2. Welcome to the Applied Industrial Technologies
Open Enrollment for healthcare benefits.
As an Applied® associate, you have the opportunity each year to
select the healthcare plans that best meet the needs of you and
your eligible dependents. During this Open Enrollment period,
you’ll be making your plan choices for the 2009 calendar year.
The Open Enrollment period begins with your receipt of this
Guidebook and materials. The Electronic Benefit System is open
and available beginning Monday, November 3 for you to make
your benefit selections for 2009. The system will remain open
through Friday, November 21, 2008.
You must complete your plan selections by November 21, 2008.
4. Benefit Plan Changes for 2009
Applied® is committed to providing eligible
Self-Insured associates with quality healthcare plan
options, at competitive levels of associate
contributions. Since Applied® is ‘self-insured’
Applied® does not pay a for virtually all the healthcare expenses of
monthly insurance premium our associates and their eligible dependents,
to an insurance company. we recognize that rising healthcare costs
Rather, the Company pays all are placing an increased financial burden
healthcare expenses incurred on both our associates and the Company.
by our associates and their Nevertheless, in 2009 Applied® will continue
eligible dependents out of the to pay the majority of the healthcare expenses
general assets of the Company. for these benefit plans.
Therefore, these expenses
Medical Plan Changes
directly impact our bottom line.
• Associate contributions for 2009 will be
increased consistent with the increase in
medical inflation as well as the benefits
paid under each plan.
Anthem Healthplan Mandatory Mail order
• The Basic PPO prescription plan annual
Participants: PrograM:
maximum benefit will be increased to
$2,500.
Anthem’s MyHealth The Anthem mail order program, serviced
Risk Assessment by WellPoint NextRx, must be used for all
long-term maintenance medication needs.
Dependent Eligibility: Maintenance medications are those that a
physician prescribes on a long-term basis
To control costs for all Applied® associates
If you graded your health today,
(60 days or more) for continuing care of a
who participate in our healthcare plans, it
what score would you get?
health condition. Examples of maintenance
is important that only those dependents
Anthem offers you the ability to
prescriptions would be diabetic medicine,
who are eligible for benefits are enrolled
not only measure your overall
cholesterol medicine, or any other drug that
in the plan(s). Detailed information
health, but it also provides
is taken on a daily or consistent basis. All
regarding the definition of an “Eligible
you with specific action steps
Applied® associates with Anthem are required
Dependent” can be found at the HR
for changing your habits and
to participate in the mail order program if
Intranet site under OE 2009.
reducing your health risks.
they, or a covered dependent, are prescribed a
As you participate in the Electronic Open
How to get started? maintenance drug. There are no exceptions to
Enrollment process, please use these
the mail order program.
Simply log in at www.anthem.com descriptions to determine who is eligible
and click on MyHealth ➟ for enrollment in the plan(s). You will
Flexible Spending (FSAs)
Personalized Health Manager ➟ be required to confirm that you have
MyHealth Assessment. Remember, you must re-enroll each year
reviewed the eligibility of the dependents
that you wish to maintain an FSA. Review
that are covered on your Company
page 19 for details regarding the program.
sponsored healthcare plans.
If you have a question regarding the
eligibility status of any person you wish to
enroll in the Applied® healthcare plan(s),
you are encouraged to call the Human
Resource Services Call Center at
216-426-4269 prior to completing the
electronic Open Enrollment process.
4 Applied Choices
5. Before You Enroll… If, for some reason, you are unable to enroll
What You Need to
through the Electronic Benefits Enrollment
We encourage you to choose your benefit
system, request assistance from your location
Do On-Line
plans wisely. To help in the selection process,
manager or supervisor.
a Case Study & Personal Worksheet can be
If you have any questions, please contact the
found on the HR Intranet site under OE
Human Resource Services Call Center at 1. If you are keeping the same
2009. The goal of these tools is to assist you
216-426-4269. benefits coverage (except
in performing a careful financial analysis
FSAs) for 2009, no action
of your medical expenses. Please refer to it
Confidentiality and Information is required. You will be
frequently as you consider your options for
Security automatically re-enrolled
2009.
in the same medical plan(s)
Regardless of the PC you use, you can be
How to Enroll for 2009. Confirmations will
assured that all of your personal information
be mailed mid-December
When you are ready to enroll, log on to is secure and confidential. Each associate’s
confirming your elections.
www.myApplied.com. You can enroll from enrollment information is protected by
2. If you are making changes in
your home computer or at work. technology that encrypts all sensitive
your medical coverage, simply
information.
To Log on From Your Home Computer
click on the medical plan you
(with Internet access):
Confirmation of Your Selections want to select and follow the
• Type www.myApplied.com. This will take screen prompts.
The decisions you make using the Electronic
you to the log on screen.
Benefits Enrollment system will be confirmed
• Next, enter your JD Edwards User Name to you in two ways:
and Password. If you do not currently have
1.) While you are still logged on to the
a JDE User Name and Password, you will
Electronic Enrollment system, you will be
Summary Plan
be required to complete the registration
given the option, at the end of the process,
process within JD Edwards to obtain one.
