Your GE Medical Plan
Transcription
Your GE Medical Plan
Welcome! See inside for important tips, tools and information TAKE TIME TO UNDERSTAND + How to use your plan + Support resources available to you INSIDE YOU CAN FIND + How to get high-quality care while reducing spending + Preventive screenings and services covered 100% + Tips on doctor visits, prescription drugs, savings accounts and more + Key phone numbers and Web sites Your GE Medical Plan A guide to help you make the most of your health care benefits This booklet provides helpful tips on how to use your GE medical plan. It will be a valuable resource, so keep it handy and refer to it often. benefits.ge.com is now OneHR.ge.com! Visit the site for all your pay and benefits information. SECTION 1 SECTION 4 Understanding how your GE medical plan works 2 What you pay; what GE pays 3 Quick tips: How to make the most of your GE medical plan 17 Using your plan 4 Be prepared for your doctor visit 18 Filling a prescription 6 Key things to know about your prescription drug benefits 20 Tips for Option 1 & 2 and Option 2 Select participants 22 Managing your WageWorks savings accounts 24 Paying your doctor bill — Option 1 & 2 28 Going to the pharmacy — Option 1 & 2 31 Tips for Option 3 participants 32 Paying your doctor bill — Option 3 38 SECTION 2 Ten ways to get high-quality treatment while reducing your health care spending 8 SECTION 3 The importance of preventive screenings 12 Preventive screenings and services for women 15 Going to the pharmacy — Option 3 39 Understanding Health Savings Account (HSA) contributions on your W-2 40 Tools, resources and contact information41 1 SECTION Understanding how your GE medical plan works You pay 100% of health care costs until you reach your deductible; then you pay 20% and GE pays 80% in-network. Once you reach your co-insurance maximum, GE pays 100% of remaining covered expenses in-network. 2 What you pay; what GE pays Your Deductible Your deductible is the dollar amount you’ll need to spend before insurance payments begin. You pay all health care costs until this amount is reached. Your deductible is made up of your eligible medical, pharmacy and behavioral health claims for you and your covered dependents. Dental, vision and over-the-counter (OTC) purchases do not count toward your deductible. + Your Co-Insurance Maximum Once the deductible is met, co-insurance begins. Co-insurance means you pay 20% of the cost and GE pays 80% in-network. For outof-network services, you pay 40% of the cost and GE pays 60%. Additional out-ofnetwork provider charges may apply.* = Your Out-of-Pocket Maximum After you reach your co-insurance maximum, GE pays 100% of covered expenses in-network. Your deductible plus co-insurance is the most you will pay for your eligible medical, pharmacy and behavioral health benefits. Once the deductible is met, co-insurance begins. The amount of co-insurance that you pay is capped. *Does not apply to GE Health Choice Option 2 Select participants, which is an in-network plan only. Another good reason to use in-network doctors and facilities: When you receive care out-ofnetwork, any costs above the amount your health plan administrator determines to be eligible are not applied to your deductible, co-insurance or outof-pocket maximum. This can substantially increase the amount you spend for care in a year.* *Does not apply to GE Health Choice Option 2 Select participants, which is an in-network plan only. 3 Using your plan Your GE medical plan design is based mostly on deductibles and co-insurance. As a result, you are responsible for the full cost of most medical services and prescription drugs until you meet your deductible — but at negotiated rates with in-network providers. When you go to a network doctor: If you are new to the medical plan or your health plan administrator has changed, bring a copy of the Doctor’s Letter to explain your plan to your doctor. To print copies of the letter, please visit the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/healthcaredecisions and select “Provider Search.” Do not pay your doctor at the time of your visit. Here’s why. Before you pay, your bill needs to go through the claims process for two reasons: • First, so you can be billed accurately at GE’s negotiated rate • Second, so that the correct amount can be applied to your deductible and co-insurance maximum 4 Even if your doctor’s office specifically requests payment at the time of the visit, try to avoid it. It will probably only create confusion and more work for you down the line. If your doctor absolutely insists on payment at the date of service, follow the steps on page 28 (Options 1 & 2 and Option 2 Select) or page 38 (Option 3). 1 Show your medical ID card. Have you reached your deductible? Show your medical ID card. The doctor should not ask you to pay anything at the time of the visit. If you have not reached your deductible, your health plan administrator notifies the doctor that you are responsible for paying the full cost of your visit as indicated on your Explanation of Benefits (EOB). 2 3 4 Your doctor submits a claim. Your doctor submits a claim to your health plan administrator. Your health plan administrator processes the claim. Your health plan administrator processes the claim using the discounted rate that the doctor has agreed to for plan members. If you have reached your deductible, your GE medical plan covers innetwork services at 80%. Your health plan administrator notifies the doctor that you are responsible for paying the remaining 20% in-network co-insurance. Your doctor sends you the bill. Your doctor sends you a bill for the amount that your health plan administrator says you owe. Explanation of Benefits Your health plan administrator sends you an EOB that summarizes how the claim was processed. You should compare it to the bill from the doctor to make sure the amount billed matches what the health plan administrator says you owe. If it does not match, call your health plan administrator for clarification. You pay the bill. 5 Filling a prescription GE Exclusive Choice is the retail pharmacy network in certain states. These states include Connecticut, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Michigan, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas and Wisconsin. If you live in or travel to any of these states and choose to purchase your prescriptions at a retail location, you must use an Exclusive Choice retail network pharmacy for your prescriptions to be covered. The network includes CVS, Walmart, Sam’s Club and select local independent pharmacies. There is no coverage for prescriptions filled at out-of-network pharmacies. If you are not in an Exclusive Choice state, you can use any network pharmacy in that state to receive prescription drug coverage. To see a list of retail network pharmacies, go to