company benefits that benefit the company. - …€¦ · company benefits that benefit the company....

COMPANY BENEFITS THAT BENEFIT THE COMPANY.2013 overview of health plans for small businesses (two to 50 employees)

Blue Cross and Blue Shield of Minnesota is a nonprofit whose passion is keeping people healthy.

We do more than provide health coverage when you and your employees are sick. We also provide services, products and advice to help you become healthier, like health coaching, Fitness Discounts, Stop-Smoking Support and more.

That means a healthier workforce for you. And a healthier workforce is a more productive workforce.

That helps the health of your business.

MAKE YOUR HEALTH CARE DOLLARS COUNT … TWICE.

GET EXTRA BENEFITS WITH YOUR BENEFITS.COST SAVINGSMonthly premiums aren’t the only costs to consider for

you and your employees:

➜➜ Get industry-competitive limits on your out-of-pocket

costs each year

➜➜ Copays are waived when you visit a retail health clinic

➜➜ Pay no copay on certain over-the-counter prescription

drugs prescribed by your doctor

You and your employees will also receive discounts on:

Visit bluecrossmn.com/discounts to learn more.

Weight Watchers is the registered trademark of Weight Watchers International, Inc. and is used under license.

CONVENIENCEYou and your employees can connect with the care

and information you want, when you want with:

➜➜ A personalized online account to access your

health plan information 24 hours a day, 7 days a week

➜➜ The ability to view, print or email your member ID cards

quickly and easily from your online account

➜➜ Online Care Anywhere® featuring live, interactive

visits with a health care provider online at

OnlineCareAnywhereMN.com (currently available in

Minnesota only; additional states coming in 2013)

➜➜ Medications delivered to your door by mail

➜➜ Gym memberships

➜➜ Acupuncture, massage

➜➜ Weight Watchers®

➜➜ LASIK eye surgery

COVERAGEWhether you’re at home or traveling, the Blue Cross

network is there for you and your employees:

➜➜ Minnesota networks: Choose a plan with the Aware®

network, or take advantage of cost savings and give

your employees more choice and control over

their health care dollars with a plan with the Blue

PerformanceSM network

➜➜ National network: The BlueCard® network covers you

at more than 92 percent of physicians nationwide and

96 percent of hospitals

➜➜ International network: The BlueCard Worldwide®

network gives you access to hospitals and doctors in

more than 200 countries

We feature a large network of health care providers. Each provider is an independent contractor and is not our agent.

➜➜ Blue Distinction Centers®: Get access to top providers

for cardiac care, complex and rare cancers, knee and

hip replacement, spine surgery and transplant

services nationwide

Note: Designation as Blue Distinction Centers means these facilities’ overall experience and aggregate data met objective criteria established in collaboration with expert clinicians’ and leading professional organizations’ recommendations. Individual outcomes may vary.

Blue Cross plans with the Aware network include a fourth quarter deductible carryover. That means any

money your employees pay toward their deductible for care received in October, November or December

counts toward the current year’s deductible and rolls over to count toward the next year’s deductible.

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THE 2013 GROUP PLAN COMPARISON FOR SMALL BUSINESSESHEALTH PLAN AWARE GOLD® COMMUNITY BLUESM TRI-BLUESM OPTIONS BLUESM (HSA) OPTIONS BLUE (HRA) BLUE VALUESM

What I want I want to offer top-notch benefits to recruit and retain the best employees.

I want to offer a traditional health plan with comprehensive coverage.

I want to offer an affordable plan with more employee cost sharing that provides some up-front benefits before meeting the deductible.

I want to offer a plan with the tax advantages and employee ownership of a health savings account.

I want to offer a plan that allows me to recover unspent health reimbursement funds but still provides prescription drug benefits.

I want to reduce my monthly rates by increasing employee cost sharing.

