farm bureau wellmark health insurance
TRANSCRIPT
-
8/16/2019 Farm Bureau Wellmark Health Insurance
1/16
E D U C A T t
M A T T E R S
GET THE EST OF OTH
welimark V
F RM URE U
P
rod
u cts
avai ab e at F
a r
m
u
re a
u
F ina
n
c ia
S
ervices
2 6
F A R M B U R E A U
I N D I V I D U L
A N D F A M I L Y P L A N S
-
8/16/2019 Farm Bureau Wellmark Health Insurance
2/16
-
8/16/2019 Farm Bureau Wellmark Health Insurance
3/16
GET THE EST OF OTH
)ellmar"
v
RM BURE U
)ellmar lue Cross lue Sield o* $oa
)ellmar #ealt Plan o* $oa, $nc.
Products available at Farm ureau Financial Services
P + % - + 0 ) # 0 ' 8 * ' # t * + 0 4 # 0 % '
# 0
% # 0
$ '
1 ' 4 8 * ' / + 0 )
B t
8 + t * t * '
* '
1 (
t * +
) + & '
9 1 '
- 0 1 8 1 / '
- ' 9 3 ' t + 1 0
t1
# -
9 1 4 ' (
1 9 1
% # 0
' 0 4 1 +0
#
* ' # t * # 0 t*# t
$ ' t ( + t 9 1 4 + ( ' # 0 & $ & ) ' t . Y 1 ' # 1 ( + 0 &
+ / 1 4 t # 0 t + 0 ( 1 4/ # t + 1 0 # $ 1 t & + ( ( ' 4 ' 0 t t 9 ' 1 (
% 1 ' 4 # ) ' , 0 ' t 8 1 4 -
# 0 &
# t * ' ) e l lmar B '
C 4 1 # 0 &
B '
S * +' & # 0
1 ( ( ' 4 ' & $ 9 F # 4 /
B 4 ' #
t*# t / ' ' t
9 1 4 ' 4 1 0 # 0 ' ' & .
I N S I D E
ecodin+ te ar+on
. . . . . . .
. .
%arroin+our o/tions
. . . . . . .
Farm ureau!clusiveCo/aPlans
Farm ureau !clusive
#i+
- eductible #ealt Plans . . . ..
Co/a)ellm ar lue &eardsPlans . .
(nderstandin+ o u r bene*its 1
M O R E T H A N ! U S T
H E A L T H
I N S U R A N C E
B 9 % * 1 1 + 0 ) " ' / # 4 - # 0 & F # 4/
B 4 ' #
9 1
% # 0 ( ' ' % 1 0 ( + & ' 0 t 1 + 0 + 0 ) t * ' * 0 & 4 ' & 1 (
t * 1 # 0 &
1 (
I 1 8 # 0 8 * 1
* # '
# 4 ' # & 9 + % - ' &
#
) e l l
mar B '
C 4 1 # 0 &
B '
S * + ' &
# 0 .
" '
' ' $ ' ' 0 4 1 +& +0 ) t 4 t ' & % 1 ' 4 # ) '
# 0 &
% t 1 / ' 4
' 4 + % ' t 1 I1 8 # 0
( 1 4 7 5 9 ' # 4 # 0 &
8 '
1 1 - ( 1 4 8 # 4 &
t 1
' 4 + 0 ) 9 1 .
'rustour local Farm u reau a+entto el
/rotect ouand our
*aml
*rom medical
costs. ecomin+ a membero* te $oa
Farm ureau
is
a sim/leand /oer*ula
to su//ort our*ello $oans,ileavin
s/ecialadvanta+esri+tat our*in+erti/s.
)it
Fa
rm ureau,ou aveeclusive
accessto insuranceserviceo/tions, alon
it discounts on entertainment and
travel. Findout ooucan arnesste
/oero* communit toda.
Plan Com/arison uide 2016
$
-
8/16/2019 Farm Bureau Wellmark Health Insurance
4/16
D E C O D I N G T H E ! A R G O N
B ' ( 1 4 ' % * 1 1 5 + 0 ) 9 1 4 * ' # t * 2 # 0 , 0 & ' 4 t # 0 &
t * ' ' - ' 9 t ' 4 / .
9 Premium -
)
at
oul
/a e ac mont *or our e a t
insurance bene*its.
9
Coinsurance - @oursareo*
t
e
co
s
ts *or a covered e a
t
care service, calculated as a /ercent.
@ou
must t/icall reac
our deduct
ble be*ore our coinsurance a// ies. #oever,
de/endin+onour
/
an bene*its,ourdeductiblemabeaived .
>
Co/a
-
; *
i
ed amount 5*or eam/le, 1 ou /a *or
a
coveredealtcare
se rv i
ce, usuallenou receiveteservice.
9 eductible - 'e amount ou oe *or ealt care
s
ervices
tat our /lan covers be*oreour
e a
t /lan be+insto /a.
Some /lansaive te deductible *or certain services, ic
- meansour bene*its ic in immediatel.
9
>ut-o*-/ocet maimum 5>P=- 'e mostou /adurin+ a
/olic/eriod5usualla earbe*oreourealt /lan be+insto
/a 100 /ercent o* te alloed amount. 'is doesnt include
our /remium or te cost *or ealt care our ealt /lan
doesnt cover.
9
Personal
doctor-
'e /rovider ou cooseas our /ersonal
*ami /sicianat te t ime ou enroll in our)ellmar
e a
t
/lan.Coosin+a /ersonaldoctor can leadto better e a
t
outcomes because e7senosour *amil istor, oversees
all treatments , mana+escronic conditions, nosour
/rescri/tions, el/sou avea ealt li*estle andassists
it coordinatin+ care.