Descriptions
to “Print” a hard copy of your 2009 benefit
Detailed instructions can be found on the
selections. We encourage you to print that
HR Intranet site under the “JD Edwards”
screen for your own records.
tab. Anthem Booklets, known as
2.) In December 2008, you will receive a
• Enter your one-time activation code (if you Summary Plan Descriptions,
personalized letter from the Human Resource
have not already done so in 2008) found are available online at www.
Services Department. This letter will confirm
in the upper right-hand corner of the myApplied.com. Simply click on
the benefit selections you made during
enrollment letter included in this packet. the “Forms” tab located on the
the Open Enrollment process. Again, we menu bar of the home page and
• Once you have reached the myApplied. encourage you to save the confirmation letter choose the appropriate booklet.
com home page, select “Enrollment” from for your personal records.
the menu to begin the on-line process.
To Log on From the PC at Your Service
Center or Other Work Location:
If you are accessing the Internet at work
and have the Company Intranet site called
“Within Applied” set as your default log on,
simply click on the myApplied.com link.
OR,
• Launch Internet Explorer.
• Type www.myApplied.com.
• Once you have completed the enrollment
process, be certain to close the Internet
Explorer to ensure that your information
remains confidential.
5
Applied Choices
6. Changing Your Plan Coverage In The Future
The choices you make during this Open
Newborn Baby/ Qualified Status Changes
Enrollment period will remain unchanged
until December 31, 2009. The only way you
Adoption Reminder • Marriage/Divorce
can change the dependents listed on your
• Birth/Adoption
plan is if you experience a Qualified Status
Change. • Death
In order to be covered under an
You must contact the HR Department within
Applied® health plan, you MUST • Disability
31 days of event occurrence for any of the
enroll your newborn or newly
• Termination of your employment
Qualified Status Changes.
adopted child within 31 days
• Loss of a dependent’s eligibility
of the date of birth or date of Your change in coverage must be consistent
placement. Be certain to contact • Loss of coverage due to a change in
with a change in status that affects eligibility
the Corporate Human Resource your spouse’s employment
for coverage. For example, if you have a baby,
Services department within 31 adding a dependent to your coverage would • Issuance of a Court Order or administra-
days. Elections received after the be consistent as your baby would be newly tive decree that requires coverage for a
31st day will not be accepted, eligible. Adding coverage for your spouse dependent child
and you must wait until the next because his/her insurance contributions
• Significant change in your spouse’s
Open Enrollment period. increased would not be considered a
benefits (increases in plan contributions
Qualified Status Change. You may not switch
required by any employer do not meet
plan options mid year for any reason, other
this standard)
than a Qualified Status Change.
• Relocation of your home or work site, or
Requesting A Change that of your spouse or eligible depen-
dent, which takes you out of, or into, the
Any of the above changes must be requested
plan’s service area (may require a plan
within 31 days of the Qualified Status
option change)
Change. If you miss that deadline, you must
wait until the next annual Open Enrollment
period to make the change.
To make a change, you must obtain an
Applied® Choices enrollment form. Forms
can be found on the HR Intranet site under
“Your Benefits” and on myApplied.com
under “Forms–Medical.” This form must be
returned within 31 days of the date of the
Qualified Status Change.
Be sure to notify
Human Resources
within 31 days of
marriage if you wish
to add your spouse
to your healthcare
coverage.
6 Applied Choices
7. Your Medical Plans
This section of the Guidebook addresses the Coverage Levels: With all medical plan
Eligible Dependent
medical plan providers and the plan designs options, you can choose:
that are available to Applied® associates. It
Reminder
• Associate Only,
also provides the 2009 associate contributions
• Associate + 1,
for each plan.
• Associate + 2 or More, or Eligible dependents include:
current legal spouse and
• No Coverage.
unmarried natural born children,
Important Note: You can choose medical,
stepchildren, adopted children,
dental and vision coverage separately.
custodial agreement children,
However, you must use the same coverage
incapacitated children and
level for all your choices. For example, if
guardianship children up to
you choose “Associate Only” coverage for
the age 19 or 25 if full-time
your medical plan, then you must choose
students. Complete information
“Associate Only” coverage for the dental
and definitions can be found on
and/or vision plans.
the HR Intranet site under OE
Dependent Children: Unmarried dependent 2009.
children are covered under all the medical
The health plan prohibits
plans. Under the Anthem BCBS plans,
enrolling ineligible dependents
children can be covered to age 19, or to age
in the plan. Be certain to notify
25 if they are full-time students. Please check
the Human Resource Services
the plan descriptions carefully, or contact
department within 31 days of
your HMO directly.
a change in dependent status.
Prescription Drug Coverage: All of the Ineligible dependents may not
Applied® medical plans include prescription use the health plan beyond the
Your Medical Choices drug coverage. date the dependent becomes
Medical Plan Options: You may choose a ineligible. Please remember,
medical plan design. However, the medical you will be responsible for
plan options available to you depend on reimbursing the company for
those available to your work location. Not any benefits paid beyond the
all medical plans are available in all Applied® last day of eligible coverage.
locations. Please refer to the personalized
letter included in your Open Enrollment
packet to learn which medical plan options
are available to you.