www.caremark.com or call 1-800-509-9891. This does not apply for mail order. If you need to switch pharmacies, you should take the following steps: • Review your current medications and where you purchase them. • If you do not currently purchase your prescription(s) at an Exclusive Choice pharmacy, you will need to transfer your prescription(s) to a pharmacy in the network. This is very important — and very easy. • If you need to transfer a prescription, visit or call a local Exclusive Choice pharmacy with your prescription bottle and CVS Caremark ID card in hand, and tell them you need to transfer your prescriptions. All you need is on your prescription bottle label and your ID card. • Finally, inform your doctor of this change. When you go to a network pharmacy Step 1 Show your CVS Caremark card. The claim will count toward your deductible and co-insurance maximum. Step 2 If you have not reached your deductible, you pay for the prescription in full, at the network discount rate. Step 3 If you have reached your deductible, you pay a co-payment for generic drugs or co-insurance for brand-name drugs. 6 1 2 3 4 Get low-cost generic prescriptions and 24/7 access with CVS Caremark. CVS Caremark and GE offer GE medical plan participants a lowcost $4 and $10 generic program. CVS Caremark will provide a list of eligible generic drugs that are available for this program in CVS retail stores and by mail order. To view the list of $4 and $10 generics, order prescriptions and submit refills 24/7, go to www. caremark.com. Specialty and Targeted drugs Remember: Drugs on the Specialty and Targeted drug list are not subject to deductible for Options 1 & 2 and Option 2 Select. For details on Specialty and Targeted drugs, visit the prescription drugs page on the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/ healthcaredecisions, or go to www.caremark.com. For more information, visit www.caremark.com. 7 SECTION Ten ways to get high-quality treatment while reducing your health care spending To get the most from your GE medical plan, you need to be an active consumer of health care. That means working closely with your doctor, following care regimens, asking questions and getting involved in treatment decisions. It also means managing your spending and using resources wisely. Here are some key points to keep in mind. Need more assistance? See the “Tools and Resources” section on page 41. 8 Make healthy lifestyle choices, including getting all of your recommended preventive screenings. When you use in-network providers, the plan covers many preventive screenings and services at 100%. See page 12 for details. If you need help or advice on making healthy lifestyle choices like eating better, exercising or quitting tobacco, call Health Coach from GE at 1-866-272-6007 and ask about lifestyle coaching. Learn more about Health Coach from GE on page 11. Avoid out-of-network care and services whenever possible.* When you use doctors or hospitals out-of-network, you pay more. About 90–95% of doctors and hospitals are in the typical GE network.* Network providers have met quality standards and have agreed to provide services to GE members at a discount. Note: Even when being treated at an in-network hospital, be sure to verify that the doctor who is treating you is in-network. Make sure you understand how your savings accounts work. Using them correctly is a key to maximizing your plan. If you have a Health Reimbursement Account (HRA) or Health Care Flexible Spending Account (FSA)/Limited Purpose FSA (LPFSA), read the WageWorks Quick Start brochure for your account. And if you have a Health Savings Account (HSA), visit your partner bank’s Web site to ensure you are maximizing your opportunities. Go to the “Savings Accounts” section of the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/ healthcaredecisions, and click on “Savings Accounts Overview.” Use generic drugs. Generic drugs can cost much less than brand names. If no generic equivalent is available, ask your doctor about similar lower-cost drugs that may be equally effective. Visit www.caremark. com and click on “Find Savings and Opportunities” to explore ways to save money and better understand your drug costs. *Does not apply to GE Health Choice Option 2 Select participants, which is an in-network plan only. 9 Always use your CVS Caremark card to receive all the discounts you are entitled to. Using your CVS Caremark card also ensures pharmacy expenses are counted against your deductible. If you have questions, contact CVS Caremark at 1-800-509-9891 or www.caremark.com. You can also use your CVS ExtraCare health card to save 20% on eligible health-related CVS/pharmacy brand products in-store and online at www.cvs.com. To request additional cards, call 1-800-509-9891. Develop a relationship with a primary care doctor — especially if you have a chronic condition. It’s always a good idea to have one doctor coordinate your care. If you don’t have a primary care doctor, Health Coach from GE can help you find one. Call 1-866-272-6007. 10 Avoid emergency room visits for non-emergencies. For minor issues, visit an in-network convenience clinic or your doctor’s office. If it’s more serious and your doctor is not available, consider an urgent care facility. All of these options cost far less than emergency rooms. For a list of urgent care facilities in your area, call Health Coach from GE, use the Treatment Cost Calculator at www.treatmentcostcalculator.com/ge or visit your health plan administrator’s Web site. In certain states, for minor illnesses, you may even be able to see a doctor online from your computer or smartphone using NowClinic. See page 42 for more information on NowClinic. 1 Before you get the care, get the cost. The Treatment Cost Calculator lets you comparison shop for your medical care. In minutes, you can: • Search for a medical treatment, service or condition • Review a general estimate of your costs • Find physicians, hospitals and clinics in your area • Compare those providers by quality, cost and location • Locate the nearest urgent care facility Additional features: • Outpatient bundling for a more complete cost estimate • Fully functional mobile site • Advanced search functionality by specialty options Go to your mobile device app store and search for “GE TCC” to download the Treatment Cost Calculator app to your mobile device! Visit www.treatmentcostcalculator. com/ge For the answers you need and support you can trust, call Health Coach from GE at 1-866-272-6007. 