Employee Benefits
Healthcare Benefits





Health Care Assistance Plan Document   

2014 - Health Care Assistance Plan (HCAP) Document
2014 - Summary of Benefits and Coverage (SBC)​



 

Medical: Independence Blue Cross

Medical Preferred Provider Organization (PPO) network, provider search, review paid claims, benefits summary, print temporary ID card &/or request new one.
Member Services (888) 276-4732 or email Healthcare@adventistrisk.org

 Healthy Lifestyles Benefits   2014 - ARM Rewards Milestones

Make healthy choices, earn rewards!  The Healthy Lifestyles Rewards Program is designed specifically to encourage the right balance of healthy activities including healthy assessments, prevention, education, physical fitness, and safety.  You are free to work at your own pace and choose the lifestyle changes that are right for you.


   

Prescription: Express Scripts

Prescription PPO network retail & mail order, provider search, review paid claims, benefits summary.
Member Services (888) 276-4732 or email Healthcare@adventistrisk.org



 

Dental: United Concordia

Dental PPO network, provider search, review paid claims history, benefits summary, member services.
Member Services (888) 276-4732 or email Healthcare@adventistrisk.org

   

Vision Benefits:

No PPO network required, review paid claims history, print Red ID card &/or request new one.
Member Services (888) 276-4732 or email Healthcare@adventistrisk.org

   

Other Benefits:

Chiropractic, Acupunture, Massage,
Refractive Eye Surgery, Hearing Aids

No PPO network required, review paid claims history, print Red ID card &/or request new one.
Member Services (888) 276-4732 or email Healthcare@adventistrisk.org



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Medical

Independence Blue Cross:

                Office Visit

                                In-Network – $25

                                Out-of-Network – $40

                Emergency Room

                                In-Network – $100

                                Out-of-Network – $200

                Deductible

                                In-Network – $300/$600

                                Out-of-Network – $400/$800

                Co-Insurance

                                In-Network – 20% - $2,500/$5,000

                                Out-of-Network – 40% - $4,750/$9,500

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Dental

United Concordia

                Preventive – ok

                Deductible

                                In-Network – $100/$300

                                Out-of-Network – $150/$450

                Restorative Services

                                In-Network – 20%

                                Out-of-Network – 25%

                Plan Year Maximum Payable – $2,500/$7,500

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Prescription

Express Scripts:
            

                Retail (30-day supply) – $10/$20/$40

                Mail (90-day supply) – $20/$40/$80

                Plan year Maximums out-of-pocket – $750/$1,500

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Vision

Vision exams, glasses, contacts
Paid at 80%/20%
Plan Year Maximum payable $560
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Alternative Therapies

  •  Massage – paid at 50%/50% (maximum allowable charge $90) 
  •  Chiropractic & acupuncture paid at 80%/20% 
  •  30 visit limit per therapy type – collectively 45 visit limit 
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