Persons NOT Eligible
for Enrollment
The Women’s Health & Cancer Rights Act
This Federal legislation requires all medical plans to provide
• Ex-Spouse
coverage for breast reconstruction following a mastectomy,
(Regardless of court order)
including:
• Domestic Partners
• Reconstruction of the breast on which the
mastectomy was performed, • Same Sex Marriage
• Surgery and reconstruction of the other • Part Time Students
breast to produce a symmetrical • Married Child
appearance, and
• Other Relatives
• Prosthesis and treatment for physical
• Other Household Residents
complications in all stages of the
mastectomy, including lymphedema.
7
Applied Choices
8. Medical
The Anthem BCBS Plan Designs
Non-Duplication of Through Anthem BCBS, Applied® offers three
Benefits Provision very different PPO plan designs. Each plan
varies in the level of coverage it provides
Applies to All
and the associate contributions are reflective
Anthem BCBS of the level of plan benefits you choose.
Medical and CIGNA Remember to carefully complete the Case
Study found on the HR Intranet site under
Dental Plans OE 2009 to ensure you are receiving the most
economical plan for your healthcare needs.
The Anthem BCBS plans are described below.
The benefits provided by our
A summary of the various plan coverages
medical and dental plans will be
may be found on Page 10 of this Guidebook.
coordinated with the benefits
provided by any other plans
that cover you and your eligible
dependents. This does not
apply to benefits provided by
the Anthem WellPoint NextRx
PPO STANDARD PLAN Associate
prescription plan or VSP.
This is the “standard” plan of the healthcare PPO Monthly
This means that if the Applied®
industry. Often referred to as an “80/20”
Standard Contribution
plan provides secondary
plan, the PPO Standard Plan is similar to that
coverage for your dependents,
Associate Only:
offered by most employers today. The PPO
then the Applied® plan will
Standard Plan offers Applied® associates a Full Rate $86
adjust its benefits so that the
quality healthcare plan at a very competitive
total benefits payable under all Non-Smoker Discount* $78
price. Carefully review your anticipated
plans, for eligible charges, do Associate +1:
healthcare costs for 2009. You may find that
not exceed the eligible charges
Full Rate $214
the PPO Standard Plan is the most efficient
payable under the primary plan
way to provide quality healthcare for you and Non-Smoker Discount* $190
(other coverage). For example, if
your eligible dependents.
the primary plan would normally Associate +2:
pay $80 of a $100 eligible
Full Rate $240
expense and the secondary
Non-Smoker Discount* $214
plan would pay $90, then the
secondary plan (Applied®) would
pay only an additional $10.
Because our plan contains a
Non-Duplication of Benefit
Terms to Know • Co-pay – a fixed amount you pay when
Provision, Anthem sends letters
you receive a specific service (for example,
out each year in order to verify if • In-network – doctors and facilities that
an office visit).
there might be other insurance have a contract with a health plan. When
coverage. In order to avoid • Co-insurance – the percentage you pay
you use a doctor or facility that’s in-net-
delays in processing claims, when you receive care (for example, under
work, your out-of-pocket costs are lower.
please be certain to respond to the PPO Plan, X-rays may cost $200. If
• Out-of-network – doctors and facilities
Anthem’s inquiry promptly. your deductible is already met, the plan
that do not have a contract with a health
would pay 80%, or $160, and your co-
plan are not part of the network. When
insurance would be 20%, or $40).
you use a doctor or facility that does not
• Out-of-pocket maximum – the maxi-
participate in the network, your out-of-
mum amount you must pay before the
pocket costs are much higher.
plan pays 100% for covered services. This
• Deductible – the amount you must pay
amount does not include deductibles.
first before the plan begins paying ex-
• Out-of-pocket cost – the amount you
penses for a service. Co-pays do not apply
pay when you receive care.
toward your deductible.
* You nor any of your dependents can use tobacco products, and you must live in a smoke-free environment.
8 Applied Choices
9. PPO BASIC PLAN
Tobacco-Free
Associate
If you and your eligible dependents are PPO Monthly Household Discount
in good general health, and you do not
Basic Contribution
anticipate the need for extensive medical
Associate Only:
services in 2009, the PPO Basic plan design
It’s a fact that people who do
may be a good option for you. The co-pays Full Rate $32 not smoke and who are not
and out-of-pocket maximums are higher, Non-Smoker Discount* $28 exposed to secondhand smoke
but the associate contributions are very low.
are healthier. In recognition of
Associate +1:
This is a great plan design to combine with
that, Applied® offers a
Full Rate $76
an FSA.
non-smoker discount for each
Non-Smoker Discount* $66 of the medical plans. If you and
your covered dependents do not
Associate +2:
smoke or use tobacco products
Full Rate $84
and live in a smoke free
Non-Smoker Discount* $76 environment, you can qualify for
this discount. If your household
smoking status changes
during the year, please contact
Human Resources for premium
PPO ELITE PLAN adjustments.
