1570 Midway Pl. Menasha, WI 54952 ASSURE … · 1570 Midway Pl. Menasha, WI 54952 ... see if the...

1570 Midway Pl.Menasha, WI 54952800-276-8004networkhealth.com/assure

Self-insured plans administered by Network Health Administrative Services, LLC.

c-sls-assurepbro-1017SAL-293-02-1017

Available to employers with 2-100 enrolled employees

ASSURE Level-Funded PlansEnjoy the best of both worlds—the security of a fully insured plan with the advantages of a self-funded plan

What is level-funding? ........................................................................................................................2

How does Assure work? ......................................................................................................................2

What companies qualify to purchase Assure? ..................................................................................3

What are the advantages of Assure? ................................................................................................3

Who’s who? .........................................................................................................................................4

Why choose Network Health? ............................................................................................................5

Practical example ................................................................................................................................6

What’s the provider network for Assure? ..........................................................................................8

Pharmacy benefits and online tools ..................................................................................................8

Health management services ............................................................................................................9

Empower wellness program ............................................................................................................ 10

Network Health’s Nurse Line........................................................................................................... 10

Assure plan benefit designs ............................................................................................................ 11

Looking for more?Contact your agent, broker or consultant to see if the Assure plan is right for your business and to get a quote. Visit networkhealth.com/assure for more details or you can call our sales team at 800-276-8004.

Providing a comprehensive health plan for your employees at a cost-effective rate can be a challenge. Network Health is making it easier for employers by offering a new hybrid product that combines the best features of a fully insured and self-funded plan.

Our Assure level-funded product includes all the features of our fully insured plans, like health management, a wellness program, network discounts and online tools. By self-funding the plan, we are able to offer benefit designs comparable to your current plan while avoiding many costly mandates of an ACA plan.

In this book you will find ...

1

800-276-8004 networkhealth.com/assure

WHAT IS LEVEL-FUNDING?Level-funding is a cost-effective health plan funding solution that allows companies to benefit from predictable, set monthly rates similar to a fully insured plan.

Instead of monthly premiums, your company will be responsible for a specified level of claim liability. This means, each month you will fund this maximum claim liability, thereby eliminating the normal volatility of self-funding. If your company’s claims are less than the amount you’ve funded at the end of the year, you get 50 percent of the funding surplus. Payments are calculated after the 24-month claim liability period has expired (12 months after the end of the policy year).

If your claims go over the funded amount, your company is protected by stop-loss coverage. This limits the risk your company is exposed to and protects you from catastrophic claims. An advance funding feature allows the payment of claims, even when your funding level is less than claim payments. This feature ensures that you’ll never pay more than your maximum claim funding amount for any month of the year.

HOW DOES ASSURE WORK?Your company funds the account for your Assure plan, while Network Health Administrative Services, LLC, administers the plan.

Your monthly funding will consist of the following. •Administrative fee •Stop-loss premium •Claims funding

This funding amount will only vary based upon the number of employees and/or dependents covered by the plan. Assure is a bundled product that includes the features of a fully insured health plan but with the opportunity to get some money back.

WHAT COMPANIES QUALIFY TO PURCHASE ASSURE?To qualify to purchase our Assure product, your company must have 2-100 enrolled employees with at least 80 percent of employees located in Network Health’s service area.

Assure is an excellent choice for employers looking for an alternative to ACA-compliant health plans.

WHAT ARE THE ADVANTAGES OF ASSURE? u Enjoy the opportunity to earn back 50 percent of surplus claim funds at the end of your policy yearu Your employees can earn rewards for healthy choices with our Empower wellness program—employees can earn up to $225 in rewardsu Eliminate the financial risk and funding fluctuations that you may see in a traditional self-funded planu Save on health care costs and put more resources back into your business u Experience a bundled product like a fully insured plan, while enjoying the financial advantages of a self-funded plan

Claims funding is variable and it can change based on the health care needs of the group.

