2020 Health Plans and Benefits - Home | HealthSource RI

2020 Health Plans and Benefitsfor small businesses

1-855-683-6757HSRIforEmployers.com

When to enroll:• Atyourrenewaldateorthe1stofanymonth• Importantdeadlinestorememberforthemonthpriortoyourcoveragestartdate:oBy the 12th:finalizeyourcoverageoptionsoBy the 17th:employeespicktheirplansoBy the 23rd:makeyourfirstpayment

Call for a free quote today• Tofindabrokerorforinformationonenrolling,visitHealthSourceRI.com/Employers• CallourBusiness Engagement Teamat1-855-683-6757

Exclusive options from HealthSource RI for Employers

Full Choice:• Youremployeespickanyplanfrommultiplehealthinsurancecompanies• Yousticktoyourbudgetusingouruniquedefinedcontributionoption

• Tiercontributionsbyemployeegroupstocustomizeyourbenefitsplanlikeneverbefore• Greatcost-effectiveoptionstoincentivizeemployees

Tiered benefits:

Personalizeyourcomprehensivebenefitspackagewithexciting new productsincluding:• Vision• Life• MedicalBridge• Pet• Telehealth

More than just health insurance:

Staycompetitivebyofferingadditionalproductstypicallyfoundonlyatlargercompanies.Notsurewheretostart?We’llhelpyoudesigntheperfectbenefitspackagebasedonyourneeds.

Rates as of November 1, 2019.Thisisapartialsummaryofbenefitsandcoverageandshouldnotbeconsideredacontract.Thisinformation,includingallquotedrates,shouldbeusedforinformationalpurposesonly.Changesmaybemadetothebenefitsandcoveragepoliciesdescribedhere.YoushouldonlyrelyupontheEvidenceofCoveragedocumentprovidedtoyoufromyourhealthinsurancecompanyforinformationaboutcoveredbenefits,limitationsandexclusions.

The following case study illustrates how Full Choice works:

Ask your broker about HealthSource RI for Employers!

Joe writes a single check to HealthSource RI for Employers, and his employees can call our Business Engagement Team if they have questions or need support.

Joe owns a manufacturing company in Providence. He selects a plan that costs $500/month per individual. He decides to contribute $325/month toward the individual premium.

Joe’s employees can either pick the health insurance plan he selected or choose another plan, using Joe’s $325 contribution to help pay the monthly premium. If the plan they select is more expensive, the employees pay more out of their paychecks. If the plan is less expensive, the employees pay less.

Full Choice

Employer sets budget

Solutions that work

2020 Small Group Market Plan Benefits BCBSRI: Blue Cross & Blue Shield of Rhode IslandNHPRI: Neighborhood Health Plan of Rhode Island

BASIC PLAN INFORMATIONHEALTHSAVINGSACCOUNTS(HSAs):AHealthSavingsAccount-qualifiedplanallowsyoutocontributetoaseparatetax-exemptaccountwhichcanbeusedforhealthcareexpenseslikedeductiblesandcopayments.

HOW YOU GET YOUR CARESomeinsurersofferplansthatincludeasmallernumberofprovidersthattheinsurershavedecidedofferhigh-qualitycareatalowercost.Planshavedifferentmonthlypremiumsandout-of-pocketcostsforcare,aswellasdifferentproviders(likedoctorsandhospitals)youcanvisit.Theprovidersincludedinaplan’snetwork—andhowthoseprovidersarepaidforthecaretheygiveyou—helpsdeterminehowmuchyouwillpayforyourhealthinsuranceplan.Someplansassignlevels(“tiers”)todoctorsandhospitalswithintheirnetworks,andyoumaypaylesstoseeprovidersincertaintiers.

Whenchoosingaplan,youshouldconsiderthemonthlypremium,aswellasanyout-of-pocketcosts,providersyouprefertovisit,prescriptiondrugsyoutake,andanyotherhealthcareneedsyouhave.Allplanscoverpreventivehealthcareservicesatnocost.

