This year’s highlights… 

Health  Insurance: We are pleased to announce Anthem will con nue to be St. Claire HealthCare’s (SCH) health insurance provider again for 2020. All 3 health plans (Green, Blue & Red) will con nue to be offered with essen ally the same benefits as last year. SCH is con nuing to pay approximately 75‐80% of the total cost with an an cipated contribu on over $7.5 million for 2020. At the end of plan year 2019, SCH’s contribu on to your health insurance costs totaled nearly $32 million for a 4 year period.

Dental  Insurance Op ons:  For ‘20 we are con nuing to offer the same Delta Dental PPO Plan (1) & PPO Plan (2) with the same benefits as last year & no premium  increase. See page 4 for premiums and coverage details.

Vision  Insurance  Op ons:  For ‘20 we are con nuing to offer Anthem Blue View Vision with the same benefits. See page 4 for premiums and coverage details.

Looking Ahead to 2021: Tobacco Surcharges: an cipated increases and new requirements.

Benefits & Wellness Fair Thursday, October 24th 8:00 am  ‐ 3:00 pm 

Cafe B ‐ D 

HEALTH INSURANCE

Ques ons for Anthem: Please call 1‐855‐333‐5735

Requirements under the Affordable Care Act mandate that all health insurance companies collect all spouse and dependent social security

numbers. Please be sure that you have this informa on when comple ng your open enrollment.

 

Higher Premium Cost

 

   

Moderate Premium Cost

 

Lower Premium Cost

COST Staff Cost  per Month   

Staff Cost  per Month   

Staff Cost  per Month   

Single (Staff Only)  $134.50  $84.20  $39.20 

Staff plus Spouse  $414.00  $283.00  $148.50 

Staff plus Child(ren)  $358.00  $243.00  $131.00 

Family  $633.00  $430.00  $229.20 

BENEFITS              In‐Network              In‐Network              In‐Network 

Deduc ble (Single/Family) Applies toward Maximum Out‐of‐Pocket $750/$1,500 $1,500/$3,000 $2,800/$5,600

Out‐of‐Pocket Maximum (Single/Family) (Annual) $2,500/$5,000 $3,000/$6,000 $3,500/$7,000

Preven ve Office Visit No Member Cost No Member Cost No Member Cost

Physician Office Visit Diagnos c Allergy Injec on

$35 Copay $5 Copay

$25 Copay $5 Copay

20% a er deduc ble

Specialist Office Visit $50 Copay $30 Copay 20% a er deduc ble

Inpa ent Hospital Services 25% a er deduc ble 20% a er deduc ble 20% a er deduc ble

Outpa ent Hospital Services 25% a er deduc ble 20% a er deduc ble 20% a er deduc ble

Emergency Room $150 Copay $150 Copay 20% a er deduc ble

Ambulance Services (Ground and Air) 100% Covered 100% Covered 20% a er deduc ble

Lab/Diagnos c Imaging No Member Cost 20% a er deduc ble 20% a er deduc ble

Prescrip on Based on 30‐day supply

Level One: $10 Copay Level Two: $20 Copay

Level Three: $40 Copay

Level One: $10 Copay Level Two: $30 Copay

Level Three: $60 Copay 20% a er deduc ble

Outpa ent Therapy Services Physician Home & Office Visit

In Hospital or Other Care Facility

$35 Copay

25% a er deduc ble

$25 Copay

20% a er deduc ble

20% a er deduc ble 20% a er deduc ble

Maternity Services

Office Visit

Inpa ent Hospital

$35 Copay

25% a er deduc ble

$30 Copay

20% a er deduc ble

20% a er deduc ble 20% a er deduc ble

Urgent Care $35 Copay $25 Copay 20% a er deduc ble

Life me Maximum Unlimited Unlimited Unlimited

Consider these plans if you or a family member have regular health care

expenses for instance, due to a chronic illness, or you expect to have

other moderate to significant health care needs over the

course of the next year.

