1 2013 Benefit Options Presentation Plan Year January 1 through
December 31, 2013
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2 How to access the Guide: View the Guide on the OSEEGIB
website at www.sib.ok.gov or www.healthchoiceok.com Complete the
online request to get one by mail Contact your Insurance
Coordinator Contact OSEEGIB Member Services The Employee Benefit
Options Guide
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2013 Plan Changes Health Plans Dental Plans Vision Plans
HealthChoice Life Insurance Plan Eligibility 3 Topics
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For More Information 2013 Employee Benefit Options Guide
Frequently Asked Questions at www.sib.ok.gov or
www.healthchoiceok.com Plan websites and customer service
representatives Your Insurance Coordinator OSEEGIB Member Services
4
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5 Click the links below to access a particular section of this
presentation. 2013 Plan Changes HealthChoice Health Plans Dental
Plans Vision Plans HealthChoice Life Insurance Plan Eligibility
Index
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2013 PLAN CHANGES 6
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7 There are no eligibility changes for plan year 2013.
Eligibility Changes
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Tobacco-free Attestation To enroll in or remain enrolled in the
HealthChoice High or Basic Plan, you must attest that you and your
covered dependents are tobacco-free The Attestation is available:
On the OSEEGIB website By calling HealthChoice Member Services 8
HealthChoice Plan Changes
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If you cannot complete the Attestation, you must either: Enroll
in the quit tobacco program AND complete three coaching calls, or
Provide a letter from your doctor indicating it is not medically
advisable for you or your dependent to quit tobacco. If you do not
complete the Attestation or complete one of the reasonable
alternatives as defined previously, you will be enrolled in the
HealthChoice High Alternative or Basic Alternative Plan with a
higher deductible and out-of-pocket limit. 9 HealthChoice Plan
Changes
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HealthChoice Dental Plan year maximum is increasing to $2,500
10 Dental Plan Changes
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Superior Vision $25 copay for standard progressive lenses
in-Network; plan pays up to $49 out-of-Network 5% to 50% discount
off surgical fees for laser vision correction 11 Vision Plan
Changes NEW!
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There are no changes to the HealthChoice Life Insurance Plan
for Plan Year 2013 12 Return to Index HealthChoice Life Insurance
Plan Changes HealthChoice Life Insurance Plan Changes Continue End
Presentation
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HEALTHCHOICE HEALTH PLANS 13
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Available Plans HealthChoice High HealthChoice High Alternative
HealthChoice Basic HealthChoice Basic Alternative HealthChoice
S-Account HealthChoice USA Using a HealthChoice Network Provider
will lower your out-of-pocket costs. 14 Click here to view
HealthChoice plan changes
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When using a Network Provider: $30 copay for primary care
office visits $50 copay for specialist office visits Annual
deductible $500 for an individual or $1,500 for a family Plan pays
80% and member pays 20% of Allowed Charges up to the out-of- pocket
limit of $2,800 for an individual or $8,400 for a family High
15
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16 High Alternative When using a Network Provider: Benefits the
same as High Plan except deductible and out-of-pocket limit Annual
deductible $750 for an individual or $2,250 for a family Plan pays
80% and member pays 20% of Allowed Charges up to the out-of- pocket
limit of $3,050 for an individual or $9,150 for a family
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When using a Network Provider: Office visit copays do not apply
Plan pays first $500 then member pays next $500 as deductible;
$1,000 deductible for a family of two or more Plan then pays 50%
until the out-of- pocket limit is met; $5,500 for an individual or
$11,000 for a family Plan then pays 100% of Allowed Charges Basic
17
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18 When using a Network Provider: Office visit copays do not
apply Plan pays first $250 then member pays next $750 as
deductible; $1,500 deductible for a family of two or more Plan then
pays 50% until the out-of- pocket limit is met; $5,750 for an
individual or $11,500 for a family Plan then pays 100% of Allowed
Charges Basic Alternative
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Plan designed for members with a Health Savings Account (HSA)
