Frequently Asked Questions About the Health Plans
What Health Plans are offered?
Riverside Health System is pleased to offer the following two health plans for 2014:
What are the major changes for 2014?
- The Anthem HealthKeepers 25/30 is not being offered in 2014.
- The PPO deductibles are increasing from $0/$0 to $500/$1,000 for both the Riverside Platinum tier and the Non-RHS In-Network tier. Riverside Platinum Network employee coinsurance is decreasing from 20% to 10%. The out-of-pocket limits are increasing from $3,500/$7,000 to $4,000/$8,000.
- The 2014 spousal surcharge will increase to $200 per month or approximately $92.31 per pay period.
There are no major changes to the Lumenos High Deductible Health Plan in 2014.
When will I receive my 2014 health plan rates?
Health Plan Rates are available by logging in to Employee Self Service (ESS). Your Human Resources representative will also have the rates available.
What preventive services are free?
You may find a list of preventive services that may be provided at no charge to you through network providers at: https://www.healthcare.gov/what-are-my-preventive-care-benefits/. These services include many screenings and immunizations.
If a member is required to follow-up more frequently on an otherwise preventive service because of diagnosis or physician concern, for example, a mammogram or colonoscopy, is the service still covered at 100%?
Typically, when you have been diagnosed with a condition or have symptoms and/or a family health history, the service is no longer considered preventive and is not covered at 100%.
Will Riverside continue to offer employee discounts at Riverside providers and facilities on charges not covered by insurance?
All employees and eligible family members are eligible to receive a 25% discount on services at most Riverside providers. M.D. Express offers 25% discount on copay only if employee badge is presented at time of service or within three days of service.
Will Riverside continue the inpatient liability waiver up to $1,000 for special out-of-area situations?
Yes, employees and family members who are covered under any Riverside Health System group health plan may be eligible for partial waiver of the inpatient liability up to $1,000 if:
1) They live or work in an area where no Riverside facilities are available
2) An emergency admission is required while out of the Riverside service area
3) There are no Riverside facilities able to treat a particular illness or condition
4) The Anthem physician in the area able to treat the illness or condition does not admit to a Riverside facility
Other situations where the participant is unable to use an Riverside facility may be discussed in advance on an individual basis. To be considered for the Inpatient Deductible Waiver in an alternate facility, send a brief letter explaining your situation to Total Rewards/Benefits Services, through interoffice mail or fax at (757) 534-5550.
Will Riverside offer a waiver for the deductibles on either of our health plans?
No, employees and family members who are covered under any Riverside Health System group health planwill be responsible for paying any deductibles that may apply. A few things to keep in mind when preparing and trying to manager costs:
- Riverside will still be offering a 25 percent discount for team members who use eligible Riverside services.
- Employees can choose to participate in the Medical Flexible Spending Account. Participation in the Flexible Spending Account is optional. The amount you can set aside in any given year is capped at $2,500. It's also important to note that this type of account has a use-it-or-lose-it status. Funds that do not go to pay healthcare expenses do not roll over, and you lose them at the end of the year. That's why it's important to try to estimate exactly how much you're likely to spend. The good news is that you can use the money you set aside in the Flexible Spending Account for qualifying medical, dental and vision costs.
- If you sign up for the HDHP plan you will automatically be enrolled in a Health Savings Account. The amount you can set aside is capped at $3,300 for an individual, and $6,500 for a family. Any funds left in this account at the end of the year do roll over. An employee in the Lumenos High Deductible Health plan can sign up for both an HSA and a medical FSA. However, the medical FSA will be limited to dental, vision and/or preventive care expenses. Ultimately, it is the participant's responsibility to maintain IRS compliance within their plans.
Under the Riverside CareAdvantage PPO, at what labs can members get diagnostic lab draws?
The network for the Riverside CareAdvantage PPO does have participating labs in order to remain in-network, but there is not an exclusive arrangement with LabCorp like we have had under Anthem HealthKeepers HMO 25/30. The same applies to the Lumenos High Deductible Health Plan. To determine in-network labs, go to www.anthem.com. Select Find A Doctor. In section 1 (What are you looking for?) select Lab/Pathology/Radiology. In section 2 (About the Provider) select Laboratories as the Specialty. In section 3 (Where are you looking?) select the mile radius you would like to select and the zip code. In section 4 (what insurance plan would you like to use?) select Virginia as the state, PPO as the Plan Type/Network, and Anthem KeyCare PPO as the Plan Name. Click the Search button and results that meet these criteria will be brought up.
Will a copay be required for Riverside Urgent Care at the time of service?
It will depend on the type of service. If it is considered a professional visit, then the co-pay will be based on whether the visit is primary care or specialist. Other services will be charged as co-insurance.
