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Member Question:

I had a copayment of $121 for labs that my family physician requires as part of the annual visit and is part of the preventative care. I never before had to pay for these labs when we had the Anthem insurance.

Surest Answer - Surest covers regular diagnostic labs and x-rays at 100% with $0 member responsibility.听 If the lab was done in physician鈥檚 office, it would be covered under the office visit copay.听 Major diagnostic labs require a separate co-pay. To find co-pays for major diagnostic labs search the app or website.

UMR - UMR plan covers preventive labs at 100% with $0 member responsibility. Depending on how the claim was submitted it may have been covered as diagnostic, which then goes toward the deductible.听听

Member Question:

What is covered by an annual preventative care visit? Are ongoing health issues/chronic conditions included? And are labs ordered by the doctor for discussion during this visit covered as preventative care?听

Surest Answer - When a member searches for a preventive visit on the app or website, they select a physician and then can see what鈥檚 included in the visit.听 Like UMR and most insurance companies, it depends on how the claim is filed with Surest.听 If the claim is not filed as routine, the applicable co-pay will apply.

UMR Answer - See preventive flyer.

Member Question:

What is the best way to use this, if you have never had a health savings plan before? Should you let it roll over or always use it? Is there a better way to maximize the benefits? How much should I put in, a percentage or dollar amount?

The best usage of an HSA (Health Savings Account) is a personal decision. Unlike an FSA, available HSA funds are allowed to be rolled over each year for future medical claims.听 听

Members can save money by reducing their taxable income. Members must select a flat dollar amount to contribute to HSA. Member make the selection through the Benefitfocus application.听

More HSA Information is available at: /hr/benefits/health-savings-account-hsa听

Member Question:

The insurance company says the doctor is in-network, but the doctor's office (and the doctor) say they are not. Please comment on this issue.

Surest and UMR use the UnitedHealthcare Choice Plus Network. UHC does their very best to keep the app and website updated but if a member finds an error, a member should report it via the app, website or member services and they will have it corrected.

Member Question:

I鈥檓 on the regular PPO Plan. I considered Surest, but the billing department at my doctor鈥檚 office cautioned me that many low-cost plans like Surest can differ from 鈥渞egular鈥� PPO plans in terms of what they cover, how frequent they allow office visits or medical tests, etc., especially since I am older, am on medications, and require quarterly visits to my doctor and semiannual blood work tests. So, it would be nice to have a side-by-side comparison of the differences between what Surest and the PPO plan covers (and how often) and excludes so there are no surprises. The table in the the annual enrollment brochure was useful, but it really just covered costs, copays, deductibles, etc. rather than differences in coverages, exclusions and frequency of services.

While the Surest plan does function differently from traditional PPO plans it鈥檚 not a 鈥渟kinny鈥� plan, or a narrow network.听 The plan does not have limits on doctor visits or medical tests.听 Members use the app or website to search for care. They can review up front costs before having services rendered.听 There are standard services, like UMR that have visit limits, i.e., rehabilitation services such as PT, OT, Home Health, and a few others.听

The intention with UMR Core and Surest was to have similar plan limits. For example, both plans have the same number of PT/OT visits allowed. The differences are found in the deductible, co-pays, co-insurance and out-of-pocket maximum. Surest has no deductible or co-insurance and the co-pays and out-of-pockets vary between the plans.听 听

Member Question:

I was on the fence about switching from the HSA to the Core plan this past fall. How do I check to see how much Jardiance or Trulicity would cost on the Core plan. It showed that the most expensive drug was a Tier 4 as $150. Is this $150 for a one month supply or a three month supply. I'm struggling with trying to crunch the numbers on which plan is better, paying a big chunk for Trulicity to have it meet the deductible or paying more each month with a lower drug cost. Help working through this math would be greatly appreciated!听

Assumptions: Member has individual coverage; income under 41K per year; and prescription is for Jardiance, which is the lower cost of the two drugs.听

Currently a 30-day supply of Jardiance costs:

• $584.29 on the HSA Plan - $3,962 annually
  • approximately depending on where filled
• $40 on the Core Plan - $480 annually (save 3,482 in drug cost annually)
• $20 on the Surest plan - $240 annually (save 3,722 in drug cost annually)

Salary below 41k premiums:

• HSA - 58.04 x 12 = $696.48
• Core - 120.62 x 12 = $1,447.44 (costs $750.96 MORE than HSA plan)
• Surest - 48.56 x 12 = $582.72 (costs $113.76 LESS than HSA plan)听

Factoring in the HSA contribution to the individual, which for individual coverage is $750 per year, the surest or Core plan would still save the member money.听听

Drug Cost + Premium - HSA Contributions -听

• HSA - $3,962.00 + $696.48 - $750.00 = $3,908.48
• Core - $480.00 + $1,447.44 - $0.00 = $1,927.44
• Surest - $280.00 + $582.72 - $0.00 = $822.72

Please keep in mind, the numbers listed above are for this particular question and every person's care needs are different.

Below are the costs without factoring in any usage assuming individual coverage with income under 41k.听

• HSA - $696.48 - $750.00 = ($53.52)
• Core - $1,447.44 - $0.00 = $1,447.44
• Surest - $582.72 - $0.00 = $582.72

Surest co-pays may change year to year, but will not change during the plan year.听

You can find costs for services on the provider's app or website.听

UMR: 听

Surest: 听

For members considering Surest you can look up services on the pre-member website:

听

Access Code is: Indiana2024

This site will ask for an email or phone number but it is only used to verify identity so not all people have access.听

Members of both plans can see counselors in person or virtually.听

Talkspace is a great resource for either plan with a low average wait time, get into see a professional counselor faster.听听

For more information visit:听

For employees, there is a free resource called TimelyCare.

For more information visit:听

/hr/benefits/employee-assistance听

Before you pay any invoice from a provider, make sure you have received an explanation of benefits (EOB).

The EOB tells you:

• How much your provider billed
• Your network discount
• The amount the Insurance paid
• How much you owe the provider
• It will list a denial reason

If a claim is denied - depending on the reason you maybe able to help resolve the issue.

Some denial Reasons:

• More information is needed from the provider
• The insurance has questions about a third party or other insurance
• A service is not covered by the insurance

If you believe the denial is a mistake you can take steps to correct it by addressing the issue stated on the EOB or filing an appeal within 180 days of the claim denial.听