Consider this plan if you and your family are generally healthy and don’t expect significant health

care expenses this year like surgery or other procedures.

GREEN PLAN 

BLUE PLAN 

RED PLAN 

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HSA eligible‐see page 7

All deduc bles, copayments and coinsurance apply toward the out‐of‐pocket maximum.

If applicable, benefits listed with a coinsurance are subject to deduc ble.

Dependent Age: to the end of the year which the child a ains age 26.

Preven ve Care Services that meet the requirements of federal and state law, including certain screenings, immuniza ons and physician visits are covered at no member cost.

Pre‐exis ng Exclusion Period: None.

This plan comparison is intended to be a brief outline of coverage.

Anthem’s summary of benefits for each plan is available on SCH’s Intranet or at www.schstaff.org. To contact Anthem:  Visit www.anthem.com  or  Call 1‐855‐333‐5735. 

 For a complete list of preventa ve services covered by the Affordable Care Act (ACA) please visit 

 h p://www.hhs.gov/healthcare/facts‐and‐features/fact‐sheets/preven ve‐services‐covered‐under‐aca/

PLAN NOTES

The discounts below are intended for staff/family covered by a SCH health planA. Plan specific discounts are listed below. 

 

 

 

SCH HEALTH PL AN DISCOUNTS FOR SERVICES @SCH

Outpa ent Laboratory Services and Diagnos c Imaging (X‐Ray, MRI, CT, Mammography & Ultrasound): Upon request, a 30% discount will be applied to the “member responsibility” por on of charges. This discount may be received by contac ng Pa ent Financial Services upon receipt of your bill. You must make arrangements to pay in full the remaining por on of the bill at the me of the discount.

Outpa ent Therapy Services: SCH provided OUTPATIENT THERAPY visits can be received for

COPAYMENTS ONLYB. Green Plan is $35; Blue Plan is $25 and Red Plan is $35. 

"Fast Track" @ SCH ED: ($75 Copayment) This discount applies to SCH’s Fast Track level of care only. If the pa ent’s clinical condi on determines that they are not eligible for treatment in the Fast Track, the regular ED co‐pays apply. Examples of the kinds of condi ons that could be seen in the Fast Track MAY include things like minor contusions, sprains, minor lacera ons, minor burns, upper respiratory infec ons, insect s ngs, and ear infec ons.

"FAST TRACK" @ SCH is open from 7 a.m. un l 3 a.m. 7 days/week. A Must be covered within your health plan B Number of Total Visits/Year is determined within each plan

MEDICAL, SURGICAL & DENTAL OFFICE VISIT DISCOUNTS @SCH

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The discounts below are intended for any SCH staff including their spouse and dependent children ‐ par cipa on in an SCH sponsored health insurance plan is not required. 

SCH Medical, Surgical and Dental office visit: Copayments/Co‐insurance are discount‐

ed by $15C for office visits with an SCH physician. SCH staff, their spouse, and dependent

children are eligible. (Ref: Policy #HR‐01‐0008) C$15 but no more than the pa ent’s cost

NEW FOR ALL EMPLOYEES 

SHORT TERM DISABILITY:  GUARANTEED ISSUE & ENHANCED BENEFITS!  ‐  Updated policy now waives the elimina on period if insured is admi ed to a hospital facility on day one. New elimina on periods from which to choose! 12 month pre‐exis ng condi ons exclusion s ll applies for new coverage.

WHOLE LIFE COVERAGE:  GUARANTEED ISSUE AMOUNTS UP TO $100,000 FOR EMPLOYEES WITH ENHANCED BENEFITS!  ‐ Spouse & Juvenile policies available. New benefit op ons including Double Indemnity & Chronic Care Riders (allows monies to be used for skilled nursing care). Issue age determines certain eligibili es.