Associate
The PPO Elite Plan has this name because of PPO Monthly
the very high level of benefits it provides. The
Elite Contribution
cost of these benefits comes at a high price,
Associate Only:
both to the associate and to the Company.
Therefore, the PPO Elite Plan contributions Full Rate $190
are the most expensive of all the plans. Non-Smoker Discount* $168
Associate +1:
Full Rate $460
Non-Smoker Discount* $410
Associate +2:
Full Rate $510
Non-Smoker Discount* $456
INDEMNITY PLAN Associate
(Note: this plan is only available if an associate has
Monthly
no access to the Anthem BCBS network)
Indemnity Contribution
With this plan, an associate may receive
Associate Only:
healthcare services from any medical
provider. There are no network restrictions. Full Rate $86
However, the cost of medical care is not
Non-Smoker Discount* $78
“discounted” by the medical provider, and the
Associate +1:
associate must pay a fixed percentage of the
full cost of medical care. Full Rate $214
Non-Smoker Discount* $190
Associate +2:
Full Rate $240
Non-Smoker Discount* $214
* You nor any of your dependents can use tobacco products, and you must live in a smoke-free environment.
9
Applied Choices
10. Medical
Your BCBS Medical Plans At-a-Glance
Here’s a closer look at each of the BCBS plans and the key services covered under each one. The plans pay all eligible co-insurance
(for example 80%) after you meet the deductible, if applicable.
PPO-Standard PPO-Basic PPO-Elite INDEMNITY
In- Out-of- In- Out-of- In- Out-of-
Network Network Network Network Network Network
DeDuCTIble
Individual $200 $600 $1,500 $3,000 None $1,500 $200
Family $600 $1800 $3,000 $6,000 None $3,000 $600
OuT-Of-POCKeT
MAxIMuM
(does not include deductible)
Individual $1,000 $3,000 $5,000 $10,000 $500 $5,000 $1,000
Family $2,000 $6,000 $10,000 $20,000 $1,000 $10,000 $2,000
lIfeTIMe MAxIMuM Unlimited Unlimited Unlimited Unlimited Unlimited $2.5 million Unlimited
OffICe vISITS $20 co-pay* 60% $25 co-pay* 50% $20 co-pay 50% 80%
PReveNTIve CARe
Not Not Not
(includes physical exams,
$20 co-pay* $25 co-pay* $20 co-pay 80%*
covered covered covered
immunizations, OB-GYN,
well child visits***)
eMeRgeNCy CARe
Doctor’s office $20 co-pay* 60% 75% 50% $20 co-pay 50% 80%
$100 co-pay $100 co-pay
Hospital 80% 80% 75% 75% 80%
(waived if admitted) (waived if admitted)
Urgent care 80% 80% 75% 75% $25 co-pay $25 co-pay 80%
Out of area 80% 80% 75% 75% $50 co-pay $50 co-pay 80%
Ambulance 80% 80% 75% 75% No charge No charge 80%
INPATIeNT HOSPITAl 80% 60%* 75%* 50%* $250 co-pay 50% 80%
OuTPATIeNT HOSPITAl 80% 60%* 75%* 50%* $125 co-pay 50% 80%
SuRgeON’S feeS 80% 60%* 75%* 50%* No charge 50% 80%
x-RAyS/lAb 80% 60%* 75%* 50%* No charge 50% 80%
DuRAble MeDICAl
80% 80% 75% 75% 100%‡ 50% 80%
eQuIPMeNT
MeNTAl HeAlTH
Outpatient $25 co-pay* 50%* $25 co-pay* 50%* $25 co-pay* 50%* 80%*
Inpatient 80%* 60%* 75%* 50%* $250 co-pay* 50%* 80%*
SubSTANCe AbuSe
Outpatient $25 co-pay* 50%* $25 co-pay* 50%* $25 co-pay* 50%* 80%*
Inpatient 80%* 60%* 75%* 50%* $250 co-pay* 50%* 80%*
ClAIM fORMS? No Yes No Yes No Yes Yes
HOSPITAl
Doctor Associate** Doctor Associate** Doctor Associate** Associate**
PReCeRTIfICATION
Responsibility Responsibility Responsibility Responsibility Responsibility Responsibility Responsibility
ReQuIReD?
‡Includes coverage for hearing aids – limit 2 per lifetime up to $800 each.
*May be subject to certain limitations, separate deductibles or co-pays and/or plan limits per lifetime.
** $300 penalty applies for non-compliance.
***One annual routine mammogram is covered in full at an in-network facility. Office visit co-pay/deductibles apply.
10 Applied Choices
11. Health Maintenance Organizations (HMOs)
How to Read the
Although the Anthem BCBS network serves the vast majority of Applied® associates, it does
Charts in This
have a few geographic limitations. As a result, Applied offers an HMO option in those few
geographic areas. You will know if you may select an HMO by reading the personalized letter Guidebook
enclosed in this Open Enrollment packet. The personalized letter provides you with the plan
choices for your Applied® work location.
Any time you see a percentage
With an HMO, you must use the medical providers in that HMO plan. If you seek medical
listed in a chart, this is the
treatment “out-of-network,” the HMO plan will not provide any coverage – except in the case
percentage the plan pays.
of a true life-threatening emergency.
