2013 Employee Benefits Guidebook - Administration Home

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MEDICAL PLANS EBMS MEDICAL BENEFITS EL PASO COUNTY MEDICAL EPO PLAN: In 2013 you will have one medical plan option – the El Paso County Medical EPO Plan administered by Employee Benefit Management Services (EBMS).* With this plan you have access to the County Employee Health Centers and a customized El Paso County Cofinity Network. The custom Cofinity Network uses only Penrose Hospital and Penrose affiliated providers and facilities to serve the Colorado Springs service area. Any non-emergent, medical services must be provided through a provider or facility contracted with Cofinity for this custom network. If you have procedures performed at a Memorial facility (now University of Colorado Health) or other non-contracted facilities (other than true emergencies and/or certain medical procedures not available through Penrose that have been pre-approved by the CareLink Care Management team), it will not be covered. You may find out if a provider is in the custom El Paso County Cofinity Network by calling Cofinity Provider Network Customer Service by logging on to their website at www.cofinity.net/EPCDirectory/Index.aspx. This plan has a $2,000 individual deductible ($6,000 Family Maximum) that applies to some services such as inpatient hospital services, surgery, and ambulance. See the EBMS Summary of Benefits on the following pages for additional information on deductibles, co-pays and co-insurance. *Please note that our medical plan administrator has the same acronym but is NOT the same as the El Paso County Employment, Benefits & Medical Services (EBMS) Department. GENERAL INFORMATION: Once you make your elections you may not change or cancel your benefits or change enrolled dependents until the next open enrollment period, unless you have a Qualifying Life Event. GRANDFATHERED HEALTH PLAN: El Paso County believes this Medical Health Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your Plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. 2013 Employee Benefit Guidebook Updated August 2013
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at EPC EBMS Benefits Department (719) 520- 7420. You may also contact the U.S. Department of Health and Human Services at www.healthreform.gov. Medical Plan Summaries: Two medical plan summaries are listed on the following pages. 1.) The Standard Medical EPO Benefits Schedule reflects benefits for employees who did not meet the Reach Your Peak (RYP) Wellness 2012-2013 requirements for Phase 1 by the established deadline. 2.) The Reach Your Peak (RYP) Medical EPO Benefits Schedule reflects benefits for employees who are considered Reach Your Peak Wellness Program Participants. The RYP benefits are effective the first of the calendar year following complete enrollment in the RYP program. Please refer to the appropriate schedule of benefits. Your medical ID card will reflect the plan in which you are enrolled. 2013 Employee Benefit Guidebook Updated August 2013
Page 1 and 2: EMPLOYEE BENEFITS Open Enrollment G
Page 3 and 4: PHONE DIRECTORY Employment, Benefit
Page 5 and 6: IMPORTANT INFORMATION SUMMARY OF BE
Page 7 and 8: EMPLOYEE CONTRIBUTIONS AND POP: The
Page 9: MEDICAL, VISION AND DENTAL PLAN PRE
Page 13 and 14: (including ER Physician services) M
Page 15 and 16: All subsequent prenatal visits, pos
Page 17 and 18: Note: The copayment will apply as l
Page 19 and 20: Pregnancy * Initial visit (to confi
Page 21 and 22: Wellness Exams The County Employee
Page 23 and 24: Walgreens Health Initiatives now Ca
Page 25 and 26: Medication List (PML)/formulary is
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Page 29 and 30: Guardian DENTAL PLANS El Paso Count
Page 31 and 32: What is an FSA? FLEXIBLE SPENDING A
Page 33 and 34: You can only be reimbursed up to th
Page 35 and 36: VOLUNTARY TERM LIFE INSURANCE Volun
Page 37 and 38: DISABILITY BENEFITS SHORT TERM DISA
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2013 Employee Benefits Guidebook - Administration Home

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