west virginia forestry association healthcare program · this plan is not insurance and is not...

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West Virginia Forestry Association Healthcare Program

Easy and truly a�ordable healthcare solutions specificallydesigned for your business.

Program Solutions and Highlights

EverydayCARE

Build the healthcare plan that make sense for your business and your employees. With Redirect Healthyou are always control of your budget and your employees receive meaningful access to healthcare.

Your program manager will help you customize a benefit design that will give you a huge competitive business advantage!

EverydayCARE PLUS*

EverydayCARE + Sedera delivers an easy and comprehensive healthcare solution for employees. EverydayCARE covers preventative, primary care, chiropractic o�ce visits, labs and imnunizations. Sedera medical cost sharing community steps in to share in larger needs such as child birth, surgery, hospitalization and other high-dollar expenses.

EverydayCARE is the core medical plan that delivers meaningful access to healthcare for all youremployees with no additional out-of-pocket. Benefits include preventative and wellness, in-o�ce primary care visits and free chiropractic visits - $0 copay. Employees access these benefits though a 24 hr concierge line with access to medical professionals, who in many cases can diagnose, create a care planand even prescribe when necessary - saving time and money!

EverydayCARE PLUS plans add limited accident and sickness benefits as well as dental and vision discounts. The limited accident and sickeness benefits provide first dollar protection for covered unexpected non-routine medical costs. Dental and vision discounts deliver up to a 40% savings!

Hospital indemnity sickness - Pays a fixed indemnity benefit for Hospital Stays, Emergency Room Treatment and various Diagnostic Testing due to a covered sickness. Critical illness - Pays a lump sum benefit upon diagnosis of a covered critical illness.Accident Medical Expense – Reimburses out of medical expenses incurred as a result of a covered accident.Accidental Death and Dismemberment – Pays a lump sum benefit for loss due to a covered accident.

EverydayCARE + Sedera

*not availible in all States

Copyright © Redirect Health ® 2017. All Rights Reserved

EverydayCARE

Care Management - Chronic & Acute Disease(Includes predictive analytics & population health management)

24/7/365 Medical Phone Support in English & Spanish

888-407-7928

24/7/365 Medical Phone Support & Scheduling (English & Spanish, Preemptive PCP Telehealth, Overpricing

Protection, Healthcare Navigation)

Physician-to-Physician Case Management(Hospital Cost Reduction, Discharge Management)

Patient Assistance Programs(Pharmaceutical Programs, State Medicaid Programs,

& Nanthealth Cancer Program)

Workers Compensation Case Management(E-MOD Protection & Stay-at-Work Programs)

Primary Care & Injury Office Visits

$0 Copay & No DeductibleOpen Network

(When Directed By Redirect Health)

Chiropractic Office Visits

Preventive Adult Care *

Preventive Well Child Care *

Labs

Immunizations *

Other Care

Diabetic Supplies

Everyday 1TO1™

Care Navigation (Support Service Only, No Benefit)

X-ray

MRI, PET, & CT Scans

Specialist Consults & Care

Hospital Care(Inpatient Care & Outpatient Services)

Urgent Care

Emergency Room Service

Prescription Drug Programs Directed through Redirect Health (otherwise no benefit)

MEC Covered Preventative Medications $0 Copay

Prescriptions(Generic, Brand, Specialty)

Discount Program

* All Minimum Essential Coverage as outlined by the Affordable Care Act. For more information, visit hrsa.gov.

This only serves as a summary of your benefit plan. Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.

EverydayCARE Benefit Summary (A) R5.11.16.2017

EverydayCARE™ Benefit Summary

Copyright © Redirect Health ® 2018. All Rights Reserved



Labs

Immunizations *

Urgent Care

Specialist Consults & Care

Prescriptions *

Prescriptions(Generic, Brand, Specialty)

Specialty Pharmacy(Including non-formulary exceptions)

Vision & Dental Discounts

VSP Vision Savings Pass

Careington Dental

Employee Limited Accident & Sickness BenefitsUnderwritten by Federal Insurance Company, a member insurer of the Chubb Group of Insurance Companies.