LEVEL-FUNDED

Potential to get 50 percent of unused claims funds back

Stop-lossAdministrative fee

Claims funding

FULLY INSURED

Expected claims and

administrative fee

TRADITIONALSELF-FUNDED

Stop-loss

Administrative fee

Claimsfunding

?

?

ACA-compliant health plans ACA-compliant health plans are individual or small group plans that include the required Essential Health Benefits and are labeled by metal level (Bronze, Silver, Gold and Platinum).

Stop-loss This is protection for claims that exceed the agreed upon claims funding.

networkhealth.com/assure 800-276-80042 3

WHY CHOOSE NETWORK HEALTH?We live and work in Wisconsin, which means no one from across the country answers calls or tells us how to manage our plans. We do it all in Wisconsin, from handling claims, billing and enrollment to working one-on-one with customers like you.

We keep things running smoothlyWe deliver quick and accurate plan administration and our customer service rates higher than Wisconsin and national averages in several areas.

We speak in plain language We know health insurance can be confusing and intimidating. That’s why we’ve made a pledge to end the health insurance jargon. We give you straight answers that are easy to understand.

We understand the importance of quality health careCo-owned by Froedtert Health and Ministry Health Care, a part of Ascension, we’re able to offer access to a large network of high-quality providers. Across 23 Wisconsin counties, we’ve negotiated deep discounts for the benefit of our customers.

Focused on the individualOur Assure plan gives employees access to nurse care managers to manage health conditions. We believe in partnering with individuals for better health.

WHO’S WHO?Plan Sponsor - Employer and stop-loss policy holderPlan Participant - EmployeeStop-Loss Insurance Carrier - Network Health Insurance Corporation (NHIC) Third Party Administrator (TPA) - Network Health Administrative Services, LLC (NHAS)

NHAS administers everything for your plan on your behalf, including the following.u Paying claims and maintaining proper funds on deposit for claims paymentu Preparing claims reports or other data necessary for the plan and/or the stop-loss insurer (NHIC)u Providing plan information for filing government required reportsu Billing and collecting administrative fees and stop-loss premium for the planu Handling appealsu NHAS prepares the plan document on behalf of the plan sponsor/employeru NHAS will secure stop-loss coverage through NHIC. There is an integrated approach between NHAS, the administrator and NHIC (the stop-loss carrier).u COBRA Administration services provided by Employee Benefits Corporation

networkhealth.com/assure 800-276-8004 800-276-8004 networkhealth.com/assure 54

Pie in the Sky Pizzeria is a family-owned and operated pizza restaurant with multiple locations in northeast Wisconsin and has become a favorite among locals and tourists. Since the company’s opening in 2011, Pie in the Sky Pizzeria has grown from ten to 30 full-time employees. Tony, the owner, is currently offering a health plan to his employees that’s compliant with the Affordable Care Act. Because the costs are really cutting into his bottom line, he decided to start searching for an alternative health plan.

Pie in the Sky Pizzeria has a total of 20 full-time employees and 25 dependents participating in the health plan. All of the employees live in Winnebago, Outagamie and Waupaca counties.

Let’s take a look at how the Network Health Assure plan works and why it’s a perfect fit for Tony and his employees.

BE

ST

CA

SE Annual claims funding ......... $33,190.32

Annual medical claims total ........................... $20,000.32

Annual claims difference ...........$13,190

Pie in the Sky Pizzeria’s 50 percent refund ...........$6,595Network Health Administrative Services (TPA) issues the refund.

WO

RST

CAS

E Annual claims funding ......... $33,190.32

Annual medical claims total ........................... $42,000.32

Annual claimsdifference ...................... -$8,810Stop-loss insurance covers the claims difference. Pie in the Sky Pizzeria does not have to pay the difference.

Joseph is an employee at Pie in the Sky Pizzeria and is a participant of the Assure plan. This year he incurred $13,000 in claims due to his cardiac disease. The graphic below shows how this affects Pie in the Sky Pizzeria’s annual claimsfunding.

