• enhancing a balanced well-being in mind, body and spirit,
• encouraging positive life choices,
• and investing in you through valuable new services.
• are culturally aligned with Seventh-day Adventist heritage and values,
• underwent a similar and very successful health plan redesign in 2013 for more than 32,000 members,
• have recently received multiple national workplace wellness awards,
• and engage a dedicated, fully-integrated confidential care coordination team.
The Accelerate Plan — offers industry-best practice benefits at the best value, in exchange for your engagement in the Ascend to Wholeness program, and activities such as integrated wellness and care coordination. This plan also incorporates lifestyle management programs such as CHIP, Full Plate and Weight Watchers.
The Access Plan — provides quality, market-competitive benefits but requires no healthy lifestyle participation from plan members.
To enroll in 2019, you and your covered spouse must complete the following health stewardship activities during 2018 to better understand your own health status:
• biometrics screening
• online wellness assessment
• activity points earned
• participation in personalized health coaching and/or care coordination
You will receive an actionable wellness plan based on your responses.
Points are earned through activities such as preventive care, healthy lifestyle habits and wellness webinars. We encourage you to choose activities you enjoy which meet your specific needs.
|TOTAL POINTS||Biometrics Screening/Wellness Assessment (required)||Activities Points||Date Eligible for Health Plans|
|200||120||80||Jan 1 – Mar 31, 2018|
|160||120||40||Apr 1 – Jun 30, 2018|
|0||0||0||Jul 1 – Dec 31, 2018|
Accelerate Plan members who are at risk for serious health issues must participate in care coordination, education, and support through one-on-one health coaching. You will learn how to reduce risk, identify resources, overcome barriers and set goals to make lifestyle changes to improve your health.
If you or your spouse are enrolled in the Accelerate Plan, and are contacted by a care coordination team member but choose not to participate, you and your family will only qualify for the Access Plan the following plan year.
As your health plan administrator, ARM and all partners adhere to all HIPAA privacy regulations.
Changes in plans can only occur during open enrollment, unless you have a qualifying life event such as marriage, divorce, birth or adoption of a child, or a spouse losing or gaining other coverage. As you are accustomed, your employer will send out clear communications on the open enrollment process.
The one exception to this rule is if you and your spouse are both NAD employees enrolled individually under your own coverage.
Costs, Coverages & OUT-OF-POCKET
An out-of-pocket maximum (OOP) is the most you’ll pay during a policy period (usually a year) for health care services.
Once you’ve reached your OOP, your plan begins to pay 100 percent of the allowed amount for covered services.
OOP limits will decrease for the Accelerate Plan and increase for the Access Plan. Both plans will accrue your co-pays, coinsurance, and deductible toward your OOP, which means you will reach your OOP quicker.
On the Accelerate Plan, your individual OOP will decrease by $50, and the family OOP will decrease by $100.
On the Access Plan, your individual OOP will increase by $400, and your family OOP will increase by $800.
The OOP for prescriptions is increasing in 2018 for both the Accelerate and Access Plans. (However, based on historical data, this will not impact many health plan members.)
You are required to notify HR within 30 days of the date of the event to make benefit plan changes. Failure to notify HR within 30 days may disqualify you and require you to wait until the next open enrollment to make plan changes.
There are two exceptions:
1) emergency/urgent care, and/or
2) unavailable care.
If specialized care is unavailable at a PPO facility, the health plan’s member services will help you complete an Unavailable Service request which, upon approval, would allow payment at a non-PPO facility.
Goals for the 2018 employee health plans and Ascend to Wholeness are to actively empower us to manage our own wellbeing and to implement major tenets of our Seventh-day Adventist health message.
These plans enable you to get the right care at the right time to avoid preventable conditions, as well as to manage conditions you may already have. The plans are not designed to discriminate against the sick by denying them care. Quite the contrary — they are designed to extend preventive services and care coordination to those who are most in need.