On the Riverside CareAdvantage PPO plan, when it says for Riverside network "10% of the amount the health care providers in our network have agreed to accept for their services," what does that mean?
Here is an example that will demonstrate how this works. The 10% is based on the amount the provider agrees to accept, the "allowable amount," which is usually a percentage below their charges. "Allowable amount" is defined as the maximum fee that the health plan will reimburse a provider for a given service. For example, an office visit charged at $100 may have an "allowable" amount of $60 and the member would be responsible for 10% or $6. Allowable amounts may vary by procedure code used by the practice. This is just an example.
What will I need to do to enroll in one of the 2014 plans?
You will make your health plan selection online during Open Enrollment Nov. 4 to 15, or if you are new hire, within your 30 day eligibility period. It’s important that you review your choices for health plans and make your selection before you login to Employee Self Service/Open Enrollment (or for new hires, Employee Self Service/New Hire Enrollment) to select your benefits.
Will I receive a new health insurance ID card?
If you are newly enrolling or changing plans, you should receive a new health insurance ID card in a home mailing. If you do not receive your new card by Jan. 1, 2014, please call the phone number below for the appropriate plan member services. If you are continuing coverage in the same plan, you will not receive a new card and can continue to use your existing card.
- Riverside CareAdvantage PPO (Anthem KeyCare) Member Services may be reached at (800) 451-1527.
- Lumenos HDHP Member Services may be reached at (800) 582-6941.
All members who enroll in the Riverside CareAdvantage PPO will also receive a member ID card from Premier/MedImpact, our new prescription benefit manager. This will replace your Envision RX Options member card starting on Jan. 1, 2014. Premier/MedImpact can be reached at (800) 910-1835.
I am selecting the Riverside CareAdvantage PPO plan for 2014. Why am I being asked to provide the name of my primary care provider during this online Open Enrollment process?
Riverside is asking you to provide the name of your “Primary Provider” for purposes of communication and reporting and to aid in managing your care into the future. A Primary Provider is required for Riverside team members, spouse, and children over the age of 18 if covered under the PPO. Having a Primary Provider can facilitate better access to health care, increase satisfaction with care, and ultimately improve health.
My Primary Provider is not a member of Riverside Medical Group. Do I have to change physicians under the Riverside CareAdvantage PPO?
You do not have to change physicians, but you will pay the costs under the Anthem In-Network benefits or Out-of-Network benefits accordingly. You also will provide this physician’s name during online enrollment as your primary provider (medical home).
What if I am located geographically in an area where the Riverside network has few providers?
You will need to compare the two health plans to determine which provider network and coverage choice best meets your needs.
What are some other resources that team members can consider to meet their healthcare needs?
There are a number of services available in our area, including:
- FAMIS, (877) KIDSNOW
- Medicare, (800) MEDICARE
- Medicaid, (800) 432-5924
- The Partnership for Prescription Assistance (PPA), (888) 4PPA-NOW
- Project CARE, (757) 856-7100
More information about the Federal Health Insurance Marketplace can be found at www.healthcare.gov.
How can I find more information about each health plan?
Both of our health plans are offered through Anthem. More information is available at www.anthem.com and on the Total Rewards page of the Riverside Intranet. Prescription drug information for the Riverside CareAdvantage PPO is available from Premier/MedImpact online at http://mp.medimpact.com/PHI.
What is the spousal surcharge?
The spousal surcharge is an additional premium that will apply when your spouse works full-time and has access to group health coverage from his or her employer but elects to decline that coverage, using Riverside Health System's health plan for primary coverage instead. The 2014 spousal surcharge will increase to $200 per month or approximately $92.31 per pay period. If you're trying to make a decision about insuring a spouse, you may want to check out the list of what plans Riverside accepts.
If my spouse chooses Riverside Health System's health insurance because her company doesn't offer insurance, or my spouse is self-employed, would the surcharge apply?
What if my spouse quits or loses his job but has access to COBRA. Does COBRA constitute employer-sponsored coverage?
No. The spousal surcharge applies to those who are employed full-time and have access to employer-sponsored health care. COBRA coverage would not qualify as employer-sponsored health care. Medicare would not qualify as employer-sponsored health care, either.
My spouse is unemployed. Do I have to pay the surcharge?
My spouse is retired and has coverage based on his retirement. Do I have to pay the surcharge?
No. That is why the spousal surcharge is often called the working spousal surcharge.
If my spouse does not have a job during Riverside's annual enrollment but starts working after I have elected to cover her under Riverside, do I have to pay the surcharge?
