Your employees want and need
help with health care coverage.
Now there’s a way to provide it.
Medical
Wages
Income
Protection
Catastrophic
Illness
Retirement
Now affordable health care coverage is within
reach – for you and your employees.
In today’s times, employees not only want affordable health care coverage, they need it. But if you’re like many employers today, it’s becoming harder and
harder to provide it.
It’s often just too difficult to squeeze the cost of any type of health care coverage into your business’ – or your employees’ – budget.
But there is a solution:
the Colonial
Health Advantage
smplan.
As a result of high health insurance costs, 266,000 firms – 90 percent of which employ 3-23 workers – stopped offering health coverage between 2000 and 2005.1
3-23 workers – stopped offering health coverage between 2000
Employer-sponsored insurance is likely to continue to decline as increasing premiums and the souring economy will likely lead more employers to drop coverage, and increasing unemployment and shifts to part-time and temporary work will reduce access to
employer-sponsored insurance.2
1
Help With the Basics
With the Colonial Health Advantage limited benefit medical plan, you can provide your employees with limited coverage that helps toward the everyday health care expenses they typically incur, such as:
doctor’s office visits prescriptions
diagnostic tests and X-rays hospital confinement
It also has a benefit for preventive
care to help cover services such as:
routine physical exams well-baby check-ups immunizations mammograms
prostate cancer screenings
Standard
Standard Plus Enhanced
Premier
Hospital Indemnity Benefi t
60-day maximum per covered person, per year $200/day $200/day $300/day $400/day Doctor’s Offi ce Visit Benefi t
Maximum of 6 days per covered person, per year, including 1 emergency room sick visit
$40/day $40/day $50/day $50/day
Diagnostic Testing, X-ray, & Lab Benefi t Maximum of 3 days per covered person, per year
$40/day $40/day $50/day $50/day
Preventive Care Visit Benefi t
Maximum of 2 days per covered person, per year $40/day $50/day $75/day $75/day Surgical Benefi t
(maximum per procedure) $0 $0 $0 $500(See Surgical
Schedule) Anesthesia
20% of surgical benefi t shown on
Surgical Schedule (maximum per procedure)
$0 $0 $0 $100
(See Surgical Schedule) Pharmacy Co-Pay Benefi t
Benefi ts provided for generic prescription drugs, for which the covered person pays a $15 co-pay to the pharmacy for each 30-day supply. For brand-name drugs, the covered person pays the pharmacy the greater of a $50.00 co-payment or 50% of the prescription amount for each 30-day supply.
Mail-order service available for generic and brand prescription drugs. $0 Maximum benefi t of $150 per covered person, per calendar month Maximum benefi t of $150 per covered person, per calendar month Maximum benefi t of $150 per covered person, per calendar month
Intensive Care Unit (ICU) Benefi t
Maximum of 15 days per covered person, per year $400/day $400/day $600/day $800/day Hospital Admission Benefi t
Maximum of 1 admission per covered person, per year
$0 $0 $250
lump sum $250 lump sum Ambulance Benefi t
Maximum of 3 trips per covered person, per year $0 $50/trip $100/trip $100/trip Accident Benefi t
Maximum of 3 accidents per covered person, per year
$100
lump sum $200 lump sum $300 lump sum $300 lump sum Accidental Death & Dismemberment (AD&D)
Benefi t
Benefi t is 50% for spouse and dependent children if covered $25,000/ covered accident for named insured $25,000/ covered accident for named insured $25,000/ covered accident for named insured $25,000/ covered accident for named insured
Colonial Health Advantage
smPlans
Coverage levels: employee, employee + spouse, employee + dependent children, employee + spouse + dependent children
Joe pays without CHA Standard Plan benefits: $130.00 Joe pays with CHA Standard Plan benefits: $9.25
Optional Coverage to Help with Catastrophic Costs
To provide your employees with financial protection in case a catastrophic illness occurs, you can choose to add the Critical Illness benefit to your group’s Colonial Health Advantage plan. This benefit provides a lump-sum payment upon diagnosis of a covered critical illness, including:cancer stroke
heart attack major organ transplant coronary artery bypass end-stage renal failure
If you decide to add this benefit to your plan, your employees would then choose the benefit amount and level of premium that best fits their needs. They can choose from benefit levels of:
$2,500 $5,000 $7,500* $10,000* * requires underwriting approval.
Example – Doctor Office Visit:
Joe goes to his doctor. The usual charge for an office visit is $60, but it is only $47 because the doctor is in the provider network.
Joe also has some lab work done. The usual charge is $70, but because of the network discount, the charge is $42.25.