As an example, let’s look at the
The HMO plan also provides coverage for prescription drugs. Please consult the HMO
medical plan chart on page 10.
summary plan description for the co-pay amounts and limitations the HMO may place on
Under X-rays/lab in the
prescription drug coverage. If you have questions regarding these options, contact the HR Call
in-network PPO option, you’ll
Center at 216-426-4269.
see 80%. This is what the plan
pays (after you pay the
HMO Associate Monthly Contribution deductible). So, in this case, you
United Healthcare Kaiser would pay 20% of the cost (plus
your deductible) if you get X-rays
Associate Only:
taken or use a lab service.
Full Rate $142 $138
Non-Smoker Discount* $128 $124
Associate +1:
Full Rate $354 $330
Non-Smoker Discount* $316 $296
Associate +2:
Full Rate $388 $366
Non-Smoker Discount* $348 $326
* You nor any of your dependents can use tobacco products, and you must live in a smoke-free environment.
Out-of-Pocket Maximum and Co-Insurance
It is very important to understand that once
you reach an “out-of-pocket maximum” during
a plan year, the plan you choose will pay 100%
of in-network medical expenses. for example, if
you incur a $20,000 hospital bill under the PPO
Standard Plan, and you have already met your
family’s deductible and out-of-pocket maximum
earlier in the plan year, the plan will pay 100% of
the $20,000 hospital bill.
“Out-of-pocket maximum” does not include
deductibles.
Check the Anthem website at www.anthem.com to
locate a network provider, or to make certain that
your doctor or hospital participates in the Anthem
network.
Always verify with your provider that they are part
of the Anthem PPO network.
11
Applied Choices
12. Your Prescription Drug Plans
To help reduce your healthcare expenses, be
Highlights of Your Categories of Drugs
sure to use generic medications whenever
possible.
Prescription Drug There are three categories of prescription
drugs:
Your co-pay for a generic drug will be
Plan substantially lower than your co-pay for the • Generic drug – these drugs have the
brand name equivalent. exact same active ingredients as brand
name drugs, but can cost one-half to
Here are some key things to know about your
You pay a co-pay each time
two-thirds less than the brand name
prescription drug plan:
you get a prescription filled, so
equivalent drug. Please use generic
you always know up front how • The Anthem BCBS medical plans
drugs whenever possible.
much your prescriptions will include prescription drug coverage, also
cost. • Formulary drug – these are brand
provided by Anthem BCBS. Your Anthem
name drugs that are listed in the
Identification Card is to be used for both
Prescription drug coverage is
Anthem Formulary Drug List. This list
medical and prescription drug services.
included in the monthly cost for
may be found at www.anthem.com.
your medical plan. You do not • The HMO medical plans include their
Because Anthem has negotiated a
pay a separate amount for this own prescription drug coverage, so HMO
contract price for these drugs, your
benefit. participants will not receive benefits
co-pay is lower when your doctor
through WellPoint NextRx.
Maintenance Drugs – If you are
prescribes one of these medications.
an Anthem participant, you and • Refer to page 13 for important information
• Non-Formulary drug – also brand
your eligible dependent(s) must regarding the Mandatory Maintenance
name drugs, Anthem has no price
use the mail order program for Drug Program.
guarantee for these medications.
maintenance drugs.
Therefore, your co-pay is higher as well.
Share the Formulary Drug List with your
physician. It might be to your advantage
if your physician prescribes a similar
medication from the Formulary List.
letter of “Creditable”
Prescription Drug Coverage
The Medicare Part D prescription drug
program went into effect on January
1, 2006. Under this program, Applied
Industrial Technologies is required to
notify associates and/or their dependents
who may be eligible for Medicare that
the Applied® prescription coverage is
considered “creditable.” This means
that Applied® plan is at least as good as
Medicare Part D Drug plan.
Because your current prescription drug
coverage through Applied® is considered
at least as good as the standard Medicare
Part D Prescription drug coverage, you
do NOT have to enroll in Part D coverage
and you can keep your Applied® coverage.
Provided you do not have a lapse of more
than 63 days in “creditable” prescription
coverage, you will not have to pay a
higher Part D premium if you decide to
enroll in Medicare Part D prescription
coverage at a later date. You will receive a
notice of “creditable” coverage each year.
12 Applied Choices
13. Terms to Know Using Mail Order
• Non-maintenance drug – a drug used to
treat an occasional, short-term condition.
NextRx
• Co-pay – a fixed amount you pay when
• Formulary drug – brand name drugs that
you have a prescription filled.
are included on Anthem’s Formulary Drug
• generic drug – these drugs have the
List. Using formulary drugs saves you money. There are three convenient ways
exact same active ingredients as brand
to use “NextRx,” the name
• Anthem Formulary drug List – the list
name drugs and are the most cost
given to Anthem’s prescription
of those name brand medications which
effective for both you and the Company.
mail order service.
Anthem has selected, based on quality,
• Maintenance drug – a drug used to treat
safety and cost. New Presciption Orders:
a chronic, long-term condition.