LEVEL TERM COVERAGES:  GUARANTEE ISSUE AMOUNTS UP TO $75,000 FOR EMPLOYEES!  NEW RIDER OPTIONS!  ‐ 10, 20 & 30 year guaranteed level plans & a new 15 year plan. Guaranteed Issue amounts up to $75,000 for employees, (based on issue age). Stand‐alone spouse policies con nue to be offered. New Chronic Care Rider available.

ACCIDENT INSURANCE:  NEW COVERAGE OPTIONS!  24/7 coverage with new rider op ons, including a cri cal care & upgraded hospital admission rider. Stand‐alone spouse & dependent policies with spousal disability op ons! NEW accidental Gunshot coverage pays an extra $1,000.

CRITICAL ILLNESS COVERAGE:   GUARANTEED ISSUE UP TO $15,000!  Coverage for heart a acks, strokes, Occupa onal HIV, Hepa s B,C & D, and more.

SUPPLEMENTAL MEDICAL BRIDGE COVERAGE:  GUARANTEE ISSUE OPTIONS AVAILABLE!  Coverage for inpa ent hospital stays & outpa ent surgery, emergency room visits and much more.

No rate increases ‐ SCH is con nuing to offer 2 Delta Dental PPO plans. These plans include Delta’s preferred provider organiza on which offers

comprehensive dental coverage. In plan year 2020 alone, SCH’s an cipated contribu on is nearly a quarter of a million dollars.

Plan 1  Plan 2  Full Time   

Staff  Cost per Month 

Part Time Staff  

Cost per Month 

 Full Time  Staff  

Cost per Month 

Part Time Staff  

Cost per Month 

Employee Only $6.00 $12.50 N/A N/A

Two Person $26.50 $36.00 $15.00 $25.00

Family $45.00 $61.00 $28.50 $42.00

6 month Exam & Cleaning No Cost No Cost

Individual/Family Deduc ble $25/$75 $50/$150 Maximum Benefit

Per Person—Per Benefit Year $1500 $1000

Orthodon cs Per Person—Per Life me

$2000 50%/$1,000 max

DELTA DENTAL

Anthem Blue View Vision

Full Time & Part Time  

Staff  Cost per Month 

Employee $6.60 Emp.+ Spouse $11.55

Emp. + Child(ren) $12.52 Family $19.10

Benefit Overview

Anthem Vision (In Network) 

Rou ne Eye Exam (once every 12 mo) $10 copay

Eyeglass Frames (once every 24 mo) $130 allowance, 20% off balance over $130

Eyeglass Lenses (once every 12 mo) $15 standard plas c lenses

Contact lenses (instead of, but not in addi‐on to eyeglass lenses) (once every 12 mo)

$130 allowance, 15% off balance over $130

Contact lenses fi ng & 2 follow‐up visits Up to $55, 10% off retail

Take advantage of group rates to get affordable Anthem Blue View Vision coverage for eye exams, frames, lenses, contacts and more. See more details on SCH’s Intranet or at www.schstaff.org.

VISION INSURANCE

SUPPLEMENTAL INSURANCE

Maximum Benefit Carryover  (Plans 1 & 2):

Member receives annual maximum at the beginning of the group’s benefits period.

Member must have one covered dental service during the benefit period.

Paid claims for the benefit period must be less than half of the annual maximum.

A por on of the unused maximum will be carried over for future use.  

Ques ons? Call 1.800.423.2184 

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A Flexible Spending Account (FSA) allows you to save up to 30% on your eligible healthcare and/or dependent care expenses every year by using pretax dollars. Your Health FSA contribu ons are deducted from your taxable pay on a pretax basis before federal, state and Social Security (FICA) taxes are taken out.

Medical Reimbursement Accounts:  Set aside pretax money for medical expenses not covered by insurance including deduc ble/co‐pays/co‐insurance and prescrip on costs. Also covers eyeglasses and dental costs. The IRS Annual Maximum is $2,650 (for ‘19, ’20 will be announced at the end of Oct.).

Dependent Care Accounts: Set aside pretax money for child care expenses. The IRS Annual Maximum: $5,000 (for ‘19, 20 will be announced at the end of Oct.). 