The doctor files the claims and receives the $40 benefit for a Doctor’s Office Visit and the $40 benefit for Diagnostic, X-Ray and Lab. He charges Joe the balance of $9.75, which Joe pays out of his pocket.
How It Works
The policyholder goes to a doctor or other health care provider. He presents his Colonial Health Advantage ID card.
The provider files a claim for services and is paid the indemnity benefit amount provided for that specific service.
If the provider’s fee is greater than the benefit amount , the policyholder pays the provider directly for the difference.
Colonial Health Advantage features a broad network of providers that, if used, provide a discount on services, which means Colonial Health Advantage policyholders can pay less out of pocket if they use a network provider:
$ 60.00 doctor fee
$ 70.00 lab fee
– 13.00 network discount – 27.75 network discount
$ 47.00 charged
42.25 charged
– 40.00 doctor’s offi ce visit – 40.00 diagnostic,
X-ray & lab benefi t
Pharmacy Co-Payment Benefit – Generic
The Pharmacy Co-Payment Benefit is $15 for a 30-day supply for a generic prescription drug. Jerry goes to his pharmacy and the charge for the 30-day supply of the generic prescription is $22. The pharmacy takes Jerry’s Colonial Health Advantage ID card and files the claim. Jerry must pay the $15 co-pay. Colonial Life pays the remaining $7 as the pharmacy benefit.
$ 22.00 cost for 30-day supply of generic prescription drug
- 7.00 plan pays
$ 15.00 co-pay Jerry pays to pharmacy
5
Quality, Experienced Service
As with all Colonial Life products, you can expect our long-standing tradition of high-quality service, for both you and your employees.
To ensure we maintain the same standards of excellence with Colonial Health Advantage, we partnered with three of the most respected health care vendors in the industry to provide benefit and claims support:
Harrington Healthis a nationally recognized benefits administration expert with 50+ years of outstanding customer service experience. Harrington Health
Why Should You Consider Colonial Health Advantage?
With the Colonial Health Advantage limited benefit medical plan, you can offer your employees affordable, limited health care coverage. In addition:It can help you recruit and retain your employees, and increase their productivity because they have better access to health care.
Your employees will have a plastic Colonial Health Advantage ID card to present to providers as proof of coverage, which will help them have better access to care, and make it easier for them to get care when they need it since they have a way to help cover the costs.
Since it’s a limited plan, it’s affordable for you and your employees. You can choose to pay all or some of the premiums, or you can have your employees pay their own. If you pay 100% of the premium, you may qualify for a premium discount.*
It’s easy to offer and administer. There are no complicated participation or up-front premium requirements. And if you take advantage of our electronic billing services, you simply submit an electronic file and we’ll reconcile your invoice for you.
It comes with Colonial Life’s benefits communication and enrollment services, through which our benefit counselors can meet with each employee and explain the Colonial Health Advantage plan, how it works and what it costs, from the employee’s paycheck.
* available to accounts with a minimum of 25 employees.
Now, affordable health care coverage — for you and your employees —
Applicable to TX
This information is only intended for proposal use with employers.
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. "Colonial Health Advantage" is a service mark of Colonial Life & Accident Insurance Company.
2008 Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina 29210 This is a Group
Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment plan. It is not designed to replace a major medical, other comprehensive and/or catastrophic plan. This is limited coverage that may not provide a reimbursement for all medical expenses you may incur. PS01300
Health Advantage
BSMBVoluntary Monthly Premiums
Monthly Premiums Without Critical Illness
Standard Standard Plus Enhanced Premier Employee $49.50 $77.00 $99.50 $124.00 Employee + Spouse $93.88 $148.88 $193.88 $242.88 Employee + Children $89.44 $141.69 $184.44 $230.99 Family $133.82 $213.57 $278.82 $349.87
Monthly Premiums With $2,500 Critical Illness
Standard Standard Plus Enhanced Premier Employee $55.50 $83.00 $105.50 $130.00 Employee + Spouse $102.88 $157.88 $202.88 $251.88 Employee + Children $98.44 $150.69 $193.44 $239.99 Family $145.82 $225.57 $290.82 $361.87
Monthly Premiums With $5,000 Critical Illness
Standard Standard Plus Enhanced Premier Employee $61.50 $89.00 $111.50 $136.00 Employee + Spouse $111.88 $166.88 $211.88 $260.88 Employee + Children $107.44 $159.69 $202.44 $248.99 Family $157.82 $237.57 $302.82 $373.87
Monthly Premiums With $7,500 Critical Illness*
Standard Standard Plus Enhanced Premier Employee $67.50 $95.00 $117.50 $142.00 Employee + Spouse $120.88 $175.88 $220.88 $269.88 Employee + Children $116.44 $168.69 $211.44 $257.99 Family $169.82 $249.57 $314.82 $385.87
Monthly Premium With $10,000 Critical Illness*
Standard Standard Plus Enhanced Premier Employee $73.50 $101.00 $123.50 $148.00 Employee + Spouse $129.88 $184.88 $229.88 $278.88 Employee + Children $125.44 $177.69 $220.44 $266.99 Family $181.82 $261.57 $326.82 $397.87
*Requires underwriting approval
Applicable to TX
This information is only intended for proposal use with employers.