Yes, you will need to notify Total Rewards (Benefits Services) of this change. Please note that if your spouse becomes employed after the plan year begins, this is a qualifying event that will allow you to make new elections under Riverside's health plan. For example, you could choose to terminate your spouse's coverage under Riverside's plan and he/she could become covered under his/her employer's plan.
My spouse works full- time and wants to elect Riverside's benefits as primary coverage, even though his employer also offers health care coverage. Do I have to pay the surcharge to use Riverside as his primary benefits provider?
Yes, you will have to pay a surcharge for benefits under the Riverside health care benefit plans.
If my spouse is covered by Medicare, a Medicare individual policy, or Medicaid, will the surcharge apply?
If both me and my spouse work at Riverside Health System, will the surcharge apply?
What happens if my spouse picks-up coverage at his/her employer and sends in notification of their other coverage at a later time?
Upon receipt of a letter from the other employer showing the effective date of the group health insurance coverage, the spousal surcharge will be discontinued the first of the month following the receipt of the documentation. The documentation must be submitted within 30 days of the effective date of other coverage. No refund of health insurance premiums at the higher rate will be made.
Is the spousal surcharge deducted before or after income tax?
The spousal surcharge will be included with the health care premium, so it is deducted before income taxes.
What are the 2014 Health Savings Account Annual Contribution Limits?
The 2014 HSA annual contribution limits are $3,300 for an individual and $6,550 for a family. Participants age 55 and over may contribute an additional $1,000 annually.
How does the My Healthy Lifestyle incentive Riverside contributes to my Health Savings Account (HSA) incentive affect my HSA pre-tax contribution limit?
The HSA annual contribution limits apply to the combined total of the employee and employer contributions, if applicable. For example, if you are an individual age 55 or over and you receive the full $750 My Healthy Lifestyle incentive, your Health Savings Account contribution would be limited to $3,550. Please refer to the charts below for further information.
HSA contribution limits, individual:
|Age||Full MHL incentive||No MHL Incentive|
|Under age 55||$2,550||$3,300|
|Age 55 and over||$3,550||$4,300|
HSA contribution limits, family:
|Mid-level MHL incentive||No MHL Incentive|
|Under age 55||$5,800||$6,175||$6,550|
|Age 55 and over||$6,800||$7,175||$7,550|
- Full MHL incentive - the team member and covered spouse (if applicable) send a completed Physical Exam Verification Form to Health Advocate with a minimum of 50 points or show a 20-point improvement over your baseline score from 2013.
- Mid-Level MHL Incentive (for team members who cover a spouse) - either the team member or the covered spouse, but not both, sends a completed Physical Exam Verification Form to Health Advocate with a minimum of 50 points or show a 20-point improvement over your baseline score from 2013.
- No MHL Incentive - the team member and covered spouse (if applicable) do not send a completed physical exam verification form to Health Advocate with a minimum of 50 points or show a 20-point improvement over your baseline score from 2013.
How does Employee Self Service (ESS) know what my annual Health Savings Account (HSA) contribution limit is?
The ESS system uses employee groups based on criteria attached to your employee record to manage benefits coverage and contributions. However, the system is not sophisticated enough to read your 2014 Benefit Open Enrollment elections and know in real time what your HSA limit should be. Thus, Benefits Services sets the HSA contribution to the highest limit based on an individual's age and My Healthy Lifestyle (MHL) incentive eligibility. Benefits Services performs a series of audits after the close of Open Enrollment prior to any data being transmitted to carriers and before the upcoming year's payroll deductions begin. One such audit pertains specifically to the HSA contribution limits. Through the audit process, Benefits Services compares plan and coverage selections to the HSA contribution elections and adjusts accordingly. The limit you may observe in ESS represents the limit based on your age and your MHL incentive eligibility. If, for example, you are age 55 and over, you elect the HDHP, employee-only coverage, and you qualify for a full MHL incentive, your 2014 HSA contribution limit is $3,550. In this scenario, if you were to make a HSA contribution election of more than $3,550, Benefits Services would adjust your contribution accordingly prior to the first payroll deduction in January.
Where do my HSA contributions go once they are deducted from my paycheck?
Riverside provides for HSA pre-tax payroll deduction to BenefitWallet (formerly ACS|BNY Mellon HSA Solution (The HSA Solution)) the HSA service provider offered through Anthem. For HDHP participants eligible for a MHL incentive, Riverside's HSA contribution also will be directed to BenefitWallet.
What if I have a HSA account with another service provider and/or previous employer?
BenefitWallet accepts transfers "in" from other HSA service providers/accounts. If you wish to consolidate your accounts, contact Riverside Benefits Services at (757) 534-5544 for the appropriate form.