• Telephone: 888-613-6091
• Non-Formulary drug – brand name
• brand Name drug – a prescription drug NextRx Customer Service
medications that are not included on
that is protected by a patent that is only will contact your physician
Anthem’s Formulary Drug List. These are
issued to the original drug company. Some for your prescription. When
the most expensive drugs and are subject
examples include: Nexium, Zoloft and you call, please have the
to the highest co-pay.
Lipitor. following information ready:
medication name, physician
name and phone number,
How To Fill Prescriptions
your Anthem ID card, and
How you get your prescriptions filled your credit card information.
depends on whether you use maintenance • FAX : Using the Fax Physician
or non-maintenance drugs. Maintenance Order Form, your physician
drugs are drugs that are used to treat chronic, can FAX the medication order
long-term conditions, such as diabetes or to NextRx from the doctor’s
high blood pressure. Non-maintenance drugs office.
are drugs used to treat occasional, short-term • Mail : Using the initial order
conditions. form, you may mail your
prescription to:
Maintenance Drugs – NextRx Mail Service Pharmacy
MANDATORY MAIL ORDER PO Box 746000
If you are required to take a prescription Cincinnati, OH 45274-6000
drug for a chronic or long-term condition Refills:
such as high blood pressure or asthma, you • Telephone: NextRx Customer
will need to utilize the Anthem mail order Service 800-962-8192
program once you have received two “fills” • Internet: go to
at your local pharmacy. This means you www.anthem.com
can have the original prescription filled and
Important Reminders:
then receive one additional “refill.” If you
• Always allow 10-14 business
need to continue to take this prescription
days to receive your
you should ask your doctor to write a new
medication from NextRx.
prescription for a 90-day supply for a one-
• Prior payment of your co-pay
year duration. For your convenience, mail
is required before NextRx will
ordered prescriptions can be refilled via the
ship your medications.
Internet at www.anthem.com (members
• NextRx Customer Service is
log-in). Prescriptions are then mailed right to
ready to assist: 800-962-8192
your home.
Non-Maintenance Drugs
If you need a prescription for a non-
maintenance drug, you can use a retail
pharmacy and receive a 30-day supply and
if needed one refill. You must show your
Anthem card when you pick up your
prescription.
13
Applied Choices
14. Prescription Drug
Prescription Plan Co-pays
What You Need
To Do About PPO-Standard, PPO-Elite, Indemnity
Prescription Drug Mail Order 90-day
Coverage Retail 30-day Supply Supply**
Generic $10 co-pay $20 co-pay
Formulary Brand $25 co-pay $50 co-pay
Nothing. Your prescription
drug plan is included with your Non-Formulary Brand $45 co-pay $90 co-pay
medical coverage.
PPO-Basic*
Mail Order 90-day
Retail 30-day Supply Supply**
PPO-Basic RX
Generic
Coverage Update $20 co-pay $40 co-pay
Formulary Brand $30 co-pay $60 co-pay
Non-Formulary Brand $45 co-pay $90 co-pay
The PPO-Basic prescription plan
*The maximum PPO-Basic benefit per year is $2,500 per person. Once Anthem NextRx has provided $2,500 in
annual maximum benefit will be
prescription coverage, no additional prescription benefits will be available for the remainder of the calendar year.
increased to $2,500.
**Mail Order – Must be used for all maintenance drugs used to treat chronic or long-term conditions.
Helpful Tip: How to Save on your Prescription Drug Costs
• Review with your doctor the drugs he/she • If you want to use brand name drugs, ask
has prescribed for you. Ask if a generic if your doctor thinks it is appropriate to
drug is available. If not, check the Anthem prescribe drugs that are on the Anthem
Formulary Drug List to see if a formulary Formulary Drug List. Using these formulary
brand drug can meet your needs. This brand drugs cost you less.
could decrease your costs.
14 Applied Choices
15. Your Dental Plan
Your Coverage Levels
CIGNA also offers
You can choose:
discount programs
• Associate Only,
to our dental
• Associate + 1,
participants that
• Associate + 2 or More, or
promote healthy
• No Coverage.
living.
Remember, you can elect dental, medical
and vision coverage separately. However,
if you elect more than one, the coverage
Information about these
level for each one you elect must be the
discount programs are listed on
same. For example, if your dental coverage
the Web site at www.cigna.com
is at the Associate Only level, then your
or you can get information by
medical and/or vision coverage must
calling 1-800-870-3470. These
also be at the Associate Only level.
special offers and savings are in
Dependent Children: Dependent children addition to the CIGNA Dental
are covered under the dental plan to age PPO plan. You and all of your
19, or to 25 if they are full-time students.
Your Dental Plan covered dependents are eligible.
You may be able to save
The dental claims administrator is
even more on things that can
CIGNA Dental. CIGNA’s Dental
help you feel better and stay
national network is one of the nation’s
healthy!
largest and includes more than 76,000
dentists. You can access the CIGNA
network of dentists at www.cigna.com.
When you visit the Web site, be sure
to click on “CIGNA Dental DPPO,”
and then click on “Core Network.”