100 90 80 100 100 80

IN-NETWORK BENEFITS AWARE AWARE BLUE PERFORMANCE BLUE PERFORMANCE AWARE BLUE PERFORMANCE AWARE AWARE

Deductible options (single/family) Plan 4: $0 Plan 113: $0Plan 118: $300/$900Plan 120: $500/$1,000Plan 121: $750/$1,500Plan 122: $1,000/$2,000Plan 123: $2,000/$4,000Plan 125: $3,000/$6,000

Plans 420, 421, 520 and 521: Tier 1 = $500/$1,000Plans 422, 423, 522 and 523: Tier 1 = $1,000/$2,000Plans 424, 425, 524 and 525: Tier 1 = $1,500/$3,000All plans: Tier 2 = Double Tier 1

Plans 430 and 530:Tier 1 = $500/$1,000Plans 432 and 532:Tier 1 = $1,500/$3,000Plans 434 and 534:Tier 1 = $3,000/$6,000All plans: Tier 2 = Double Tier 1

Plan 176: $1,600/$3,200 Plan 178: $2,300/$4,600Plan 180: $3,200/$6,400Plan 181: $3,200/$6,400*Plan 182: $6,000/$12,000Plan 183: $6,000/$12,000*

Plan 184: $3,200/$6,400Plan 185: $3,200/$6,400*

Plan 170: $1,600/$3,200Plan 172: $2,300/$4,600Plan 174: $3,200/$6,400Plan 175: $3,200/$6,400*

Plans 476 and 576: Tier 1 = $1,200/$2,400Plans 478 and 578: Tier 1 = $2,000/$4,000Plans 480 and 580: Tier 1 = $3,000/$6,000Plans 481 and 581: Tier 1 = $3,000/$6,000*All plans: Tier 2 = Double Tier 1

Plan 167: $3,000/$6,000Plan 169: $5,000/$10,000

Plan 161: $1,500/$3,000Plan 165: $2,500/$5,000

Plan 131: $1,500/$4,500Plan 132: $2,500/$7,500Plan 133: $3,500/$8,500

Fourth quarter deductible carryover included Plan 4: N/A, because there are no deductibles All plans: Yes All plans: No All plans: No All plans: Yes All plans: No All plans: Yes All plans: Yes

CoinsuranceOON = Out of Network

Plan 4: 0% Plans 113, 118, 120, 121 and 122: 20%Plans 123 and 125: 25%

Plans 420, 422, 424, 520, 522 and 524 Tier 1 = 20%Tier 2 = 40%OON = 50%Plans 421, 423, 425, 521, 523 and 525Tier 1 = 30%Tier 2 = 50%OON = 60%

All plans: Tier 1 = 25%Tier 2 = 45%OON = 55%

All plans: 0% All plans: 10% All plans: 20% All plans:Tier 1 = 0%Tier 2 = 20%OON = 40%

All plans: 0% All plans: 20% All plans: 30%

Medical out-of-pocket maximum (single/family) Plan 4: $1,500 Plan 113: $2,000/$6,000Plan 118: $2,000/$6,500Plan 120: $2,800/$6,500Plan 121: $3,000/$6,500Plan 122: $3,250/$6,500Plan 123: $4,000/$7,500Plan 125: $5,200/$9,900

Plans 420, 421, 520 and 521: Tier 1 = $1,000/$2,000Plans 422, 423, 522 and 523: Tier 1 = $2,000/$4,000Plans 424, 425, 524 and 525: Tier 1 = $3,000/$6,000All plans: Tier 2 = Double Tier 1

Plans 430 and 530: Tier 1 = $1,000/$2,000Plans 432 and 532:Tier 1 = $3,000/$6,000Plans 434 and 534:Tier 1 = $4,500/$9,000All plans:Tier 2 = Double Tier 1

All plans: Equal to deductible

All plans: $6,050/$12,100

Plan 170: $3,200/$6,400Plan 172: $4,600/$9,200Plan 174 and 175: $6,050/$12,100

All plans:Tier 1 = Tier 1 deductibleTier 2 = Four times Tier 1


Plan 161: $3,500/$7,000Plan 165: $4,500/$7,000

Plan 131: $4,500/$6,000Plan 132: $5,500/$8,000Plan 133: $6,500/$10,000

Prescription drug out-of-pocket maximum (single/family)