2 Five reasons to call Health Coach from GE: 3 • Select high-quality, cost-effective doctors and hospitals 4 • Understand your diagnosis and treatment options • Understand your after-hours care options • Access lifestyle coaching • Get help resolving medical claim issues* *Previously, you had to first contact your medical plan administrator for claims help. Now, if you prefer to work with a Health Coach on these issues, you can make Health Coach your first call. Take advantage of the tools and resources GE offers to help manage your care and benefits. • NowClinic • Employee Assistance Program (EAP) • Expert Medical Opinion (EMO) Program by Cleveland Clinic • Tobacco Cessation Program • Centers of Excellence (COEs) Access a wealth of useful tools and information through www.ge.com/ healthahead/healthcaredecisions. Scan the QR code to bookmark www.ge. com/healthahead/ healthcaredecisions on your smartphone 11 SECTION The importance of preventive screenings With your GE medical plan, preventive screenings and services, as recommended by the U.S. Preventive Services Task Force (USPSTF), are covered 100% in-network and not subject to the deductible. Screenings in the following categories cost you nothing. • Screenings for cervical, breast, prostate and colon cancer • A variety of blood, urine and other lab tests • Annual adult physicals • Immunizations for influenza, hepatitis, tetanus and many more • Annual routine gynecological care • Screenings for conditions such as osteoporosis, depression and more • Annual lung cancer screening: age 55–80 with 30-year tobacco history • Pediatric prevention, including wellchild care visits and screenings • Hepatitis C virus screenings for adults born in U.S. from 1945–1965 and those at high risk See the entire list of preventive screenings and services by visiting the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/healthcaredecisions. Age, condition and frequency restrictions may apply. If you’re not sure whether a specific service is covered for you or a family member, please contact your health plan administrator. 12 13 14 Preventive screenings and services for women 1 Services will be covered at 100% and not subject to the deductible when you use in-network providers. Some services include: 2 • Annual well-women visits • Counseling and screening for human immuno-deficiency virus (HIV) 3 • Counseling and screening for interpersonal issues and domestic violence 4 • Prenatal preventive visits • Gestational diabetes screenings • Sterilization for women • Prescribed generic contraceptives, including over-the-counter (OTC) and contraceptives counseling • HPV testing • Breast Cancer Susceptibility Gene (BRCA) genetic testing when medically appropriate • Counseling for sexually transmitted infections Calling Doctor… 1 2 3 4 5 6 7 8 9 • Breastfeeding support, supplies and counseling for new mothers • Breast cancer preventive medication for women with increased risk; including some prescription medications. Please call CVS Caremark for more information, 1-800-509-9891 Remember that in-network preventive screenings and services covered at 100% are based on the U.S. Preventive Services Task Force (USPSTF) recommendations. Talk with your doctor to determine if any screenings or services fall outside of these guidelines, as you may be responsible for all or part of the costs of such services. Contact your health plan administrator if you have any coverage questions. 15 SECTION 16 Quick tips: How to make the most of your GE medical plan Our goal is to provide you and your family with all the information you need to manage your health care needs and make smart, cost-effective choices. In this section, you’ll find a set of essential tips as you consider your treatment options, visit your doctor, go to the pharmacy, manage your savings accounts and more. These tips are easy to scan through, easy to understand and designed to help you get the most value for your health care dollars. You’ll find general tips that apply to all GE medical plan participants, plus specific advice tailored to the plan option you’ve chosen — Option 1, Option 2, Option 2 Select or Option 3. Need more assistance? See the “Tools and Resources” section on page 41. 17 Be prepared for your doctor visit Call Health Coach from GE first. When you’re sick, the registered nurses at Health Coach can help you decide if you need to see a doctor. They can also help you find the nearest convenience clinic or urgent care facility. Call them at 1-866-272-6007. If an office visit is necessary, talk with your Health Coach about questions you should ask your doctor. Health Coach from GE: 1-866-272-6007 and select Option 2 18 Write down your questions. Be specific. Make sure you cover all your concerns and have a clear understanding of your diagnosis, treatment options and next steps before you conclude the visit. Also, keep in mind that the best way to save money is to ask questions, such as: Is there an acceptable generic drug available? Where’s the best place for my MRI? Do I really need all these tests? Keeping a personal health record may help you determine the questions you should ask. 1 2 3 4 Tell your doctor you have a consumer-driven health plan. Use an imaging center for MRI and CT scans. Tell your doctor that you want the best care, but with your health plan you are responsible for a large portion of the cost. Doctors may not think about costs when they choose treatments. If your doctor orders tests, talk to him or her about getting these types of tests at an imaging center instead of a hospital — you could save hundreds of dollars. 19 Key things to know about your prescription drug benefits Use mail order service for maintenance medication — your savings could be significant. • To ensure prompt delivery of your prescribed medication, make sure you have a form of payment on file with Caremark • Use generic drugs whenever possible. If no generic is available, ask your doctor about similar lower-cost drugs that may be equally effective. Make sure to check drug costs on www.caremark.com before completing your orders. You can also call Caremark at 1-800-509-9891 • If you have a Health Reimbursement Account (HRA) or Health Care Flexible Spending Account (FSA) and you do not use your WageWorks health care card at the time you order/fill your prescription, remember that you will need to submit a claim to WageWorks If you used personal funds at the pharmacy: To submit your claim on the WageWorks online portal, go to OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/HRA/HSA).” You’ll need to provide either the invoice or receipt to be reimbursed. Understand the key components of your plan by visiting the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/ healthcaredecisions. Save money on prescriptions Be a smart shopper and save. Local pharmacies often offer certain generic drugs at special pricing to attract customers — just like they do with other products. GE’s contract with CVS Caremark allows you to save money with these lower prices under the GE Prescription Drug program. For example, some retailers offer a list of drugs available at special pricing. These lists, available online and in-store, contain common generic drugs and are available to you for as little as $4 for 30 days or $10 for 90 days. 20 Walmart is an example of an in-network retailer that offers special pricing that can save you money. Compare prices before you purchase your next prescription. And visit other retailers on the Web to see if you can save money. Remember: If you fill your prescription at a local pharmacy, show your CVS Caremark prescription ID card so that you get credit toward your deductible and co-insurance maximum on top of getting the discounted price. 