FMOLHS Benefits Guide

Health Plan Coverage and Benefits Summary

• The health plan covers routine office visits, physical exams, immunizations, and preventive care in accordance with CDC and federal guidelines.
• The High Deductible HSA Plan offers a tax-free health savings account that is portable and allows you to determine contributions and reimbursements for qualified medical expenses.
• The HSA plan has specific eligibility requirements and deductible amounts for different enrollment types and provider networks.
• The plan covers different types of medical services with varying coverage percentages based on provider networks and deductibles.
• The plan covers bariatric surgery with a copay and specific eligibility requirements, and organ transplants at Blue Distinction Centers with 80% coverage after the deductible.
• The plan covers various medical services such as laboratory testing, chemotherapy, and mental/nervous and substance abuse treatments with varying coverage percentages.
• The plan covers pregnancy care and delivery services, including lactation counseling and breast pumps, and routine well-child care visits.
• The health plan premiums vary based on enrollment type and the chosen plan, with different levels of coverage and premiums for EPO, PPO, and HSA plans.
• Prescription drug coverage is coordinated through Express Scripts and offers different tiers of coverage based on the prescription drug product.
• Rising drug costs are a significant cause of the increasing cost of healthcare, and patients can minimize medication costs by exploring available benefits and considering mail-order options.
• Patients can review plan options and medication prices on the Express Scripts website before enrolling in the plan.
• The plan does not cover out-of-network services or out of area coverage under the High Deductible HSA Plan.

FMOLHS Total Rewards and Benefits Information for 2023

• Total Rewards at FMOLHS is a comprehensive package that includes six areas to meet individual and family needs.

• Benefit education resources are available online to help team members understand their benefits and make the most of them.

• The FMOLHS askHR team is available by phone or email to assist with benefit enrollment and answer questions.

• Enrollment options for 2023 will be displayed in Oracle Employee Self-Service, and team members have 30 days to enroll from their new hire or eligibility date.

• Various benefit plans are available for enrollment, including health, dental, vision, life, disability, and retirement plans.

• Medicare-eligible team members have more choices about their prescription drug coverage and should refer to page 58 for more information.

• My Health Toolkit is a free mobile app that provides easy access to benefits information, insurance cards, claims, and covered local providers.

• Dependent eligibility for FMOLHS Benefit Plans includes legal spouses, dependent children up to age 26, disabled dependent children, and grandchildren for whom the team member has legal custody.

• Enrollment changes based on qualifying life events must occur within 30 days of the event, and dependent verification documents may be required.

• Team members may qualify for the Just Premium reduction in medical plan premiums based on total household income, number of dependents, FTE status, and hourly rate.

• Approved team members will receive higher FMOLHS medical plan subsidies to improve affordability and access to coverage.

• The Just Premium application and tax return must be submitted within 30 days of the new hire or eligibility date to be considered for the premium reduction.Overview of Health Benefits and Provider Networks for FMOLHS Employees

• FMOLHS offers comprehensive health care plans to support and protect employees against potentially large financial expenses and cover preventive care.

• The health benefits are administered by Blue Cross Blue Shield and the option chosen by the employee will be in place for the entire year of 2023, unless there is a qualifying life event.

• FMOLHS provides a customized provider directory for its plan members, which can be accessed online or by calling Blue Cross Blue Shield customer service.

• Network Guides are available by phone 24/7 to help employees navigate the FMOLHS network, find in-network providers, and schedule appointments with network-based primary care physicians.

• The primary care physician (PCP) plays an important role in an employee's healthcare journey and is responsible for providing comprehensive care, having knowledge of the employee's overall medical history, and assisting with navigating certain health risks.

• FMOLHS offers three health plans: EPO Plan, PPO Plan, and HDHSA Plan, each with different deductibles, copays, and out-of-pocket maximums.