Plan 4: $1,000/$2,000 All plans: $1,000/$2,000 All plans: N/A, there is no drug out-of-pocket maximum

All plans: N/A, there is no drug out-of-pocket maximum

All plans: Drug expenses count toward medical out-of-pocket maximum All plans: N/A, there is no drug out-of-pocket maximum All plans: N/A, there is no drug out-of-pocket maximum

Prescription drug copays (with the GenRx drug list)

31-day supply

Plan 4: $12 preferred generic drugs, $45 preferred brand drugs and $90 non-preferred drugs

All plans: $12 preferred generic drugs, $45 preferred brand drugs and

$90 non-preferred drugs

All plans: $12 preferred generic drugs, $45 preferred brand drugs and $90 non-preferred drugs

All plans: $0 after deductible

All plans: Deductible then 10% coinsurance



All plans: $12 preferred generic drugs,$45 preferred brand drugs and


All plans: $12 preferred generic drugs,$45 preferred brand drugs and$90 non-preferred drugs

Specialty drugs Plan 4: 20% coinsurance to a maximum of $200 per prescription

All plans: 20% coinsurance to a maximum of $200 per prescription








90dayRx (retail and mail order drugs)90-day supply












Office visit or urgent care visits Plan 4: $25 copay and no coinsurance Plans 113 and 118 : $30 copay, no coinsurance; Plans 120 and 121: $35 copay, no coinsurance; Plans 122, 123 and 125: $40 copay, no coinsurance

All plans:Tier 1 = $30 copay and no coinsuranceTier 2 = deductible then coinsurance

All plans:Tier 1 = A total of three free visits to an office, urgent care or specialist with no copays or coinsurance, and then visits are subject to deductible and coinsuranceTier 2 = deductible then coinsurance







Plans 131 and 132: $45 copay and no coinsurancePlan 133: $55 copay and no coinsurance

Specialist visits Plan 4: $45 copay and no coinsurance Plans 113 and 118 : $50 copay, no coinsurance; Plans 120 and 121: $55 copay, no coinsurance; Plans 122, 123 and 125: $60 copay, no coinsurance










Retail health clinic visits Plan 4: 0$ All plans: $0 All plans:Tier 1 and Tier 2 = $0

All plans:Tier 1 and Tier 2 = $0




All plans: Tier 1 = $0 after deductibleTier 2 = Deductible then coinsurance



All plans: $0

In addition to these plans, we also offer mandated copay and deductible plans. HRAs are available with all plans.

This is only a summary. The contract and certificate include complete details of what is and isn’t covered. Services not covered include eyeglasses, hearing aids, items primarily used for a nonmedical purpose, over-the-counter drugs (except as specified in the Certificate of Coverage), nutritional supplements, services that are cosmetic, experimental, not medically necessary, or covered by workers’ compensation or no-fault auto insurance. Preexisting conditions may not be covered for a limited period of time. This limit is reduced by prior continuous coverage and doesn’t apply to pregnancy, newborns,

adopted children, individuals under 19 or handicapped dependents. We feature a large network of health care providers. Each provider is an independent contractor and is not our agent. Nonparticipating providers do not have contracts with Blue Cross and Blue Shield of Minnesota. Benefits are effective July 1, 2013.

Consumer Price Index Annual Adjustment: The deductible, copay and out-of-pocket maximum amounts are subject to annual adjustments. These adjustments are based on the medical care component of the Consumer Price Index (CPI) published by the U.S. Department of Labor. These annual adjustments are effective on the annual renewal date.

Your out-of-pocket costs depend on the network status of your provider. To check network status, visit bluecrossmn.com.