Also available through CIGNA Dental is a
program referred to as Healthy Rewards,
which provides discounts on such services as
massage therapy, fitness club memberships,
tobacco cessation, weight management and
more. Visit the Web site at www.cigna.com
or call CIGNA at 1-800-870-3470 for
a list of discounts and benefits.
Terms to Know
• Network – a group of dentists affiliated • Co-insurance – the percentage you pay
with a dental plan. When you use a dentist when you receive care (for example, basic
who’s in the CIGNA network, your out-of- services).
pocket costs are lower and your benefit • Out-of-pocket cost – the amount you
level is higher. pay when you receive care.
• Out-of-network – dentists who are not • Annual maximum – the total amount the
part of the network. When you use a plan will pay per covered person, per year.
dentist who does not participate in the
CIGNA network, your out-of-pocket costs • uCR – usual customary and reasonable.
The prevailing amount allowed for a
are higher and your benefit level is lower.
service performed by a healthcare profes-
• Deductible –the amount you must pay sional.
first before the plan begins paying ex-
• PD – predetermination estimate.
penses for a service.
15
Applied Choices
16. Dental
Your Dental Plan At-a-Glance
What You Need to Here’s a look at the services and coverage under the dental plan:
Do On-Line
Dental
If you are keeping the same
benefits coverage (except FSAs) In-Network
for 2009, no action is required.
(CIgNA Dental Out-of-Network
You will be automatically
Core Network) (Subject to uCR)
re-enrolled in the dental plan
Deductible None $25 Individual/$75 Family
for 2009.
Annual Maximum $1,500 Per Covered Person $1,000 Per Covered Person
Confirmations will be mailed
mid-December confirming your Preventative Services/ 100% 100%
elections. Diagnostic
X-rays
Oral Examinations
Prophylaxis
Fluoride Treatment
CIGNA has Space Maintainers
Emergency Care
changed its dental
Basic Services 90% of the CIGNA Fee 80% After the Deductible
network’s name to
Fillings
the CIGNA Dental Oral Surgery
Core Network. Root Canal
Extractions
Major Services 60% of the CIGNA Fee 50% After the Deductible
To locate a CIGNA Dental Core
Complete or Partial Dentures
Network Provider:
Crowns
• Go to www.cigna.com Inlays
Onlays
• Click “Provider Directory” at
Fixed Bridges & Crowns
the top of the page
(when part of a bridge)
• Click “Dentist”
Orthodontia 50% of the CIGNA Fee 50% After the Deductible
• Enter search criteria (location,
Orthodontic Lifetime $1,000 Per Covered Person $750 Per Covered Person
name, etc.)
Maximum
• Select the CIGNA Dental
Temporal Mandibular 90% of the CIGNA Fee 80% After the Deductible
DPPO, and in the drop down
Joint Dysfunction (TMJ)
menu, select “Core Network”
Diagnosis surgery, in mouth
appliance therapy, non-surgical
treatment, and restoration and
construction, which alter the
jaw, jaw joints or bite
relationships.
TMJ Lifetime Maximum $1,500 Per Covered Person $1,000 Per Covered Person
Associate Monthly
Dental Contribution
Associate Only: $12
Associate +1: $16
Associate +2: $22
16 Applied Choices
17. Your Vision Plan
How the Plan Works
Highlights of Your
When you need vision care, VSP offers a
Vision Plan
choice of providers.
• In-Network Providers: The best value in
vision care lies with using a provider in
• The plan provides reduced
the VSP network. In doing so, your cost
costs for eye exams, glasses
is limited to the co-pays, unless you select
and contacts.
frames and/or lenses, which exceed the
• The plan features in-network
plan allowances.
and out-of-network options.
• Out-of-Network: VSP will still pay a
• Plan features discount
portion of your vision care expenses if
towards LASIK surgery.
you choose an ‘Out-of-Network’ provider.
However, reimbursement for these services
from VSP is limited to smaller, stated
dollar amounts for specific services.
Your Vision Plan
Vision Service Plan (VSP) insures our vision
plan. Nearly all your vision needs are covered
through this benefit.
VSP allows you to:
• use a provider in the VSP network and
receive a higher level of benefits; or
• use a provider who does not participate in
the VSP network and receive a lower level
of benefits.
Contact VSP member services at
1-800-877-7195 or check VSP’s Web site at
www.vsp.com for a list of providers in the
network. Click on “Members and Consum-
ers,” then “Find a Doctor.” Simply tell your
provider that you participate in VSP. The
plan does NOT issue ID cards.
Terms to Know
• In-Network – a group of vision care
providers affiliated with a vision plan.
When you use a provider who is in-
network, your out-of-pocket costs are
lower.
• Out-of-network – vision care providers
who are not part of the network. When
you use a provider who does not partici-
pate in the network, your out-of-pocket
costs are higher.
• Co-Pay – a fixed amount you pay
when you receive a specific service (for
example, an eye exam).
• Out-of-pocket cost – the amount you
pay when you receive vision services.
