Employee Benefits
Healthcare Benefits
  2013 Health Care Assistance Plan (HCAP) Document
2013 Summary of Benefits and Coverage (SBC)


Medical: Independence Blue Cross

Medical Preferred Provider Organization (PPO) network, provider search, review paid claims, benefits summary, print temporary ID card &/or request new one.

Member Services (888) 276-4732 or email Healthcare@adventistrisk.org

 
 

Prescription: Express Scripts (Medco)

 

Prescription PPO network retail & mail order, provider search, review paid claims, benefits summary.

Member Services (800) 841-5396 or email Healthcare@adventistrisk.org 


Dental: United Concordia

Dental PPO network, provider search, review paid claims history, benefits summary, member services.

Member Services (888) 222-3044 or email Healthcare@adventistrisk.org

  Vision Benefits

No PPO network required, benefits summary, review paid claims history, review paid dental claims for services obtained prior to 2011.

Member Services (888) 276-4732 or email Healthcare@adventistrisk.org

  Other Benefits:

 

(Massage, Chiropractic, Acupuncture, Refractive Eye Surgery, Hearing Aids)

No PPO network required, benefits summary, review paid claims history.

Member Services (888) 276-4732 or email Healthcare@adventistrisk.org

Major Medical

Preventive Services per Schedule paid at 100%

Other Services         
Co-Pay                  
Office Visit - $20                  
Emergency Room - $50         
Deductible:  $250/$500
Out-of-Pocket:                            
80%/20%                           
In Network $2,000/$4,000                           
Out-of-Network $4,500/$9,000


Dental

Preventive Services per Schedule paid at 100%
Restorative Services paid 80%/20%
Network available, but utilization not required
Claims paid per contracted rate whether in or out of network
Plan Year Maximum payable $3,000/$9,000

Prescription

Copays – Generic/Brand/Non-Preferred
Retail (30-day supply) - $10/$15/$25
Mail (90-day supply) - $20/$30/$50
Plan Year Maximum out-of-pocket $400/$800

Vision

Vision exams, glasses, contacts
Paid at 80%/20%
Plan Year Maximum payable $560

Other Benefits

Alternative Therapies

         Massage, chiropractic, acupuncture

         Paid at 80%/20%

         30 visit limit per therapy type – collectively 45 visit limit

Refractive Eye Surgery

         Paid at 80%/20%

         Lifetime Maximum payable $2,400

Hearing Aid

         Paid at 80%/20%

         Plan Year Maximum payable $3,200

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