HEALTH INSURANCE PLANS
Summary of Benefits & Coverage per ACA Guidelines
The purpose of the Summary of Benefits and Coverage (SBC) is to provide individuals with standard information so they can compare medical plans as they make decisions about which plans to choose.
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)
LUMENOS HIGH DEDUCTIBLE HEALTH PLANS
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%.
If you enroll in a High Deductible Health Plan, a Health Savings Account (HSA) with BenefitWallet will be automatically opened for you. If you do not want the BenefitWallet HSA account, when you get the welcome letter, please call BenefitWallet and request they close your account. If you do want to keep the BenefitWallet HSA account follow the instructions in your welcome letter to set up your account.
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. If you choose to open your HSA account with your own bank, please call BenefitWallet to request they close your BenefitWallet HSA account that was automatically opened when you enrolled in the High Deductible Health Plan.
ANTHEM HMO PLANS
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
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
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.
HSAs if You are Approaching or Over Age 65
If you are approaching or over Age 65, there are important issues you should be aware of in regards to having and contributing to an HSA account. Read the brochure below for more information.
If your permanent residence is in the 6 New England states, the Regional High Deductible Health Plan is available to you. The regional plan contracts with providers throughout the six New England States (NH, VT, MA, ME, RI and CT). The regional plan does offer out of Network Benefits which is subject to a 30% co-insurance once you meet your deductible.
If your permanent residence is outside the 6 New England states, the National High Deductible Health Plan is available to you. The national plan contracts with providers throughout all 50 states.
REGIONAL 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
NATIONAL HDHP
- Consists of: Contracted providers throughout all 50 states.
- Choose if: If you and your family live permanently out of the six New England states (NH, VT, MA, ME, RI and CT).
Site of Service Informational Presentation
Updates
Health Through Oral Wellness (HOW) Program
This program extends additional preventive benefits to those who are at greater risk for oral disease. Benefit enhancements may include sealants for children and adults, greater frequency of cleanings (up to 4 cleanings per year), periodontal maintenance, fluoride treatments, oral health counseling and tooth decay susceptibility testing.
Read the HOW Brochure to get more information! You can also go to the HOW web site for more information.
If you have any questions or concerns regarding the program call Delta Dental Customer service at 603-223-1000 or 1-800-537-1715.
(Please know, any additional preventive benefits you may qualify for through the HOW program are subject to the City’s dental benefit plan design. These benefits are subject to the $1,500 calendar year maximum. Also, if your qualify for additional periodontal maintenance services under “Basic Restorative”, you will be responsible for the 40% coinsurance).
Introducing Anthem's LiveHealth Online
Avoid long ER waits, see a doctor from the comfort of your living room! With LiveHealth Online, you have a doctor by your side 24/7 and you can talk face-to-face with a doctor through your mobile device or a computer with a webcam. No appointments, no driving and no waiting at an urgent care center.
To learn more about the program, see the two video's below and view the following brochures:
Want a Good Reason to Work Out?
How about $200? If you are on the any of the City of Manchester's Anthem health insurance plans, you are eligible to receive up to $200 per plan year toward your membership dues/fees when you exercise regularly at a fitness club. The reimbursement of $200 is per subscriber contract, per plan year for membership dues at a fitness center.
You only need to complete 48 workouts per plan year to be eligible for the $200 reimbursement. Also, you are not required to use Anthem's Fitness Program Log card, you can use your Fitness Center's computer printout! Get the Reimbursement form and fitness program overview in the "Forms" section of this web site.
YMCA Offering 10% Discount Off Cost of Monthly Membership Fee
The YMCA is offering a 10% discount off the cost of the monthly membership fee for City of Manchester retirees. They will also waive the join fee. You just need to bring verification that you are a retired City of Manchester employee. For more information, view the YMCA Brochure above.
Utilization Reports
These reports were completed for the City of Manchester by Anthem Blue Cross & Blue Shield. They are in-depth analysis of the medical claims for the City of Manchester.