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Benton County Employee Benefits – Medical

PacificSource Health Plans is the provider for Benton County medical insurance. 

Medical Coverage Questions

Toll-free 888-977-9299

cs@pacificsource.com

Employees:  Do you need to order a new ID card, review your claim history, look up your group plan number or your ID number, or find a participating provider in your area? Try using PacificSource - InTouch for Members. InTouch for members allows you to review and manage information about your membership.

PacificSource Enrollment form

Termination of Dependent form

HSA Bank is the provider for Benton County's Health Savings Account.

Health Savings Account Questions

866-357-5232 Business Relations

800-523-4175 Lost or Stolen HSA Bank Cards

www.hsabank.com

COBRA Continuation of Coverage Rights

COBRA: Information about Continuation of Coverage Rights under COBRA (PDF) for employees or dependents whose County insurance coverage ends.

Prescription Drug Plan

Prescription Drug Information:  Effective June 1, 2009, PacificSource made changes to their drug list.  The PacificSource drug list is updated monthly.  You can find more prescription drug information at PacificSource: Prescription Drug Information.

Mail Order Prescription: If you take a medication on a regular basis, mail order service is a convenient and cost saving way to order prescription. Read More...

Please note that effective September 1, 2009, Walgreens will no longer be a mail order prescription provider for Benton County. Click "Switch Kit" to learn who will be replacing Walgreens and to learn more about the Mail Order Vendor Change. You'll also find information about the County's other mail order prescription provider Wellpartner on the Switch Kit web page. For member who currently use Walgreen's for their mail order proscription, you should continue to use Walgreens until September 1, 2009. If you don't switch to Wellpartner, your prescriptions will automatically be switched to the new mail order prescription provider, CVS.

Prescription Plan
Up to a 34-day supply	From any participating Caremark retail pharmacy using the PacificSource Pharmacy Program
Up to a 45-day supply	From a participating mail order service
46 to 90-day supply	From a participating mail order service

Prescription plan and the Out-of-Pocket limits: For the Traditional Plan option, the prescription drug plan is not subject to the deductible which means prescription co-payments do not apply to the out-of-pocket maximum.  For the High Deductible Health Plan, the prescription drug plan is subject to the deductible which means the amount individuals pay for prescription out of pocket while satisfying the deductible applies to the out-of-pocket maximum.; Once the prescription plan moves to co-payments, the prescription co-payments continue to apply towards the out-of-pocket maximum.

Vision Coverage

Vision Benefit*

Eye exam once every 12 months

Lenses or contact lenses one pair every 12 months

Frames once every 24 months

Vision Plus Benefit Allowance Amounts

*Vision benefit resets 12 months from the last date of service, not August 1st.  For example, if your last eye exam was on February 17th, 2009, your vision benefits will reset February 17th, 2010.

Alternative Care & Chiropractic Benefit

Subject to the annual deductible.

Co-payment after the deductible.

$1000 maximum per contract year.

Covered services include the services of a licensed naturopath for medically necessary diagnosis and treatment of illness or injury, acupuncture services of a licensed acupuncturist or physician for diagnosis and treatment of illness or injury, and services of a licensed chiropractor for medically necessary diagnosis and treatment of illness or injury.

Participating Provider

To maximize your plan's benefits, always make sure your healthcare provider is a PacificSource participating provider.  Do not assume all services at a participating facility are performed by participating providers.  You can get a list of participating providers at www.pacificsource.com/provider-networks.

Please note that when you receive services or supplies from a nonparticipating provider, your out-of-pocket expenses is likely to be higher than if you had used a participating provider.  If the same services or supplies are available from a participating provider to whom you have reasonable access, you may be responsible for more than the deductible, co-payment, and coinsurance amounts show on your member benefit summary.

Payment to providers is based on the prevailing or contracted PacificSource fee allowance for covered services.  Although participating providers accept the fee allowance as payment in full, nonparticipating providers may not.  Services of nonparticipating providers could result in out-of-pocket expenses in addition to the percentage indicated in the benefit summary and employee handbook.  Network Not Available payment is allowed when PacificSource has not contracted with providers in the geographical area of the member's residence or work for a specific service or supply.  Payment to providers for Network Not Available is based on the usual, customary, and reasonable charge for the geographical area in which the charge is incurred.  For more information, refer to the payment to providers section in the employee benefit handbook.

Medical Coverage (including prescription and vision) Summaries

What are the medical plan coverage options?

Employees can elect to be enrolled in a Traditional Preferred Provide Plan or a High Deductible Health Plan.  Employees enrolled in the high deductible health plan will also be enrolled in a Health Savings Account.  Below you'll find the medical plan summaries:

Traditional Medical Plan Summary of Benefits

CD - HDHP Medical Plan Summary of Benefits

What is an Health Savings Account (HSA)?

The HSA is an account established to help pay for eligible medical expenses. For more detailed information, you can review the Internal Revenue Services Publication 502 - Medical and Dental Expenses.  The HSA is attached to the CD - HDHP. The HSA can be funded with pre-tax dollars by you, the employee, and/or Benton County. The account, including the funds in the account, belongs to you. If you change plans in the future, or leave County employment, the account goes with you. For the 2009-10 plan year, Benton County will contribute 50% of the deductible on August 1, 2009 (the start of the plan year) to your HSA, $600 for the employee only, and $1200 for two or more. The County's contribution amount is pro-rate to and employees date of hire and the number of hours the employee works per week.

For information over the rules governing HSAs, you can review the Internal Revenue Services Publication 969 - Health Savings Accounts and Other Tax-Favored health Plans.

Are there eligibility requirements to participate in the HSA?

To be an eligible individual and qualify for an HSA, you must meet the following requirements:

• You have a high deductible health plan (HDHP),
• You (and your spouse, if you have family coverage) cannot have any other health coverage that is not an HDHP,
• You are not enrolled in Medicare, and
• You cannot be claimed as a dependent on someone else's tax return

Frequently Asked Questions (revised for new hires).

If you elect to enroll in the CD-HDHP with HSA, you'll need to complete the HSA Bank Enrollment and Contribution form in addition to the PacificSource Enrollment form.

*The County's contribution to an employees health savings account is pro-rated to the employee date of hire and the number of hours the employee works per week.

Basic Comparison of the Traditional Plan Option and the Consumer Driven - High Deductible Health Plan Option (in-network/Preferred Provider)
	Traditional Plan	CD - HDHP
Annual Deductible	$150 EE, $300 EE+1, $450 Family	$1,200 EE/$2,400 Family
Out-of-pocket Limits	$1,500 EE/$3,000 EE plus	$2,800 EE/$5,600 EE plus
Preventative Services	Not subject to the annual deductible	Not subject to the annual deductible
Prescription Plan	Not subject to the annual deductible	Subject to the annual deductible
Alternative Care (Acupuncture and Naturopath) & Chiropractic Benefit	$1000 maximum per contract year (not available for BCDSA)	$1000 maximum per contract year
Vision Benefit	Not subject to annual deductible	Not subject to annual deductible
Health Savings Account	No	Yes
Health Savings Account - County Contribution (IRS eligibility rules apply)	No	Yes - 50% of annual deductible for full-time employees and  Pro-rate for part-time employees and employees hired after August 1, 2009.
Monthly Insurance Premiums (full-time employees)	Yes	No (Monthly premiums are pro-rated for part-time employees)