9
Primar care /rovider 5PCP
-
; t/e o* /rovider tat delivers
/rimar care. PCPs include*amil /ractitioners,+eneral
/ractitioners, internal medicine /ractitioners,
obstetr
cians7
+necolo+ists,/ediatricians,/sicianassistantsand advanced
re+istered nurse/ractitioners.
9
=etallic tiers - ueto te ;**ordable Care;ct 5;C;,te
*ederal +overnment created *our cate+orieso* covera+eor
"metallic tiers." Plansare assi+ned a metallic tier 5 ronBe,
S lver, oldor Platinumbasedon te /ortion o* claims/aid b
te insurer.=etallic tiers mae it easier*or ou to com/are
/lansand, t/icall, te morecovera+ea
/
an o**ers, te more
oull /a
in
/remiums. ;t)ellmar, e ave/lans*or
individuals and *amilies
in
te ronBe,Silverand oldtiers.
9
$n-netor
-
;n
in
-netor /rovider
is
oneo asan
a+reementit )ellmar to /rovide services to members*or a
ne+otiatedrate. (s in+ /roviderstat are in -netor meansoull
/a lessout o* our on /ocet *or care, savin+oumone.
9
>ut-o*-netor
-
;n out
-
o*-netor /rovider doesnot ave
ana+reementit)ellmarto /rovide servicesto membersat
a ne+otiated rate. $* ou useanout-o*-netor /rovider,
ou
ll
/amoreout-o*-/ocet *or services tan i* ou usedan
in-netor /rovider.@ou maalsobe res/onsible *or /ain+
te di**erence beteen te amount a /rovider car+es *or te
service and te maimum amount tat )ellmarill /a *or
tat /rocedure or service
9
ene*it ear -
;
12-mont /eriod o* bene*its covera+eunder
our ealt /lan. For individual and *amil /lans, tis runs
P=
accumulations. ;mounts ous/end ou
t
-o*-/ocet *or
a//licable covered items and services *rom P=.
9
>/en !nrollment Period 5>!P- 'e>!P
is
te earl time
/erioden ou can maeadustments to our ealt
covera+e*or te net ear.
9 S/ecial !nrollment Period 5S!P- ;n
S!P
is a indoo* time
enoucan a//l *or ealtcovera+eor maea can+eto
our current covera+edueto a Auali*in+ li*e event.?uali*in+
li*e eventsaremaorcan+eslie+ettin+ married, avin+a bab
or losin+covera+etrou+ a moveor ob loss . 'eonlaou
cancan+eour covera+eoutside o* te>!Pis trou+ anS!P.
) # ; ' S ; % # S; :
2 $ PlanCom/a
r
isonuide2016
-
8/16/2019 Farm Bureau Wellmark Health Insurance
5/16
N A R R O " I N G Y O U R O P T I O N S
C 1 0 5 + & 4
t * ' '
+ / 1 4 t # 0 t 3 6 5 t + 1 0 5 8 * ' 0 % * 1 1 5 + 0 ) # 2 # 0 .
)en looin+at our /lan o/tions, rememberto notonl considerour /otential costs *or toda,but also*uture costs. &emembertat
costsaremore tan ust our montl /remium.>ut-o*-/ocet e/ensescome *rom tin+s liedeductible amounts, co/aments and
coinsurance*or doctor visits, os/ital stas, labor, /rescri/tion dru+s, andemer+encroomvisits.
o )at ind o* netor best *its our needs:)it)ellmar,
ou *eel /rotected noin+ ou can +et te covera+eou need
en and ere ou need it. @oucan coose*rom tree t/es
o* netorsD
9
)ellmar lue PP>S= /lans +iveou te *reedom and
convenience to +et ealt care *rom an /rovidero
/artici/ates it a lueCross lue Sield /lan. ee/
in
mind, coosin+ a netor /roviderill reduceour outH
o*-/ocet costs.
> )ellmar lue #=os=/lanscover care ere in $oa.
100 /ercent o* os/itals and 6 /ercent o* doctors *rom
$oaare in te netor. ont orr - ou can still +et
out-o*-state covera+e
in
emer+enc and accidental
inur situations.
9
)ellmar lue&eardsP>SS= /lans letoucooseoto
useit evertime ou needcare.'eamount ou /aout-o*H
/ocet
is
determined bte tier our /rovider
is
in, andoull
/alessb seein+ lue&eards/roviders. 'e)ellmar
lue &eards
P> S
netor /lans are uniAue to)ellmar
and evenalloouto earn reards*or ealt beavior.
o ;reour /rescri/tions covered at te cost-sare l eve l ouant
to /a:!ver/lancovers/rescri/tion dru+s
a
little di**erentl.
e*orecoosin+
a
/lan, besure to understand te di**erent tiers
o*te lue & !ssentialsEdru+/lan.Fora Auic overvieo* te
tiers, turn to /a+e 10 o* tis +uide.
@ou
canalsoeasilsearc*or
our s/eci*ic /rescri/tion dru+ on)ellmar.com.P
but souldbeconsidereden /icin+
a
ealt/lan.
9 eductibles *or in-netor andout-o*-netor services
are anoter /art o* our total costs.
;
/lanit a i+er
deductible ma saveou mone in montl /remiums, bu
ou ma aveto cover a lar+er /ortion o* o ur ealt care
services be*ore bene*its be+in.
9
>P=salsoa**ect our costs. '/icall,te i+erte >P=
te loerte montl /remium.
o ;reou interested
in
/otentiall savin+moneon our taes
savin+
*or
our retirement:Coosin+a i+-deductible eal
/lanand /uttin+ dollars in a ta-advanta+edealt savin+s
account 5#S;to /a*or Auali*iedmedical e/ensesis one
to ee/our /remiumdon. Plus,te *unds ou /ut into ou
#S;are+enerallta-deductible.
