Page 6 - Adreima Enrollment Guide
P. 6
Annual Enrollment
Medical Plan
Important Medical Plan These plans allow you to see the healthcare provider of your choice,
Changes in 2016 although your out-of-pocket cost is reduced when you see providers
For 2016, Adreima was originally who are part of BCBSIL’s Preferred Provider Organization (PPO)
network.
given a 30 percent increase by BCBS
to medical and pharmacy rates due In 2016, due to the cost of the High Plan, Adreima will only be
to the amount of claims during moving forward with the Low Plan (now called the Traditional PPO)
2015. In order to decrease rates to a and the CDHP for 2016. If you are currently enrolled in the High
10–15 percent increase, depending on Plan, we ask that you select between the Traditional PPO plan
your medical plan option, Adreima is (formerly called the Low Plan) and the CDHP in order to have
moving to what is called a self-funded coverage in 2016.
arrangement. In this arrangement,
BCBS will still administer claims, but There will be two slight changes to the Traditional PPO and CDHP
Adreima will be the entity at risk for in 2016.
paying claims instead of BCBS. This
transition will be seamless. Adreima Per Health Reform mandates, pharmacy copays must accumulate
will not have access to your individual toward a separate pharmacy out-of-pocket maximum in the
claim information and nothing will Traditional PPO plan. This will beneit you as a plan member
change for you as a member of the because the maximum for the number of copays you paid in the past
medical plan. Please keep in mind that was unlimited. After you reach the $600 out-of-pocket pharmacy
every dollar you accumulate in claims maximum for an individual or $1,200 for a family, you will not have
will be paid for by the company. While to pay any further pharmacy copays.
you contribute toward these costs,
Adreima still pays approximately 70–85 Additionally, the CDHP will cover certain preventive medication
percent of the total cost of claims, prescriptions at 100 percent. For example, if you are traveling
Health Reform taxes, and BCBS outside of the country and your doctor recommends an anti-malarial
administrative fees, depending on the medication, depending on which medication is recommended, this
plan. may be covered at 100 percent. Please note only preventive drugs
are covered; if you are taking a drug for treatment, this will not
Going forward, we are asking you and be covered at 100 percent. If you are unsure of whether a drug is
your family members to help keep considered preventive or as treatment, it would be best to talk to your
costs down by being wise consumers doctor, then call to conirm with BCBS using the number on the
of our plans by doing things such as back of your ID card.
researching the cost of a procedure at
various facilities or using urgent care As part of your healthcare beneits, the medical plans provide
facilities instead of emergency rooms 100 percent coverage for wellness/preventive care services. The
for non-emergent situations. plan designs vary in deductible, coinsurance, and copays. They are
designed to offer you both lexibility and choice in meeting your
6 family’s healthcare needs.
Medical Plan
Important Medical Plan These plans allow you to see the healthcare provider of your choice,
Changes in 2016 although your out-of-pocket cost is reduced when you see providers
For 2016, Adreima was originally who are part of BCBSIL’s Preferred Provider Organization (PPO)
network.
given a 30 percent increase by BCBS
to medical and pharmacy rates due In 2016, due to the cost of the High Plan, Adreima will only be
to the amount of claims during moving forward with the Low Plan (now called the Traditional PPO)
2015. In order to decrease rates to a and the CDHP for 2016. If you are currently enrolled in the High
10–15 percent increase, depending on Plan, we ask that you select between the Traditional PPO plan
your medical plan option, Adreima is (formerly called the Low Plan) and the CDHP in order to have
moving to what is called a self-funded coverage in 2016.
arrangement. In this arrangement,
BCBS will still administer claims, but There will be two slight changes to the Traditional PPO and CDHP
Adreima will be the entity at risk for in 2016.
paying claims instead of BCBS. This
transition will be seamless. Adreima Per Health Reform mandates, pharmacy copays must accumulate
will not have access to your individual toward a separate pharmacy out-of-pocket maximum in the
claim information and nothing will Traditional PPO plan. This will beneit you as a plan member
change for you as a member of the because the maximum for the number of copays you paid in the past
medical plan. Please keep in mind that was unlimited. After you reach the $600 out-of-pocket pharmacy
every dollar you accumulate in claims maximum for an individual or $1,200 for a family, you will not have
will be paid for by the company. While to pay any further pharmacy copays.
you contribute toward these costs,
Adreima still pays approximately 70–85 Additionally, the CDHP will cover certain preventive medication
percent of the total cost of claims, prescriptions at 100 percent. For example, if you are traveling
Health Reform taxes, and BCBS outside of the country and your doctor recommends an anti-malarial
administrative fees, depending on the medication, depending on which medication is recommended, this
plan. may be covered at 100 percent. Please note only preventive drugs
are covered; if you are taking a drug for treatment, this will not
Going forward, we are asking you and be covered at 100 percent. If you are unsure of whether a drug is
your family members to help keep considered preventive or as treatment, it would be best to talk to your
costs down by being wise consumers doctor, then call to conirm with BCBS using the number on the
of our plans by doing things such as back of your ID card.
researching the cost of a procedure at
various facilities or using urgent care As part of your healthcare beneits, the medical plans provide
facilities instead of emergency rooms 100 percent coverage for wellness/preventive care services. The
for non-emergent situations. plan designs vary in deductible, coinsurance, and copays. They are
designed to offer you both lexibility and choice in meeting your
6 family’s healthcare needs.