1 2 Remember: GE Exclusive Choice is the retail pharmacy network in certain states. These states include Connecticut, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Michigan, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Texas and Wisconsin. If you live in or travel to any of these states and choose to purchase your prescriptions at a retail location, you must use an Exclusive Choice retail network pharmacy for your prescriptions to be covered. The network includes CVS, Walmart, Sam’s Club and select local independent pharmacies. To see a list of retail network pharmacies, go to www.caremark.com, use the CVS Caremark mobile app or call 1-800-509-9891. This does not apply for mail order. Did you know? Certain over-the-counter (OTC) preventive drugs prescribed by a doctor are covered at 100%. Covered drugs are based on recommendations by the U.S. Preventive Services Task Force (USPSTF). They include: • Aspirin to prevent cardiovascular disease (CVD) • Iron supplements in children • Chemoprevention of dental caries (cavities) — Fluoride supplementation • Vitamin D supplementation to prevent falls in community-dwellings for adults age 65 years and older who are at increased risk for falls • Certain tobacco use and smoking cessation products for adults • Certain immunizations as recommended by the USPSTF • Prescribed generic contraceptives, including OTC drugs • Breast cancer preventive medication for women with increased risk; including some prescription medications Age and gender restrictions apply. Save more money with the CVS Caremark ExtraCare health card. As a GE employee, you could save hundreds of dollars every year! With your ExtraCare health card, get all the current benefits of the traditional CVS ExtraCare Card plus a 20% savings on eligible items in-store and online at www.cvs.com: • Health-related CVS brand products • Low-cost CVS brand OTC medications • Applies to more than 1,500 items at more than 7,000 stores • To request additional cards, call Caremark’s customer care at 1-800-509-9891 21 3 4 Tips for Options 1 & 2 and Option 2 Select participants This section applies to participants in Options 1 & 2 and Option 2 Select only. For you, GE has opened and funded a Health Reimbursement Account (HRA), which you can use to pay for most medical and prescription drug expenses. In addition, you may have opened and funded a Health Care Flexible Spending Account (FSA) during Annual Enrollment. These tips will help you use these accounts correctly when you go to the doctor, purchase prescription drugs and more. 22 You can carry over up to $500 of unused Health Care Flexible Spending Account (FSA) funds into the following year. For Dependent Care Flexible Spending Accounts (DCFSA), any funds not used by the following March 15 will be forfeited. WageWorks administers the Health Reimbursement Account (HRA) and FSA. Make the most of your benefits and know when to use your WageWorks health care card, when to pay online and how the claim process works. 1 2 3 WageWorks offers: 4 • An intuitive Web portal — enhanced to help you manage claims more easily and improve your overall experience, based on input from GE members • Strong customer service with a GE-specific Web site and phone line • Mobile capabilities and applications • Increased features to help you better manage your accounts Access the WageWorks online portal two ways: Go to OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/HRA/HSA)” or visit www. wageworks.com/ge. Four simple rules for managing your WageWorks accounts: • Use your WageWorks health care card whenever you purchase prescription drugs from a network pharmacy or mail order • Do not use your WageWorks health care card when you go to the doctor • Always save your receipts and Explanation of Benefits (EOB) forms • If you need to verify a claim, do so promptly to avoid tax penalties Visit the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/ healthcaredecisions to learn more about using your HRA and FSA funds and more. 23 Managing your WageWorks savings account To manage your Health Reimbursement Account (HRA)/Health Care Flexible Spending Account (FSA) funds online, visit OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/ HRA/HSA)” or go to www.wageworks. com/ge. If you need help or have any questions about the portal, call WageWorks at 1-888-303-3006. Scan the QR code to bookmark WageWorks on your smartphone. Coordinate claim payment or reimbursement. Stay informed and keep information up-to-date. Check for unpaid claims submitted by your medical, vision or dental administrator. You can either pay yourself (if you paid with your own funds) or send a payment directly to the provider (if you have not paid anything yet). Ensure that your information is correct and opt to receive email messages, electronic statements and other notices. Where to go: Log in to the WageWorks portal, click on “Submit Receipt or Claim” and select your claim option. Where to go: Log in to the WageWorks portal and select “Profile” from the top navigation bar. Verify your claims. A note about using your WageWorks accounts. You can use funds in your WageWorks account via your WageWorks health care card by paying your provider directly or by paying with out-of-pocket funds and reimbursing yourself. All claims, including card use, require verification that the expense is eligible according to IRS guidelines. Systems are in place to automatically verify expenses when possible, but there are times when you are asked to provide documentation. 24 You may need to verify a claim when you use your WageWorks health care card at a provider’s office. Verification must include patient name, date of service, service provided, provider name and amount paid (e.g., an Explanation of Benefits [EOB] from your health plan administrator). You can either fax the receipt or EOB using the WageWorks provided form, or you can scan a copy of the receipt and upload it to the site. Where to go: Log in to the WageWorks online portal and check your Alerts & Messages for a Card Use Verification notice. If nothing appears, you have no transactions requiring verification. Things to know about claims processing How long does it take for my health plan administrator to receive a claim from my provider (doctor, hospital, lab)? Providers generally bill in cycles, so times will vary — typically weekly or bi-weekly. How long does it take for my health plan administrator to process the claim from my provider? Once the claim has been received, it takes up to ten business days to process the claim. If it’s a complex claim, expect longer processing times (up to four weeks). Once the claim is processed, how long does it take for WageWorks to be made aware of the claim and adjust my account balance(s)? Claims are sent to WageWorks once a week; the day of the week varies across health plan administrators. 