ASEA AFSCME Local 52 Health Benefits Trust is in Alaska

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Plan Comparison Chart

The chart below helps you compare the features and benefits of the different Plans—and choose which one is best for you.

Benefit

PLAN A

Full Plan for Employees and Families

PLAN B

Full Plan for Employees Only

PLAN C

Supplemental Plan for Employees and Families with Other Coverage

PLAN D

Low Option Plan with $1,000 HRA for Employees and Families

2019/2020 Monthly Employee Contribution (Effective 7/1/2019)

$295.00†

$140.00

$35.00

$40.00

MEDICAL

Annual Deductible

$300/Individual
$600/Family

$300/Individual

None

$5,000/Individual
$10,000/Family

Plan Pays
Based on Plan’s Allowable Expenses

80%
(60% of contracted price for non-PPO services*)

80%
(60% of contracted price for non-PPO services*)

20%

100%
(80% of contracted price for non-PPO services*)

Out-of-Pocket Limit*
(not including deductible)

$1,200/Individual

($2,400/Individual for non-PPO services*)

$1,200

($2,400 for non-PPO services*)

None

None

Preventive Care
Based on Plan’s Allowable Expenses.
Click here for a list of preventive services recommended under the Affordable Care Act (ACA).

100% for services recommended under ACA–not subject to deductible; 80% for all others

100% for services recommended under ACA–not subject to deductible; 80% for all others

100% for services recommended under ACA–not subject to deductible; 20% for all others

100% for services recommended under ACA–not subject to deductible; 80% for all others

Prescription Drugs**

Member copays:

20% brand name, 10% generic up to $60 per Rx

$600 copay max per person per Plan Year

 

Member copays:

20% brand name,  10% generic up to $60 per Rx

$600 copay max per person per Plan Year

 

Plan pays 20%; Member pays 80%

 

Under the Medical Plan:

Plan pays 100% after deductible

Major Medical Maximum

Unlimited

Unlimited

Unlimited

Unlimited

DENTAL

Annual Deductible

$25/Individual
$75/Family

$25

 

$25/Individual
$75/Family

Not Covered

Plan Pays
Based on Plan’s Allowable Expenses

 

Preventive: 100%
General: 85%
Major: 50%
(Benefits paid for preventive services do not apply to the $2,000 maximum.)

Not Covered

Individual Maximum

$2,000/Plan Year

Not Covered

 

VISION

Plan Pays
Based on Plan’s Allowable Expenses

VSP In-Network Out-of-Network
Exam: Covered in full every Plan Year Exam: up to $150, every Plan Year
Basic Single Vision or Lined Lenses: Covered in full every Plan Year

Polycarbonate lenses and UV coating: Covered in full every Plan Year

One of the following covered in full every Plan Year: Progressive or photochromic lenses or anti-reflective coating
Single Vision or Lined Lenses: up to $175, every Plan Year
Frames: $150 retail allowance every other Plan Year and 20% discount on the amount over the allowance Frames: up to $150, every other Plan Year
Contacts: $200 allowance in lieu of lenses and frames Contacts: $200 allowance in lieu of lenses and frames

Not Covered

† If you enroll your spouse in Plan A, you must confirm if your spouse is employed and eligible for employer-sponsored coverage through his/her employer. If your spouse has opted out of employer sponsored coverage for which he/she is eligible, a $125 monthly surcharge will be added to your payroll deduction.

*Non-PPO out-of-pocket limit provisions apply to inpatient and outpatient services obtained at a non-preferred hospital in Anchorage or Mat-Su Valley or performed at a non-preferred physical therapist provider in Anchorage.

**Benefits subject to formulary exclusions. Plan pays 80% of generic equivalent for brand name if generic equivalent is available. For non-network pharmacies, you are responsible for the difference between the retail price at the pharmacy and the network reimbursement rate.

The Plan covers pediatric oral and vision services to the extent covered by the Affordable Care Act.

 

Allowable Expense

To maximize your benefits and reduce your costs, use a PPO provider within the Municipality of Anchorage/Mat-Su Borough. If you use a non-preferred provider for inpatient or outpatient services within the Municipality of Anchorage your benefit payment will be based on the PPO provider’s discounted rate. Click here for the list of PPO providers within the Municipality of Anchorage/Mat-Su Borough.

  • For non-PPO services within Anchorage, the allowable expense for inpatient hospital services will be limited to the contracted rate at the preferred provider hospital.
  • The allowable expenses for outpatient hospital charges at a non-PPO provider in Anchorage will be calculated as the case rate at the preferred provider hospital, if any, or 50% of the billed charges.
  • Click here for a PPO Checklist for Services Received in the Municipality of Anchorage

PPO vs. Non-PPO in Anchorage—How the Out-of-Network Penalty Adds Up

  PPO Hospital Non-PPO Hospital
Billed Amount $30,000 $30,000
Discount Amount $15,000 $0 (no PPO discount)
Allowed Amount $15,000 $15,000
(non-PPO penalty reduces the allowed amount to the PPO allowed amount)
Plan Payment $13,800
(80% of the allowed amount until the $1200 out-of-pocket limit is reached; 100% thereafter)
$12,600
(60% of the allowed amount until the $2400 non-PPO out-of-pockt limit is reached; 100% thereafter)
Amount You Pay $1,200
(Allowed amount minus plan payment)
$17,400
(Billed amount minus plan payment)
This example for Plans A and B assumes you have met the annual deductable.

 

 


Coordination of Benefits

It’s important to understand how the ASEA Health Trust Plan works together with your other health coverage to pay covered expenses. The information provided below is a general summary of how Coordination of Benefits usually works. For more detailed information about Coordination of Benefits, please see the Coordination of Benefits section of the Plan Booklet.

  • For You:
    • The ASEA Health Trust Plan is primary for you as the employee (it pays your claim first). Your other plan is secondary (it pays second).
  • For your spouse:
    • His or her employer plan is primary, and the Health Trust’s plan is secondary.
  • For your children:
    • The plan of the parent with the birthday earliest in the year is primary, and the other plan is secondary. For example, if your birthday is October 14 and your spouse’s birthday is May 28, your spouse’s plan is primary for your children.
    • If you are separated or divorced, the custodial parent’s plan is primary unless otherwise ordered by the Court.

Once the primary plan pays benefits, the secondary plan reimburses covered expenses as allowed under its provisions. Benefits from your primary and secondary plans may combine to pay up to—but no more than—100% of covered expenses.

Clarification When the ASEA Health Plan is the Secondary Plan

When the ASEA Health Plan is the secondary plan, the Health Plan’s allowable expense will be limited to the expense that is allowed by the primary plan. In the event that the primary plan’s allowed expense has been reduced because you did not follow its plan rules and procedures (for example, you did not obtain a required precertification or did not use the plan’s in-network provider), the ASEA Health Plan will not pay the amount of the reduction.

Coordination with State of Alaska Health Plans

The ASEA Health Trust Plan also coordinates coverage with the State of Alaska’s health coverage for active employees if you or your dependents are covered under both plans. Benefits may be reduced under certain circumstances.

More Details:

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