When using a Network Provider: Combined $1,500 deductible for an
individual and $3,000 for a family* Entire deductible must be met
before benefits are paid (including prescriptions) $50 copay for
office visits The calendar year out-of-pocket limit is $3,000 for
an individual or $6,000 for a family *Individual deductible does
not apply if two or more family members are covered. S-Account
19
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For members who live and work outside of Oklahoma and Arkansas
for more than 90 consecutive days Benefits are the same as the
HealthChoice High Plan Members have access to the USA Plans
nationwide provider network USA 20
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Network Pharmacy Benefits 21 Prescriptions can be filled at
HealthChoice Network Pharmacies Benefits are the same for all
plans; S- Account members must meet the Plan deductible before
benefits are paid You are responsible for the cost difference when
choosing a brand- name if a generic is available
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Network Pharmacy Benefits 22 When purchasing up to a 30-day
supply: Generic cost of medication up to a $10 copay Preferred
brand-name maximum copay of $30 Non-Preferred brand-name maximum
copay of $60
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Network Pharmacy Benefits 23 When purchasing up to a 90-day
supply Generic cost of medication up to a $25 copay Preferred
brand-name maximum copay of $60 Non-Preferred brand-name maximum
copay of $120 90-day fill does not apply to medications with
quantity or dosage limits
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Network Pharmacy Benefits 24 Certain prescription tobacco
cessation medications for a $0 copay A calendar year pharmacy
out-of- pocket limit of $2,500 per person (does not apply to
S-Account Plan) Specialty medications must be purchased through
Accredo Health, the HealthChoice specialty care, delivery service
pharmacy Return to Index Continue End Presentation
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DENTAL PLANS 25
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26 Assurant Freedom Preferred Assurant Heritage Plus with SBA
(Prepaid) Assurant Heritage Secure (Prepaid) CIGNA Dental Care Plan
(Prepaid) Delta Dental PPO Delta Dental Premier Delta Dental PPO
Choice HealthChoice Dental Plans Available
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27 All the dental plans have the same core benefits which are
divided into four different classes: Preventive Care includes
cleanings, bitewing x-rays, and routine oral exams Basic Care
includes fillings, extractions, root canals, endodontics, and
periodontics Dental Benefits
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*HealthChoice and Assurant Freedom Preferred have a 12-month
waiting period for orthodontic care unless you provide proof of
prior group dental coverage. Major Care includes dentures,
bridgework, crowns, and implants Orthodontic Care* is covered for
members under age 19 and members age 19 or older with
temporomandibular joint dysfunction (unless otherwise noted) 28
Dental Benefits
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Preventive Care is covered at 100% A $25 deductible applies to
Basic and Major Care. After the deductible: Basic Care is covered
at 85% Major Care is covered at 60% Orthodontic Care under age 19
covered at 60%; lifetime maximum benefit $2,000 All other services
have a combined $2,000 maximum annual benefit Freedom Preferred
Dental Plan 29
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No deductible or annual maximum for general dentist You must
select a Primary Care Dentist for each covered person Preventive
Care is covered at 100% Copay schedule applies to other services
Orthodontic Care for children and adults The Special Benefit
Amendment provides an additional discount for network specialists
Heritage Plus with SBA Dental Plan 30
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No deductible or annual maximum with general dentist You must
select a Primary Care Dentist for each covered person Preventive
Care is covered at 100% Copay schedule applies to other services
Orthodontic Care for children and adults Heritage Secure Dental
Plan 31
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No deductible or maximum annual benefit You must select a
Primary Care Dentist for each covered person After a $5 copay,
routine cleanings, x-rays, and evaluations are covered at 100% A
copay schedule applies to other services, including specialist care
Orthodontic Care for children and adults Dental Care Plan 32
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Preventive Care is covered at 100% $25 annual deductible for
Basic and Major Care Preventive Care is covered at 100% Basic Care
is covered at 85% Major Care is covered at 60% Orthodontic Care for