MAXIMUM OUT-OF-POCKET

Inadditiontoyourmonthlypremium,themaximum out-of-pocketamountisthemostyoucouldhavetopayindeductibles,copaymentsandcoinsuranceduringtheplanyear.

DEDUCTIBLES

Thedeductibleistheamountyoumustpayout-of-pocketforcertainhealthcareservicesbeforeyourinsuranceplanbeginstopay.Thedeductibleamountisinadditiontoyourmonthlypremium.Servicessubjecttothedeductiblevarybyplanandmayincludedoctorvisitsandhospitalsstays,aswellasprescriptionmedications.

COPAYMENTS & COINSURANCE

Copaymentsarefixeddollaramountsthatyoumustpayforcertaintypesofhealthcareserviceseachtimeyouusethem.

Coinsuranceisapercentageofthetotalcostofcertaintypesofhealthcareservicesthatyoumustpay.Coinsuranceusuallyappliesafteryoumeetyourdeductible.

APatient-Centered Medical Home (PCMH)isateamofhealthcareprovidersthatworktogethertocoordinateyourcare.VisitingaPCMHprovidermaycostlessincertainplans.**Specialistcopaysmaybedifferentforcertainspecialistssuchaschiropractor,acupuncture,andvision,pleasecheckwithyourinsurancecompany.

PRESCRIPTION DRUGSInsurancecompaniesseparateprescriptiondrugsintodifferentcategoriesknownas“tiers.”

The“tier”ofthedrugidentifieshowmuchyoupayforyourprescription,likeantibioticsorinsulin.ContactHealthSourceRIformoreinformationaboutmedicationtiers.

SMALL GROUP PREMIUMS

Premiumsvarybyageandfamilysize.Thepremiumsforsmallemployerswilldependontheemployeeswhowillbecovered.*HSRIforEmployerswilladduplistbillratesforeachemployeeanddependent,basedonage,todetermineatotalpremiumforthegroup.Wewillalsoaveragethelistbillratestocalculateaquotedcompositeforeachfamilytype.Employercontributionsandemployeeshareswillbedeterminedfromthecompositerates.

INSURANCECOMPANY BCBSRI NHPRI

PLANNAME VantageBlue100/80500/1000

NeighborhoodPRIME

METALLEVEL PLATINUM PLATINUM

HSAQUALIFIED No No

PLANTYPE(SEEDEFINITIONSONPAGE3)

PPO HMO

REFERRALREQUIRED No No

NETWORKCOVERAGEAREA National RIonly

RIPROVIDERINFORMATION(SUBJECTTOCHANGE)

1,422PCPs/Pediatricians

3,008Specialists14of14Hospitals

979PCPs/Pediatricians


OUTOFNETWORKCOVERAGE,NON-EMER-GENCY

Yes-20%afterdeductible

Notcoveredexceptforurgentoremergentcare

MAXIMUMOUT-OF-POCKET(MOOP)MEDICAL+DRUG

$1,800Individual$3,600Family


DEDUCTIBLE-MEDICAL $500Individual$1,000Family

$500Individual$1,000Family

DEDUCTIBLE-DRUG $0 $0

PRIMARYCARE $10PCMH$20Non-PCMH

$10

SPECIALISTVISIT** $30 $30

PREVENTATIVECARE $0 $0

URGENTCARE $50 $30

ERSERVICES $100 $100

INPATIENTHOSPITAL 0% 0%

X-RAYS&OTHERDIAG.IMAGING $0 0%

HIGHENDIMAGING:CT/PET/MRI 0% 0%

MENTALHEALTH/SUBSTANCEABUSE-OFFICEVISITS $20 $10

SPEECH/OCCUP/PHYSTHERAPY,OUTPATIENTREHAB 20% $30

LABSERVICES,OUTPATIENT $0 0%

SKILLEDNURSINGFACILITY 0% 0%

OUTPATIENTSURGERY/SERVICES 0% 0%

PEDIATRICDENTALCOVERAGE No No

TIER1 $10 $5

TIER2 $25 $10

TIER3 $35 $35

TIER4 $60 $50

TIER5 $100 Tier5/Tier6:$100

SAMPLELISTBILLMONTHLYRATE*(21-YEAROLD,JANUARYRATE)

