Wraps around low cost high deductible group major medical plans
Benefits Proposal for Kenton Iron Products
Effective Date: 05/01/2016
Broker: Kevin Kennedy Prepared by: Morgan White Group
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Premium Saver Plan Dharma Initiative
Current Plan Starmark
Deductible: $5,000 / Coinsurance: 20% to $1,600
Premium Saver Standard Life
Deductible: $3,500 / Coinsurance: 20% to $1,100 / Benefit: $2,000
Current MM Rates
Current PS Rates
Total w/PS
# on Plan
Total Monthly Premium
Employee
$394.01
$21.17
$415.18
11
$4,566.98
E + Spouse
$906.21
$41.78
$947.99
10
$9,479.90
E + Child
$0.00
$0.00
$0.00
0
$0.00
E + Child(ren)
$624.27
$36.81
$661.08
2
$1,322.16
Family
$1,136.47
$57.57
$1,194.04
13
$15,522.52
Total
$29,418.86
$1,472.70
36
$30,891.56
Renewal Plan Starmark Major Medical
Deductible: $5,000 / Coinsurance: 20% to $1,600
Premium Saver Standard Life
Deductible: $3,500 / Coinsurance: 20% to $1,100 / Benefit: $2,000
Renewal MM Rates
Renewal PS Rates
Total w/PS
# on Plan
Total Monthly Premium
Employee
$690.58
$21.17
$711.75
11
$7,829.25
E + Spouse
$1,588.30
$41.78
$1,630.08
10
$16,300.80
E + Child
$0.00
$0.00
$0.00
0
$0.00
E + Child(ren)
$1,081.01
$36.81
$1,117.82
2
$2,235.64
Family
$1,978.73
$57.57
$2,036.30
13
$26,471.90
Total
$51,364.89
$1,472.70
36
$52,837.59
Alternate Major Medical Plan lower cost high deductible plan by Anthem
Deductible: $5,000 / Coinsurance: 20% to $1,850
Premium Saver Standard Life
Deductible: $4,000 EE / $8,000 Family Coinsurance: 20% to $1,350 EE / $2,700
Family Benefit: $1,500 EE / $3,000 Family Office Copay: $30
Outpatient RX Benefit:
(see attached plan description)
Alternate MM Rates
Alternate PS Rates
Total w/PS
# on Plan
Total Monthly Premium
Employee
$576.96
$128.51
$705.47
11
$7,760.17
E + Spouse
$1,268.16
$260.21
$1,528.37
10
$15,283.70
E + Child
$0.00
$183.38
$183.38
0
$0.00
E + Child(ren)
$973.91
$241.02
$1,214.93
2
$2,429.86
Family
$1,781.08
$366.06
$2,147.14
13
$27,912.82
Total
$44,130.02
$9,256.53
36
$53,386.55
Total Monthly Savings
($548.96)
Total Annual Savings
($6,587.52)
Alternate major medical rates could be an estimate. Actual rates are based on the major medical carrier's actual quote.
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Premium Saver Plan Dharma Initiative
How this plan works
Supplemental Plan Deductible and Coinsurance
This plan has a deductible of $4,000 for employee only and $8,000 for family coverage. The family deductible can be met by one family member or a combination of family members, however there are no benefits until expenses equaling the family deductible have been incurred. After the deductible is met individuals with employee only coverage pay 20% coinsurance until they pay $1,350 coinsurance. Those with family coverage pay 20% until the family has paid $2,700 coinsurance. This plan wraps around your high deductible health plan and pays the amount applied to your major medical plan's Deductible, Coinsurance or Copayments until our payments reach the Maximum Benefit Amount.
Coverage
This plan covers all eligible expenses covered by your major medical plan.
Office Copay
After the insured person pays $30 copay per office visit for the professional fee of a primary care physician or specialist in a doctor's office or medical clinic, this plan will cover the balance in full up to 6 visits per person per benefit year. The supplemental plan deductible and coinsurance described above apply to all charges except professional fee of a primary care physician or specialist in a doctor's office or medical clinic.
Prescription Drug Benefit (see attached plan description)
Max Benefit Amount
$1,500 is the maximum benefit amount payable during a benefit year for individuals with employee only coverage. $3,000 is the maximum benefit amount payable during a benefit year for those with family coverage.
The Prescription Drug Benefit described on attached page has a separate benefit amount.
Monthly Rates* (12 Mo Rate Guarantee)
Employee
$128.51
E + Spouse
$260.21
E + Child
$183.38
E + Child(ren)
$241.02
Family
$366.06
* Monthly rates include a non-commissionable $3.00 administration fee for billing, and $1.00 association fee for prescription drugs.
Participation requirements: All persons covered by the group major medical or comprehensive health plan must be covered by the Premium Saver Plan except when the HSA is funded.
This is a brief description of coverage, see policy for complete details.