1 When will my pharmacy claims be reflected in my deductible and out-of-pocket maximum? 2 Pharmacy claims are immediately reflected on the Caremark Web site. Your health plan administrator tracks your deductible. In most cases, the claim will be reflected in the deductible and out-of-pocket maximum posted on your health plan administrator’s Web site after one to two business days. To learn more about the claims process, visit the WageWorks portal by going to OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/HRA/HSA)” or go to www.wageworks.com/ge. When you use your WageWorks card, the money will be pulled from your Health Care Flexible Spending Account (FSA) first. If your FSA funds have been depleted or you only have a Health Reimbursement Account (HRA), your HRA credit will be used. Remember, you can only use HRA credits for medical claims. HRA credits cannot be used for dental or vision claims. 25 3 4 26 Pick & Process: the easy way to manage your claims This feature lets you pay yourself or your providers directly from your Health Care Flexible Spending Account (FSA) and Health Reimbursement Account (HRA). You can review claims WageWorks has received from your GE plan administrators and “pick” how you want to “process” them. With your provider invoices and Explanation of Benefits (EOB) in hand, simply follow these steps. 1 2 • Go to www.wageworks.com/ge or visit OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/ HRA/HSA)” 3 4 • Click “Pick & Process” • Click “Next” to go to the “Pick a Transaction” page • Click on the claim(s) you want to process, then your processing choice There are three actions you can take with Pick & Process • Need to verify a transaction made with your WageWorks Card? Click “Health Care Card Receipt” • Need to pay a provider directly from your account? Click “Pay My Provider.” If you have multiple claims from a single provider, use the claims bundling feature. Simply select the items you want to bundle from the claims list and make those payments in one transaction For each type of transaction, just enter the transaction amount and follow the steps to complete the process. It’s painless, quick and efficient. Give Pick & Process a try. • Need to reimburse yourself for a payment you did not make with your WageWorks health care card? Click “Pay Me Back” Manage your accounts on the go with the WageWorks EZ Receipts® Mobile App. Download it from your smartphone’s app store to submit claims and receipts, view balances and claims history and more. 27 What you need to know about paying your doctor bill Do I have to pay at the time of service? The doctor should not ask you to pay anything at the time of the visit. Instead, have the provider bill you and pay later through the WageWorks portal. Doing this will avoid complications and the need for you to validate the use of your WageWorks card. If your provider insists that you pay at the time of service, here’s what you can do: • Have the provider call your health plan administrator to determine what you owe • Your health plan administrator may be able to confirm patient responsibility per the actual negotiated rate • Use your WageWorks health care card to pay your doctor • The money will automatically come from your Health Care Flexible Spending Account (FSA) first • WageWorks will send you a message asking you to submit a receipt to verify your expense on the WageWorks online portal • If you find you have overpaid your provider once you’ve received your Explanation of Benefits (EOB), ask your provider to refund the difference back to your WageWorks health care card. If you receive a refund check, you should sign it over to WageWorks and send it in for deposit back into your account • If your FSA funds have been depleted or you only have a Health Reimbursement Account (HRA), your HRA credit will be used. Please note: HRA credits cannot be used for dental or vision expenses If you do not have your WageWorks health care card, you can pay using your own funds and submit a claim for reimbursement after your health plan administrator has processed the claim from your doctor. We recommend that you avoid using your WageWorks health care card at a provider’s office. 28 Paying your doctor bill online through WageWorks 1 2 You’ve heard a lot about using your WageWorks health care card, but did you know that you can also pay your bill online through WageWorks? Paperless claims. To get started: When you receive a bill from your doctor, you can pay it with your WageWorks funds using the online Pay My Provider or Pick & Process services. Pick & Process lets you pay yourself or your providers directly from your Health Care Flexible Spending Account (FSA) and Health Reimbursement Account (HRA). You can review the claims WageWorks has received from your GE plan administrators and “pick” how you want to “process” them. You can verify transactions made with your WageWorks card, pay providers directly from your account, reimburse yourself and more. See page 27 for more information. To access the WageWorks online portal, go to OneHR.ge.com; select “Health Care” and then “Savings Accounts (FSA/HRA/HSA).” Log in and click “Pick & Process” so that you can select reimbursement to the provider or yourself and select which account to use (FSA or HRA). 3 4 Only claims processed by your health plan administrator or by Davis Vision or MetLife Dental are available for paperless claims. Need to submit a manual claim to WageWorks? Here’s what you need to know. How do I submit a manual claim? When is it necessary to submit a manual claim? You can reimburse yourself for any eligible expenses by logging in to the WageWorks online portal and entering a claim, or by printing and submitting your claim form to WageWorks. Click on “Submit Receipt or Claim” to access the online claim features, or click on “Help” and “Form & Documents” to print a claim form. • When paying for dependent care (if you have a Dependent Care Flexible Spending Account [DCFSA]) • When you pay for prescription drugs and prescribed over-the-counter (OTC) drugs with your own funds Manual claims are claims you submit to WageWorks through the Web portal or via mail/fax with a claim form and the appropriate documentation. Please note that when submitting a manual claim, you must send in a receipt or documentation, such as an Explanation of Benefits (EOB). To access the WageWorks online portal, go to OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/HRA/HSA)” or visit www.wageworks.com/ge. 29 30 Are you going to the pharmacy? 