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. "Colonial Health Advantage" is a service mark of Colonial Life & Accident Insurance Company.
2008 Colonial Life & Accident Insurance Company 1200 Colonial Life Boulevard, Columbia, South Carolina 29210 This is a Group
Health Advantage
SMEmployer Paid Monthly Premiums
Discounted rates available for 100% employer paid accounts with 25 or more eligible lives
Monthly Premiums Without Critical Illness
Standard Standard Plus Enhanced Premier Employee $42.84 $66.22 $85.34 $106.17 Employee + Spouse $80.57 $127.32 $165.57 $207.22 Employee + Children $76.79 $121.21 $157.54 $197.11 Family $114.52 $182.30 $237.76 $298.16
Monthly Premiums With $2,500 Critical Illness
Standard Standard Plus Enhanced Premier Employee $47.94 $71.32 $90.44 $111.27 Employee + Spouse $88.22 $134.97 $173.22 $214.87 Employee + Children $84.44 $128.86 $165.19 $204.76 Family $124.72 $192.50 $247.96 $308.36
Monthly Premiums With $5,000 Critical Illness
Standard Standard Plus Enhanced Premier Employee $53.04 $76.42 $95.54 $116.37 Employee + Spouse $95.87 $142.62 $180.87 $222.52 Employee + Children $92.09 $136.51 $172.84 $212.41 Family $134.92 $202.70 $258.16 $318.56
Monthly Premiums With $7,500 Critical Illness*
Standard Standard Plus Enhanced Premier Employee $58.14 $81.52 $100.64 $121.47 Employee + Spouse $103.52 $150.27 $188.52 $230.17 Employee + Children $99.74 $144.16 $180.49 $220.06 Family $145.12 $212.90 $268.36 $328.76
Monthly Premium With $10,000 Critical Illness*
Standard Standard Plus Enhanced Premier Employee $63.24 $86.62 $105.74 $126.57 Employee + Spouse $111.17 $157.92 $196.17 $237.82 Employee + Children $107.39 $151.81 $188.14 $227.71 Family $155.32 $223.10 $278.56 $338.96
*Requires underwriting approval
How does this plan work? Can I go to any doctor or hospital?
You may go to any doctor or facility you choose. The benefit payable under the plan does not vary based on which provider you use. However, if you go to a doctor or facility that is a member of the NPPN network, the out-of-pocket expenses that remain after your Colonial Health Advantage plan benefit is paid may be less.
Through Colonial Health Advantage, you have access to NPPN*, Coalition America’s Preferred Provider Organization that is one of the nation’s largest and fastest-growing networks. The network currently lists more than 550,000 physicians, nearly 4,000 acute care facilities and 90,000 ancillary care provider locations
nationwide.
To determine if your health care provider is in NPPN’s network, or to nominate your provider to be in the network, go to the NPPN website at www.nppn.com or
call 1.800.557.1656.
I have not yet received my ID card but need to go to a provider now. What do I do?
If your coverage is in effect but you have not received your Colonial Health Advantage ID card, go to www.harringtonhealth.com, sign up as a member and print off a temporary card. You should use this temporary card at both your provider’s office as well as the pharmacy, if your plan includes pharmacy benefits. If you don’t use a card, you will be required to pay your provider or pharmacy the entire fee out of pocket, then submit a claim to Harrington Health or Express Scripts to receive your benefit(s).
What does the “per day” maximum mean? Several benefits contained in the Colonial Health Advantage plan are limited to a certain benefit amount “per day.” This means that, no matter how much expense you incur for a certain type of service on one day, the benefit payable for that type of service will not be greater than the daily maximum noted.
Your Colonial Health Advantage
smplan was designed to be easy to
understand and use, and we hope you find it that way. To further help
you understand how the plan works, please review these Frequently
Asked Questions and keep this document for reference.
Colonial Health Advantage
smCustomer Service Guide
What do I do when I go to a medical
provider?