IRS rules allow par cipants to receive an addi onal two‐and‐a‐half month “grace period” to incur and reimburse eligible expenses from the prior year’s remaining unused benefits.

FLEXIBLE SPENDING ACCOUNTS : MEDICAL REIMBURSEMENT & DEPENDENT CARE

DENTAL INSURANCE

Tobacco Premium Surcharge for 2020 For 2020, staff will incur a $85 surcharge per month via payroll on their healthcare premiums if they, their spouse, or their dependent child(ren)

enrolled on SCH’s health plan uses a tobacco product. (Note: only one (1) surcharge per plan)

What is considered Tobacco?  

Tobacco is defined as cigare es, pipes, cigars, e‐cigare es/vape pens/juuls (containing nico ne), chewing and/or smokeless tobacco.

What if no one on my plan uses tobacco products in 2020? 

All staff will be required to complete a Tobacco Surcharge Cer fica on located on SCH’s Employee Portal by Nov. 9, 2019 indica ng if they, their

spouse, or their dependent child(ren) use tobacco.

Are there any op ons available that enable me to not incur the surcharge? 

Each tobacco using member would need to enroll and successfully complete a tobacco cessa on program by March 31, 2020 and recer fy a

Tobacco Surcharge Cer fica on with Human Resources.

What resources are available if I want to quit using tobacco?  Nearly 7 in 10 cigare e smokers want to stop smoking. Annually, more than 4 in

10 cigare e smokers make an a empt to quit.

SCH con nues to offer the Cooper‐Clayton Tobacco Cessa on classes. Classes are at no cost to the par cipant with free nico ne supplements. For

addi onal informa on please contact Ashley Gibson at ext. 7561. Other Op ons:  Quit Now Kentucky: 1‐800‐QUIT‐NOW, or visit

www.QuitNowKentucky.org. You can also visit www.BecomeAnEX.org to assist you in crea ng a personal quit plan.

Tobacco Premium Surcharge planned for 2021 For 2021, staff  will incur a surcharge increase and poten ally an addi onal  surcharge amount if their spouse, or their dependent child(ren)

enrolled on SCH’s health plan uses a tobacco product.

What if no one on my plan uses tobacco products?  

All staff may be required to complete a Tobacco Surcharge Cer fica on located on SCH’s Employee Portal by Nov. 2021 indica ng if they, their

spouse, or their dependent child(ren) use tobacco. Addi onally, cer fica ons of non‐tobacco use may require in‐person nico ne screenings of all 

covered adults over 18 years of age. 

  Tobacco Health Facts We have over 2,000 people covered by our health insurance, this includes covered staff and their covered family members. Our premiums are based on the cost of all the previous year’s medical and Rx claims created by this large group and the expected cost of the upcoming year. Simply stated when our claims increase our premiums increase as well. Tobacco usage substan ally effects everyone’s premiums. Further, tobacco usage impacts na onal health care costs. According to the CDC, smoking‐related illness costs nearly $170 billion for direct medical care for adults. In addi on, more than $156 billion in lost produc vity including $5.6 billion in lost produc vity due to secondhand smoke exposure. Together these two impacts result in costs of more than $300 billion each year.

Addi onal Health Facts: Smoking is the leading cause of preventable death. 

Worldwide, tobacco use causes nearly 6 million deaths per year and current trends show that tobacco use will cause more than 8 million deaths annually by 2030.

Cigare e smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resul ng from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.

On average, smokers die 10 years earlier than nonsmokers.

If smoking con nues at the current rate among U.S. youth, 5.6 million of today’s Americans younger than 18 years of age are expected to die prematurely from a smoking‐related illness. This represents about one in every 13 Americans aged 17 years or younger who are alive today.

Smoking leads to disease and disability and harms nearly every organ of the body. Smoking causes cancer, heart disease, stroke, lung diseases, diabetes and chronic obstruc ve pulmonary disease (COPD), which includes emphysema and chronic bronchi s.