Hospital Indemnity Sickness Benefits (per plan year)

Hospital Confinement

Emergency Room Treatment

Diagnostic Testing (X-ray and Lab)

Advanced Diagnostic Testing (Angiogram / Arteriogram, EEG, Myelogram, CT

Scan, MRI Scan, PET Scan)

Critical Illness Benefits

Type 1 Cancer

Heart Attack & Stroke

Accident Only Benefits (per plan year)

Accident Medical Expense(Accident Medical Expense Deductible)

AD&D (100% Primary & Spouse, 20% Children)

EverydayCARE™ Plans Benefit Summary




888-407-7928

$500/day x 5 days($5,000 Max Benefit /

Plan Year)

$150/day x 2 days

$75/test x 2 tests

$150/test x 2 tests

$2,000

$2,000

Up to $3,000($100)

Up to $10,000

Discount Program

Discount Program

$0 Copay

Discount Program

Care Navigation Only



$250/day x 5 days($5,000 Max Benefit /

Plan Year)

$100/day x 2 days

$50/test x 2 tests

$100/test x 2 tests

$1,000

$1,000

Up to $2,000($100)

Up to $5,000

Discount Program

Discount Program

$0 Copay

Discount Program




N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

$0 Copay

Discount Program




$1000/day x 10 days ($10,000 Max Benefit /

Plan Year)

$250/day x 1 days

$75/test x 2 tests

$250/test x 1 tests

$5,000

$5,000

Up to $10,000($100)

Up to $10,000

Discount Program

Discount Program

$0 Copay

Discount Program




Discount Program

Discount Program

$1,500/day x 15 days ($22,500 Max Benefit /

Plan Year)

$250/day x 1 days

$75/test x 2 tests

$250/test x 1 tests

$10,000

$10,000

Up to $15,000($100)

Up to $10,000

$0 Copay

Discount Program




EverydayCARE EverydayCAREPlus 30 Plus 50

EverydayCAREPlus 125

EverydayCAREPlus 200

EverydayCARE

t Summary (A) R11 2.7.18

Pre-existing Condition Limitation

Issue Ages 18-65

Eligibility Accident and sickness plans are guaranteed issue

Rate Guarantee 1 year

General ExclusionsHospital Indemnity Sickness Benefits This insurance does not apply to any loss caused by or resulting from, directly or indirectly, any of the following:

• Commission or attempted commission of a felony;• Alcoholism or drug or substance abuse;• Pre-existing Condition if the Sickness occurs during the first 12 months of coverage;• Pregnancy, except a Complication of Pregnancy;• Pregnancy of a Dependent Child;• Participating in military action while in active military service with the armed forces of any country or established international authority;• Suicide, attempted suicide or intentionally self-inflicted injury;• Voluntary abortion, except where such person’s life would be endangered if the fetus were carried to term;• War, declared or undeclared;• Routine newborn well baby care.

Critical Illness Benefits This insurance does not apply to any loss caused by or resulting from, directly or indirectly, any of the following:

• Any illness not specifically listed as a Covered Condition.•

Person’s insurance.• Refusal of the following recommended medical treatment:

• a Physician has recommended treatment with angioplasty or Coronary Artery By-Pass Graft for coronary artery disease, the Insured

• a Physician has recommended treatment for a brain aneurysm or carotid artery stenosis, the Insured Person refuses treatment, and

• a Physician has recommended a Diagnostic biopsy or Diagnostic/therapeutic excision of a mass or lesion suspected of beingCancer, the Insured refuses and the Insured Person develops Type 1 Cancer.

Accident Only Benefits No benefits will be paid for any Accident caused by or resulting from any of the following:

• Emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection, bodilymalfunctions or medical or surgical treatment thereof;

• Commission or attempted commission of any illegal act, including but not limited to any felony;• Any occurrence while incarcerated after conviction;• Intoxication while operating a motorized vehicle at the time of an Accident. Intoxication is defined by the laws of the jurisdiction where

such accident occurs;• Being under the influence of any narcotic or other controlled substance;• Participation in military action while in active military service with the armed forces of any country or established international

authority. However, this exclusion does not apply to the first sixty (60) consecutive days of active military service with the armed forcesof any country or established international authority;

• Suicide, attempted suicide or intentionally self-inflicted injury;• War, declared or undeclared.

Dental & Vision Discount

Limited Accident & Sickness Plans

This insurance does not pay any benefits for Sickness caused by or resulting from a Covered Person’s Pre-existing conditions if the sickness occurs during the first 12 months that a Covered Person is insured under this policy.