"' / # 4 - * 2 5
9 1 6
( ' '
5 ' % 6 4 ' t * 4 1 6 ) * t * ' : 8 * # t
+ ( :
@oumabe ealt toda, but at a//ens i* ou ave
a
ealt issuetomorro:
)enconsiderin+ a /lan *rom )ellmar, maesureoure com*ortable it o
muc ou maaveto /aout-o*-/ocet *or ealt care costs i* te "at i*"
a//ens. !itera,)ellmars /lans el/ou *eel con*ident noin+ oull beable
to +et te ealt care ou needen and ere ou need it.
?uic 'i/D (sete Auestions on /a+e13 to assessour needs *or toda and tomorro.
PlanCom/arisonuide2016
$
-
8/16/2019 Farm Bureau Wellmark Health Insurance
6/16
F A R M B U R E A U E ; C L U S I V E C O P A Y P L A N S
$1,000 /
$3,500
/
6
500
$
(
0
% 40%
$7 ,000 $
14,000
2,000
!nance d lue s=
old
$
$
. . . . . . .
L 1
1000 P P > 7
# = >
3
5 001
%
ot
in
+le 7 amil"
$ $
1
000
20%
%
ot
$
(
O
$ 2,000
a//licab
e $7
,000
a//licable
$
$
S$GJ!& >>
\
P P O
$2,500 $6
850 $9,850
$
(
0
% 50%
$13,700
$1 8
,90 0
m pl t blu '"
$
$5
,
00 0
S ilve r 200
jj
P > 7
# = >
$2
50 0
% ot
$6 ,850
%ot
$
(
$
30 %
a// icable
Sin+le 7
F a m i
2
O
$5,000
a// icable
$13,700
$
S $ GJ!&->>
8
$3 50 0 $6 ,600 $9
600
$
(0% 50%
$1 9 ,200
7,000
$
13,200
om/ lete lue
S =
$
Silver
300
P P >
7# = >
$3,5 0 0
$
% ot
6 600 %ot
$
(
in+le 7 Famil
2
O
$7 ,000
30 %
a//licable
$
13,200
a//licable
$
I
&>%K!
>
+
$5
,000
/
50%
$6
850
9 ,850
$
(
$10,000
50 %
$13,700
$
18,700
Sim/
l lue
S = ronB
e $
000 P P > 7
# = >
S n +le 7 Famil
2
$5
000
% ot
$6 ,850 %ot
$
(
O
$10,000
50 %
a//
icable
$13,700
a//licable
$
N
;+e
D
= id 2 0s
StatusD S in+le
4 $ PlanCom/arison
ui
de 2016
;s
a
ou n+ adu lt, ou m a n ot +o to te doc tor *or an tin + ote r tan
a
earl / reven t ive
e
am . #oeve r
,
ou als o m a n ot ave te dis / os able
in com e to / a *or m e dic al c os ts i* a cata s tro/ic ev en t a//en
s.
'ats
ou m a
a
n t to cons ide r bene *i
t
-ric / lan s it a mon t l / rem i um
ou can bu ild in to ou r bu d+e
tD
>
Com/ le te l u e S ilv er 300 #= > (See above)
> ! n a nc e d lu e o ld 1000 # = > (See above)
>
m ue #S% = o ld 21 0 0 #
= >
(See pa
ge
6)
-
8/16/2019 Farm Bureau Wellmark Health Insurance
7/16
P4'/ +6/
3
D
2 co/a
edIctib e a
n d
ed.uctible and ed.uctible and e d .uc t
b l
e and e d
.
uctible a n d
300 co a
eductible a v e d
coinsura
nce
coinsuranc e
coins
u r a n c e comsura n
ce
coinsurance O ! #% / " % ~ ! ) ' ie r 1 O
0 co / a
& a
v
e a
a//l a// a//l a//l a//l ' ie r
2
D
3
'ier 3 D
N 0
3 D 2 co/a
educt
ble and
ed.uctible and
Pre*err e d s
/e c
ialtD 100
% ot
c
oinsurance
% ot
% ot
30 0 c o/a %on-/re*erreds / ec
i a l
t D
D 0
co/a
a//licab e
a//
i
cable
coinsura
nce
a//licable
(
& a# v e!#" a
!# % %e!)
0M c
oinsur
anc e
a
//l
a//l
40
co/a
e d .uc t
b e
and
e ductible and
eductible
and
e ductible and eductible and
30
eductibleaived
co
nsurance
coinsura
n c e
. .
C PI
N0 c o / a
comsurance
co nsurance
comsurance (
& a# ve!#" a
!# % %e!)
' e r 1 D
8
a//l
a//l
a//l
a//l a//l ' e r 2 D
3
' er 3 D
N0
3
D
40
co/a
eductible and
e ductible
and
Pre*erred
s
/ecialt D 100
%ot
coinsurance
%ot
%
ot
30
co/
a
% o n
-
/re*erred
s
/e c
alt
D
D N 0
co/a
a//l
cable
a//licab e
c o n s u rance
a//l
cable
(&
a#ve! #a!# % %e!)
0 M co nsurance
a//
a//l
3 D
40 co/a
eductible and
eductib e a n d
eductibl e and
e d . u c
t
ible and
ed.uctible
and
30
co / a
e d uc
tibl
e
ai
v e d
C P D N 0
c o
/ a
coinsurance
coinsurance
coin
s
urance
com surance coinsuran
ce
(
& a#ve!#"
a!# % %e!)