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HEALTH INSURANCE - TOBACCO SURCHARGE

The CDC es mates that smokers cost employers an addi onal $6,000 per year in medical costs and lost produc vity. 

Changes you can make during the Open Enrollment period include:  Enroll, change or drop health, dental and/or vision coverage

Establish a flexible spending account

Add or change dependents

Review and update disability coverage and beneficiaries

Sign up for supplemental life insurance and/or dependent life insurance

Do all FT & PT SCH staff members need to par cipate in Open  Enrollment?  YES—Any eligible staff member FT or PT are required to complete an open enrollment appointment either online, or with a benefit counselor, otherwise they will be excluded from par cipa ng in the associated benefits for CY20. You will re‐affirm, change, or waive coverage. Your benefits will not roll over into the 2020 Plan Year. Staff members who would like to meet with a benefit counselor may signup for an appointment in the cafeteria. Appointments are avail‐able Friday, Oct 25th thru Saturday, Nov 9th. Infusion Solu ons and Family Medicine offices outside Rowan County only: Enrollers will be visi ng on specific dates previously arranged.        If I don’t make “changes”  during Open Enrollment can I  make them later? Only Under Special Circumstances. Unfortunately, as a result of IRS rules, SCH can only make Open Enrollment benefits available during the ‘open enrollment’ period, unless you have a family status qualifying event. For example: new dependent (due to birth or adop on), marriage, divorce, spouse/dependent gains or loses other group coverage, dependent becomes ineligible, death of spouse or child. Changes must be submi ed to HR within 30 days of the event. Excep on: Colonial supplemental coverage can only be changed at Open Enrollment. 

If I have ques ons about my Open Enrollment Benefits how can I get answers?  Intranet: This can be accessed while logged on to any SCH computer by typing “Intranet” in your web browser address bar and go to the Human Resources link. Internet: Go to www.schstaff.org from any Internet accessible computer and go to the Human Resources link. Benefits & Wellness Fair: Anthem, Delta Dental, Anthem Vision, Colonial Life, and FEBCO representa ves will be available at SCH’s Benefits & Wellness Fair on Thursday, Oct. 24th, in the Cafeteria from 8am‐3pm. 

Spousal Premium Surcharge What is a Spousal Premium Surcharge?  For 2020, staff will incur a $58 surcharge per month via payroll on their healthcare premiums if they elect coverage under SCH’s health plan for their spouse who is eligible for subsidized health care benefits of a (comparable plan) through their own employer.  What does SCH consider a comparable plan?   A comparable plan is a plan that provides minimum essen al coverage under a group health plan as outlined by ACA guidelines. Why do we have this surcharge?  The cost of health insurance coverage for a spouse because they are adults is very high. SCH must look at all possible ways to manage costs.  What if I do not have a spouse on my health plan?  All staff will be required to complete a Spousal Surcharge Cer fica on located on SCH’s Employee Portal by November 9, 2019.  What if my spouse is not employed, or is not eligible for his/her own health insurance through his/her employer?  If your spouse is currently unemployed, self‐employed, or is not eligible for his/her own employer health insurance then no surcharge will be applied.

Health Insurance Tobacco & Spousal Surcharge Cer fica ons:

All staff must recer fy both surcharge cer fica ons (tobacco & spousal) for the 2020 plan year. Selec ons previously made in 2019 will not rollover. Please complete your surcharge cer fica ons by November 9, 2019.  NOTE:  A staff member who submits inaccurate or false informa on on any surcharge cer fica on may be subject to having the surcharge applied retroac vely for the applicable plan year and possibly receive disciplinary ac on for dishonesty and falsifica on of documents. Surcharges only apply to the health insurance (excludes dental, vision and supplemental coverage). 

