AtlantiCare Benefits Book 2020

Medical Plan FAQs

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOUNTS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56

What if AtlantiCare does not provide the service I require? AtlantiCare is able to provide you with enhanced benefits when you utilize our services because the dollars spent for these services stay within AtlantiCare. While AtlantiCare offers most services, not all services are provided at the AtlantiCare Tier 1 level. If you require services outside of AtlantiCare you will still have access to these services, however, depending on the plan you choose, you will be required to pay for them at the Geisinger (Tier Two) or Horizon (Tier Two) benefit level. If the service can only be provided through an out-of-network provider, please contact your insurance carrier (Geisinger or Horizon) to file an appeal prior to receiving the service. Helpful Tip: If you know that you will need services performed at another facility, utilize your FSA account to help you budget for the expense and reduce your taxable income at the same time. If I enroll in the Engaged Plan, does that mean my personal medical information will become part of my HR file? No, personal medical information is not part of your HR file. Neither HR staff nor your management team have access to your personal medical information. AtlantiCare Health Engagement, a separate company within AtlantiCare, collects data and administers the wellness program. Health Engagement is accountable under a number of federal and state laws to maintain any employee health information it obtains in separate, confidential files. Can I have my annual preventive care visit certification performed by a specialist such as an OB/GYN? No. All preventive care visits must be performed by a primary care provider.

Why is AtlantiCare including the completion of an Advance Directive as part of the Wellness Activity Checklist? A common misbelief about advance care planning is that only older or very sick people need written healthcare directives. However, life can change in a moment for anyone at any age. Traumatic accidents and sudden serious illnesses can happen even to young people and those in the prime of life. For this reason, we strongly encourage all adults age 18 and older to prepare an advance healthcare directive and select a healthcare agent. With your treatment preferences clearly established in writing, your medical team will know exactly what care to provide should you ever become critically injured or mentally unresponsive and unable to communicate. We encourage you to participate in an online or in-person class to learn more about the Advance Directive form and how to complete it prior to your Preventive Care Visit. If I receive care at an AtlantiCare facility, are the doctors who treat me automatically considered AtlantiCare providers? No. For example, an anesthesiologist may not be covered even if they administer anesthesia at an AtlantiCare facility. Likewise, a physician who treats you at an AtlantiCare facility and then in another location, should not be automatically considered in- network. You are responsible for confirming network participation. What should I do if I disagree with how a claim was paid? Contact your insurance carrier, Geisinger or Horizon, directly via the phone number listed on the back of your insurance ID card. What should I do if 10-14 business days have passed and I have not yet received my medical plan ID card? You can obtain a temporary card online. For assistance with this, please contact Geisinger at 1-866-379-4465 or Horizon at 1-800-355-2583 to obtain your member ID to register online.

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