Compare your plan options

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2015

Compare your plan options

Plans for businesses with 1–50 employees

SMALL BUSINESS GROUP

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Questions about our plans?

We’re always here to help at 1-800-542-6312.

In response to the changing health care landscape, our 2015 plans are designed to help you keep costs down and satisfaction up, with a variety of choices to fit the needs of your employees. New options include two Bronze HSA-compatible plans and a Platinum plan. For many of our plans, we’re offering expanded pre-deductible coverage to include specialty visits, and lower premium rates and deductibles.

You can choose the level of coverage you want, looking at how plans share costs differently between the member and the plan. And you can choose between two networks. Each option gives employees access to a broad network that includes primary care physicians, specialists, alternative care practitioners, and community hospitals throughout our service area.

Because we operate our own care system—Group Health Medical Centers—

our health plan administrators and doctors work as a team to achieve the single objective of better health for all members, wherever they receive their care. Together, we build health plans and care systems that are more patient- centered and deliver care that keeps people healthier.

Value, choice, and quality—

the Group Health difference

Your job is running a business.

Ours is providing the health plans that work for you and your employees.

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Determine whether you’ll offer 1 or 2 plans

To offer 2 plans, you must have between 10 and 50 employees.

If you offer 2 plans, there are a few guidelines:

• You can offer any combination of Core plans and Connect plans

• Groups with 10–24 employees must have at least 3 employees enrolled in each plan

• Groups with 25–50 employees must have at least 5 employees enrolled in each plan

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Determine whether you’ll offer 1 or 2 plans.

Decide which provider network you want to offer—Core or Connect—

for each plan.

Choose the coverage level you want for each plan.

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Your plan choices

You’ll want to familiarize yourself with the choices you have by reviewing the health plan grids on pages 8–11.

Once you’ve reviewed them, get started with these 3 easy steps:

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2 Decide which provider networks you want to offer

Why choose Core?

Your highest priority is value.

With Core, members have network access to physicians at Group Health Medical Centers—our high-performing group practice—an additional 9,000 network providers, and 45 hospitals in our service area. It’s our most cost-effective option.

Why choose Connect?

Your highest priority is choice.

Connect gives members access to any licensed physician and pharmacy. When members use in-network providers, they will save money with lower out-of-pocket costs.

Core plans network

(Also known as Group Health) Offered by Group Health Cooperative The network available with Core plans gives members access to:

• More than 1,000 Group Health Medical Centers doctors at 25 clinics

• More than 9,000 network providers

Connect plans network

(Also known as Alliant Plus)

Offered by Group Health Options, Inc.

The network available with Connect plans gives members access to:

In network:

• More than 1,000 Group Health Medical Centers doctors at 25 clinics

• 450 Virginia Mason Medical Center doctors at 8 clinics

• Nearly 400 The Everett Clinic doctors at 16 clinics

• More than 9,000 providers in our service area, plus thousands of additional practitioners Out of network:

• Providers with First Choice Health network in Oregon, Alaska, Montana, Idaho, and Washington. Discounted costs and no balance billing.

• Providers with First Health Network in all other states. Discounted costs and no balance billing.

• Any additional licensed provider in the U.S.

Source: OIC Provider Network Form A

COMPARE YOUR PLAN OPTIONS 5

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Choose the coverage level you want

Under the Affordable Care Act (ACA), health plan carriers can offer different levels of coverage that define how costs are shared between the plan member and the health plan. We’re offering all four of those levels: Bronze, Silver, Gold, and—new for 2015—Platinum.

All of our small group plans include the same

benefits. What is different are the monthly premiums versus the member’s cost shares (deductibles, copays, coinsurance, and out-of-pocket limits).

Compare the coverage levels

As premium costs go up for different metal levels, cost shares go down, so it’s important to consider how much your employees tend to use health care services in deciding what plan or plans to offer.

(See chart below.)

In addition to overall plan differences between metal levels, we are offering Core Plus plans at the Silver, Gold, and Platinum levels in which the deductible does not apply to the first three office visits per calendar year—either primary care or

specialty care. Similarly, the deductible does not apply to the first three in-network primary care office visits per calendar year in the Connect3 Silver and Connect3 Gold plans. (See grids for details.)

Advantages of a Bronze HSA plan

Our Core Bronze HSA and Connect Bronze HSA plans offer a lower-cost HSA-compatible, high-deductible plan that can be combined with a tax-favored savings account. The savings account—used to pay for eligible medical expenses—is owned and controlled by the employee.