Lowest out-of-pocket costs: in-network providers.Higher out-of-pocket costs: out-of-network participating providers.Highest out-of-pocket costs: out-of-network nonparticipating providers. (You are responsible for the difference between Blue Cross’ allowed amount and the amount billed by nonparticipating providers. This is in addition to any applicable deductible, copay or coinsurance. Benefit payments are calculated on Blue Cross’ allowed amount, which is typically lower than the amount billed by the provider.)

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EMPL

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THE 2013 GROUP PLAN COMPARISON FOR SMALL BUSINESSESHEALTH PLAN AWARE GOLD® COMMUNITY BLUESM TRI-BLUESM OPTIONS BLUESM (HSA) OPTIONS BLUE (HRA) BLUE VALUESM

What I want I want to offer top-notch benefits to recruit and retain the best employees.

I want to offer a traditional health plan with comprehensive coverage.

I want to offer an affordable plan with more employee cost sharing that provides some up-front benefits before meeting the deductible.

I want to offer a plan with the tax advantages and employee ownership of a health savings account.

I want to offer a plan that allows me to recover unspent health reimbursement funds but still provides prescription drug benefits.

I want to reduce my monthly rates by increasing employee cost sharing.

100 90 80 100 100 80

IN-NETWORK BENEFITS AWARE AWARE BLUE PERFORMANCE BLUE PERFORMANCE AWARE BLUE PERFORMANCE AWARE AWARE

Deductible options (single/family) Plan 4: $0 Plan 113: $0Plan 118: $300/$900Plan 120: $500/$1,000Plan 121: $750/$1,500Plan 122: $1,000/$2,000Plan 123: $2,000/$4,000Plan 125: $3,000/$6,000

Plans 420, 421, 520 and 521: Tier 1 = $500/$1,000Plans 422, 423, 522 and 523: Tier 1 = $1,000/$2,000Plans 424, 425, 524 and 525: Tier 1 = $1,500/$3,000All plans: Tier 2 = Double Tier 1

Plans 430 and 530:Tier 1 = $500/$1,000Plans 432 and 532:Tier 1 = $1,500/$3,000Plans 434 and 534:Tier 1 = $3,000/$6,000All plans: Tier 2 = Double Tier 1

Plan 176: $1,600/$3,200 Plan 178: $2,300/$4,600Plan 180: $3,200/$6,400Plan 181: $3,200/$6,400*Plan 182: $6,000/$12,000Plan 183: $6,000/$12,000*

Plan 184: $3,200/$6,400Plan 185: $3,200/$6,400*

Plan 170: $1,600/$3,200Plan 172: $2,300/$4,600Plan 174: $3,200/$6,400Plan 175: $3,200/$6,400*

Plans 476 and 576: Tier 1 = $1,200/$2,400Plans 478 and 578: Tier 1 = $2,000/$4,000Plans 480 and 580: Tier 1 = $3,000/$6,000Plans 481 and 581: Tier 1 = $3,000/$6,000*All plans: Tier 2 = Double Tier 1

Plan 167: $3,000/$6,000Plan 169: $5,000/$10,000

Plan 161: $1,500/$3,000Plan 165: $2,500/$5,000

Plan 131: $1,500/$4,500Plan 132: $2,500/$7,500Plan 133: $3,500/$8,500

Fourth quarter deductible carryover included Plan 4: N/A, because there are no deductibles All plans: Yes All plans: No All plans: No All plans: Yes All plans: No All plans: Yes All plans: Yes

CoinsuranceOON = Out of Network

Plan 4: 0% Plans 113, 118, 120, 121 and 122: 20%Plans 123 and 125: 25%

Plans 420, 422, 424, 520, 522 and 524 Tier 1 = 20%Tier 2 = 40%OON = 50%Plans 421, 423, 425, 521, 523 and 525Tier 1 = 30%Tier 2 = 50%OON = 60%

All plans: Tier 1 = 25%Tier 2 = 45%OON = 55%

All plans: 0% All plans: 10% All plans: 20% All plans:Tier 1 = 0%Tier 2 = 20%OON = 40%