• The EPO Plan provides access to a narrow network of healthcare providers, while the PPO Plan has higher deductibles, coinsurance, and copays, but offers out-of-network coverage for most services. The HDHSA Plan has higher deductibles and out-of-pocket maximums, but FMOLHS provides funding to the employee's HSA account to help with out-of-pocket medical expenses.

• The cost of a physician office visit depends on the plan chosen and whether the provider is in or out of the network.

• Medical services may require the attention of a physician who may send a separate bill for payment, and the employee may receive a separate bill for services performed by a provider who is not in the FMOLHS Network Tier 1.

• Employees can view their medical claims online by registering for Blue Cross Blue Shield Online Services.

• If a medical service or claim is denied, employees have the right to file an appeal within 180 days of being notified of the denial of benefits.

• The charts provide a summary of the 2023 Health Plans for FMOLHS, and all covered services are subject to medical necessity as determined by the Plan, while all out-of-network services are subject to reasonable and customary limitations.Comparison of Health Coverage Plans at FMOLHS

• FMOLHS offers two health coverage plans: EPO and PPO.

• The EPO plan has a narrower network of providers and requires referrals for specialists.

• The PPO plan has a wider network of providers and allows for out-of-network coverage, but at a higher cost.

• Both plans have annual deductibles and out-of-pocket maximums, which vary depending on the coverage tier and whether the employee has dependents.

• The plans cover a range of medical services, including office visits, hospital stays, surgery, and diagnostic tests.

• The EPO plan generally has lower copays and coinsurance for in-network services, but may not cover certain services at all.

• The PPO plan covers a wider range of services, but at a higher cost for out-of-network care.

• Both plans cover some maternity and prenatal care, but with some limitations and copays.

• Mental health and substance abuse services are covered under both plans, but with copays and limitations on inpatient stays.

• Both plans cover some preventive care services, such as annual physical exams and immunizations, at no cost to the patient.

• Prescription drug coverage is included in both plans, with some limitations and copays.

• The plans have different coverage for some specialized services, such as bariatric surgery and organ transplants, with copays and restrictions on providers.Summary of Health Insurance Benefits and Coverage

• The health insurance plan covers routine office visits, physical exams, immunizations, and preventive care in accordance with federal guidelines.

• There is a High Deductible Health Plan with a tax-free Health Savings Account (HSA) that allows account holders to determine how much to contribute and when to use the money for qualified medical expenses.

• The HSA plan has different tiers of coverage for in-network, preferred, non-preferred, and out-of-network providers, with varying levels of coverage percentages and deductibles.

• Bariatric surgery is covered with a $3,000 copay at an accredited FMOLHS facility for eligible participants.

• Mental/nervous and substance abuse inpatient care, as well as outpatient services, are covered with varying levels of coverage percentages and deductibles.

• Pregnancy care and delivery, including associated charges and maternal/fetal ultrasound, are covered with varying levels of coverage percentages and deductibles.

• There is coverage for routine well child and well adult care, including age-appropriate screenings and immunizations.

• The plan covers adult immunizations subject to current CDC recommendations with age limitations.

• The cost of prescription drugs is determined by tiers assigned to the drug product with different copays or coinsurance percentages.

• Express Scripts (ESI) coordinates the prescription drug program, and members can search for network pharmacies and review plan options and prices on medications.

• Members can minimize medication costs by considering mail order for maintenance medications, exploring benefits before enrolling, and choosing generic options when available.

• The plan has different premium rates for team member only, team member and spouse, team member + child(ren), and family coverage, with different rates for EPO, PPO, and HSA plans.

FMOLHS Health Benefits and Plan Options

• FMOLHS offers comprehensive health care plans to its team members through Blue Cross Blue Shield.

• Health benefits provide significant value through support and protection against potentially large financial expenses, as well as covering preventive care.

• FMOLHS has a customized provider directory for its plan members, with Network Guides available to assist in finding in-network providers.

• Primary Care Physicians (PCPs) play an important role in a team member's healthcare journey, and FMOLHS offers various ways to connect with and receive care from in-network PCPs.