Employers are increasingly turning to account-based plans to lower their costs and to help employees have more personal control over their health care expenses. Any unused funds in the account are carried over from year to year, which further encourages thoughtful choices in spending.

Employees can open an HSA with their own financial institution.

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BRONZE SILVER GOLD PLATINUM

Monthly premium $ $$ $$$ $$$$

Cost to enrollees when they get care

Copays, deductible, coinsurance

$$$$ $$$ $$ $

Good choice for enrollees who...

Don’t expect to use a lot

of health care services. Need to balance monthly premium with out-of-pocket costs.

Want to save on monthly premiums while keeping out-of-pocket costs low.

Expect to use a lot of health care services.

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The 10 essential health benefits

In accordance with the Affordable Care Act (ACA), all small group plans must include the 10 essential health benefits: ambulatory patient services, emergency care, hospitalization, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and pediatric services.

Definitions

Coinsurance

The percentage amount you pay for the cost of the care you receive. You’ll notice that the coinsurance levels differ among all of the plans.

Copayment, copay

The set dollar amount you pay when you receive certain covered services.

Deductible

What you’ll pay each calendar year before your full coverage kicks in. All our Small Business Group plans have traditional deductibles (also called embedded deductibles). Once a family member meets their individual deductible, services are covered for that person without the entire family deductible being met. Other family members continue to pay toward the family deductible amount. For certain services, the deductible does not apply.

Drug formulary

The list of generic and brand-name prescription drugs that are usually covered by our health plans.

The drugs are selected by a committee of Group Health physicians and pharmacists based on safety, effectiveness, and cost.

Hospital stays—inpatient

Hospital room and board; inpatient surgery;

anesthesia; intensive and coronary care; laboratory tests; radiology services; drugs while in hospital.

Includes mental health inpatient treatment.

Office visits

Primary and specialty care, including naturopathy and outpatient mental health and substance abuse visits.

Out-of-pocket maximum

The most you’ll be required to pay for covered services in a calendar year. Deductible, coinsurance, and copays count toward limit.

Outpatient surgery

Surgery in an office, outpatient surgery center, or hospital setting that does not require an overnight stay.

Pediatric dental and pediatric vision For children up to and including age 18.

Prescription drugs, outpatient

Formulary drugs that require prescriptions, including self-administered injectables, mental health drugs, and diabetic pharmacy supplies.

Preventive care services

For children and adults. Includes wellness visits, screenings, supplies, and immunizations as established in Group Health’s well-care schedule and the U.S. Health Resources and Services Administration women’s preventive and wellness services guidelines.

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2015 Core plans

CORE BRONZE HSA CORE SILVER CORE GOLD CORE PLUS SILVER CORE PLUS GOLD CORE PLUS PLATINUM

COVERAGE

Annual deductible

Deductible does not apply to services noted with ^u $2,850 per member or $5,700 per family $1,500 per member or $3,000 per family $750 per member or $1,500 per family $1,250 per member or $2,500 per family $600 per member or $1,200 per family $250 per member or $500 per family

Member coinsurance 40% 20% 10% 30% 20% 10%

Out-of-pocket maximum $6,450 per member or $12,900 per family $6,350 per member or $12,700 per family $4,500 per member or $9,000 per family $6,350 per member or $12,700 per family $4,500 per member or $9,000 per family $2,000 per member or $4,000 per family

BENEFITS After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay:

Office visits 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit

Deductible does not apply to first 3 office visits per year

$20 primary / $45 specialty copay per visit

Preventive care services Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û

Maternity care

Routine outpatient prenatal and postpartum visits

Labor and delivery—inpatient Covered in full ^u

40% coinsurance

Covered in full ^u 20% coinsurance

Chiropractic/manipulative therapy 10 visits per calendar year 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $45 specialty copay per visit $10 primary / $30 specialty copay per visit $10 primary / $25 specialty copay per visit Acupuncture 12 visits per calendar year 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $45 specialty copay per visit $10 primary / $30 specialty copay per visit $10 primary / $25 specialty copay per visit

Lab/radiology services 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Devices, equipment, and supplies Including prosthetics 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Outpatient surgery 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Emergency care $200 + 40% coinsurance $200 + 20% coinsurance $200 + 10% coinsurance $200 + 30% coinsurance $200 + 20% coinsurance $200 + 10% coinsurance