All plans: 0% All plans: 20% All plans: 30%

Medical out-of-pocket maximum (single/family) Plan 4: $1,500 Plan 113: $2,000/$6,000Plan 118: $2,000/$6,500Plan 120: $2,800/$6,500Plan 121: $3,000/$6,500Plan 122: $3,250/$6,500Plan 123: $4,000/$7,500Plan 125: $5,200/$9,900

Plans 420, 421, 520 and 521: Tier 1 = $1,000/$2,000Plans 422, 423, 522 and 523: Tier 1 = $2,000/$4,000Plans 424, 425, 524 and 525: Tier 1 = $3,000/$6,000All plans: Tier 2 = Double Tier 1

Plans 430 and 530: Tier 1 = $1,000/$2,000Plans 432 and 532:Tier 1 = $3,000/$6,000Plans 434 and 534:Tier 1 = $4,500/$9,000All plans:Tier 2 = Double Tier 1


All plans: $6,050/$12,100

Plan 170: $3,200/$6,400Plan 172: $4,600/$9,200Plan 174 and 175: $6,050/$12,100

All plans:Tier 1 = Tier 1 deductibleTier 2 = Four times Tier 1


Plan 161: $3,500/$7,000Plan 165: $4,500/$7,000

Plan 131: $4,500/$6,000Plan 132: $5,500/$8,000Plan 133: $6,500/$10,000

Prescription drug out-of-pocket maximum (single/family)

Plan 4: $1,000/$2,000 All plans: $1,000/$2,000 All plans: N/A, there is no drug out-of-pocket maximum

All plans: N/A, there is no drug out-of-pocket maximum

All plans: Drug expenses count toward medical out-of-pocket maximum All plans: N/A, there is no drug out-of-pocket maximum All plans: N/A, there is no drug out-of-pocket maximum

Prescription drug copays (with the GenRx drug list)

31-day supply












Specialty drugs Plan 4: 20% coinsurance to a maximum of $200 per prescription









90dayRx (retail and mail order drugs)90-day supply












Office visit or urgent care visits Plan 4: $25 copay and no coinsurance Plans 113 and 118 : $30 copay, no coinsurance; Plans 120 and 121: $35 copay, no coinsurance; Plans 122, 123 and 125: $40 copay, no coinsurance










Specialist visits Plan 4: $45 copay and no coinsurance Plans 113 and 118 : $50 copay, no coinsurance; Plans 120 and 121: $55 copay, no coinsurance; Plans 122, 123 and 125: $60 copay, no coinsurance










Retail health clinic visits Plan 4: 0$ All plans: $0 All plans:Tier 1 and Tier 2 = $0

All plans:Tier 1 and Tier 2 = $0




All plans: Tier 1 = $0 after deductibleTier 2 = Deductible then coinsurance



All plans: $0

* The plan is available with embedded and unembedded deductibles. An embedded deductible means individuals on a family plan may meet the per person deductible and get medical bills covered before the family deductible is reached.

STILL UNDECIDED? WE’RE HERE TO HELP YOU MAKE A DECISION.➜➜ Call your agent

➜➜ Need an agent? Find one at bluecrossmn.com by clicking “Find an agent.”

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With all of these plans, your employees pay $0 for preventive care, have no annual or lifetime limit on what Blue Cross pays and get international coverage with BlueCard worldwide.

➜➜ Covers 98% of health care providers and 100% of hospitals in Minnesota

➜➜ A more traditional network

➜➜ Your employees’ health plan coverage is the same no matter which in-network provider they choose

➜➜ The broadest selection of providers nationally (BlueCard Traditional network)

AWARE® NETWORK

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Blue Cross gives you choice and control in how you spend your health care dollars by letting you select your network.

Choose the statement about a network that fits your business best.

A NETWORK THAT FITS YOU.