17
Applied Choices
18. Vision
Your Coverage Levels
What You Need to Remember, you can elect dental, medical and vision
Remember,separately. However, ifmedical and vision
coverage you can elect dental, you elect more than
You can choose:
Do On-Line coverage separately.level for eachyou elect more must be
one, the coverage However, if one you elect than one,
• Associate Only,
the coverage level for each youryou elect must beis at same.
the same. For example, if one dental coverage the the
• Associate + 1, For example, if your dental coverage is at the family level,
family level, then your medical and/or vision coverage
If you are keeping the same
then your medical and/or vision coverage must also be at
must also be at the family level.
• Associate + 2 or More, or
benefits coverage (except FSAs)
the family level.
• No Coverage.
for 2009, no action is required.
You will be automatically Dependent Children: Dependent children are covered under the vision plan to age 19, or to 25
re-enrolled in the vision plan if they are full-time students.
for 2009.
Your Vision Plan At-a-Glance
Confirmations will be mailed
mid-December confirming your Here’s a look at the services and coverage under the vision plan. Please refer to the enclosed
elections. VSP brochure for complete details of the Contact Care Program.
Vision
Out-of-Network
In-Network (Reimbursement Amount)
Eye Exam $10 co-pay $35
(one per calendar year)
Lenses $25 co-pay • Single: up to $25 / pair
(one per calendar year) • Bifocal: up to $40 / pair
• Trifocal: up to $55 / pair
Special Note:
• Lenticular: up to $80 / pair
Polycarbonate lenses for
children under 19 are
covered in full at an
in-network provider
Frames Up to $130 retail Up to $45 / pair
(one per calendar year)
or:
Soft Contact Lenses $120 benefit provides full None
Program coverage for the simple exam
current soft contact wearers: (fitting & evaluation) and
(one per calendar year)
contact lenses
Contact Lenses • Elective: up to $120 Elective: up to $105
1st time contact wearers, or current • 15% discount off the cost
wearers with special needs or materials,
of contact exam
evaluation fees and fitting costs
(fitting & evaluation)
(one per calendar year)
LASIk / PRk Discount is available None
Associate Monthly
Vision Contribution
Associate Only: $8
Associate +1: $12
Associate +2: $16
18 Applied Choices
19. Flexible Spending Accounts (FSAs)
Flexible Spending Accounts are an excellent
Highlights of Your
way to save money. Any money you
contribute to an FSA is deducted from your
Flexible Spending
gross income, before your Federal taxes,
Accounts
FICA, and state taxes are calculated.
Once you open an FSA, you can use your
contributions to reimburse yourself or an • The accounts – the healthcare
eligible dependent for: reimbursement account
• Healthcare Expenses and the dependent care
reimbursement account save
• Dependent Care Expenses
you money on eligible
You must open a separate FSA for each of expenses because your
these two expense categories. You cannot taxable income is reduced
combine both expense categories into one by the amount of money you
IRS Rules for FSAs
FSA. put aside in the account.
Both types of FSAs are discussed in further The IRS has established certain rules for • You decide how much you
detail below: FSAs, which must be followed: want to set aside for each
account (up to the annual
• FSAs do not automatically renew from one
How the FSA Process Works limits).
year to the next. You must enroll to create
• Determine what you believe your 2009 out- a new FSA for 2009, even if you had an • When you contribute to
of-pocket expenses will be for one of the FSA in 2008. an FSA, you decrease your
expense categories above. taxable income because
• If you do not use the entire amount you
the contributions are taken
• The on-line enrollment system allows contributed to your FSA, you must forfeit
before Federal, state and FICA
you to open an FSA account for the total any money remaining in your account.
taxes that are calculated.
amount you wish to contribute during However, you have until March 31, 2010 to
2009. submit expenses incurred in 2009. Helpful • FSA contributions are deducted
Hint: Carefully estimate your expenses for from every paycheck.
• During 2009, equal payroll deductions will
the coming year and do not set aside more
be taken from each paycheck until the total • Refer to the enclosed brochure
money than you are certain you will use.
amount is accumulated in your FSA. for additional information.
• If you open two FSAs, one for Healthcare
• As you incur out-of-pocket expenses
and one for Dependent Care, you cannot
during 2009, submit the receipts for eligible
transfer money between your two
expenses to the FSA administrator. You do
accounts.
not have to wait until the end of 2009 to
be reimbursed. You may submit expense • You cannot use a Dependent Care Account
receipts throughout the year. for healthcare expenses. Nor can you use
a Healthcare Account for dependent care
• The FSA administrator will send you a
expenses.
reimbursement check each month for the
eligible expenses you submitted. • Changes to both the healthcare and
dependent care can be made in the event of
• You have until March 31, 2010, to submit
an IRS approved qualifying event.
receipts for reimbursement for expenses
incurred during 2009.
Healthcare Reimbursement
• Minimum annual amount $100.
Accounts
You may set aside up to $3,600 each year for
eligible healthcare expenses, for yourself and
all eligible dependents, that are not covered
by any other healthcare plan. Further, if an-
other healthcare plan does not reimburse the
full amount of a medical expense (example:
the co-pay for an office visit), you may submit
this expense for reimbursement from your
FSA. You do not have to participate in the
health plan in order to participate in the FSA.
19
Applied Choices