1 2 Activate your Health Reimbursement Account (HRA) and/or Health Care Flexible Spending Account (FSA) WageWorks health care card. Activate your HRA and/or FSA WageWorks health care card by following the instructions on the label affixed to the card (like you would any other debit card). Give the pharmacist your CVS Caremark ID card. 3 Give the pharmacist your CVS Caremark ID card. This ensures that you receive the negotiated rate for your medication and that this prescription cost goes toward your deductible and co-insurance maximum. Swipe your WageWorks health care card. Find your CVS Caremark ID card. Find your CVS Caremark ID card and ensure that you have it with you. Check your account balance. Before using your WageWorks health care card, be sure to check your account balance. You can review your account balances on the WageWorks online portal, accessible from OneHR.ge.com. Swipe your WageWorks health care card at the counter and select “Credit” or “Debit.” You should save your receipt for your own records. If you paid with an alternate means, you may file a manual claim with WageWorks to be reimbursed. Remember, your WageWorks health care card will pull funds from your FSA first, then from your HRA. CVS Caremark does not pass pharmacy transactions through to WageWorks. You should use your WageWorks health care card to pay for prescription medications. If you select “Credit,” no PIN is necessary to use this card. If you select “Debit,” please call WageWorks to obtain your PIN. You will not need to verify any pharmacy claim when you pay at the counter using your WageWorks health care card. To access the WageWorks online portal, go to OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/HRA/HSA)” or go to www.wageworks.com/ge. 31 4 Tips for Option 3 participants This section applies to participants in Option 3 only. To get the most from this option, make sure you open a Health Savings Account (HSA) to pay for current and future health care expenses (certain IRS restrictions apply). In addition, you may have opened and funded a Limited Purpose Flexible Spending Account (LPFSA) during Annual Enrollment to pay for dental and vision expenses. These tips will help you use these accounts correctly when you visit your providers, purchase prescription drugs and more. 32 Save your receipts. You can carry over up to $500 of unused Limited Purpose Flexible Spending Account (LPFSA) funds into the following year. For Dependent Care Flexible Spending Accounts (DCFSA), any funds not used by the following March 15 will be forfeited. While you don’t have to submit claim forms or receipts when you use your Health Savings Account (HSA), you are required to save receipts in case you are audited by the IRS. 1 2 3 Maximize your health care benefits. 4 If you enrolled in Option 3, make sure you opened an HSA so you can save money on a pre-tax basis to pay for current and future health care expenses. To open an HSA or make changes to your HSA contributions, go to OneHR.ge.com. REMINDER: To pay for over-the-counter (OTC) medications, follow these steps: • Obtain a prescription from your physician for the necessary OTC medication • Purchase the prescribed OTC drug with your HSA bank debit card • Put your prescription and receipt in a safe place for possible later use; if audited by the IRS, you will need proof of the qualifying expense. A non-qualifying expense will be subject to income tax plus a penalty Visit the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/ healthcaredecisions to learn more about using your HSA. 33 34 Be informed: What you need to know about Health Savings Accounts (HSAs) 1 2 With an HSA, there are three ways to pay for qualified medical expenses: 3 Use your HSA debit card. Log on. Withdraw. Use your bank issued HSA debit card to pay for services. Log on to the HSA bank’s online portal. You can have a check sent to your doctor or pay yourself back if you’ve already paid your doctor or pharmacy. Withdraw money from an ATM using your HSA debit card if your bank offers this option. Use what you have. An HSA is your bank account for health services — and just like a bank account, you can only use funds you have already contributed. Be sure to check your balance before using your funds to pay for qualified health care expenses. You may be charged a fee if you use your debit card to make a purchase that exceeds your HSA balance. Added benefit of an HSA: 4 (Note: Additional fees may apply.) Save your receipts. Once your HSA is open, you can reimburse yourself for eligible medical claims during the plan year. Why is this important? If the IRS asks you to prove that you used your HSA funds for qualified expenses, you will need your receipts. Since you can only use HSA funds already contributed, there may be times when you have to use personal funds to pay for medical expenses. You can then wait until your HSA has enough funds and pay yourself back from your account. For more information about managing an HSA, go to the “Savings Account” section of the GE Health Benefits or GE Health Choice Web site through www.ge.com/ healthahead/ healthcaredecisions. For more information, visit www.ge.com/healthahead/healthcaredecisions. 35 Are you using your Health Savings Account (HSA) correctly? You can open an HSA and make pre-tax payroll contributions to your health plan administrator’s partner bank at any time by signing up on OneHR.ge.com. Regular pre-tax payroll deductions are the easiest way to build your HSA balance, and you’ll immediately see the tax benefit in your paycheck. Once you’ve opened your HSA, or if you already have one, here’s how to maximize its value. Contribute the annual IRS maximum. To find out how much you can contribute this year, visit www.irs.gov or the “Savings Accounts Overview” page of the GE Health Benefits or GE Health Choice Web site through www.ge.com/ healthahead/healthcaredecisions. You can also get this information directly from your HSA bank. Once the balance exceeds an amount determined by your bank, you can invest it as you would an IRA. You can increase, decrease or stop and restart contributions to your HSA at any time. 36 Important IRS restrictions: You cannot have an HSA if your spouse’s Health Care Flexible Spending Account (FSA) can pay for any of your medical expenses before your Option 3 deductible is met. In order for you to be eligible for an HSA, the FSA would need to be a Limited Purpose FSA (dental and vision only), a post-deductible FSA or an employee-only FSA. Special IRS rules apply to mid-year enrollees (e.g., new hires) with less than 13 months in an HSA. See OneHR.ge.com for detailed information. 