$469 $329


$599 $420


$1,272 $829

TheWHITEareaisnotsubjecttothedeductible.Itisthedollaramountorpercentageyoupaypervisitorhealthcareservice,regardlessofwhetheryouhavemetyourdeductible.

TheSHADEDareaissubjecttothedeductible.Youpaythefullcostofavisitorhealthcareserviceuntilyoureachyourdeductibleamount.Afterthat,youpayonlythedollaramountorpercentageshown.

Preferred Provider Organization (PPO):Youwillpaylessifyouusehospitalsanddoctorsintheplan’spreferrednetwork,butyouareoftenfreetoseeproviderswhoarenotinthepreferrednetwork.Health Maintenance Organization (HMO)/ Point of Service (POS): Youagreetouseonlyproviderswhoarepartofthenetwork.Insomeplans,youmustchooseaPrimaryCareprovider,whocoordinatesyourcare.

2020 Small Group Market Plan BenefitsBCBSRI: Blue Cross & Blue Shield of Rhode IslandNHPRI: Neighborhood Health Plan of Rhode Island

INSURANCECOMPANY BCBSRI BCBSRI BCBSRI NHPRI

PLANNAME VantageBlue100/80750/1500

VantageBlue100/601500/3000BlueSolutionsforHSA100/60

1500/3000CopayPlanNeighborhood

PREMIER

METALLEVEL PLATINUM PLATINUM GOLD GOLD

HSAQUALIFIED No No No


PPO PPO PPO HMO

REFERRALREQUIRED No No No No

NETWORKCOVERAGEAREA National National National RIonly















MAXIMUMOUT-OF-POCKETMEDICAL+DRUG





DEDUCTIBLE-MEDICAL $750Individual$1,500Family




DEDUCTIBLE-DRUG $0 $0 CombinedwithMedical $0


$10PCMH$20Non-PCMH

$5PCMH$15Non-PCMH

$15

SPECIALISTVISIT** $30 $30 $20 $50

PREVENTATIVECARE $0 $0 $0 $0

URGENTCARE $50 $50 $100 $50

ERSERVICES $100 $100 $200 $250

INPATIENTHOSPITAL 0% 0% 0% 0%

X-RAYS&OTHERDIAG.IMAGING $0 $0 0% 0%

HIGHENDIMAGING:CT/PET/MRI 0% 0% 0% 0%

MENTALHEALTH/SUBSTANCEABUSE-OFFICEVISITS

$20 $20 $15 $15

SPEECH/OCCUP/PHYSTHERAPY,OUTPATIENTREHAB

20% 20% $20 $50

LABSERVICES,OUTPATIENT $0 $0 0% 0%

SKILLEDNURSINGFACILITY 0% 0% 0% 0%

OUTPATIENTSURGERY/SERVICES 0% 0% 0% 0%

PEDIATRICDENTALCOVERAGE No No No No

TIER1 $10 $10 $10 $5

TIER2 $25 $25 $30 $10

TIER3 $35 $35 $50 $35

TIER4 $60 $60 $75 $50

TIER5 $100 $100 $125 Tier5/Tier6:$180


$447 $410 $369 $287


$571 $523 $471 $367


$1,213 $1,111 $1,000 $779



INSURANCECOMPANY BCBSRI BCBSRI BCBSRI NHPRI

PLANNAME VantageBlue100/802500/5000BlueSolutionsforHSA100/60

1900/3800VantageBlue80/603000/6000

NeighborhoodEDGE

METALLEVEL GOLD GOLD GOLD GOLD

HSAQUALIFIED No No No


PPO PPO PPO HMO

REFERRALREQUIRED No No No No