' e r 1 D
a//l
a//l
a//l
a//l a//l
' ie r
2 D
3
'
i
e r 3 D N0
3 D
40 co/ a
e ductible and
e
d
.
uctible a
n d
Pre*e
r re
d s/ecialt
D
10 0
% o t
coinsurance
% ot
% ot
30 co/
a % on-/re*e
r
r e d
s/ecialt
D
N0
co/a
a//licable
a//licable
coinsurance
a//licable
(
&
a#ve!#
a
!# % %e!) 8
0 M coinsurance
a//l
a//l
D 60 co/a
eductib
e and
eductib
e
and
educt
ble and
e d .uc t b
l
e and e d
.
uc t b le and
educt b e
and
eductib e
coinsurance
co
i
nsurance co nsurance
com surance coins urance
coinsurance
a//l a//
a//l
a//l
a//I a//I
a//l
educt
b le and
c
o in
surance
a//
3 D
60 co/a
% ot
e d .
uc t ble
a n d
% ot
e ductible and
%ot
eductible and
P D eductible
a//
icab e
coinsurance
a// icab e
co
i
nsurance
a//licab e
co nsurance
a//l
a//l
a//
H 1 8
& 1
% 1 # 9 # 0 & % 1 + 0 4 # 0 % ' # / 1 0 t 8 1 4 - 8 + t *
/ 9
#
0
<
) it a co/ a /lan
,
ou ll ave a ce rtain am ount ou ave to /a
ou
t-o *-/ocet *o r re +u lar
doctor vis its an d / re scri/ tion dru +s . @ ou r de du ctible
is t/ical
aived
*
or te s e
s e rvice
s
.
eductible an
d
coins urance m a st a/ /l *or m aor s ervice s
l
i e sur+e r or o s / ita li
Bation
1 ot in -n e t
or
and out-o
*
-neto r s
er
v ic e s a//l
t
oa
r
d a s in + le d e d u c tib le .
# o
e v e r , ou t
-
o*-/oc e t costs
*or
in
-n
et o r s e
r
v ic e s a
// l
tote in-net
or
out-o*-/oc e t m a im u m o n l. > ut-o*- /ocet costs
*o
o
u
t-o
*-netor s e rvice s a//l to te
o u t
-o* -n
e
t
o
r o u
t
-
o
*-/ oc
et
ma imum.
2 ' e *am i l deduc
tible
c a n b e met
t
rou+ a n com b in atio n o * *amil membe rs . % o o n e membe r
ill
b e
re
A uired to m e e t m ore tan te s in+le deduct ib le a m oun t to receiv e ben e *its *or c o v ered s e
r
vices
dur
in+ a
benelit
/eriod
.
3 ' e /r im ar care o** ic e c o / a a//lie s to *a m il /ract t ioners, +eneral / ractit io n e rs , internal m edicine
/ ra
c tition e rs , o b s
tetr
icians 7+ n e c o
l o + i
s ts, / e d i
a
tr ic
i a n s
, / s icia n a s s is
tant
s a n d a d v
anced
re + ist e
re d
n u rs e
/ ra
c
titioners
.
' is lo e r o**ic e co/
a
a l
s o
a / / l ie s
toin-n
et or
c
iro/ractor
s ,
/ s i c a l te ra / is ts
,
occ u / a t o n a l tera / ist s
, s
/ e e c /at
o
lo + i
s t
s
,
a n
d
in s o m e c a s e s
,
m e
nt
a l
e a
lt or
c
e m ic a l d e / e n d e n c v is its
.
; ll
ot
e r i
n -n e
t
or /rac
t it i
o n ers are
s
u b
e c t to te n o n - / ri
ma r
c
a r e o**i
c
e
c o / a . ' e
co/ a a
/
/ l i e s
/
e r
/ractit o n e
r
,
/ e r dat e
o*
se r
v ic e .
Plan C om /aris on uide 2 01 6 $
-
8/16/2019 Farm Bureau Wellmark Health Insurance
8/16
F A R M B U R E A U E ; C L U S I V E H I G H = D E D U C T I B L E H E A L T H P L A N S
$2,100
0 M
20M
2,1001
,200
m lue
# S ; s =
old 2100
$
L $
4,200 4 ,200 8,400
$
(
P P > 7
# = >
Sin+le Famil1
$ $ $
$2,1001
0 M
% ot
2,1001
%o
t
$
$ $
4,200
a//licable
4,200
a//l ic
a
ble
$
(
S ILVER
OO
$7,"
J
$
$3 ,500
M 30M
3 ,5001
000
m lue
# S ; s =
S
il v
e r
300
$
L 7 $
N ,000
N ,000 1 0
,
00 0
$
(
P P > 7
# = >
Sin+le
Fami
$ $ $
$3 ,500
0 M
% ot
3 ,5001
% ot
$
$ $
N ,000 a//licab
e
N ,000
a//l
i
cab
e
(
B R O N > E O
1/
'
$6,000
M
0
M
$6 ,0001
$9,500
m lue
# S ; s = ronBe
$
$
$
7
$
1 2 ,00 0
12,000 18,000
$
(
6000 P P > 7# = >
S in+ e Famil
$ $
O
$6,000
0 M
% ot
$6 ,0001
% ot
$
$
1 2
,
00 0
a//licable
12,000
a//licable
$
(
J O E
A N D
M A R T H A
;
+
eD =id 0s
Sta
tus
D
=arried and
looin
+
*o
rard to
ret
i
rement
6 $ Plan
Com/ a
risonuide2016
Some )ellmar ealt /lans ma el/
o u
save
*o
r me
d ic
al costs
and ou
r
*utu
r
e
.