Pre-existing condition means an accident or a sickness for which, in the 6 months before the Covered Person becomesinsured under the policy, medical advice, treatment or care was sought by a Covered Person, or was recommended by,prescribed by or received from a Physician. (Not applicable for Accident Only benefits.)

Plan Provisions

Plan Provisions & Disclosures

Careington International Corporation

THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. THis plan is not a Qualified Health Plan under the A�ordable Care Act. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all servies but will recieve a discount from participation providers. The list of participation providers is at www.careington.com/members. A written list of participating providers is availible upon request. Discount Plan Organizations and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380. This plan is not availible in Vermont or Washington.

Underwritten by Federal Insurance Company, a member insurer of the Chubb Group of Insurance Companies

This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit Federal Insurance Company from providing insurance, including, but not limited to, the payment of claims.

This information is a brief description of the important features of this insurance plan. It is not an insurance contract. Insurance benefits are underwritten by Federal Insurance Company. Coverage may not be available in all states or certain terms may ere required by state law. Chubb NA is the U.S.-based operating division of the Chubb Group of Companies, headed by Chubb Ltd. (NYSE:CB) Insurance products and services are provided by Chubb Insurance underwriting companies and not by the parent company itself.

This policy provides limited benefits on a fixed indemnity basis. It does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the A�ordable Care Act (ACA). For more information about the ACA, please refer to http://www.HealthCare.gov

Copyright © Redirect Health ® 2018 All Rights Reserved

General Disclaimers

EverydayCARE

Care Management - Chronic & Acute Disease(Includes predictive analytics & population health management)


888-407-7928

24/7/365 Medical Phone Support & Scheduling (English & Spanish, Preemptive PCP Telehealth, Overpricing

Protection, Healthcare Navigation)

Physician-to-Physician Case Management(Hospital Cost Reduction, Discharge Management)

Patient Assistance Programs(Pharmaceutical Programs, State Medicaid Programs,

& Nanthealth Cancer Program)

Workers Compensation Case Management(E-MOD Protection & Stay-at-Work Programs)





Labs

Immunizations *

Prescription Drug Programs Directed through Redirect Health (otherwise no benefit)

MEC Covered Preventative Medications $0 Copay

Prescriptions(Generic, Brand, Specialty) Discount Program

This only serves as a summary of your benefit plan. Please refer to your Summary Plan Description or Membership guidlines for details, limitation, and exclusion provisions.

EverydayCARE™ + Sedera Select Membership Summary

Sedera Select Medical Cost Share

Sedera is a non-insurance, community sharing approach to managing healthcare costs. Sedera members are self-pay patients, only submitting bills to Sedera when costs exceed their IUA** (example: illiness, injury, pregnancy). Members can use the provider of choice, Redirect Health Care Logisitcs team will help direct members to recieve quality care and fair pricing.

Primary Care & Injury O�ce Visits

Chiropractice O�ce Visits

Membership Options: $500 IUA - Member pays first $500 per Need**$1,000 IUA - Member pays first $1,000 per Need**

Need Sharing Steps: 1. Call Redirect Health, Care Logistics will helpguide care and make sure member recieves the fair price2. Collect and submit healthcare bills to Sedera3. Sedera facilitates cost sharing with the community4. Payment is sent directly to the member5. Member pays the provider

Yearly IUA* Limits: Sedera shares at the first dollar after Need** limit is reached.Individual - (3) Needs per membership year Family - (5) Needs per membership year

Prescription Need SharingMaintenance: Eligible for sharing as part of a need for the first 120 days following a new diagnosis.

Curative / Acute: Eligible for sharing when prescribed as curative medication, as part of treatment for a qualfied Need**

** IUA ( Initial Unshareable Amount): The amount each member pays for before a need is eligible for sharing by the community.** Need: One of more medical expenses caused by a single accident or illness. (Example: car accident, cancer, pheumonia, child birth) Please refer to your membership Guidlines to confirm that a need meets sharing qualifications.

* All Minimum Essential Coverage as outlined by the A�ordable Care Act. For More Information, visit hrsa.gov

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west virginia forestry association healthcare program · this plan is not insurance and is not...

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