$13,000 claims for

cardiac disease

$10,000 specific

deductibleper employee

$3,000 balance

covered by stop-loss

PIE

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PRACTICAL EXAMPLE


800-276-8004 networkhealth.com/assure

HEALTH MANAGEMENT SERVICESComplex Case ManagementWe offer case management services to help people with high-risk conditions. We’re able to identify candidates through claims, health assessment data and doctor and self-referrals. Our experienced nurse case managers work with people to develop customized care plans and help them navigate the health care world. Case managers can help with the following.u Coordinate care with providersu Explain medical instructionsu Provide guidance on care and how to avoid problemsu Make follow-up calls so customers know exactly what to do, who to see and where to go to get the treatment they needu Assist with access to careu Inform people about signs indicating their condition is worsening, so they know when to call the doctor

Condition ManagementNetwork Health’s condition management programs empower people with health conditions to take charge of their health and better manage symptoms. Our team of registered nurses provide health coaching, education and other resources to help. Here is what they do.u Help identify health goals and find tools to achieve themu Find educational self-management workshops and community events to teach skills needed to manage a conditionu Promote healthy lifestyle behaviors such as exercise and eating rightu Provide resources on how to manage symptomsu Support communication with doctors

We offer condition management programs for these conditions.u Chronic obstructive pulmonary disease (COPD)u Asthmau Diabetesu Heart failureu Heart disease

WHAT’S THE PROVIDER NETWORK FOR ASSURE?To search for specific providers in each network, use our Find a Doctor search at networkhealth.com. Under Choose a Plan, select 2018 HMO/POS/EPO (I get coverage through my employer).

PHARMACY BENEFITS AND ONLINE TOOLSThrough our partnership with CVS/caremark™, you’ll have access to an extensive pharmacy network, so your employees will have the convenience of a pharmacy near their home or work. CVS/caremark works to provide innovative and accessible prescription benefits while keeping costs low. The pharmacy network for Assure includes the following pharmacies.

u CVS

u Costco

u Shopko

u Walmart

u Other independent pharmacies and clinical locations are also available, along with a prescription drug mail-order program.

Here are some of the online tools that are included.u Mobile app to check on or refill prescriptions on-the-gou Search tool to get directions and maps to pharmaciesu Ask-a-pharmacist messaging to get confidential and reliable answers to prescription drug questions

CVS/caremark’s customer service center is also open 24 hours a day, seven days a week to answer questions about prescription drug coverage.

Our nurses are even known to go as far as to visit customers in the hospital. It’s that kind of personal attention that sets Network Health apart.

I love feeling like I’m actually making a difference. Yvonne Morrow, RN, oncology care manager at Network Health

““


EMPOWER WELLNESS PROGRAMEmpower is an innovative program that encourages participants and their covered spouses to make healthy decisions. Empower rewards participants for meeting health and fitness goals, and gives them access to the tools they need to support their goals.

Participants earn points with cash value up to $225 redeemable toward a variety of rewards.

Another perk of the Empower program is that participants also receive a free Fitbit™ pedometer to help monitor activity.

NETWORK HEALTH’S NURSE LINEThe Network Health Nurse Line is available 24 hours a day, seven days a week, 365 days a year. It’s there for those need-it-right-now situations and it’s a great resource for any of the following.u Symptoms like a sore throat, muscle pain or feveru Help figuring out where to go for care if it’s not an emergencyu Advice or additional information on general health issuesu Questions, information or instructions for current medications or newly prescribed ones

To access the Network Health Nurse Line call 888-879-8960.

Everyone who registers online in My Account can request a FREEpedometer (a $59 value). Go to My Account and register. Select Empower, click on Order Pedometer & Allow Access. Participants can also upgrade to a different Fitbit device.(One pedometer per lifetime.)