; i+-deductible ealt /lan, /aired
it
#S;
contributions,
can earn
interes
t and be
invested
so
its
a +reat a
t
o save. $t can also el/ ou
/ an *or
medical costs
a*ter
ou reac
a+e 6 $nterest and
i
nvestment earnin+s a
r
e +enerall not subect
to *ederal income ta. ;n remanin+ balance ou ave in our #S;
rolls over eac
ear 'ats
ou ma
ant to consi
de
r
D
> m
lue #S; Silver 300 PP> (See above)
> m lue #S;
r
onBe 6000 PP
>
(See above)
> Com/lete*s u
e -
"
Silver
300
PP>
(See page
(
)
-
8/16/2019 Farm Bureau Wellmark Health Insurance
9/16
P4'/ +6/
e
ductible a n d
educt b le
educ
t
ible
a
n
d
eductib e educti
b
e a n d
educt
ib le
eductible
a//
ie s
c o
n s u r a n
c e
a//
ie s
c o in s u r a
n
c e a// l
a//lie s coins urance a//
a//lie s a//l
e s
a//
i
b e
a// li
e s
%ot
eductible
%ot
eductible
%ot eductib e eductible
a//licab e
a
/ / l i
e s a//
icab e a//lies a / / li
c a
b le
a//l
e s
a//lies
e
d
u
cti b e
a n d
e d u
c
t
ible e
duc t b e a n d e d uct b le
e d u c
tible a n d
e
d
uc t
b le
eductib
e
ib l e - a / /
lies
c o
in
s u r a n c e
a// li
e s
coinsur a n
c e
a / / l
a / / ie s
c o in sura
n
c e
a
/
/
a//
ie s
a / / lies
a
/ /
l
i
b le a//
li
e s
%ot
e d
u c
t
b le
%ot educti
b le
%ot
eductible
educt
b
e
a//
li
cab
e a / / ie s
a// licab
e
a// li
e s
a / /
l
ic
a
b
le a// li
e s
a//lies
eductib
e a n d
eductible eductible a n d
eductib
e educt
ib le a n d
eductib e educt b le
a//
ie s
coinsurance
a//lies
coins urance a//l a//lie s
c o in surance
a//l
a//lies
a//lies
a//
e a//l e s
% ot eductib
e
%ot
educ.tible
%ot
eductib
e
1
eductible
a// li
cab le
a / /
lies a//
icable
a//lies a//
icab e
a// l
ie s
a//lies
"*# t
/ # - ' / 9 B ' H S A # 0
& + ( ( ' 4 ' 0 t <
)e l mar
s
m lue
HS A
/ lan s are actual
Au a l
i* ie
d i
+
-deducti
b e ealt / lan s 5# #Ps .
'ere d
i
**e re nt *rom an ote r e alt / an becaus e te don t include co / am e nts an d
coin su ran ce *or in -n etor s ervice s. ' at m e an s ou / a te *u ll cos t *or care 5e clu din +
/reventive
car
e
and
/rescr
/ t
ions
unt i
l
ou re ac ou r de du ctible . ) it
a
Auali*ied
# #P
,
ou can o/e n a ealt sav
i
n +s accou nt 5#S ;. ' e s e are s avin+s accounts ou can us e to
s et as ide m one ,
i
c +ros ta *re e, and te n
i t
dra *unds *rom , +e ne rall on
a
ta-*ree
basis .
@ou
c a n u
s e tis m one to / a *or
Aual i
*ie d m e dical e / en se s,
i
e doc to r s
o* * ice vis its and /rescr i/ tion dru+s . ;n in te re s t +ain e d is als o t/ ic all n ot s ube ct to *e de ral
in come ta .
1
ot
in- net
o r
a n
d o
ut-
o
r-net
or serv
i
ce s
a
/
/ l
to
ard a
sin+
le
d e d u
c tib le
.
# o e v
er
,
o
ut- o *-/oc e t c
o
st s l
o r
in
-
n e t
o
r s e
r
v i
ce s
a
// l
to
te in - neto
r
out-
o* -
/ocet m a i
m u
m
o n
l
.
>ut-o*
-/oce
t costs lo
o u t-a
i- n e
t
o r
s e
r
v i
ce s
a
/
/ l t
o t
e
o
ut- o *-ne
tor
out-o*-/ocet m a im u m .
2
or te m l
u e
# S ;
bro
n
B e
a n d s i ver
ealt
/ a n s , n o o n e member ill
b e
reAuir
e d to
mee t
more
tan t
e
s i
n+le
deductible
.
F o r t e m l
u e
#
S ;
+ o
ld e a t / l
a n ,
te en ti re lam i l deductible
must b e met
b e *ore
bene
*its a re /aable
.
Plan Com/arison
uide 2 016
-
8/16/2019 Farm Bureau Wellmark Health Insurance
10/16
-
8/16/2019 Farm Bureau Wellmark Health Insurance
11/16
P4'/ +6/
# - J e e Parmacies > n l 8
eductible aived
1
eductible
a n d
e d .uctib
l
e
a n d
ed.uctible and
ed.uctible a n d
20
co/a
'
e r
1
dru+s D 10
coinsurance com surance com surance
c o
nsurance
(&a#ve!
#
a!# % %e! )
'ier 2
dru+sD
3
30
a//I a//I
a//I
a//I
' e r 37/re*erred s/ecialtD N0
%on-/re*erreds/ecialt dru+s D 0M
coinsurance
# - J e e Parmacies > n l 8
e ductib
e
aived
e ductible
a n d
e d . u c t
b
e
a n d
e ductible a n d
eductib
e a n d
30 co/a
'ier 1
dru+sD
1 0
30
co
nsurance
co
nsurance
coinsurance
co
nsurance
(&a#ve!
#
a!# % %e! )
'ier
2 dru+sD
3
6 0
a//l
a//
a//l
a//
'ier 37/re*erred
s/ec
altD N0
%on-/re*erreds/ecia
t
dru+sD 0M
coinsurance
# - J e e Parmacies > n l 8
eductible a//lie s
(&a#ve!