Urgent care At network urgent care center 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $45 specialty copay per visit $10 primary / $30 specialty copay per visit $10 primary / $25 specialty copay per visit

Ambulance 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Hospital stays—inpatient 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Skilled nursing 60 days per calendar year 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Adult vision 1 routine exam per year; annual hardware allowance

toward glasses or contact lenses 40% coinsurance

$100 hardware allowance u

$100 hardware allowance u Pediatric vision 1 routine eye exam per year; hardware—1 pair

of lenses and frames per year or annual supply of contacts Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û

Pediatric dental

Deductible shared with annual medical deductible

Class I preventive services covered in full u Class I diagnostic services

subject to 50% coinsurance ^u

Other services subject to 50% coinsurance

$50 deductible per member per year (separate from medical)

Prescription drugs Cost per 30-day supply

Filled at pharmacy:

40% preferred generic, 40% preferred brand, including specialty brand

Filled by mail order:

Filled at pharmacy:

$10 preferred generic u, 50% preferred brand u, including specialty brand u Filled by mail order:

$5 preferred generic û, 45% preferred brand û, including specialty brand û

Filled at pharmacy:

$7 preferred generic u, $25 preferred brand u, including specialty brand u Filled by mail order:

$2 preferred generic û, $20 preferred brand û, including specialty brand û

Deductible notes

Does not apply to preventive care, Class I pediatric dental, pediatric eye exam

& glasses, or adult vision hardware allowance

Does not apply to preventive care, prescription drugs, Class I pediatric dental, pediatric eye exam & glasses, or adult vision hardware allowance

This is an overview of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the medical coverage agreement. Other terms and conditions may apply.

A list of excluded services and other limitations can be found in each plan’s Summary of Benefits and Coverage document.

PRIMARY CARE COPAYS APPLY TO: Acupuncture • Audiology • Chemical Dependency/Substance Abuse • Chiropractic/Manipulative Therapy • Emergency Medicine (where ER copay doesn’t apply) • Enterostomal Therapy • Family Planning • Family Medicine • Health Education • Internal Medicine • Massage Therapy • Mental Health • Midwifery • Naturopathy • Nutrition • Obstetrics/Gynecology • Occupational Medicine • Occupational Therapy • Optometry • Osteopathy • Pediatrics • Physical Therapy • Respiratory Therapy • Speech Therapy • NOTE: The specialty care copay will apply if a service is provided by a specialty care provider.

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Core plans offered by Group Health Cooperative.

CORE BRONZE HSA CORE SILVER CORE GOLD CORE PLUS SILVER CORE PLUS GOLD CORE PLUS PLATINUM

COVERAGE

Deductible does not apply to services noted with ^u $2,850 per member or $5,700 per family $1,500 per member or $3,000 per family $750 per member or $1,500 per family $1,250 per member or $2,500 per family $600 per member or $1,200 per family $250 per member or $500 per family

Out-of-pocket maximum $6,450 per member or $12,900 per family $6,350 per member or $12,700 per family $4,500 per member or $9,000 per family $6,350 per member or $12,700 per family $4,500 per member or $9,000 per family $2,000 per member or $4,000 per family

BENEFITS After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay:

Office visits 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit

Preventive care services Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û

Maternity care

Routine outpatient prenatal and postpartum visits

Labor and delivery—inpatient Covered in full ^u

40% coinsurance

Chiropractic/manipulative therapy 10 visits per calendar year 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $45 specialty copay per visit $10 primary / $30 specialty copay per visit $10 primary / $25 specialty copay per visit Acupuncture 12 visits per calendar year 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $45 specialty copay per visit $10 primary / $30 specialty copay per visit $10 primary / $25 specialty copay per visit

Devices, equipment, and supplies Including prosthetics 40% coinsurance 20% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 10% coinsurance

Emergency care $200 + 40% coinsurance $200 + 20% coinsurance $200 + 10% coinsurance $200 + 30% coinsurance $200 + 20% coinsurance $200 + 10% coinsurance

Urgent care At network urgent care center 40% coinsurance $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $45 specialty copay per visit $10 primary / $30 specialty copay per visit $10 primary / $25 specialty copay per visit

Adult vision 1 routine exam per year; annual hardware allowance

toward glasses or contact lenses 40% coinsurance

$100 hardware allowance u Pediatric vision 1 routine eye exam per year; hardware—1 pair

of lenses and frames per year or annual supply of contacts Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û

Deductible shared with annual medical deductible

Filled at pharmacy:

