2013 Amarr Health Fund Plan
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2013 Amarr Health Fund Plan. WHAT IS THE AMARR HEALTH FUND (CIGNA CHOICE HEALTH REMBURSEMENT ACCOUNT)?.

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2013 Amarr Health Fund Plan

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2013 amarr health fund plan

2013 Amarr Health Fund Plan


2013 amarr health fund plan

WHAT IS THE AMARR HEALTH FUND (CIGNA CHOICE HEALTH REMBURSEMENT ACCOUNT)?

  • The Amarr Health Fund (AHF) is a consumer driven health plan that includes a fund account established by Amarr that can be combined with your health care plan enabling you to be reimbursed for eligible medical expenses.

  • Amarr has allocated a set amount of money to your fund account and you can use this money to pay for eligible medical expenses.

  • In-network preventive care will continue to be paid at 100%.

  • Pharmacy benefits will not be deducted from your fund. The current pharmacy copay structure will remain as it is today.

  • You will receive CIGNA’s negotiated discount at participating providers.

  • 50% of your remaining AHF monies will rollover to the next calendar year.

  • The AHF will be capped at a maximum of $2,000.

  • All costs paid out-of-pocket for services covered under the AHF goes toward your calendar year out-of-pocket maximum. Once you reach your out-of-pocket maximum, the AHF plan pays for covered services at 100% for the remainder of the calendar year.


2013 amarr health fund plan

HOW IS THE AMARR HEALTH FUND DIFFERENT FROM YOUR CURRENT PPO?

Similarities

  • Wide choice of doctors/hospitals

  • Preventive care covered at 100%

  • Plan begins to pay at coinsurance level after calendar year deductible is met

  • Plan begins to pay at 100% after annual out-of-pocket maximum is met

  • Covers routine, emergency and catastrophic care

  • Plan pays higher percentage of claim expenses for covered in-network care

  • Plan pays percentage of claim expenses for covered out-of-network care

  • Cigna receives claims, processes claims, and sends payment to the providers

  • Pharmacy copay structure will remain unchanged

    Differences

  • A fund account is established by Amarr

  • Plan begins to pay after calendar year deductible is met. The Amarr Health Fund is applied to help you meet your deductible.

  • No medical co-pays due at time of service

  • Deductibles and Out of pockets are accumulative


2013 amarr health fund plan

2013 HEALTH CARE PLAN


Claim flow examples option 1 plan

Claim Flow ExamplesOption 1 Plan


2013 amarr health fund plan

Medical Office Preventive Care Visit Claim Submission Example for Amarr’s Health Fund Claim 1

The patient presents their Cigna ID card during the preventive care office visit.

Patient has a preventive care visit with an in-network doctor.

2

1

The doctor’s office bills Cigna $210

for the preventive care office visit.

3

4

  • CIGNA receives the claim, applies the in-network discount and the office visit charge is now $180.

  • The patient pays $0 (because preventive care is covered at no charge)

  • Amarr through Cigna will pay the doctor the amount owed of $180.

Amarr Health Fund Balance

Beginning fund balance: $ 600

No payment from the fund $ 0

Remaining Fund Balance $ 600

6

  • Explanation of Benefits (EOB) is mailed to the Amarr TM and will show:

  • The amount billed to Cigna

  • The amount of the in-network discount applied

  • Theamount of payment sent to the doctor

  • The amount the patient will owe. If no money is owed, the EOB will show $0 as the patient responsibility.

  • The amount the patient saved by going in-network

5

6


2013 amarr health fund plan

Medical Office Sick Visit Claim Submission Example for Amarr’s Health Fund Claim 2

The patient has a sick visit with an in-network doctor.

The doctor’s office bills Cigna $180

for the office visit.

3

The patient presents their Cigna ID card during an office visit.

1

2

Amarr Health Fund Balance

Beginning Balance: $ 600

The Amarr Health Fund pays the doctor$ 130

Remaining Fund Balance$ 470

6

  • CIGNA receives the claim, applies the in-network discount and the office visit charge is now $130.

  • The patient pays $0 (because the cost of the visit is paid from the Amarr Health Fund)

  • Amarr through Cigna will pay the doctor the amount owed of $130.

5

4

  • Explanation of Benefit (EOB) is mailed to the Amarr TM will show:

  • Theamount billed to Cigna

  • The amount of the in-network discount applied

  • The amount of payment that was sent to the doctor

  • The amount the patient will owe. If no money is owed, the EOB will show $0.

  • The amount the patient saved by going in-network

7


2013 amarr health fund plan

Specialist Office Visit (with lab work and x-ray)

Claim Submission Example for

Amarr’s Health Fund Claim 3

The patient presents their Cigna ID card during the specialist office visit

The patient has an in-network specialist visit, with lab work and x-rays.

2

1

3

The specialist office bills Cigna $310

for the office visit, lab work and x-rays.

Amarr Health Fund Balance

Beginning Balance:$ 470

The Amarr Health Fund pays the doctor$ 240

Remaining Fund Balance$ 230

6

  • CIGNA receives the claim, applies the in-network discount and the office visit charge is now $240.

  • The patient pays $0 (because the cost of the visit is paid from the Amarr Health Fund)

  • Amarr through Cigna will pay the doctor the amount owed of $240.

4

  • Explanation of Benefit (EOB) is mailed to the Amarr TM and will show:

  • The amount billed to Cigna

  • The amount of the in-network discount applied

  • The amount of payment that was sent to the doctor

  • The amount the patient will owe. If no money is owed, the EOB will show $0

  • The amount the patient saved by going in-network.