1 2 3 4 For more information regarding Health Savings Accounts (HSAs), contact the HSA bank associated with your health plan administrator. If you are enrolled with: That bank is: UnitedHealthcare Optum Bank Aetna JPMorgan Chase (through 3/31/15) PayFlex (beginning 4/1/15) Capital District Physicians’ Health Plan or Blue Cross Blue Shield of Alabama BenefitWallet (formerly Mellon Bank) HealthAmerica HealthEquity 4 5 6 7 8 9 For additional questions about enrolling or contributing to an HSA, call the GE Benefits Center at 1-800-252-5259. 37 Paying your doctor bill Do I have to pay at the time of service? The doctor should not ask you to pay anything at the time of the visit. However, in certain situations, you may be required to pay for services in full at the time of your visit. If you are required to pay at the time of service, here’s what you can do: • Have the provider call your health plan administrator to determine what you owe • Your health plan administrator may be able to confirm patient responsibility per the actual negotiated rate If you open a Limited Purpose Flexible Spending Account (LPFSA), it can only be used for dental and vision expenses. You will receive a WageWorks health care card to access your funds. • Do not pay at the time of service. Wait until you receive a bill from the provider and pay it directly from your LPFSA like an online bill payment service • If you must pay at the time of service, use your health care card. WageWorks may send you a message asking you to submit a receipt to verify your expense on the WageWorks online portal • Use your bank’s Health Savings Account (HSA) debit card to pay your doctor To access the WageWorks online portal, go to OneHR.ge.com; select “Health Care” then “Savings Accounts (FSA/HRA/HSA).” • The money will automatically come from your HSA Understand the key components of your plan by using the information and resources available on the GE Health Benefits or GE Health Choice Web site through www.ge.com/healthahead/ healthcaredecisions. • Be sure to keep your receipts to provide proof that you used the funds for a qualified medical expense Make sure you only use your HSA dollars to pay for qualified expenses. If you withdraw money for non-medical or ineligible expenses, you will have to pay income taxes on the money, and you may incur a penalty as well. If you overpaid your doctor with your HSA funds, contact your HSA bank for reimbursement instructions. 38 1 2 3 4 Going to the pharmacy Activate your Health Savings Account (HSA) debit card. Give the pharmacist your CVS Caremark ID card. Activate your HSA debit card by following the instructions on the label affixed to the card. Give the pharmacist your CVS Caremark ID card. This ensures that you receive the negotiated rate for your medication and that this prescription cost goes toward your deductible and co-insurance maximum. Find your CVS Caremark ID card. Find your CVS Caremark ID card and ensure that you have it with you. Check your account balance. Before using your HSA debit card, be sure to check your account balance. You can review balances on your partner bank’s Web site. If you opened your HSA with a different bank, follow their instructions for checking account balances. Swipe your HSA debit card. Swipe your HSA debit card at the counter. You should not have to file a claim, but save the receipt for your records. 39 Understanding Health Savings Account (HSA) contributions on your W-2 If you contributed to an HSA through payroll deductions, you will see the amount reported in Box 12 of your W-2 Wage and Tax Statement form in January of the following year. The IRS explanation that accompanies the form can be confusing, so allow us to clarify: W-2 Wage and Tax Statement As shown in the sample above, your HSA contributions will be reported in Box 12, following the code letter “W.” This is the dollar amount you should report to the IRS on Form 8889 when you file your tax return. Because you contributed through payroll deductions, this amount has already been deducted from the taxable income reported on your W-2. If you make direct contributions to your HSA or contribute to a non-partner bank, those amounts will not be included here. You will have to report those separately. Please consult your tax advisor if you have questions on how HSA contributions may affect your tax liability. 40 1 2 3 4 Invest and save for future health care expenses Since it’s similar to how an IRA works, if you have a certain amount saved in your Health Savings Account (HSA), you may have the option to invest those dollars in a mutual fund. While rules vary from bank to bank, that account threshold is typically $2,000. If your HSA contains less than that amount, you can earn simple interest. Partner banks have provided information about investing your HSA along with easy, step-by-step instructions on how to get started with your investments. To learn more about investing your HSA, visit the “Savings Accounts” section of the GE Health Benefits or GE Health Choice Web site through www.ge.com/ healthahead/healthcaredecisions and click on “Savings Accounts Overview.” Tools, resources and contact information The HealthAhead Web site is here to help guide you and your family to better health by offering you all of the information you need to make smart, cost-effective health care choices. There are many resources available to you within and outside of GE to help you get the most from your benefits. Take advantage! Visit www.ge.com/ healthahead/healthcaredecisions. Scan the QR code to bookmark www.ge.com/ healthahead/ healthcaredecisions on your smartphone. 41 Key health and wellness resources NowClinic® See a doctor online. Exclusively for GE Health Benefits and GE Health Choice members in most states and the District of Columbia* • Get help with minor illnesses such as allergies, cough/cold, seasonal flu, fever, nausea, sore throat, sinus infection, etc. • Connect with a doctor on the Web via secure online chat or phone • Doctors can diagnose and prescribe most drugs** • $45 per visit … available 24/7 with no appointment required New! National Hip and Knee Replacement Centers of Excellence (COEs) Employees, retirees and their dependents are eligible to go to one of four new total hip and knee replacement COEs under the GE Health Benefits or GE Health Choice Plans: • 100% coverage for Option 1 & 2 members; not subject to deductible and co-insurance, and 100% coverage, after meeting deductible, for Option 3 members • Providers and facilities in this program are nationally recognized for excellence in orthopedic care: –– Hospital for Special Surgery; New York, NY For more information or to get started, go to www.myNowClinic.com/GE. –– Northwestern Memorial Hospital; Chicago, IL NowClinic is mobile … search for “NowClinic” in your mobile app store. –– The Christ Hospital; Cincinnati, Ohio *NowClinic is not available in Arkansas, Alabama, Alaska, Louisiana and Texas at the time of this printing (2/1/15). **No controlled substances may be prescribed. Other prescriptions may be available where clinically appropriate and permitted by law and can be transmitted to a CVS Caremark participating pharmacy of your choice. Payment is not required at the time of visit for UnitedHealthcare (UHC) members. NowClinic will bill UHC directly. For non-UHC plan participants, you can pay with any major credit card, but you may need to verify your claim if you choose to use your WageWorks card. 42 –– Carolina’s Medical Center — Mercy; Charlotte, NC • Depending on the program, a travel benefit may also be available GE also has COEs for organ transplant, bariatric surgery and certain types of cancer care. To find out more, contact Health Coach from GE at 1-866-272-6007. 