children and adults is covered at 60% with a $2,000 lifetime
maximum benefit $2,500 maximum annual benefit for other services
Delta Dental PPO 33
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A $50 combined deductible applies to Diagnostic, Preventive,
Basic, and Major Care Preventive Care is covered at 100% Basic Care
is covered at 70% Major Care is covered at 50% Orthodontic Care for
children and adults is covered at 60% with a lifetime maximum of
$2,000 $3,000 maximum annual benefit Delta Dental Premier 34
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You must select a Primary Care Dentist for each covered person
No deductible for Preventive or Basic Care $100 deductible for
Major Care Copay schedule for all other services Orthodontic Care
for children and adults has a maximum lifetime benefit of $1,800
$2,000 maximum annual benefit for Preventive, Basic, and Major Care
Delta Dental PPO Choice 35
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When using a Network Provider: Preventive Care is covered at
100% A $25 deductible applies to Basic and Major Care Basic Care is
covered at 85% Major Care is covered at 60% Orthodontic Care is
covered at 50% no lifetime maximum A $2,500 calendar year maximum
applies to all other services Dental 36 Return to Index Continue
End Presentation
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VISION PLANS 37
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38 Humana CompBenefits VisionCare Plan Primary Vision Care
Services (PVCS) Superior Vision Plan United Healthcare Vision
Vision Service Plan (VSP) Vision Plans Available
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Each vision plan has its own provider network A copay schedule
for services and materials The toll-free number and website address
of each plan is listed in the Employee Benefit Options Guide
Contact each vision plan for specific benefit questions 39 Vision
Plans Overview
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When using an in-network provider: $10 copay for an annual eye
exam $25 copay for lenses and frames; one pair per year Discounts
are available for other vision services and lens options Contact
lenses are available instead of glasses; $130 allowance Discount
through TLC for laser surgery 40
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When using an in-network provider: There is no copay or limit
on the number of eye exams Lenses and frames are sold at wholesale
cost There is no limit on the number of pairs of glasses Benefits
available for contact lenses Discount through TLC for laser surgery
41
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When using an in-network provider: $10 copay for eye exams; one
per year $25 copay for lenses and frames; one pair per year Contact
lenses available instead of glasses; $25 copay/standard fitting
then plan pays 100% or $25 copay/specialty fitting then plan pays
up to $50 Discounts available for other vision services and lens
options, including laser vision correction 42
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When using an in-network provider: $10 copay for eye exams; one
per year $25 copay for lenses and frames; one pair per year Lens UV
coating and tints are covered in full Contact lenses are available
instead of glasses Discounts available for other vision services
and lens options including laser vision correction 43
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When using an in-network provider: $10 copay for eye exams; one
per year $25 copay for lenses and frames; one pair per year No
copay for contact lens exam with network provider Contact lenses
are available instead of glasses Discounts are available for
glasses and other vision benefits, including laser vision
correction 44 Return to Index Continue End Presentation
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LIFE INSURANCE PLAN 45
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Basic and Supplemental Life for You First $20,000 of life
coverage (Basic Life) All additional coverage is known as
Supplemental Life $500,000 of Supplemental Life coverage is
available with an approved Life Insurance Application Basic Life
and the first $20,000 of Supplemental Life include Accidental Death
and Dismemberment (AD&D) benefits 46 Employee Life
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During initial enrollment: You can enroll in Guaranteed Issue
(two times your annual salary rounded up to the next $20,000)
without a Life Insurance Application You can apply for amounts
above Guaranteed Issue; a Life Insurance Application is required 47
Employee Life
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During Option Period: You can enroll in Basic Life You can
enroll in Supplemental Life You can enroll in up to $500,000 of
Supplemental Life insurance coverage An approved Life Insurance
Application is required 48 Employee Life