Filled by mail order:

Filled at pharmacy:

$7 preferred generic u, $25 preferred brand u, including specialty brand u Filled by mail order:

$2 preferred generic û, $20 preferred brand û, including specialty brand û

Deductible notes

Does not apply to preventive care, Class I pediatric dental, pediatric eye exam

& glasses, or adult vision hardware allowance

Does not apply to preventive care, prescription drugs, Class I pediatric dental, pediatric eye exam & glasses, or adult vision hardware allowance

SPECIALTY CARE COPAYS APPLY TO: Acupuncture • Allergy and Immunology • Anesthesiology • Cardiology (pediatric and cardio vascular disease) • Chiropractic/Manipulative Therapy

• Critical Care Medicine • Dentistry • Dermatology • Endocrinology • Gastroenterology • Genetics • Hematology • Hepatology • Infectious Disease • Neonatal-Perinatal Medicine • Nephrology • Neurology • Oncology • Ophthalmology • Orthopedics • Otolaryngology (ear, nose, and throat) • Pathology • Physiatry (Physical Medicine) • Podiatry • Pulmonary Medicine/

Disease • Radiology (nuclear medicine, radiation therapy) • Rheumatology • Sports Medicine • General Surgery (all surgical specialties) • Urology

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This is an overview of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the medical coverage agreement. Other terms and conditions may apply.

A list of excluded services and other limitations can be found in each plan’s Summary of Benefits and Coverage document.

PRIMARY CARE COPAYS APPLY TO: Acupuncture • Audiology • Chemical Dependency/Substance Abuse • Chiropractic/Manipulative Therapy • Emergency Medicine (where ER copay doesn’t apply) • Enterostomal Therapy • Family Planning • Family Medicine • Health Education • Internal Medicine • Massage Therapy • Mental Health • Midwifery • Naturopathy • Nutrition • Obstetrics/Gynecology • Occupational Medicine • Occupational Therapy • Optometry • Osteopathy • Pediatrics • Physical Therapy • Respiratory Therapy • Speech Therapy • NOTE: The specialty care copay will apply if a service is provided by a specialty care provider.

2015 Connect plans CONNECT BRONZE HSA CONNECT3 SILVER CONNECT3 GOLD

In network Out of network In network Out of network In network Out of network

COVERAGE

Deductible does not apply to services noted with ^u $2,800 per member or $5,600 per family $1,300 per member or $2,600 per family $600 per member or $1,200 per family

Out-of-pocket maximum $6,450 per member or $12,900 per family $6,350 per member or $12,700 per family $6,350 per member or $12,700 per family

BENEFITS After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay:

Office visits 40% coinsurance 50% coinsurance

Deductible does not apply to first 3 PRIMARY CARE visits per year

40% coinsurance

30% coinsurance

Preventive care services Covered in full u Covered in full u Covered in full u

Maternity care

Routine outpatient prenatal and postpartum visits Labor and delivery—inpatient

Covered in full u 20% coinsurance

Covered in full u 30% coinsurance Chiropractic/manipulative therapy 10 visits per calendar year 40% coinsurance 50% coinsurance $20 primary / $30 specialty

copay per visit 40% coinsurance $10 primary / $15 specialty

copay per visit 30% coinsurance

Acupuncture 12 visits per calendar year 40% coinsurance 50% coinsurance $20 primary / $30 specialty

Devices, equipment, and supplies (including prosthetics) 40% coinsurance 50% coinsurance 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance

Emergency care $200 copay + 40% coinsurance $200 copay + 20% coinsurance $200 copay + 10% coinsurance

Urgent care At urgent care center 40% coinsurance 50% coinsurance $20 primary / $30 specialty

Adult vision 1 routine exam per year; shared annual hardware

allowance toward glasses or contact lenses 40% coinsurance

50% coinsurance

40% coinsurance

$100 hardware allowance ^u

30% coinsurance

$100 hardware allowance u Pediatric vision 1 routine eye exam per year; hardware—1 pair of

lenses and frames per year or annual supply of contacts Covered in full u 50% coinsurance for routine exam;

Covered in full u for hardware Covered in full u 40% coinsurance for routine exam;

Covered in full u for hardware Covered in fullu 30% coinsurance for routine exam;

Covered in full u for hardware

Deductible: Shared with annual medical deductible Class I preventive services covered in full ^u

Class I diagnostic services subject to 50% coinsurance ^u Other services subject to 50% coinsurance

$50 deductible per member per year (separate from medical) Class I preventive services covered in full ^u

Filled at pharmacy:

40% preferred generic, 40% preferred brand, including specialty brand Filled by mail order:

Filled at pharmacy:

Available only when filled through a Group Health designated mail order service.