Empower A GREAT INCENTIVE FOR HEALTHY LIVING

Welcome to

Empower

Participate in Empower and complete

activities in five healthy rewards

categories to EARN UP TO $225

in valuable rewards per year.

Empower is an innovative program that

encourages Network Health participants

and their covered spouses to make

healthy decisions. Empower REWARDS

participants for meeting health and

fitness goals, and gives them access to

the TOOLS they need to support their

goals. Participants earn points with cash

value to use toward a variety of rewards,

all while making a commitment to a

healthier life. GET STARTED today.

HMO plans underwritten by Network Health Plan. POS plans underwritten by

Network Health Insurance Corporation, or Network Health Insurance Corporation

and Network Health Plan. Self-insured plans administered by Network Health

Administrative Services, LLC. c-hpr-asrempbro-1017 SAL-150-06-10/17

For more information contact:

Network Health

1570 Midway Pl.

Menasha, WI 54952

855-212-5327

networkhealth.com

ASSUREPLANBENEFITDESIGNS


9 800-276-8004 networkhealth.com/assure

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D = Deductible Only D/C = Deductible and Coinsurance

These summaries are only intended to highlight and give a general description of some of the benefits available. For a complete description of benefits, limitations and exclusions, please refer to the Summary of Participant Responsibility Tables.

PLAN # PLAN NAME

Deductible CoinsuranceOut-of-Pocket

Maximum Office Visit CopaymentEmergency

Room Urgent CareMDLIVE®

Virtual VisitsSingle FamilyWhat

Participants Pay Single Family PCP SpecialistAE5 LF_E1000 CO-

CHOICE_20 $1,000 $2,000 20% $3,000 $6,000

$30 per visit $60 per visit $250 per visit $150 per visit $10 per visit

AE6 LF_E1500 CO-CHOICE_20 $1,500 $3,000 20% $3,500 $7,000

AE7 LF_E2000 CO-CHOICE_20 $2,000 $4,000 20% $4,000 $8,000

AE8 LF_E2500 CO-CHOICE_20 $2,500 $5,000 20% $4,500 $9,000

AE9 LF_E3000 CO-CHOICE_20 $3,000 $6,000 20% $5,000 $10,000

AE10 LF_E4000 CO-CHOICE_20 $4,000 $8,000 20% $6,000 $12,000

AE11 LF_E5000 CO-CHOICE_20 $5,000 $10,000 20% $6,850 $13,700

Standard Pharmacy Benefits All plans with 20% coinsurance

Retail30-day supply

Generics $20 per prescription or refillPreferred brand drugs $40 per prescription or refill Non-preferred prescription drugs $60 per prescription or refill Preferred specialty drugs 25% after deductibleNon-preferred specialty drugs 40% after deductible

Mail order90-day supply

Generics $55 per prescription or refill mail orderPreferred brand drugs $105 per prescription or refill mail orderNon-preferred prescription drugs $180 per prescription or refill mail orderPreferred specialty drugs No mail orderNon-preferred specialty drugs No mail order

Buy-Up Pharmacy Benefits All plans with 20% coinsurance

Retail30-day supply

Generics $10 per prescription or refill

Preferred brand drugs $25 per prescription or refill

Non-preferred prescription drugs $50 per prescription or refill

Preferred specialty drugs 25% after deductibleNon-preferred specialty drugs 40% after deductible


Generics $25 per prescription or refill mail orderPreferred brand drugs $60 per prescription or refill mail order

Non-preferred prescription drugs $150 per prescription or refill mail orderPreferred specialty drugs No mail order

Non-preferred specialty drugs No mail order

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EP

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Standard Pharmacy BenefitsAll plans with 0% coinsurance All plans with 20% coinsurance

Retail30-day supply

Generics Deductible $20 per prescription or refill after deductiblePreferred brand drugs Deductible $40 per prescription or refill after deductibleNon-preferred prescription drugs Deductible $60 per prescription or refill after deductiblePreferred specialty drugs Deductible 25% after deductibleNon-preferred specialty drugs Deductible 40% after deductible