"o + * # e + 1 )
ed.uctible
a n d
e ductible
and
e ductible a n d e ductible and
eductible a n d 'ier
1
dru+sD 2
4
com surance coinsurance
coinsurance
coinsurance
co nsurance
a//l 'ier 2 , 'ier
37Pre*erred
s/ecialt,
0
a//l
a//l
a//l a//l
%on-/re*erreds/ecialt
dru+sD
'ier
1
deductible
a n d co nsurance
a//l
H 1 8 & 1 B ' R ' 8 # 4 & # 0 8 1 4 - <
)e ll m a r lu e & eards
P > S S =
/ lans com bine e le m ents o* bot PP> and #= > / lans . ' e am ount ou
/a out-o*
-
/ocet is de te rm ine d b te le ve l o* / rovide r care ou coos e, s o i* ou s ee
a
lue &eards
/ rovide r, ou ll s / en d le s s on e alt c are e / e ns e s.
@ou
c an a ls o e arn reard s *o r ea lt be avio r.
) it lu e & eards , ou ave cove ra+e e n s ee in + lu eC ard / rovide rs ou ts ide o* $oa. e /e ndin +
on te / lan ou coos e, te lue Card de du ctible an d lue Card out-o*-/ oc et m aim um 5> P= m a
be te s am e as e n re ce ivin + c are *rom
a
' ie r 2 ) ellm ar lue P> S / rovide r. ' e lue Card
de ductible and > P= m a also be te s am e as e n re ce ivin+ care *rom an out-o *- ne tor / rovid er.
' e coin su ran ce am ou nt *or lu eC ard / rovide rs
is
alas te s am e
as
e n s e ein +
out-o*-
netor
/ rovide rs . F or m ore in *orm ation on
out-o*-
/ oc et cos ts e n s ee in + lu eC ard / rovide rs , alon + it
o te a/ /l to ou r > P= , vis it )e
lmar lue&e ards.com.
1
ot
'ier 1 a n d 'ier
2
deductible amounts count toard eac oter, but do not a//l toard lueCard or 'ier
3
out -o*-netor deductibles. 'ier 1 , ' ier
2
a n d lueCard e/enses count toard eac oters
o u t-o* -/ocet maimums )P=, a n d out o* netor e / e n s e s a//l to ' ier
3
> P = . 'ier 1 a n d 'ier 2
o u
t-o* -/ocet maimum amoun
ts
i ll a l s o count
toard
eac oter.
2 '
e
*am
il
deduct
i
b le
c a n
b e
mettrou+
a n comb
in
at
i
o n
o**am il m e m b e
r
s . % o
o n e membe r
i ll
b e re A
u i re d
to meet m o r
e tan te s i
n +
l e d e d uct i
b le
a m o u n tto
rece
ive b e n e
*i
t s * or covered services durin+ a
bene* it /er iod.
3
# - J e e is
a n
inde/endent com/an
/rov
idin+ a**init7reards
services
in su//or to* te
lue &eards
/ro+
r
a m .
4 ' e /r imar care o ** ic e co/a a / / l ie s to *a m
il
/ractitioner s, + e n e ra l /ractitioners, inte r n a
m e d ic i n e /ractitio n e r s , obstetrician s 7+ n e c o l o + ists, / e d i a tricians, /sician assistants a n d a d v a n c e d r e + i
stered
n u r s e
/ractitio n e r s .
' is
oer
o** i
c e co/a a l s o a / / l i e s to in-netor
ciro/ractors,
/sical
tera/ists, occu/ationaltera/ists,
s / e e c /atolo+
i
sts, a n d
in s o m e
c a s e s , mental ealt orcemical de/endenc visits. ;l l
oter in
-
netor /ractit io n e r s
a re
subect
to
te non-/rimar
care
o**ice
co/a
.
' e
co/aa// lies
/ e r /ractitioner,
/er date o*
s e r v i
c e
.
) @ o u
ma
onl
*
ll
/rescr i/ ti
ons at # -Je e
/armacies it l imited ece/tions .
@ o u
can
+e t more
in*ormation
about
/rescr
i/tions
*illed
at
oter /armacies in our
/olic
manual,
ic
ou ill receiv
a*ter
enrol lment .
Plan C om / aris on uide 2 01 6
$
-
8/16/2019 Farm Bureau Wellmark Health Insurance
12/16
U N D E R S T A N D I N G Y O U R B E N E F I T S
N 1 / # t t ' 4
8 * + % *
2 # 0 9 1 6 % * 1 1 5 ,
( ' ' 5 ' % 6 4 ' - 0 1 8 + 0 )
9 1 6
# 4 ' # . 8 # 9 5
% 1 7 4 & 8 + t *
E 5 5 0 t + # H ' # . t * B'0 ' ( + t E H B 5 .
o
Preve
n
tive andellness
s e r
vice and cronic
o
#os/italiBation
d is e
ase
m
ana+ement
o Gaborator services
o Prescri/tion dru+s
o
=ate
rnit and neborn care
e Pediatric
s e
r
v i
ce s
,
inclu
d i
n+ v
i
sion ca re
o = e ntal ealt and
s
ubstance usedisorder
s e
rv ices
,
o ;mbulator /atient services
includin+ beavior ealt treatm e n t
e !m e r+enc services
C &eabilitative and
a b i
litative
s e r
vices and devices
PREVENTIVE ENEFITS
; t )ellmar, e
d
e s i+n ou r insu rance
/
ans it ou
n mind ;ll
t
e
/lans
in
ti
s
boolet cover /reventive care *rom
in-
netor
and /art
i
ci/atin+ /rov
i
de r
s
at nocost to ou. Preventve services
in c lude tin+s lie / s ical e
am s
, immuniBationsand s c reenin+s.