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Keep your beneficiary designation up-to- date Beneficiaries can
be changed at any time Review your beneficiaries if you have a
change, such as a marriage, divorce, death of a family member, or
birth of a child Beneficiary Designation Forms are available
online, from your Insurance Coordinator, or by calling OSEEGIB
Member Services 49 Beneficiary Designation
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All three options offer $1,000 of coverage for dependents under
six months of age. Premier Option Spouse$20,000 Child$10,000
Premier Option Spouse$20,000 Child$10,000 Standard Option
Spouse$10,000 Child $5,000 Standard Option Spouse$10,000 Child
$5,000 Low Option Spouse$6,000 Child$3,000 Low Option Spouse$6,000
Child$3,000 50 You must be enrolled in Basic Life coverage to
enroll your eligible dependents in Dependent Life. Dependent Life
Return to Index Continue End Presentation
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ELIGIBILITY 51
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An education employee must be: Currently employed, eligible for
TRS, and working at least four hours a day or 20 hours a week A
local government employee must be: Currently employed, regularly
scheduled to work 1,000 hours or more per year, and cannot be
listed as a temporary or seasonal employee 52 Eligible
Employees
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Eligible dependents include: Your legal spouse (including
common- law) Your daughter, son, stepdaughter, stepson, eligible
foster child, adopted child or child legally placed with you for
adoption up to age 26, whether married or unmarried Disabled
dependents over age 26 with approved documentation 53 Eligible
Dependents
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54 Other unmarried dependent children up to age 26, upon
completion of an Application for Coverage for Other Dependent
Children Guardianship papers or a tax return showing dependency can
be provided in lieu of the application Other Dependent
Children
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If you insure one dependent, all eligible dependents must be
insured You can exclude dependents who do not reside with you, are
married, are not financially dependent on you for support, have
other group insurance, or are eligible for Indian or military
benefits A spouse can be excluded by signing the Spouse Exclusion
Certification statement on the back of the form 55 Dependent
Eligibility
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Certain qualifying events allow you to make a midyear change,
examples include: Marriage Divorce Adoption Death Childbirth Gain
or loss of other group insurance Notify your Insurance Coordinator
within 30 days of the event or wait until the next annual Option
Period. 56 Midyear Qualifying Events
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Option Period Enrollment/Change Form: Your Insurance
Coordinator will provide the deadline Insurance Enrollment Form:
Return your form to your Insurance Coordinator within 30 days
Insurance Change Form: Return your form to your Insurance
Coordinator within 30 days of a qualifying event 57 Deadlines for
Forms
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Tobacco-free Attestation: Must be completed as part of the
Option Period enrollment process. The Attestation can be completed
online or returned to your Insurance Coordinator. 58 Deadlines for
Forms
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OSEEGIB mails you a Confirmation Statement when you enroll or
make changes to coverage If your Confirmation Statement is
incorrect, contact your Insurance Coordinator immediately 59
Confirmation Statements
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If you do not make changes during the annual Option Period and
are not automatically enrolled in a HealthChoice alternative plan,
no Confirmation Statement will be sent; keep your enrollment form
as verification of coverage 60 Confirmation Statements
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HealthChoice High and Basic require a completed tobacco-free
Attestation To enroll in dental or life coverage, you must have
group health insurance If excluding your spouse, your spouse must
sign the Spouse Exclusion Certification Return your signed and
dated forms to your Insurance Coordinator by the set deadline
Notify your Insurance Coordinator if you have a change of address
61 Reminders
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The 2013 Employee Benefit Options Guide Plan websites and
toll-free numbers available in your Option Period packet The FAQ
section of the OSEEGIB website OSEEGIB Member Services at 1-405-
717-8780 or toll-free 1-800-752-9475 TDD users call 1-405-949-2281
or toll- free 1-866-447-0436 Your Insurance Coordinator 62
Questions Return to Index