➜➜ Covers the exact same health care providers as the Aware network

➜➜ A high-performance network: Health care providers are separated into tiers based on cost

• Tier 1 providers cost less

➜➜ Your employees pay different costs depending on whether they see a provider in Tier 1 or Tier 2. Your employees will pay more out of pocket when they see providers in Tier 2. All out-of-state providers in the BlueCard PPO network are classified as Tier 1.

➜➜ Your employees have to meet separate deductibles and out-of-pocket maximums at Tier 1 providers and Tier 2 providers

➜➜ The greatest savings for services nationally (BlueCard PPO network)

• Tier 2 providers cost more

BLUE PERFORMANCESM

Use our “Find a doctor” web tool to help you decide on a network. You’ll see what providers are in the network in your area and who is in Tier 1 and Tier 2. Visit bluecrossmn.com and click “Find a doctor.”

I WANT FIRST OPTION SECOND OPTION THIRD OPTION

The lowest monthly rateBlue Performance Enhanced network

Blue Performance Regional network

Aware network

The broadest network of providers in Minnesota

Aware networkBlue Performance Regional network

Blue Performance Enhanced network

OR

➜➜ Includes Tier 1 providers in all regions of the state

REGIONAL NETWORK OR

➜➜ Includes Tier 1 providers in select regions of the state

ENHANCED NETWORK $$$

Choose the Regional Blue Performance or Enhanced network

HOW TO FIND THE RIGHT PLAN FOR YOU AND YOUR EMPLOYEESHere’s a checklist showing what to consider when choosing the right plan

for you and your employees. The product comparison chart on the previous

page has all the details.

WORDS TO KNOW

Compare networks If you’re looking to lower your monthly rate, choose a plan with the Blue

Performance network.

Compare deductibles How much do you want your employees to pay out of pocket before

their health care coverage kicks in? Usually the higher the deductible

you choose, the lower your monthly rate.

Compare copays Some plans require copays for health care services and products.

And some plans require a specialty provider copay — a higher copay

to see a specialist.

Compare up-front benefits Some plans cover office visits, urgent care visits or retail health clinic

visits before the deductible is met.

Compare coinsurance A higher coinsurance can help lower your monthly rate.

Compare out-of-pocket maximums Look for a plan that fits the maximum you want your employees to pay

out of pocket each year.

Compare prescription drug coverage Each plan covers generic drugs and brand-name drugs differently. Some

plans count prescription drug costs toward your deductible, and plans

have different copays.

Do you want a health savings account? Options Blue plans offer tax advantages with health savings accounts.

Do your employees often travel or live out of state? Employees are covered at more than 80 percent of physicians nationwide

and 90 percent of hospitals with the BlueCard network and have access

to hospitals and doctors in more than 200 countries with the BlueCard

Worldwide network.

A deductible is a set amount that employees pay each year for covered health care services (other than preventive care) before the health plan begins paying for the covered health care services.

Tiers divide doctors, hospitals and other health care providers into levels based on cost. Tier 1 providers are the least expensive for your employees. Tier 2 and out-of-network providers will result in higher out-of-pocket costs. The tiers have separate deductibles and out-of-pocket maximums.

A copay is a set amount, for example, $30, that your employees pay for doctor’s office visits, prescription drugs, health care services or products at the time of service.

Coinsurance is a set percentage your employees pay once their deductible has been met. For example, if the coinsurance is 80 percent, Blue Cross pays 80 percent of your employees’ covered health care costs after the deductible is met and your employees pay 20 percent of the bill.

The out-of-pocket maximum is a limit on out-of-pocket health care expenses. It’s the most your employees will pay in coinsurance and deductibles for covered health care services each year.

A health savings account works like a bank account with tax advantages and can be used to cover deductibles and certain noncovered services.

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bluecrossmn.com

FOR THE HEALTH OF ALL.SM

We’re a health company that stands for the health of all. That means going beyond providing health coverage to deeply investing in programs and initiatives that build healthy cultures at home, at work and in the community — not just for our members but for everyone.

F8621R10 (3/13)

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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