Hourly Enrollment Guide - Pitney Bowes Project

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Medical Plan: Highlights This chart highlights in-network features and what you pay for services. You receive the highest level of coverage when you use in-network providers. Paycheck Deductions Health Fund (Cigna & UHC) PPO* (Cigna & UHC) Lowest Higher Higher HMO* (Kaiser, Group Health Cooperative) Health Account See page 12 for how the Health Accounts work with your medical plan Health Reimbursement Account (HRA) or Health Savings Account (HSA) Health Care Account (HCA) Health Care Account (HCA) Preventive Care Annual Deductible The amount you pay before the plan shares the cost with you Covered 100% when you use in-network providers $1,500 you-only coverage; or $3,000 family coverage <strong>Pitney</strong> <strong>Bowes</strong> contributions to your health account and PB Healthy Rewards incentives you earn help you pay your deductible $750 per covered person; not to exceed $2,250 all other types of coverage (does not apply to all covered services) $750 you-only coverage; $1,500 for family coverage (does not apply to all covered services) Coinsurance/ Copayments What you pay after you meet your deductible You pay 10% coinsurance Use your HRA or HSA funds to pay for these expenses Minor care: You pay $20–$40 copay and/or 20% coinsurance (not subject to the deductible) Major care: You pay 20% coinsurance Note: You can lower your coinsurance by using Cigna Care Network doctors if you are in Cigna and UHC Premium Network if you are in UHC Minor care: You pay $20–$40 copay and/or 10% coinsurance (not subject to the deductible) Major care: You pay 10%/20%/50% which varies by plan and type of service Out-of-Pocket Maximums The most you’ll pay during the year before the plan picks up the rest $3,000 you-only coverage; $6,000 all covered family members Includes deductible and coinsurance on medical and prescription expenses $2,500 per covered person; $7,500 all covered family members Does not include deductible, copays or prescription drug coinsurance $3,000 you-only coverage; $6,000 all other covered family members *If you live in HI and are enrolled in either the PPO or HMO, your coverage amounts are different than what is listed. Visit www.pbprojectliving.com for details. 10
Health Fund (Cigna & UHC) PPO* (Cigna & UHC) HMO* (Kaiser, Group Health Cooperative) Prescription Drug Through Express Scripts (formerly Medco) Deductible and coinsurance max combined with medical Separate $10,000 lifetime maximum for infertility drugs Through Express Scripts (formerly Medco) Separate $10,000 lifetime maximum for infertility prescriptions $1,700 combined coinsurance maximum for mail and specialty drugs Through Kaiser Retail (30-day supply) • Preventive drugs: You pay 10% coinsurance • All other drugs: You pay 10% coinsurance after deductible • Tier 1: You pay 10% • Tier 2*: You pay 30% • Tier 3*: You pay 55% *Penalty applies when you use brand if generic is available; no coinsurance maximum for retail • You pay $10 generic copay ($15 Mid-Atlantic) for generic • You pay $30 copay (Group Health Cooperative or Northwest); $50 copay Mid-Atlantic or $35 (all other Kaiser Plans) for brand-name Mail Order (90-day supply) • Preventive drugs: You pay 10% coinsurance • All other drugs: You pay 10% coinsurance after deductible • Tier 1: You pay 7% • Tier 2*: You pay 22% • Tier 3*: You pay 40% *Penalty when you use brand if generic is available In CA, a 100-day supply • You pay $20 generic • You pay $60 copay (Group Health Cooperative or Northwest) or $70 copay (all other Kaiser Plans) brand-name Contraceptives Specialty Drugs (30-day supply) Behavioral Health Part of your medical plan benefit • No cost for generic • All other: You pay 10% after the deductible • No cost for generic • All other: Follows rules for retail or mail order • No cost for formulary contraceptives You pay 10% after deductible You pay 20% coinsurance Brand copays apply Provided through Cigna or UHC Outpatient: You pay10% coinsurance after deductible Inpatient: You pay 10% coinsurance after deductible Provided through ValueOptions Outpatient: You pay $20 copay Inpatient: You pay 20% coinsurance after deductible Provided through Kaiser/GHC Outpatient: You pay $5–$20 copay Inpatient: You pay 10% coinsurance after deductible *If you live in HI and are enrolled in either the PPO or HMO, your coverage amounts are different than what is listed. Visit www.pbprojectliving.com for details. Looking for details about the Out-of-Area Plan? Go to www.pbprojectliving.com > U.S. Benefits > Health. See complete details about covered services in the medical plan comparison chart on Your Benefits Resources. 11
Page 1: 2013 Benefits Enrollment Guide FOR
Page 4 and 5: The Basics: Eligibility, Whom You C
Page 6 and 7: Your Path to Good Health Our health
Page 8 and 9: Medical Plan Options All of our med
Page 12 and 13: Health Accounts A Health Account ca
Page 14 and 15: How the Health Accounts Work with Y
Page 16 and 17: PB Healthy Rewards Incentive Progra
Page 18 and 19: Dental Coverage Dental coverage hel
Page 20 and 21: Life, Accident, Disability and Crit
Page 22 and 23: More Pitney Bowes Benefits Pitney B
Page 24 and 25: More Pitney Bowes Benefits 401(k) P
Page 26 and 27: How to Enroll and Important Reminde
Page 29 and 30: Benefits Contact Information When y

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