Generics Deductible $55 prescription or refill mail order after deductiblePreferred brand drugs Deductible $105 prescription or refill mail order after deductibleNon-preferred prescription drugs Deductible $180 prescription or refill mail order after deductiblePreferred specialty drugs No mail order No mail orderNon-preferred specialty drugs No mail order No mail order

Buy-Up Pharmacy Benefits

All plans with 0% coinsurance All plans with 20% coinsurance

Retail30-day supply

Generics Deductible $10 per prescription or refill after deductiblePreferred brand drugs Deductible $25 per prescription or refill after deductibleNon-preferred prescription drugs Deductible $50 per prescription or refill after deductiblePreferred specialty drugs Deductible 25% after deductibleNon-preferred specialty drugs Deductible 40% after deductible


Generics Deductible $25 per prescription or refill mail order after deductiblePreferred brand drugs Deductible $60 per prescription or refill mail order after deductible

Non-preferred prescription drugs Deductible $150 per prescription or refill mail order after deductiblePreferred specialty drugs No mail order No mail orderNon-preferred specialty drugs No mail order No mail order

PLAN # PLAN NAME

Deductible CoinsuranceOut-of-Pocket

Maximum Office Visit Emergency

Room Urgent Care

MDLIVE@

Virtual VisitsSingle Family What Participants Pay Single Family PCP Specialist

AEH1 LF_HSAE1500_0 $1,500 $3,000 0% $1,500 $3,000 D D D D D

AEH2 LF_HSAE1500_20 $1,500 $3,000 20% $2,000 $4,000 D/C D/C D/C D/C D/C

AEH3 LF_HSAE2000_0 $2,000 $4,000 0% $2,000 $4,000 D D D D D


AEH5 LF_HSAE2500_0 $2,500 $5,000 0% $2,500 $5,000 D D D D D


AEH7 LF_HSAE3000_0 $3,000 $6,000 0% $3,000 $6,000 D D D D D


AEH9 LF_HSAE3500_0 $3,500 $7,000 0% $3,500 $7,000 D D D D D


AEH11 LF_HSAE4000_0 $4,000 $8,000 0% $4,000 $8,000 D D D D D


AEH13 LF_HSAE5000_0 $5,000 $10,000 0% $5,000 $10,000 D D D D D

AEH14 LF_HSAE5000_20 $5,000 $10,000 20% $6,550 $13,100 D/C D/C D/C D/C D/CAEH15 LF_HSAE6500_0 $6,500 $13,000 0% $6,500 $13,000 D D D D D


9

Emergency/Urgent Care

PO

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In-Network Out-of-NetworkEmergency Room $250 per visit $250 per visitUrgent Care $150 per visit 40% after deductible

POS NON

-HSA PH

ARM

ACYStandard Pharmacy Benefits

All plans with 20% coinsurance

In-Network Out-of-Network

Retail30-day supply

Generics $20 per prescription or refill Not CoveredPreferred brand drugs $40 per prescription or refill Not CoveredNon-preferred prescription drugs $60 per prescription or refill Not Covered

Preferred specialty drugs 25% after deductible Not Covered

Non-preferred specialty drugs 40% after deductible Not Covered


Generics $55 per prescription or refill mail order Not CoveredPreferred brand drugs $105 per prescription or refill mail order Not CoveredNon-preferred drugs $180 per prescription or refill mail order Not CoveredPreferred specialty drugs No mail order Not CoveredNon-preferred specialty drugs No mail order Not Covered


All plans with 20% coinsurance

In-Network Out-of-Network

Retail30-day supply

Generics $10 per prescription or refill Not CoveredPreferred brand drugs $25 per prescription or refill Not CoveredNon-preferred prescription drugs $50 per prescription or refill Not Covered

Preferred specialty drugs 25% after deductible Not Covered

Non-preferred specialty drugs 40% after deductible Not Covered


Generics $25 per prescription or refill mail order Not CoveredPreferred brand drugs $60 per prescription or refill mail order Not CoveredNon-preferred prescription drugs $150 per prescription or refill mail order Not CoveredPreferred specialty drugs No mail order Not CoveredNon-preferred specialty drugs No mail order Not Covered

$10 per visit for all POS Non-HSA Plan. Benefits only available through the Network Health virtual visit provider network.