$* ou coosean #=>or
l
ue &ea
r
ds
/ l
an, ou must seeour
desi+nated /ersonaldoctor or > 7@%*or our annualellness
and +necolo+ical
e
am.
PRESCRIPTION DRUG ENEFITS
; l
/ l
ans ave
t
e
l
ue
& ! s s e n t i
als s=
d
ru
+ / l
an to el/ cover
ou
r medcat
i
on costs
!%!F$'G!J!GS
9
ru+'ier 1D =ost a**ordabledru+s
$n
cl
u de
s m o
st +enercs and select brand name
dr
u+s.
9
ru+ 'ier 2D Pre*erred dru+s
r
u+sare isted as /re*erred becauset
e
avebeen / rovento
be e **ective and *a v
o
rabl
/
riced com/ared to
o
te r dru+s tat
treat te same condition.
9
ru+ 'ier 3D %on-/re*
e
rreddru+s
@ 2o;
p
+ee
++e
! dru+s avenot been*ound to beanmore
cos t e **e c tive tan /re*erred brands.
9
Pre*erred s/ecialt and non -/re*erred s / ecialt dru+s
@
4+ee++e
!
ne routine vision eam/er bene*it ear at nocost
>ne *rame and one /air o* lenses/er bene*it ear or
contact lenses instead o* *rames and lenses
- (/ to 130 *or one *rame /er bene*it ear580M
coinsurance *or
cove
red car+es
m o
r
e
tan
130
- (/to 130
/e
r bene*it ear *o r non-medicall
necessar contact lenses58Mcoinsurance
*o
r
covered car+es m or
e
tan 130
P =edicall necessar con
tac
t lenses
*o #;!
o=%
#
?o=+ p+ov#!e+
pa+%#7#pa%e
< #; %8e
pe!#a%+#
7 v#
-
8/16/2019 Farm Bureau Wellmark Health Insurance
13/16
" * # t
' ' + 5 % 1 ' 4 ' & <
#eres
a i+ -
level loo at ats covered b)ellmars ealt /lans.
@ou
ill receive
a
com/lete list it
our /olic manualonce ou enroll in a )ellmar /lan. Fordetailed cost in*ormation loo at our Summar
o* ene*its andCovera+e5S C.
>
Psicianservices
P
;nestesia services
P
Psiciano**ice andout/atient visits
P &adiolo+
P Patolo+and oter dia+nostic services
P Sur+erand sur+ical assistance
P $n/atient os/ital visits
9
Psiciano**ice services
P R-
ra
,
laborator and /atolo+ services
/er*ormed in te /sicians o**ice
P Su//lies usedto treat te covered /erson
durin+ te visit
P #earin+ eamsdue to illness or inur
P !e eamsdue to illnessor inur
P ;ller+ testin+
1 / / 1 0 ' @ % + 1 0
9
>r+anand tissue trans/lants
P
#eart
P Gun+
P
Pancreas
P idne
P Simultaneous/ancreas7idne
P Small boel
P
Giver
P
onemarro7stem cell trans*ers
9
iabetesout/atient sel*-mana+ementtrainin+ an
/atient mana+ement *rom an a//roved /rovider
9
Psical,occu/ational or s/eectera/ services
9
S/inalmani/ulations 5Gimits maa//l
> urable medical eAui/ment
'ere are someservices tat are not usuall covered bour ealt /lan.)eve isted te most common, bu
*or a detailed list, loo at te /olic manual oull receiveen ou enroll
in
a )ellmar/lan.
>
Services not determined to bemedicall
necessar
9 !lective abortions
9 ;rti*icial inseminationQ in vitro *ertiliBation or an
related *ertilit or in*ertilit trans*er /rocedure
9 =assa+etera/
9
Cosmetic services
P
!ce/t
in
te *ollon+ instancesQ sur+er tat
aste /rimar /ur/ose o* restorin+ *unction
lost or im/aired
as
a result o* an illness or
inur, or birt de*ect. reast reconstruction
a*ter a mastectom.
9
&outinevision services
P
!ce/t
as
noted in te Pediatric Jision section
9 Counselin+
9
$nvesti+ational and e/erimental treatment
9
)i+s
9
;cu/uncture
9
)ei+t reduction /ro+rams
9
&outine *oot care
PlanCom/arisonuide2016 $
-
8/16/2019 Farm Bureau Wellmark Health Insurance
14/16
E # 5 9 8 # 9
t 1 # 9
>nceou decide on a )ellmar
/lan ,
ou ten aveanoter
co
ce
-
ic easato /a*its ou best.
;ll billin+ /eriods are basedon te calendar ear and ou can mae/aments eiterD
o ?uarterl 5!lectronic Funds'rans*er onl
o
Semi-annuall
e
;nnuall
o =ontl 5!lectronic Funds'rans*er onl
@ou can evenset u/ automatic itdraal *rom a savin+sor cecin+ account. $* ouould rater ave a
/a/er bill, ou can +et tose on
a
semi-annual or annual /ament *reAuenc.
" * # t t 1 ' @ ' % t
0 ' @ t
@ouve/iced our /lan and madeour /ament selection, at
s
net:
o @ou
receive
ou
r com/leted
a//l
cation. Cec to maesure
al l
o* te in*ormation *or bot ou and
our *amil members onour /olic
is
correct.
o )atc *or our )ellmar $ card in te mail. 'at card is /acedit all te in *ormation ou need.
