EUTF BENEFITS FOR ACTIVE EUTF EMPLOYEES Supplemental Medical
EUTF BENEFITS FOR ACTIVE EUTF EMPLOYEES Supplemental Medical & Prescription Drug Plan 2018 -2019 PLAN YEAR
2 EUTF SUPPLEMENTAL HEALTH PLAN PRESENTATION AGENDA • PLAN CHANGES • WHO IS ELIGIBLE? • PLAN ADVANTAGES • MEDICAL BENEFITS • PRESCRIPTION DRUG BENEFITS Beginning July 1 st, 2018, HMA will administer the EUTF Supplemental Medical & Prescription Drug Plan. HMA will provide all customer service and claims management for this plan. • REIMBURSEMENT INFORMATION • FILING A CLAIM • CONTACT HMA Please Note: All claims for services rendered prior to July 1 st, 2018 need to be submitted directly to the previous carrier, Royal State National.
3 EUTF SUPPLEMENTAL HEALTH PLAN ADDITIONAL CHANGES WHO’S ELIGIBLE? • Overall plan year maximum benefit of $2, 750 per participant which includes a $250 sublimit maximum for prescription drug copayments. • Chiropractic benefits are no longer covered. • Monthly employee contributions have been reduced. THE EUTF Supplemental Medical & Prescription Drug plan is available to active employees that have medical coverage under a separate non-EUTF sponsored plan. Retirees, HSTA VB members, Medicare and Med-Quest participants are not eligible for this plan. Please Note: If you are currently enrolled in the EUTF Supplemental Medical & Prescription Drug plan then you don’t need to do anything to remain enrolled for the next plan year starting July 1, 2018.
4 EUTF SUPPLEMENTAL HEALTH PLAN ADVANTAGES This supplemental plan is beneficial for any active employee who has access to medical and/or prescription drug insurance through a non-EUTF plan. This low-cost plan reimburses you for eligible out-ofpocket costs from your primary medical and prescription drug plan such as copayments and coinsurance. This supplemental plan leaves participants with minimal out-of-pocket costs for covered medical and prescription drug services.
5 EUTF SUPPLEMENTAL HEALTH PLAN PREVENTIVE SERVICES • Newborn and well-baby care • Immunizations • One routine office visit • Routine well-woman exam • Routine pap smear • Routine mammogram • Prostate screening • Colorectal Screening PHYSICIAN SERVICES MEDICAL BENEFITS OVERALL BENEFIT MAXIMUM: $2, 750 per participant per plan year Key Notes • Secondary Payer • Some Exclusions Apply • Office and hospital visits • Emergency room • Routine obstetrical services • Surgeon & assistant • Anesthesia • Physician Assistants & Nurse Midwives HOSPITAL & FACILITY SERVICES • Ambulatory surgical center • Emergency room • Outpatient hospital ancillary • Inpatient hospital room and board • Inpatient anesthesia • Skilled nursing facility • Birthing center TESTING & OTHER SERVICES • Allergy Testing • Ambulance • Appliances and braces • Behavioral health services • Cardiac Rehabilitation (short-term) • Chemotherapy & Radiation therapy • Diagnostic laboratory & pathology • Dialysis and related supplies • Durable medical equipment • Home therapies • Hospice care • Inhalation therapy • Injections • Physical therapy • Prosthetics • Speech therapy • Tissue and organ transplants
6 EUTF SUPPLEMENTAL HEALTH PLAN $20 Per Prescription (per 30 -day supply) PRESCRIPTION DRUG BENEFITS Key Notes • Secondary Payer • Some Exclusions Apply Prescription Drug Sublimit (per Plan Year) Per Participant: $250 The Prescription Drug sublimit is applied to the overall $2, 750 plan year benefit maximum.
7 EUTF SUPPLEMENTAL HEALTH PLAN REIMBURSEMENT INFORMATION Plan Reimburses Participants for: Eligible out-of-pocket copayments or After your primary non-EUTF medical plan pays their portion, this supplemental plan reimburses participants for eligible out-of-pocket expenses. coinsurance on medical, hospital, physician, surgical and prescription drug expenses. This plan excludes reimbursement of deductibles.
8 EUTF SUPPLEMENTAL HEALTH PLAN Process to file a claim: FILING A CLAIM Key Notes 1. Complete a Claim Form The Claim Form can be completed securely online at www. hma-hi. com/eutf. Forms can also be downloaded, • Copies of EOB’s and receipts are accepted completed and mailed or faxed directly to HMA. • All reimbursement payments are payable directly to the covered participant 2. Attach the primary health plans Explanation of Benefits (EOB) or copayment receipt. Be sure to attach a copy of the EOB or receipt(s) when completing the claim form online or submitting the claim form by mail or fax.
9 EUTF SUPPLEMENTAL HEALTH PLAN CONTACT HMA Hawaii Mainland Administrators 1440 Kapiolani Boulevard, Suite 1020 Honolulu, Hawaii 96814 HMA is proud to serve the EUTF Supplemental Medical & Prescription Drug Plan (Walk-in hours: Monday-Friday 7: 30 a. m. -5: 00 p. m. HST) Oahu: 951 -4643 Neighbor Islands: (866) 437 -1992 Fax: (808) 951 -4620 Plan information and other important documents for the EUTF Hours: Monday-Friday 7: 30 a. m. -7: 00 p. m. HST Saturday 9: 00 a. m. -1: 00 p. m. HST Supplemental Medical & Prescription Drug plan are available online at www. HMA-HI. com/EUTF
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