Under 65 Plan

REPORTS & UPDATES

City of Manchester Utilization Report 07/01/2010 - 06/30/2011
This report was completed for the City of Manchester by Anthem Blue Cross & Blue Shied. It is an in-depth analysis of the medical claims for the City of Manchester for Fiscal Year 2011.

Uniform Summary of Benefits and Coverages (SBC's) for all City of Manchester Plans
Effective 7/1/13 as part of the Affordable Care Act (Health Care Reform law) employers must follow uniform standards when providing employees their Summary of Benefits and Coverage (SBC's).
Easier Fitness Reimbursement Process
You will now only be required to complete 48 workouts per year to be eligible for the $200 reimbursement. No longer do you need to work out 3 times a week for 11 out of 13 consecutive weeks.

Fitness Brochure for Under 65 Retirees

You will be able to submit a printout from the fitness facility in lieu of the Anthem log card. The log card will still be accepted if you wish to use that format, or if the gym does not have a computer system printout available.
Expanded Benefits for Women's Preventive Care

Preventive Care Brochure effective 7/1/13

The following services, drugs and supplies will be covered at no charge as long as they are administered by a participating provider:

Well women visits
Breastfeeding support, supplies and counseling*
Prescription contraceptives (birth control) and counseling for women**
Permanent surgical contraception(sterilization) for women
Counseling for sexually transmitted infections
Counseling and screening for HIV
Screening and counseling for interpersonal and domestic violence
Screening for gestational diabetes
HPV testing

*Coverage for breast pumps (rental and purchase) and breast pump supplies is included in the preventive benefit. These services will be covered as medical (not pharmacy) benefits. Breast pumps must be purchased/rented from an in-network medical provider to get 100% coverage.

**The drug plan formulary determines which specific drugs are covered under the plan. To get 100% coverage for a covered prescription contraceptive, it must be a generic drug or a brand-name drug that doesn't have a generic equivalent and be obtained from an in-network pharmacy. A cost-share will apply for other prescription contraceptives.

HEALTH INSURANCE PLANS

For all the Health Insurance Plans listed below, Preventive Care is Covered at 100%
(see the Anthem Preventive Care VS Diagnostic Care brochure in the Forms Tab)

ANTHEM HMO PLANS
HMO Summary of Benefits HMO 80/20 Summary of Benefits
In the HMO plans (Health Maintenance Organization), you must receive your health care from providers within Anthem's network (New Hampshire, Vermont, Maine, Massachusetts, Connecticut and Rhode Island). The HMO plan does not have out of network benefits; therefore, if you see a provider that is outside Anthem's network, then you will be responsible for 100% of the cost.

ANTHEM PREFERRED BLUE RETIREE OUT OF STATE PLAN
Preferred Blue Summary of Benefits
The Preferred Blue (HMO out of State) Plan is only available to under 65 retirees who live permanently outside the New England area. If you see an Anthem provider, you will be covered under the In-network benefits, however, if you receive services from an out-of-network provider, it is your responsibility to pay the difference between the Maximum Allowable Benefit and the provider's charge.

ANTHEM POS PLANS
POS Summary of Benefits POS 80/20 Summary of Benefits
The POS plans (Point of Service) allow you to receive your health care from providers outside of Anthem's network (New Hampshire, Vermont, Maine, Massachusetts, Connecticut and Rhode Island). If you receive services from a non-network provider, under Self Referred benefits, it is your responsibility to pay the difference between the Maximum Allowable Benefit and the provider's charge.

LUMENOS HIGH DEDUCTIBLE HEALTH PLANS

Summary of Benefits Regional Plan
Summary of Benefits National Plan

The Lumenos HDHP is based on a plan year deductible of $2,000 for an individual coverage and $4,000 for a family coverage. You are responsible for paying 100% of your medical and prescription costs until you reach your plan year deductible amount. Once you reach that deductible amount, you are covered at 100%.

With the High Deductible Health Plan, you can open up a Health Savings Account (HSA). A Health Savings account is a tax advantaged medical savings account available to taxpayers in the US who are enrolled in a High Deductible Health Plan. The funds contributed to an HSA are not subject to federal income tax. Unlike a flexible spending account, funds roll over and accumulate year to year if not spent. The funds can be used to pay your health care expenses including vision and dental. As a retiree, you can open your HSA with any bank, however if you want to open it with Citizens Bank, the Bank the City utilizes, all you need is to print and complete the H S A enrollment packet.

You can enroll in either the Regional High Deductible Health Plan which contracts with providers throughout the six New England States (NH, VT, MA, ME, RI and CT); or the National High Deductible Health Plan which contracts with providers throughout all 50 states. If you and your family members reside in New England year round, your best option would be to enroll in the Regional HDHP. This will give you the opportunity to lower your costs because the network under this plan holds contracts with some hospitals at a far deeper discount than the National HDHP. If you and/or any of your family members reside outside of the 6 New England states, your best option would be to enroll in the National HDHP. For example if you live in Florida for several months of the year, or if you have a child in college outside of New England, then the National Plan may be best for you.

REGIONAL HDHP

NATIONAL HDHP

Consists of: Contracted providers throughout the 6 New England States (NH, MA, ME, VT, RI & CT).
Choose if: If you and your family members reside in New England year round.
Reason for choosing: This will give you the opportunity to lower your costs because the network under this plan holds contracts with some hospitals at a far deeper discount than the National HDHP. For example, the charge for an MRI may cost you $1,100 under the National HDHP, where it would cost $800 under the Regional plan.
Important: You must designate a Primary Care Provider

Consists of: Contracted providers throughout all 50 states.
Choose if: If you and/or any of your family members live outside the New England area for an extended period of time. For example - you live in Florida for 4 months of the year or if you have a child in college outside the New England area.

last changed 6/4/2013