Filled at pharmacy:

$10 preferred generic û, 50% preferred brand û, including specialty brand û Filled by mail order:

Filled at pharmacy:

Deductible notes Does not apply to preventive care, Class I pediatric dental, pediatric eye exam

& glasses, or adult vision hardware allowance Does not apply to preventive care, in-network prescription drugs, Class I pediatric

dental, pediatric eye exam & glasses, or adult vision hardware allowance Does not apply to preventive care, in-network prescription drugs, Class I pediatric dental, pediatric eye exam & glasses, or adult vision hardware allowance

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SPECIALTY CARE COPAYS APPLY TO: Acupuncture • Allergy and Immunology • Anesthesiology • Cardiology (pediatric and cardio vascular disease) • Chiropractic/Manipulative Therapy • Critical Care Medicine • Dentistry • Dermatology • Endocrinology • Gastroenterology • Genetics • Hematology • Hepatology • Infectious Disease • Neonatal-Perinatal Medicine • Nephrology

• Neurology • Oncology • Ophthalmology • Orthopedics • Otolaryngology (ear, nose, and throat) • Pathology • Physiatry (Physical Medicine) • Podiatry • Pulmonary Medicine/Disease • Radiology (nuclear medicine, radiation therapy) • Rheumatology • Sports Medicine • General Surgery (all surgical specialties) • Urology

Connect plans offered by Group Health Options, Inc. (same network as Alliant Plus).

CONNECT BRONZE HSA CONNECT3 SILVER CONNECT3 GOLD

In network Out of network In network Out of network In network Out of network

COVERAGE

Deductible does not apply to services noted with ^u $2,800 per member or $5,600 per family $1,300 per member or $2,600 per family $600 per member or $1,200 per family

Out-of-pocket maximum $6,450 per member or $12,900 per family $6,350 per member or $12,700 per family $6,350 per member or $12,700 per family

BENEFITS After deductible is met, you pay: After deductible is met, you pay: After deductible is met, you pay:

Office visits 40% coinsurance 50% coinsurance

40% coinsurance

30% coinsurance

Preventive care services Covered in full u Covered in full u Covered in full u

Maternity care

Routine outpatient prenatal and postpartum visits Labor and delivery—inpatient

Covered in full u 30% coinsurance Chiropractic/manipulative therapy 10 visits per calendar year 40% coinsurance 50% coinsurance $20 primary / $30 specialty

Acupuncture 12 visits per calendar year 40% coinsurance 50% coinsurance $20 primary / $30 specialty

Devices, equipment, and supplies (including prosthetics) 40% coinsurance 50% coinsurance 20% coinsurance 40% coinsurance 10% coinsurance 30% coinsurance

Emergency care $200 copay + 40% coinsurance $200 copay + 20% coinsurance $200 copay + 10% coinsurance

Urgent care At urgent care center 40% coinsurance 50% coinsurance $20 primary / $30 specialty

Adult vision 1 routine exam per year; shared annual hardware

allowance toward glasses or contact lenses 40% coinsurance

50% coinsurance

40% coinsurance

$100 hardware allowance ^u

30% coinsurance

$100 hardware allowance u Pediatric vision 1 routine eye exam per year; hardware—1 pair of

lenses and frames per year or annual supply of contacts Covered in full u 50% coinsurance for routine exam;

Covered in full u for hardware Covered in full u 40% coinsurance for routine exam;

Covered in full u for hardware Covered in fullu 30% coinsurance for routine exam;

Covered in full u for hardware

Deductible: Shared with annual medical deductible Class I preventive services covered in full ^u

Filled at pharmacy:

Deductible notes Does not apply to preventive care, Class I pediatric dental, pediatric eye exam

& glasses, or adult vision hardware allowance Does not apply to preventive care, in-network prescription drugs, Class I pediatric

dental, pediatric eye exam & glasses, or adult vision hardware allowance Does not apply to preventive care, in-network prescription drugs, Class I pediatric dental, pediatric eye exam & glasses, or adult vision hardware allowance

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FOR MORE INFORMATION

• Contact your producer (agent/broker)

• Contact your Group Health sales representative directly or call 1-800-542-6312

• Visit ghc.org/sbg