SIM USA

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SIM USA

• Effective January 1, 2015
• Shelia McAnally

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Agenda

• GuideStones Ministry
• Medical plans Traditional PPO plans
• Resources for your family
• How to enroll or make changes
• Q A

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GuideStones Ministry is Serving You

• Serving those that serve the Lord for 96 years
• Not an insurance carrier or brokerage firm
• Self-insured church plan
• Serving over 80,000 ministry participants across
  the globe
• Non-commissioned, not for profit
• GuideStone health plans do not include Biblically
  objectionable services
• Contraceptive prescriptions and methods are
  covered unless abortive in nature

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GuideStone Brings Together Best-in-Class Providers
Nationwide Medical Network
Prescription Drug Pharmacy
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Medical PlansPPOs
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Health Choice 3500
Medical Benefits In-network Out-of-network
Wellness/preventive care Covered at 100 Not covered
Primary care visit copay 25 50 after deductible
Specialist visit copay 35 50 after deductible
Urgent Care/ER copay (followed by coinsurance) 50 50 after deductible
Annual deductible (individual/family) 1 3,500/7,000 8,000/16,000
Plan pays/you pay (after deductible) 80/20 50/50
Medical and prescription maximum out-of-pocket individual/family (in-network services only, including deductible, co-pays and co-insurance) 6,350/12,700 N/A
1Includes hospitalization, maternity, outpatient
surgery services.
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Embedded DeductiblePPO Plans

• When one person in a family reaches the
  individual deductible level, that person moves to
  the coinsurance benefit level.
• Other family members expenses accrue to meet the
  remaining family deductible before they move to
  the coinsurance benefit level.
• Deductible, co-insurance and copayments accrue to
  meet the individual and family Maximum
  Out-of-Pocket.

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Maximum Out-of-Pocket PPO Plans - Individuals

• Out-of-pocket costs for all eligible, in-network
  services including deductible, co-payand
  co-insurance count toward theindividual
  maximum.
• Once you reach the MOOP limit, GuideStone covers
  all eligible, in-network health care expenses for
  the rest of the year!
• Note Out-of-network expenses accumulate
  separately and do not contribute to the maximum
  out-of-pocket limit.

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Maximum Out-of-PocketPPO Plans - Family Coverage
The below applies to plans with an embedded
deductible

• Out-of-pocket costs for all eligible, in-network
  services apply toward the deductible and also
  count toward the family individual or aggregate
  maximum out-of-pocket limit.
• Once one family member reaches the family
  individual maximum out-of-pocket limit, all of
  that members eligible, in-network expenses will
  be paid at 100.
• The remaining amount of the family
  maximumout-of-pocket limit can be accumulated by
  one or all of the family members.
• Once the family reaches the family
  maximumout-of-pocket limit, everyones eligible,
  in-network expenses will be paid at 100 for the
  rest of the year.
• Note Out-of-network and ineligible medical
  expenses do not accumulate toward, or contribute
  to, the maximum out-of-pocket limit.

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Wellness BenefitPPO Per Preventive Care Schedule

• Scheduled, in-network services are covered at
  100 including scheduled lab and x-ray.
• Well-child and adult annual preventive care are
  covered.
• Immunizations covered for all ages according to
  schedule and available at doctors office and
  neighborhood pharmacy.
• Recommendations are based on age and gender.
• Services not listed on the Preventive Care
  Schedule such as EKGs and lung X-rays are not
  included in the 100 preventive exam.
• These services are included as diagnostic under
  deductible/ co-insurance benefits.

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Urgent CarePPO Plans

• Standardized urgent care co-pay available for
  eligible, in-network, urgent care services
• 50 co-pay on all plans in-network
• Out-of-network services are covered by the
  out-of-network co-insurance amount after the
  deductible has been met

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Lab and X-ray BenefitsPPO Plans

• Diagnostic X-ray or lab work at a doctors office
• Office visit benefit applies when an in-network
  doctor performs lab work or X-ray in his or her
  office regardless of where the doctor has the lab
  work or X-ray processed or read

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Lab and X-ray BenefitsPPO Plans

• Free-standing diagnostic X-ray or lab facility
• You pay your deductible and co-insurance when you
  receive a diagnostic X-ray or lab work at a
  free-standing facility outside your physician's
  office.
• This facility may be adjacent to or within the
  same suite as your doctors office.
•  

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Vision Exam BenefitPPO Plans

• One annual eye health examination for each
  participant, including
• Dilation
• Refraction for eyeglasses or contact lens
  prescription
• Available at the Primary Care office visit level.
• No coverage for glasses, contacts or other
  eyewear.
• Must use a BCBS in-network optical provider
  (optometrist or ophthalmologist) to receive
  benefit.

