Please note: this information was mailed to Bledsoe Health Trust Active Plan members in September 2017.
ACTIVE PLAN: These changes will take effect on January 1, 2018:
- The annual deductible will be $500/person, $1,500/family (currently, it is $200/person, $600/family).
- The medical out-of-pocket maximum for covered services from participating providers and facilities will be $5,000/person, $10,000/family (currently, it is $2,200/person, $4,600/family.
- The prescription copay for generics will be $10 (currently, it is 20%, up to $20).
- The maximum copay for non-preferred brands will be $65 (currently, it is $60).
WHAT EXACTLY IS THE ANNUAL DEDUCTIBLE?
ACTIVE PLAN: This is the amount you pay for covered medical services every plan year before the Plan pays benefits. For example, beginning January 1, 2018, you will pay for the cost of your medical services until you have paid $500/person or $1,500/ family. Then, the plan will begin to pay benefits.
For families, as soon as a covered family member has met the per-person deductible, the plan will pay benefits for that person. Coverage begins for your entire family, even those family members who haven’t met the per-person deductible, when the total amount that your family has paid for health care services has met the family deductible.
Tip: If you’ve already paid the deductible for 2017, you’ll want to schedule and receive any additional services you need before January 1, 2018.
Did you know? The deductible is NOT required for many services: ACA-recommended preventive care
- Acupuncture and chiropractic care
- Durable medical equipment
- Emergency medical transportation
- Hearing aids
- Hospice services
- Outpatient rehabilitation services
Plus, if you pay for medical services you receive in October, November or December, but have not met the full deductible by the end of the plan year, that amount carries forward and is applied to the deductible for the next year.
WHAT IS THE MEDICAL OUT-OF-POCKET MAXIMUM?
This is the most you’ll pay each plan year through deductibles, copays and coinsurance for covered medical services received from participating providers and facilities. Once you reach the out-of-pocket maximum, the Health Plan pays 100% for covered medical services for the rest of the plan year.
For those with family coverage: If a covered family member incurs $7,150 of expenses for covered medical services, the plan will pay 100% of that family member’s covered medical services for the rest of the plan year. When the total amount that your family has paid for covered health care services meets or exceeds the $10,000/family out-of-pocket maximum, the Plan will pay 100% of covered medical services for each your covered family members for the remainder of the calendar year.
The medical out-of-pocket maximum does not include prescription, dental, and vision copays and coinsurance for any amounts you pay for services the Plan does not cover; for example, the billed amount that exceeds the Plan’s allowed amount or prescription costs exceeding the Plan’s limit.
Tip: Take some time to estimate your out-of-pocket costs in 2018. It’s a good idea to save money every month to pay for these expenses.
Did you know? You can keep your out-of-pocket costs down by choosing a Preferred Provider in the Regence network. To find one, go to or.regence.com and look for doctors in the Preferred network. Or, call 800-245-9272 to request a free directory.
ACTIVE PLAN: WHAT ARE MY PRESCRIPTION COPAYS FOR 2018?
|2018 ACTIVE PLAN
Up to a 30-day supply
|MAIL ORDER COPAYS
Up to a 90-day supply
|Generic||You pay $10||You pay 20%, up to $40|
|Preferred Brand||You pay 20%, up to $40||You pay 20%, up to $80|
|Non-Preferred Brand||You pay 20%, up to $65||You pay 20%, up to $120|
|Specialty||You pay $60||You pay $60|
Tip: If you buy prescriptions that you take regularly, use mail order. You may save money (and it is very convenient). Learn more at Express-Scripts.com
Did you know? You do not have to meet the annual deductible before the Health Plan pays prescription benefits.
WHO CAN I CALL IF I HAVE QUESTIONS about these changes and how they affect me?
Please contact the Trust Administrative Office / Northwest Administrators, Inc. (NWA) at 866-239-1708 (toll-free) or 503-238-6961.
HOW DOES THE BLEDSOE HEALTH PLAN COMPARE TO OTHER PLANS?
ACTIVE PLAN: How accessible is health care coverage for employees in the U.S.?
Only 56% of businesses offer group health benefits to their workers (the larger the company, the more likely it is to offer benefits). All members of the Bledsoe Health Trust enjoy the same coverage, regardless of the size of the company you work for.
ACTIVE PLAN: How much does health care coverage cost?
Nationally, the average annual cost for family coverage is $18,395 (for workers in large firms). Bledsoe’s average annual cost is $16,836.
- Most covered workers contribute toward the cost of their coverage—on average, workers pay 18% of the cost for single coverage and 30% (or approximately $459/mo.) for family coverage.
- Bledsoe Health Trust Active Plan members do not pay a monthly contribution toward the cost of their coverage.
ACTIVE PLAN: How do Bledsoe’s cost sharing provisions compare to other health plans?
Nearly all covered workers pay a share of the cost when they use health care services, through deductibles and coinsurance, up to the out-of-pocket maximum.
- The average deductible for single coverage is $1,132. Bledsoe = $500
- The average in-network coinsurance is 18% for primary and 19% for specialty care. Bledsoe = 20%
- The average out-of-pocket maximum ranges from $2,001 to $5,999, and 18% of Plans are $6,000 or more. Bledsoe = $5,000