1 Getting a second opinion: Expert Medical Opinion (EMO) program When you’re facing a serious medical condition and the best course of treatment is not clear, Health Coach may recommend a second opinion through the EMO program administered by the Cleveland Clinic. Through this program, you or a loved one enrolled in a GE medical care option can receive an online second opinion from a Cleveland Clinic specialist at no cost to you. This can help you better understand your condition and feel more confident that a given course of treatment is appropriate for your diagnosis. The EMO program lets you access the expertise of leading medical specialists in a timely fashion, without the expense of travel. • You supply your medical records to Cleveland Clinic • A specialist reviews your records and provides a second opinion online • A registered nurse calls to follow up Behavioral Health services and Employee Assistance Program (EAP) 2 Behavioral Health services include inpatient behavioral health and substance abuse treatment, outpatient behavioral health testing, halfway house and residential treatment centers, intensive outpatient therapy and other mental health and substance abuse benefits. You can access confidential mental health resources, get help with outpatient behavioral health services, arrange inpatient services and more. The Employee Assistance Program is a personal and confidential assessment, counseling and referral service. EAP assists employees and their families coping with a wide variety of concerns, such as stress, marital and family conflicts, substance abuse and depression. To access Behavioral Health or EAP services, call Health Coach from GE at 1-866-272-6007, and select Option 1 to be connected to the right resources to get the help you need. • Service is voluntary, completely confidential and offered at no cost to you To learn more about the program or get help with medical records collection, contact Health Coach from GE at 1-866-272-6007, or visit www.eclevelandclinic.org/ge One out of four GE members who get a second opinion from a Cleveland Clinic doctor through Health Coach find that their initial diagnosis or treatment plan is not appropriate. 43 3 4 Tobacco Cessation Programs: Effective resources when you’re ready to quit. GE offers services and resources to help you stop using tobacco and get healthier. With determination, a positive attitude and the proper support, you can do it! GE offers three ways to help you quit: • QuitNet Tobacco Cessation Program; visit www.quitnet.com/ge • 100% coverage for tobacco cessation counseling and prescribed products • Lifestyle Coaching through Health Coach from GE; call 1-866-272-6007 No Cost No Co-pay No Deductible Go to www.ge.com/healthahead/ healthcareresources and select “Tobacco Resources” under “Health Care Resources.” Did you know? Counseling for tobacco use and most smoking cessation drugs for adults are covered at 100%. Drugs such as Chantix® and nicotine replacement therapy (NRT) products* are considered preventive and are no longer part of the GE Targeted drug list. Talk to your doctor to select which course of treatment will work best for you. *Exception: Nicotrol® Inhaler and Nasal Spray are on the GE Targeted drug list and require a co-pay. 44 Important phone numbers and Web sites GE Health Choice GE Health Benefits For salaried employees and salaried pre-65 retirees For production employees and production pre-65 retirees, including hourly and non-exempt UNITEDHEALTHCARE www.myuhc.com 1-800-551-2445 1-866-756-4792 AETNA www.aetna.com 1-800-633-0637 1-800-433-6796 HEALTHAMERICA healthamerica. coventryhealthcare.com 1-866-838-9374 BCBS OF ALABAMA www.bcbsal.com/ge 1-800-846-6756 1-800-321-4392 MVP www.mvphealthcare. com/ge 1-866-322-8154 1-866-322-8153 COVENTRY www.chckansas.com 1-855-469-9593 CDPHP www.cdphp.com/ge 1-877-754-5063 1-877-754-5064 AURORA/UMR www.umr.com/ge 1-800-382-8110 N/A UPMC www.upmchealthplan. com/ge 1-877-381-3768 N/A KAISER www.healthy. kaiserpermanente.org 1-800-464-4000 N/A 1 2 3 4 Important phone numbers and Web sites Additional services WageWorks (HRA/FSA/DCFSA/LPFSA) OneHR.ge.com or www.wageworks.com/ge 1-888-303-3006 HealthAhead www.ge.com/healthahead/ healthcaredecisions Optum Bank — UnitedHealthcare (HSA) www.myuhc.com 1-800-791-9361 JPMorgan Chase — Aetna (HSA through 3/31/15) www.aetna.com 1-877-238-3452 PayFlex — Aetna (HSA beginning 4/1/15) www.payflexdirect.com 1-888-678-8242 BenefitWallet (formerly Mellon Bank) — Blue Cross Blue Shield of Alabama; Capital District Physicians’ Health Plan (HSA) mybenefitwallet.com 1-866-274-8494 HealthEquity — HealthAmerica (HSA) www.healthequity.com 1-877-877-4297 goto benefits App Get all of your GE pay- and benefitsrelated numbers and Web sites on one mobile site. Now, you and your family can easily connect at home or on the go! Go to www.ge.com/ healthahead/ healthcaredecisions, or scan the QR code to bookmark on your smartphone. Health Coach from GE Select high-quality, cost-effective doctors and hospitals; understand your diagnosis and treatment options; understand your after-hours care options; access lifestyle coaching; and get help resolving medical claim issues 1-866-272-6007 GE Benefits Center Learn how your medical plan works, verify dependent eligibility, enrollment and employee contributions OneHR.ge.com 1-800-252-5259 CVS Caremark Get drug costs and plan design information www.caremark.com 1-800-509-9891 Dental Care Options www.metlife.com/dental GE Dental Benefits Claim Center 1-888-529-8474 Vision Care www.davisvision.com GE Vision Care Benefits Claim Center 1-800-433-9375 Treatment Cost Calculator www.treatmentcostcalculator.com/ge User support, technical/data questions 1-800-441-5592 Search “GE TCC” in the app store for your device Behavioral Health/Employee Assistance Program 1-866-272-6007 select Option 1 Disability Benefits, Parental Leave and Leave Administration GE Disability Center 1-800-392-0789 GEMPG 2015