5

8


2013 amarr health fund plan

In-Patient Hospital Stay Claim Submission Example for

Amarr’s Health Fund Claim 4

The hospital bills Cigna $7000 for the

in-patient hospital stay.

1

The patient has an in-patient hospital stay.

3

2

The patient presents their Cigna ID card when admitted.

  • Cigna HealthCare receives the claim, applies the in-network discount and determines if the patient would owe any cost for the in-patient hospital stay:

  • The in-patient hospital charge is now $5,000 (due to in-network discounts).

  • There is $230 left in the patient’s Amarr Health Fund which is paid toward the $5,000 in-patient hospital claim. The balance now owed to the hospital is $4,770.

  • The TM’s share (deductible) is $700 for Employee Only coverage.

  • The Total Deductible of $1,300 has now been met. ($600 AHF + $700 Your Share (deductible).

  • After the deductible has been applied to the claim, the patient pays 20% coinsurance on the claim balance of $4,070, which is $814.

  • The total patient responsibility for this claim is $1,514. ($700 calendar year deductible + 20% co-insurance of $814)

  • Amarr (through Cigna) pays the remaining

  • cost of $3,256.

4

Amarr Health Fund Balance

Beginning Balance: $ 230

The Amarr Health fund pays the hospital$ 230

Remaining Fund Balance$ 0

6

  • Explanation of Benefits (EOB) is mailed to the Amarr team member and will show:

  • The amount billed to Cigna

  • The amount of the discount applied

  • The amount of payment sent to the hospital

  • The amount the patient owes

  • The amount saved by going in-network

5

9


2013 amarr health fund plan

Medical Office Sick Visit Claim Submission Example for Amarr’s Health Fund Claim 5

1

The patient has another sick visit with an in-network doctor.

The patient presents their Cigna ID card during an office visit.

3

The doctor’s office bills Cigna

$180 for the office visit.

2

Amarr Health Fund Balance

Beginning Balance:$ 0

The Amarr Health Fund pays the doctor$ 0

Remaining Fund Balance$ 0

6

  • CIGNA receives the claim, applies the in-network discount and the office visit charge is now $130.

  • The deductible has been met. Therefore this claim will be subject to coinsurance only.

  • The patient will be responsible for $26.00, which is 20% coinsurance of $130.

  • The Amarr Health Plan pays $104.00, which is 80% coinsurance of $130.

4

  • Explanation of Benefit (EOB) is mailed to the Amarr TM will show:

  • Theamount billed to Cigna

  • The amount of the in-network discount applied

  • The amount of payment the patient is responsible for sending to the doctor

  • The amount the patient saved by going in-network

5

10


2013 amarr health fund plan

REMAINING AMARR HEALTH FUND ROLLOVER EXAMPLE

Team Member ends the year with a remaining AHF Balance of $480.

Half of the $480 or $240 will roll over to next plan year.

2014 Amarr Health Fund

Roll Over from Prior Year$240

2014 Health Fund$600

Total Health Fund$840

In 2014 the Team member uses $300 for health care leaving a balance of $540 in their health fund ($840 – $300).

Half of that $540 or $270 will roll over to next year.

2015 Amarr Health Fund

Roll Over from Prior Year$270

2015 Health Fund$600

Total Health Fund$870

*Please note the Amarr Health Fund will be capped at a maximum of $2,000.

Examples only – No guarantee on health fund amounts

11


2013 amarr health fund plan

HOW CAN I BECOME A GOOD HEALTH CARE CONSUMER?

  • When you choose to utilize CIGNA in network health care providers, your costs will be lower and your plan will pay a larger share of any covered charges.

  • On myCigna.com you can find quality of care information and cost estimates for over 200 medical procedures and treatments before you see a health care professional.

  • On myCigna.com you can compare the costs of Prescription drugs .

  • Establish a patient relationship with a primary care physician to avoid unnecessary emergency room visits.

  • Seek care at urgent care facilities when needed.

  • Call CIGNA’s 24/7 Nurse Hotline # 1-800-564-9286 to avoid unnecessary physician office visits. Request generic drugs when available.


2013 amarr health fund plan

AMARR HEALTH FUND HELPFUL TOOLS

Explanation of Benefits (EOB)

  • Explains how claims are processed and indicates if a payment is made to a provider.

  • Available in print or online at myCigna.com

  • Will be mailed to participants home address. Also, available online at myCigna.com.

Quarterly Health Statement

  • Will be mailed quarterly to participants home address. Also, available online at myCigna.com.

  • Shows year-to-date deductibles, all claim activity and out-of-pocket expenses for the quarter.


2013 amarr health fund plan

SAMPLE MEDICAL ID CARD

Group Number

Your Responsibility

Prescription Copays

Coinsurance Amounts

Customer Service Number


2013 amarr health fund plan

FLEXIBLE SPENDING ACCOUNT (FSA)

Beat the tax man to your money, Enroll in Amarr’s Flexible Spending Account (FSA)!

What expenses can be reimbursed?

Money in the FSA can be used to reimburse medical, pharmacy, dental and vision expenses. Use your FSA dollars to cover “Your Share” to help you meet your deductible

How it works

  • You can choose a minimum of $100 annually up to a maximum of $2,500.

  • The amount of money you choose to contribute to the FSA will be deducted from your pay check on a pre-tax pay period basis.

  • The total annual amount you elect is available for you to use the 1st day of the new plan year.

  • Flex monies can be used to pay for out-of-pocket expenses that you may incur

  • Flex convenience card issued for your use.

    NOTE: If you have any unused monies at the end of the calendar year in your FSA, you have until March 15 of the next year to use it.


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