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Prescription BenefitsPPO Plans
Prescription Benefits Retail 30-day supply2 Mail Order 90-day supply2
Generic drug co-pay 80 80
Preferred drug co-pay1 80 80
Non-preferred drug co-pay1 80 80
Specialty drug co-pay 80 80
1If a preferred or non-preferred drug is
purchased when a generic is available, the
participant must pay the generic co-payment and
the cost between the preferred/non-preferred
drug and its generic equivalent. The cost
difference does not apply to the
Maximum-Out-Of-Pocket cost.
2The copay is the maximum you pay for a
medication unless receiving brand over a generic.
If the medication costs less, you only pay the
true cost of the medication.
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Prescription BenefitsPPO Plans

• Brand Rx over Generic Rx
• If a preferred or non-preferred drug is purchased
  when a generic drug is available, the participant
  must pay the generic copay and the cost
  difference between the preferred/non-preferred
  drug and its generic drug equivalent.
• The cost difference will not apply toward the
  participants maximum out-of-pocket limit.

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Important Rx Protection Practices

• Clinical rules and coverage management
• Step therapy for certain medications
• Pre-authorization for some medications
• Drug therapy helping patients take mediation
  correctly and consistently for chronic conditions
• Quantity limits to maintain safe limits

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Questions?
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Tools and Resources for Your Family
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MyGuideStone.org

• Establish log-in on vendor websites
• www.HighmarkBCBS.com
• www.Express-Scripts.com
• Go to www.GuideStone.org and establish log-in
• Then sign in once at GuideStone and youre done!
• Single point of access to everything you need
• Review your insurance product details
• Download detailed plan booklets
• Find a provider
• Access wellness support and information

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www.GuideStone.org

• Download forms and resources for your plan
• Get wellness support and inspiration
• Learn more about health care reform
• Find education about a range of personal finance,
  insurance, wellness and retirement topics

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Save Money When You Use In-network Providers
Out-of-network Provider
You share more of the cost
No provider discounts
You file claims
Greater out-of-pocket costs
Separate out-of-pocket maximum
In-network Provider
Receive highest level of benefits
Benefit from provider discounts
Provider files claims
Lowest out-of-pocket costs
Maximum out-of-pocket cost accumulation
Compare your provider bills to your Explanation
of Benefits (EOBs)
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Blue365Highmark Blue Cross Blue Shield

• Discounts on services and products plus valuable
  information you can use all year long
• To access these discounts
• Visit www.HighmarkBCBS.com
• Choose the Members tab and log in, or select
  Register Now
• Select the Your Coverage tab and go to Member
  Discounts
• Highlight of available discounts

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Questions?
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How to Enroll
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Key Date

• All employees must complete enrollment within 31
  days of employment.
• If you have any questions regarding enrollment
  changes or your employee benefits, please notify
  your benefits administrator.

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Before You Receive Your ID Cards

• After the effective date of coverage, if you need
  to see a doctor or fill a prescription and you
  havent received your ID cards, information found
  on the Important Reminders page of your
  enrollment packet will help you access care
• Watch the mail for TWO ID cards
• One for medical each covered participant
• One for pharmacy two cards per household
• Can order additional or misplaced cards online

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Questions?
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This information only highlights the depth of
coverage and benefits you can receive when you
protect yourself with GuideStone Financial
Resources. Limitations and exclusions apply. This
material is a general summary of the plans. The
official plan documents and contracts set forth
the eligibility rules, limitations, exclusions
and benefits. These alone govern and control the
actual operation of the plan. In the event of a
conflict with the description in this material,
the terms of the official plan documents and
contracts will control its operation. GuideStone
Financial Resources of the Southern Baptist
Convention reserves the right to change or cancel
these programs at any time. This material does
not imply an employment contract or guarantee of
benefits. Medical underwriting could be required.