MDLIVE® Virtual Visits

PLAN # PLAN NAME

Deductible Coinsurance Out-of-Pocket Maximum Office Visit

In-Network Out-of-Network In-NetworkOut-of-

Network In-Network Out-of-Network In-NetworkOut-of-

Network In-NetworkOut-of-

Network

Single Family Single Family What Participants Pay Single Family Single Family PCP SpecialistAP5 LF_P1000

COCHOICE_20 $1,000 $2,000 $2,000 $4,000 20% 40% $3 ,000 $6,000 $6,000 $12,000

$30 pervisit

D/C

$60 per visit

D/C

AP6 LF_P1500 COCHOICE_20 $1,500 $3 ,000 $3 ,000 $6,000 20% 40% $3,500 $7,000 $7,000 $14,000 D/C D/C

AP7 LF_P2000 COCHOICE_20 $2,000 $4,000 $4,000 $8,000 20% 40% $4,000 $8,000 $8,000 $16,000 D/C D/C





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PO

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SA

PLA

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Emergency/Urgent Care

PLAN # PLAN NAME

Deductible Coinsurance Out-of-Pocket Maximum Office Visit

In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Single Family Single Family What Participants Pay Single Family Single Family PCP Specialist PCP SpecialistAHP1 LF_HSAP1500_0 $1,500 $3,000 $2,500 $5,000 0% 20% $1,500 $3,000 $4,000 $8,000 D D D/C D/CAHP2 LF_HSAP1500_20 $1,500 $3,000 $3,000 $6,000 20% 40% $2,000 $4,000 $6,000 $12,000 D/C D/C D/C D/CAHP3 LF_HSAP2000_0 $2,000 $4,000 $3,000 $6,000 0% 20% $2,000 $4,000 $5,000 $10,000 D D D/C D/CAHP4 LF_HSAP2000_20 $2,000 $4,000 $4,000 $8,000 20% 40% $2,500 $5,000 $7,000 $14,000 D/C D/C D/C D/CAHP5 LF_HSAP2500_0 $2,500 $5,000 $3,500 $7,000 0% 20% $2,500 $5,000 $6,000 $12,000 D D D/C D/CAHP6 LF_HSAP2500_20 $2,500 $5,000 $5,000 $10,000 20% 40% $3,000 $6,000 $8,000 $16,000 D/C D/C D/C D/CAHP7 LF_HSAP3000_0 $3,000 $6,000 $4,000 $8,000 0% 20% $3,000 $6,000 $8,000 $16,000 D D D/C D/CAHP8 LF_HSAP3000_20 $3,000 $6,000 $6,000 $12,000 20% 40% $5,000 $10,000 $9,000 $18,000 D/C D/C D/C D/CAHP9 LF_HSAP3500_0 $3,500 $7,000 $4,500 $9,000 0% 20% $3,500 $7,000 $9,000 $18,000 D D D/C D/CAHP10 LF_HSAP3500_20 $3,500 $7,000 $7,000 $14,000 20% 40% $5,500 $11,000 $11,000 $22,000 D/C D/C D/C D/CAHP11 LF_HSAP4000_0 $4,000 $8,000 $5,000 $10,000 0% 20% $4,000 $8,000 $10,000 $20,000 D D D/C D/CAHP12 LF_HSAP4000_20 $4,000 $8,000 $8,000 $16,000 20% 40% $6,000 $12,000 $12,000 $24,000 D/C D/C D/C D/CAHP13 LF_HSAP5000_0 $5,000 $10,000 $6,000 $12,000 0% 20% $5,000 $10,000 $13,100 $26,200 D D D/C D/CAHP14 LF_HSAP5000_20 $5,000 $10,000 $9,000 $18,000 20% 40% $6,550 $13,100 $13,000 $26,000 D/C D/C D/C D/C