NETWORKCOVERAGEAREA National National National RIonly




















DEDUCTIBLE-MEDICAL $2,500Individual$5,000Family




DEDUCTIBLE-DRUG $0 CombinedwithMedical $0Tiers5&6

CombinedwithMedical


0%$20PCMH

$40Non-PCMH$20

SPECIALISTVISIT** $40 0% $50 $55

PREVENTATIVECARE $0 $0 $0 $0

URGENTCARE $100 0% $125 $55

ERSERVICES $200 0% $250 15%

INPATIENTHOSPITAL 0% 0% 20% 15%

X-RAYS&OTHERDIAG.IMAGING $75 0% $75 15%

HIGHENDIMAGING:CT/PET/MRI 0% 0% 20% 15%


$30 0% $40 $20


20% 0% 20% 15%

LABSERVICES,OUTPATIENT $25 0% $25 15%

SKILLEDNURSINGFACILITY 0% 0% 20% 15%

OUTPATIENTSURGERY/SERVICES 0% 0% 20% 15%

PEDIATRICDENTALCOVERAGE No No No No

TIER1 $10 $10 $10 $5

TIER2 $40 $30 $40 $10

TIER3 $70 $50 $70 $40

TIER4 $90 $75 $90 $55

TIER5 $125 $125 $125 Tier5/Tier6:30%


$360 $354 $326 $254


$460 $453 $417 $325


$977 $961 $886 $691

NEW



INSURANCECOMPANY BCBSRI BCBSRI NHPRI BCBSRI NHPRI

PLANNAME BlueSolutionsforHSA100/603400/6800

VantageBlue100/808150/16300

NeighborhoodCHOICE

BlueSolutionsforHSA100/606750/13500

NeighborhoodSTANDARD

METALLEVEL SILVER Silver SILVER BRONZE BRONZE

HSAQUALIFIED No No


PPO PPO HMO PPO HMO

REFERRALREQUIRED No No No No No

NETWORKCOVERAGEAREA National National RIonly National RIonly















Notcoveredexceptforurgentor

emergentcare









DEDUCTIBLE-MEDICAL $3,400Individual$6,800Family


$4,000Individual$8,000$Family



DEDUCTIBLE-DRUG CombinedwithMedical $0Tiers5and6

CombinedwithMedicalCombinedwithMedical CombinedwithMedical

PRIMARYCARE 0%$20PCMH

$40Non-PCMH$30 0% 20%

SPECIALISTVISIT** 0% $50 $60 0% 20%

PREVENTATIVECARE $0 $0 $0 $0 $0

URGENTCARE 0% $150 $60 0% 20%

ERSERVICES 0% $300 30% 0% 20%

INPATIENTHOSPITAL 0% 0% 30% 0% 20%

X-RAYS&OTHERDIAG.IMAGING 0% $100 30% 0% 20%

HIGHENDIMAGING:CT/PET/MRI 0% 0% 30% 0% 20%


0% $40 $30 0% 20%


0% 0% $60 0% 20%

LABSERVICES,OUTPATIENT 0% $50 30% 0% 20%

SKILLEDNURSINGFACILITY 0% 0% 30% 0% 20%

OUTPATIENTSURGERY/SERVICES 0% 0% 30% 0% 20%

PEDIATRICDENTALCOVERAGE No No No No No

TIER1 $10 $10 $10 $0 $10

TIER2 $40 $40 $15 $0 $15

TIER3 $70 $70 $40 $0 $40

TIER4 $90 $90 $55 $0 $55

TIER5 $125 $125 Tier5/Tier6:30% $0 Tier5/Tier6:20%


$289 $266 $233 $212 $201


$369 $340 $297 $271 $257


$784 $722 $632 $575 $545


NEW

2020 Health Plans and Benefits - Home | HealthSource RI

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