-$S,000farlldy $~,-OOr'person
selz~zd .4 szparatz out-of-pocket rlla~nlnnn r $2.2501pzrsc~n-$S,OOOr`farlldy $2,'OOipzrson
of $500 perpzrson or $1,000 pzr falllilyfor ~ $~,SOOlperson -$S,000ifanlily ~~ $=;000ipzrson
przsaiption dru~Ts
Lifetnlle nuaxinulrll $5 Ilvlhon for szn+l~zs from 311 provldzn
Off,ce visits or l!raent Care visits
~
• IIInzSS or inlur~, I00°b attel r o ~ :~ $~5 copay ,I i ~= L co pay 009b after dedudlblz
• Ezhavloral health cart (nlzntal hzalth, 100"6 attzl 4*dy,P $?S a~pay of ~ ~.: $0 a~ pay r0`~6 aftzr dzduc~lblz
ubstance abusz, zavng disorders and autisnll * r 7etall~ I ~ioat~l
' ChIrOplaCtlc RIanIF, Ll atl ~~n 1111}". altel t..t ~,y>r $~ S cOpay OI e~ e:,,W $= ~ cO pa4' L 0°6 aftel ded Ll c~lb O L~8 °' iJ !0•
t ~ 7Pi371} 4ie Qll ~ ~ 1,.~~~ i~-, ui-~ , .Jrll'i. J); ~ ~1". iY ~.
' n-ottlcz Slll~}z11'±32fC}~'-r2 3tc. C1 SctIIIC2ti ~ l~".ro 3ftzr dzClUCrtlk~2 l l}".~b 3ftPr X12 Ci ll CflLiz
pf eV entlve %a r2
• 1'vell-child senliczs and irllllluni~ations 1 004ro u0°6 after dedudlblz
• Prenatal cart I u04-b 609 after dzductiblz
• Routinz physicals and zye zxanu 100".o r0`~,t after dedu~rtlblz
• lan~c'f SQ"zznln C}5 1lll~"~l 111 °.~L 3ttc'I liZ Ci ll Ctlk?2
Lab and X-ray services 100:1, 4001 after dzdu~~lble for lnpatiznt senliczs 00°6 after dzduc~iblz
In-and outpatient hospital services
• Fazilit>' szn,lcestindude; behavioral SO"6 aftzr dzduc~tiblzt fcee o~`all~ revl? 0006 after dzduc~lblz
health carzl
' ProfeS'IQll al SeR+ICeS ~I Il CLldes bzh a\AOl"a :~l}°6 aftaf dedUdlbe~ (~-.~ d?f3 ?l~,V1 ;? ll~"6 aftel dedLl ~tlb2
health cart?
E rll el'Qe~rI CV Cale
• OUtL,3tic'nt fall lt\•~ tizlV Ices 101"o aft of $S iOL,a1' 1l}l}`~~b after $~S ~Op31'
• OLltp8t12nt prOfZ55iOrla 52r~rIC05 tiQ~~u afteF dzdLldlbe r0°~o fitter dedLlctlbe
Alllk?u genie S2rvlicS 80`0 0°.i
Medical supF?Ilzs SO".o after dzdu~~iL,lz e0`~6 after d2dudlblz
Therapy services
• Lhl lrOpra Cell thelap\' l}`~~L 3ft21 i?2li l1 C~IL,z l - cYF.'3 l?!Ol'I~',~ ~l~oL ~1t21 d2 dLl ~~lk,c. •~. ~?:3'~ -.
~efly~g$'. Ji?7 it ~~~-~~ -,•°i14~'i~iY L?I~O VJiY ~;S
' OccLl patlJll a and phi\51Ca therap)+ 80°ro after dzdudlba l5ll ".~l 8ftdr dzdu ctlbz~~ kSee Y. 91~ ~o1Cl VV?
• ~F'?eech thl er"ap\' l}u.L 3ft21 ~1211U~-(IL,z l l}uL dtt2r 112dU C~ILIIz.'~ l~'? i7?i31i} ~~af~~~:~.1
Prescription drugs
• I -day suppy; -q de supply of oral 35 aznzriv$=0 fonllulaly brand+' ~5 aenerici$0 forrllularv brand?$-15 non-
contraceptivzs for _ copays $~S nonforrluilan brand fornlularybrand; you paythz pharmacy
and file a dainl In addition to elpays,
nlzlllber Arai ba rzspomibe for arllaunts in
esczss of the allo\nrzd amount.
• ~Isil-ordzr drugs (90-day supply? ~ 10 aenznc,'$o0 formulary brand+'
`~ ~O II OIIfOnlILIal1' bl 311 Ci
FluePrint ter Health programs Enlplovee assistance • fop-sllmkiny program • ZA-hour nursz advicz Ilne' prznatal ylpport
mdudzd with plan ' online lvzllnzss cznter • csrz alpport for chronic conditions • fitrless discounts
Hovv cost sharing is calculated
Colxays are flat fe25 you pay at the trine you 12ceiv2 a service
Coinsurance i. tfl2 F: ercentag2 of charges you pay for a service. It' k:~ed on the all caved amount
Deductible charges are Subtract2l from the alloex2d amount
Allowed amount is the tie QOtr3ted 3R1JUIlt dl3C n2ibVi?rk prt VId215 haV2 31rePd fo 3ii2pt 35 tUhl p3V Rlent 32 Ch2 trRle l~OUr c131 Rt K ploi2= 2d It VJU 522 3 pf iiVlder V1. ho d1~2_li t p3ltrclp3C2 btilth
Bllle LIOti, dl2 3Vlowed 3nlOUnt IS elChlPl 2112 kllh2d ~Ilar 12 Ot 3 p2rC2nt3ge JI tll2 Il2tbVOI ~ 311ow2d 3R1~~LRl( btihllih2v2r IS he5s.
* Forhlghe~~t level of coverage, u.~ Select Network providers for outpatient o4iropradicand behavioral health .cervices.
For al! other services uce the Blue Go` Network.
Imo' ~ * Physical, occupations! and spe>edl therapy cervices limited to a $300 maximum per calendar year
°~, ~ This c ,nhr an outline .1 plan beneht<_ The conhact and cel trfieate indud2 complete details of what Is and i_n't cov212d ti211aC23 not rover2d indud2
~~U•~~9e.*'~ ~~~~~~ 2yegla~25 heanng al i. it2m< pl lmarif, Lie 1 hr a n n m2dieal F urF~~e .21 tl,2 count2l dlu ~'nuUitronal uFpl2m2nts 2ni es dlat are ~m2trc
~~ ~~~~ 2zpenmental not medicahll n2 e~ary r ~orel2d kvv+ rl,2rs ~omp2r2ati n , na fault auto 1n5urance Ple 211 Un7 coniib n may rnt b2 cav212d for
a limited penod of time. Th1 limit G 12du e 1 ly pnor ~ontlnuolc X0v21 sae ani don't apphl to pregnanvv neeibonr, adopted children or handicapped
d2p2n92nLt ll 2 12aRlre a lar~l2 netwolk of healtll -are providers Eadl pl nd2r is 3n independent contradc I an-1 is not our agent Nanpartiopating
F?0~?R?' (?,O S? pr oalder. da not have co ntrac5 evith Blue i.l Ts and Elul ~hi2d of R'linn2.ota. Elul ~m~ and BIu2 tihi2ld ai Rllnn TOta is an nld2p2nd2nt Ir21„ee
kPt3r, num[en a 115. b 120. c 12?. d 12.1 of the BIu2 Ga` and Blue 5h121d :LSOCia[ion. Benetit< ale eifxw2 Ian 1 200