=aesure evertin+
is
accurate, and soour card to our doctor os/ital or an oter ealt care
/rovider to accessour bene*its.
e &e+ is t e r *or m)ellmar - it taesust a *e Auic ste/s. m)ei mar is our /ersonaliBed ealt
ebsite tat maes it eas*or ou to mana+eour /lan.
M ' / $ ' 4 ) ' t 7 0
/ 1 4 ' 1 t+1 0 .
A # "' /#4- / ' / $ ' 4 ,
8 '
1( (' 4 9 1 1221 4 t60 +t +' 5 t 1 )' t / 1 4 '
( 4 1 /
9 1 4
* ' # t * % # 4 '
$'0'( + t5 .
L ' # 0 1 0
1 4
4 ' 1 4 % ' (1 4 / 1 4 '
+ 0 ( 1 4 / # t + 1 0 , 1 4 t
# 0 &
& + % 1 0 t 8 * ' 0 9 1
0 ' ' &
t*'/
!er'&% l
He l($
A''i'(a%(
;n time ou needel/
Personal#ealt;ssistant
24
7N
is
ere to anser
our ealt concerns,
direct ou to /roviders
o
r resources, and o**er
solutions *or everda
ealt care /roblems.
12 $ PlanCom/arisonuide 2016
P
D 7
Bl)e r"®
!rr m
)it te lueCard
/ro+ram,ou cantravelit /eaceo*
mind, noin+tat 6 /ercento* os/itals
and 2 /e rcent o* /siciansnationide
ar
e in
te lueCrossand lueSield
netor. )it a PP>/lan
,
oualsoave
accessto doctorsand os/itals
in
more
tan 200 countriesaroundteorld.)it
our)ellmar lue #=>/lans, oure
t/icall onl /rotected in emer+enc
situationsentravelin+outside $oa.
8../#4-
.
B ' 6 5
ecau
s e e a
t
s
a
b
i
+
-
&
Bl)e365 !rr m
'is member /ro+ram
+ivesou eclusive
accessto d iscounts and
resourcesto el/ ou live
a ealtier li*estle. Jisit
)ellmar.com7 lue36
m(
ll
m$+.
m)ei m a
r is
our
/ersonaliBed ealt
ebsite tat maes it
eas*or ou to
mana+eour /lan
@ou can evenaccess
it on oursmart/one
bdonloadin+ te
)ellmar mobile
a//
lue C r o s s and lu e Sield ;ssociation
,
2014.
-
8/16/2019 Farm Bureau Wellmark Health Insurance
15/16
H E A L T H I N S U R A N C E A S S E S S M E N T
U 5 t * +
8 1 4 - * ' ' t
t1 # 5 5 5 5 9 1 6 4 * ' # t * + 0 5 6 4 # 0 % ' 0 & 5 .
HEA/TH N0 1RAN E N-ORMAT ON
o o
ou aveealt insurance no:5Circle one
@e s
%o
o
$* es,doou... 5Circleone uit oursel*7 Purcasetrou+ an em/loer
e
)at is our /remium: 7montQ 7ear
o
)
at is our deductible: Co/a Coin surance
>ut-o*-/ocet m a %etor Parmacco/a
7
deductiblesD
e $*
ou ad
a
maor
m
edical bill delive
r
ed to ou toda, omuc could ou s/end toard ourdeductible or co
in
surance:
0 #oaveou usedour ealt insurance mosto*te
n in
te
/a
st ear:
o
#omandoctor visits did our *amil ave last ear:
o ;re ouillin+ to consider a /lanit i+er out-o*-/ocet costs
in
return *or a loer /remium orould ou /re*er loerout-o* H
/o
c
et costs at a i+er /remium:
o
# ave ou everconsidered
u s
in+ a ealt
sav in+
s account 5#S;*or ou a
nd
our *amil:
5Circle one
@es
7 %o 7 on t noat an #S; is
e o ou no i* our *amil doctor s / ecialist or medical /rovider is in-netor on our current /lan :
4
o
o u
,
or an o* our *amil
m
e
m b
e
rs ,
c
urrentl
re
ceive medical services, or /lan to re c
e
ive
m
e
dic
al
s e
rvic
e s
t
is
ea
r,
*
r
om
a
/rovider outside te state o* $oa:$*
s o
, o are te /roviders ou /lanon us in+ :
o
ou , or an o* our *amil
member
s travel outside te state o* $oaon a re+ular basis:$*
so,
ere doou travel most:
*.
o
ou aveon+oin+ /rescri/tion dru+ costs:
I $* s o, aveouceced te)ellmar ru+ Gist to see i* te dru+s are covered, onic tier and at at cost-sare:
IL'++.
I
.
) 1:\ /J. ill ,," ,," * + .
(l
PlanCom/arison
u i
de
2
01
6
$
1
-
8/16/2019 Farm Bureau Wellmark Health Insurance
16/16
R ' # & 9
t 1
' 0 4 1
+ 0
#
2 # 0 <
N ' ' & * ' . 2
& ' % + & + 0 ) <
" '
# 4 '
* ' 4 ' t1 * 2
9
'al
to o ur autoriBed
Fa
rm u reau
a+
ent or *ind one at
"
'/#4-.%1/.
9
Jisit"' /#4- .% 1/ to com/are o u r o/tions , so/ *or a /lan and
+e
t a
/e
rs
on
a liB ed
r a
t
e
Auote. ;ll ou a ve t
o d
o is D
o
;ns
er a *e Auestions to el/ ou decide ic / lan best *
i
ts
ou
r ne eds
.
o C
o
m / a r
e
our o/tions b
loo
in+ a
t
a
v
ail a
bl
e
/ l
a ns s id
e
b s
ide
.
U ;dd our de s ired /lanto te so//in+ ca r
t
and enroll.
* #< !o7=$e;%#< #;%e;!e! %o be =