AHP15 LF_HSAP6500_0 $6,500 $13,000 $7,500 $15,000 0% 20% $6,500 $13,000 $14,000 $28,000 D D D/C D/C

0% Coinsurance 20% Coinsurance

In-Network Out-of-Network In-Network Out-of-Network

Emergency Room Deductible Deductible/Coinsurance

Urgent Care D D/C D/C D/C

PO

S H

SA

PH

AR

MA

CY

Standard Pharmacy BenefitsAll plans with 0% coinsurance All plans with 20% coinsurance


Retail30-day supply

Generics Deductible Not Covered $20 per prescription or refill after deductible Not CoveredPreferred brand drugs Deductible Not Covered $40 per prescription or refill after deductible Not CoveredNon-preferred prescription drugs Deductible Not Covered $60 per prescription or refill after deductible Not CoveredPreferred specialty drugs Deductible Not Covered 25% after deductible Not CoveredNon-preferred specialty drugs Deductible Not Covered 40% after deductible Not Covered


Generics Deductible Not Covered $55 per prescription or refill mail order after deductible Not CoveredPreferred brand drugs Deductible Not Covered $105 per prescription or refill mail order after deductible Not CoveredNon-preferred prescription drugs Deductible Not Covered $180 per prescription or refill mail order after deductible Not CoveredPreferred specialty drugs No mail order Not Covered No mail order Not CoveredNon-preferred specialty drugs No mail order Not Covered No mail order Not Covered


All plans with 0% coinsurance All plans with 20% coinsurance


Retail30-day supply

Generics Deductible Not Covered $10 per prescription or refill after deductible Not CoveredPreferred brand drugs Deductible Not Covered $25 per prescription or refill after deductible Not CoveredNon-preferred prescription drugs Deductible Not Covered $50 per prescription or refill after deductible Not CoveredPreferred specialty drugs Deductible Not Covered 25% after deductible Not CoveredNon-preferred specialty drugs Deductible Not Covered 40% after deductible Not Covered


Generics Deductible Not Covered $25 per prescription or refill mail order after deductible Not CoveredPreferred brand drugs Deductible Not Covered $60 per prescription or refill mail order after deductible Not CoveredNon-preferred prescription drugs Deductible Not Covered $150 per prescription or refill mail order after deductible Not CoveredPreferred specialty drugs No mail order Not Covered No mail order Not CoveredNon-preferred specialty drugs No mail order Not Covered No mail order Not Covered

Subject to deductible and coinsurance

(Example: Sue has an online visit with an MDLIVE doctor. The cost is $40. She has already met her deductible. The $40 is now subject to the coinsurance of her plan. If Sue had not yet met her deductible, she would pay $40 for the virtual visit and it would be applied toward her deductible.)

MDLIVE® Virtual Visits

800-276-8004 networkhealth.com/assure 1918

Looking for more?Contact your agent, broker or consultant to see if the Assure plan is right for your business and to get a quote. Visit networkhealth.com/assure for more details or you can also reach our sales team at 800-276-8004.

1570 Midway Pl.Menasha, WI 54952800-276-8004networkhealth.com/assure

Self-insured plans administered by Network Health Administrative Services, LLC.

c-sls-assurepbro-1017SAL-293-02-1017

Available to employers with 2-100 enrolled employees

ASSURE Level-Funded PlansEnjoy the best of both worlds—the security of a fully insured plan with the advantages of a self-funded plan

1570 Midway Pl. Menasha, WI 54952 ASSURE … · 1570 Midway Pl. Menasha, WI 54952 ... see if the...

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