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Premium Saver Plan Dharma Initiative
Prescription Drug Benefits
The RxEDO pharmacy network includes over 67,000 total participating retail pharmacy locations nationwide; all major chains are included as well as 20,000+ independent pharmacies. RxEDO provides mail order services through Walgreens Mail Service. Visit Walgreens Mail Service at www.WalgreensHealth.com for more info and assistance.
Prescription Drug Benefit (Premier Plan)
$10/40/75 Co-Pay — Fully Insured Drug Plan
Generic: $10 co-pay for 30 day supply Preferred Brand: $40 co-pay for 30 day supply Non-Preferred Brand: $75 co-pay for 30 day supply.
Limited to 30 day supply at pharmacies. Annual Maximum Benefit: $6000
Helpful Hints
Please communicate to your pharmacist that you have secondary prescription insurance.
Show them your identification card. It includes the BIN and PCN numbers, as well as any other information they will need to process your claim through RxEDO.
If your pharmacy has any questions concerning the process, please have them call the RxEDO Pharmacy Help Desk at (800) 522-7487, which is printed on your new identification card.
For questions or drug look-up go to: www.rxedo.com or call 1-888-879-7336
Prescription benefits are administered by RxEDO, Inc. www.rxedo.com
Standard Life Insurance Company and RxEDO, Inc. are not affiliated.
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Premium Saver Plan Dharma Initiative
Prescription Drug Plan Exclusions
All over-the-counter products and medications, including, but not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements and all other over-the-counter products and medications.
Blood glucose meters; insulin injecting devices.
Depo-Provera; condoms, contraceptive sponges, and spermicides; sexual dysfunction drugs.
Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS injectables; immunizations; all other injectables unless shown in the definition of Prescription Drug.
All medical supplies and durable medical equipment unless shown in the definition of Prescription Drug. Liquid nutritional supplements; pediatric Legend Drug vitamins; prescribed versions of Vitamins A, D, K, B12,
Folic Acid and Niacin — used in treatment versus as a dietary supplement; all other Legend Drug vitamins and nutritional supplements.
Anorexiants; Any cosmetic drug including, but not limited to, Renova, skin pigmentation preps; Any drugs or products used for the treatment of baldness; Topical dental fluorides.
Refills in excess of that specified by the prescribing Doctor; or refills dispensed after one year from the original date of the prescription.
All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new FDA approved indication for a period of one year from such FDA approval for its intended indication.
Any drug labeled “Caution — limited by Federal Law for Investigational Use” or experimental drugs.
Any drug which the Food and Drug Administration has determined to be contraindicated for the specific treatment.
Drugs needed due to conditions caused, directly or indirectly, by a covered person taking part in a riot or other civil disorder; or the covered person taking part in the commission of a felony.
Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or an act of war; or drugs dispensed to a covered person while on active duty in any armed forces.
Any expenses related to the administration of any drug.
Drugs or medicines taken while in or administered by a hospital or any other health care facility or office.
Drugs covered under Worker’s Compensation, Medicare, Medicaid or other Governmental programs.
Drugs, medicines, or products, which are not Medically Necessary.
Smoking deterrents, Legend or over-the-counter drugs.
Replacement of stolen medication (except under circumstances approved by us), or lost, spilled, broken or dropped Prescription Drugs.
Vacation supplies of Prescriptions Drugs (except under circumstances approved by us).
Specialty Drugs
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Premium Saver Plan Dharma Initiative
Claims Payment
The Premium Saver Plan pays the benefits directly to the provider, upon assignment, which saves the insured time and it is the quickest way to get payment to the providers.
Claims Submission (two methods)
Please note: Always give your Premium Saver insurance card to the provider.
A. The Medical Provider files the claim.
This is the most efficient method to submit a claim.
Electronic Claims Submission
Claims can be filed electronically by the provider. This eliminates paperwork and helps expedite the payment of your claim to the provider. MWG Administrators has partnered with some of the largest claims clearinghouses in the nation.
Email, Mail or Fax Claims Submission
Providers can email, mail or fax your claim information to us if they are not contracted with our clearinghouses. We will be glad to contact providers that want to contract with our clearinghouses.
B. The Insured will file the claim.
If the insured files the claim, they need to submit the two forms described below:
Major Medical EOB
The Explanation of Benefits is a form provided by your major medical carrier that describes the procedures covered, facility used, benefit paid and the amount applied to the insured's deductible or coinsurance.
Hospital form UB04 or Doctor form CMS 1500
These forms describe the procedures codes, provides us with the address and the provider's federal identification number so we can pay the claim for you.
Contact Us
MWG Administrators
Attn: Claims Department
P.O. Box 16708
Jackson, MS 39236
Phone: (888) 888-2519 Fax: (601) 956-1147 Email:claims@morganwhite.comAdministrative Office
5722 I-55 North Frontage Road
Jackson, Mississippi 39211 Phone: 800-800-1397 or 601-956-2028