Health Insurance - Spousal Surcharge

OPEN ENROLLMENT FAQS

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SURCHARGE CERTIFICATIONS

Health Insurance Exchange Staff who are not eligible for SCH’s health insurance may want to consider enrolling through the Federal Marketplace @ HealthCare.gov. Open Enrollment for 2020 runs Friday, November 1 to Sunday, December 15, 2019— coverage starts January 1, 2020. Medicaid/KCHIPS If your income and/or family size meets the requirements for Medicaid make sure to see an SCH Financial Counselor prior to enrolling in SCH’s benefits. Medicare If you are 65 years of age or older and would like to consider a Medicare Supplement and/or a Medicare Advantage Plan please contact Trademark Insurance & Investments at 606‐784‐7474, or a Medicare representa ve of your choice. MEDICARE PART D RX DISCLOSURE If you (or your covered dependent) have Medicare or will become eligible for Medicare in the next 12 months, current Federal law gives you choices about your prescrip on drug coverage. For more details go to HR link at SCH’s Intranet or go to www.schstaff.org.

Under the Affordable Care Act, women’s preven ve health care such as mammograms, screenings for cervical cancer, prenatal care, and other services must be covered by health plans with no cost sharing. SCH’s plans cover these services as mandated.

However, SCH meets the requirements to be exempt from including contracep ve services from its health plans. At this me, upon receipt of SCH’s self‐cer fica on, Anthem is required by the federal government to assume sole responsibility, independent of SCH and its plan, to pay for contracep ve services without cost‐sharing, premium, fee, or other charge to plan par cipants and beneficiaries.

RELIGIOUS EMPLOYER EXEMPT CERTIFICATION

YOU MAY QUALIFY FOR OTHER COVERAGE OPTIONS

If you are enrolled in the Red Health Plan you may want to consider a Health Savings Account (HSA). 

What is an HSA? An interest‐earning, tax‐free account that is an op on with certain qualified health insurance plans like SCH’s “Red Plan.”

You can open your HSA with a bank or other financial ins tu on. You own and control the money like a personal savings account. However, the money in it is used to pay only for health care‐related expenses. The new limits for health savings accounts (HSA) for 2020 are going up $50 for individual coverage and $100 for family coverage, bringing them to $3,550 and $7,100, respec vely. The catch‐up contribu on limit for those over age 55 will remain at $1,000. For more details: h ps://www.healthcare.gov/glossary/health‐savings‐account‐HSA/ or h ps://www.irs.gov/pub/irs‐pdf/p969.pdf

HEALTH SAVINGS ACCOUNT

SCH staff enrolled with SCH’s Anthem Health Insurance plan will receive a discount on prescrip on copays. Discounts are only given for SCH staff member and are not available for staff’s family members. Payroll deduc on will also be available as a one me pay deduc on. To transfer your prescrip ons, stop by or call 606‐780‐5400.

DISCOUNTS 

SCH staff with SCH’s Anthem Green & Blue Insurance Plans will receive a 25% discount off prescrip on copays.

SCH staff with SCH’s Anthem Red Insurance Plan will receive a 25% discount off prescrip on copays up to a maximum of $15.

Discounts are only given for SCH staff members and are not available for staff’s family members.

Also, St. Claire Regional Pharmacy will gladly match any compe tor’s price in Morehead for both prescrip on and over‐the‐counter (OTC) medicines. SCH staff member must present their SCH badge to receive discount and payroll deduc on.

ONLINE ENROLLMENT INSTRUCTIONS

ONLINE ENROLLMENT INSTRUCTIONS (Oct. 25—Nov.9):  

Go to: h ps://harmonyenroll.coloniallife.com

Your User Name is SCH‐ + last name + last four digits of your SSN. (Example: SCH‐SMITH6789).

Your password is the first four le ers of your last name + last four digits for you SSN. (Example: Jane Smith’s password will be Smit6789)*

*If the employee’s last name is shorter than four le ers, then the en re last name is used. (Example: Jason May would be MAY6789).

For technical assistance accessing or using the system call the Help Center at 1‐866‐875‐4772, between 8a.m.  ‐ 7p.m. 

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RETAIL PHARMACY