• FMOLHS offers three health plan options: EPO Plan, PPO Plan, and HDHSA Plan, each with different deductibles, copays, and out-of-network coverage.

• The EPO Plan provides access to a narrow network of healthcare providers within FMOLHS, with lower deductibles and copays at time of service.

• The PPO Plan has higher deductibles, coinsurance, and copays than the EPO Plan, but offers out-of-network coverage for most services.

• The HDHSA Plan has higher deductibles and out-of-pocket maximums, but FMOLHS provides funding to the team member's HSA account to help with out-of-pocket medical expenses.

• Team members should consider their personal healthcare needs when selecting a plan.

• Billing for medical services varies depending on the plan and whether the provider is in-network or out-of-network.

• Team members can view their medical claims online through Blue Cross Blue Shield's online services.

• If a medical service or claim is denied, team members have the right to file an appeal within 180 days after notification of the denial.Comparison of Healthcare Coverage under EPO and PPO Plans

• The EPO plan provides no coverage for physician services, outpatient services, hospital services, skilled nursing facility, bariatric surgery, organ transplant, and certain other services.

• The EPO plan covers some services at 90% after deductible, including allergy testing, allergy serum and injections, other injections, diagnostics, laboratory, chemotherapy, home health care, hospice care, ambulance service, occupational therapy, physical therapy, speech therapy, applied behavior analysis, and specific genetic testing.

• The PPO plan covers most services at 80% after deductible, including physician services, outpatient services, hospital services, skilled nursing facility, bariatric surgery, organ transplant, and certain other services.

• The PPO plan covers some services at 100% with no deductible, including preventive care and immunizations for adults and children.

• The PPO plan covers some services at a copay, including office visits with PCP/medical home and specialists, and urgent care.

• The PPO plan covers some services at 60% or 40% after deductible, including emergency room, occupational therapy, physical therapy, speech therapy, durable medical equipment, insulin pump, orthotics and prosthetics, mental/nervous and substance abuse inpatient, and other outpatient services.

• Both plans have an annual deductible, with the EPO plan having lower deductibles for employee-only and employee with dependents.

• Both plans have an out-of-pocket maximum, with the PPO plan having higher maximums for employee-only and employee with dependents.

• The PPO plan has a preferred provider network (Tier 1 and Tier 2) and a non-preferred provider network (Tier 3), while the EPO plan only has an FMOLHS EPO network and out-of-network coverage.

• The PPO plan offers out-of-area coverage for subscribers with home addresses outside Louisiana or Mississippi, with some restrictions.

• The EPO plan and PPO plan have different coverage for office visits, pregnancy care and delivery, and maternal/fetal ultrasound.

• The EPO plan and PPO plan have different copays, coinsurance, and coverage for specific services, with the PPO plan generally providing more coverage but at a higher cost.Summary of FMOLHS Health Plan Coverage and Benefits

• FMOLHS offers a high deductible health plan with a tax-free health savings account (HSA) option.

• The HSA plan allows you to determine how much you contribute to the account and when to use the money for qualified medical expenses.

• FMOLHS follows federal guidelines for coverage of preventive wellness screenings.

• The network includes preferred provider and non-preferred provider tiers, with varying levels of coverage for different services.

• The out-of-area coverage is not available under the high deductible HSA plan.

• The plan covers routine well child care and adult care, including immunizations and approved wellness screenings.

• Prescription drug coverage is coordinated through Express Scripts, with costs determined by the tier assigned to the drug product.

• Rising drug costs are one of the largest causes of the ballooning cost of health care.

• Patients share the cost of medications with their employer through copays or coinsurance.

• Mail order is an option for maintenance medications, offering a 3-month supply for only two copays.

• Employees can explore available benefits before enrolling by visiting the Express Scripts website.

• Health plan premiums vary based on plan type and coverage level, with bi-weekly team member contributions ranging from $21.89 to $365.53.