Simply give your ID card to the provider, who
should file a claim for services and will be
paid an amount equal to the benefits shown
in your plan. If the provider’s fee exceeds
your plan benefit, the provider will bill you
directly for the balance.
Most providers will file your claim; however,
if one does not, you will need to pay the
provider’s entire fee at the time of service
and then file a claim with our claims
administrator, Harrington Health, to receive
the benefit provided by your plan.
You may obtain claim forms at
www.harringtonhealth.com or
call 1.877.737.0769.
How does the pharmacy benefit work? Can I go to any pharmacy?
Certain Colonial Health Advantage plans offer a pharmacy benefit. If your plan offers the pharmacy benefit, a covered person can receive a prescription benefit for a generic drug by paying a $15 co-pay, and we will pay the remaining cost for the prescription, up to a maximum benefit of $150 per covered person, per month, for all generic prescription drugs and brand name prescription drugs combined regardless of whether purchased at a retail pharmacy or through mail order.
Simply present your ID card to the pharmacy and they should apply your co-pay. If the cost of your generic prescription is actually less than the $15 co-pay, you will be charged the actual cost. If you visit a pharmacy that is not a member of the Express Scripts® network of pharmacies, you will need to pay the full amount for your prescription and submit a claim to Express Scripts® to receive the benefit provided by your plan. You can obtain a claim form
from the Express Scripts® website at www.express-scripts.com or
call 1.866.493.9157.
If you need a brand-name prescription, you will pay either a $50 co-pay or 50% of the prescription cost for a 30-day supply — whichever is greater. Your pharmacy benefit is administered through Express Scripts®, one of America’s largest pharmacy benefit managers, which provides access to more than 59,000 retail pharmacies across the country. For information on which
of your local pharmacies are in their network, go to www.express-scripts.com or
call 1.866.493.9157.
Do I need to file a claim for my health care? If so, how do I do that?
In most cases, your provider will file a claim with Harrington Health for your medical expenses, then bill you directly for any difference. However, if they do not, you can use the claim form
available at www.harringtonhealth.com to file for your benefits or call 1.877.737.0769 to obtain a claim form. Complete the form and send it to Harrington Health as the form instructs.
For pharmacy claims, if you use a pharmacy that does not participate in the Express Scripts® pharmacy network, you’ll need to complete an Express Scripts® claim form, which you can obtain from www.express-scripts.com.
If my policy is underwritten by Colonial Life & Accident Insurance Company, why do I file my claim with Harrington Health?
Your Colonial Health Advantage policy is underwritten by Colonial Life & Accident Insurance Company. Colonial Life is a national leader that has excelled in providing quality voluntary insurance products and service for nearly 70 years.
We know the value of experience in providing quality benefits administration. To administer claims under the Colonial Health Advantage plan, we searched for an expert in health care benefits administration and determined that Harrington Health, a nationally recognized leader in benefits administration for more than 50 years, is one of the very best. Harrington Health is very similar to us, particularly with their high service standards. With Colonial Life and Harrington Health working together, you have the benefit of long-standing expertise in supplemental benefits, benefits administration – and service excellence. How do I file a claim for my Critical Illness benefit?
If your plan includes a Critical Illness benefit, file your claim through Harrington Health as you do for other benefits.
I also have a Colonial Life accident policy. If I am in an accident, do I file all of my claims with Colonial Life?
No. If you give your provider your Colonial Health Advantage card, they should file your claims for the Colonial Health Advantage benefits with Harrington Health. If they do not, you must complete and submit a claim form to Harrington Health to receive your Colonial Health Advantage benefits.
This is a Group Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment plan. It is not designed to replace a major medical, other
comprehensive and/or catastrophic plan. This is limited coverage that may not provide a reimbursement for all medical expenses you may incur.
If you are a new hire and were not present for the open enrollment period, you have 31 days from your date of eligibility to enroll in this product, or you will need to wait until the next open
enrollment period.
Can I take this coverage with me if I leave this place of employment?
Colonial Health Advantage coverage is a group policy and therefore is not portable. If you leave your place of employment, talk with your employer about how you can continue this plan for a limited time under COBRA.
Can I change my coverage after it is effective? After the coverage effective date, you cannot make any changes to your coverage until your next open enrollment period, unless you have a qualifying event such as birth or adoption of a child; issuance of a court order requiring
coverage of a child; marriage; divorce; or death of a covered person. Please see your certificate for details regarding a qualifying event. If you have a qualifying event, notify your plan administrator immediately. He or she will submit the necessary information to Colonial Life to handle your change.
What happens if I don’t see this payroll deduction on my check when my coverage begins? What should I do?
If you are to be paying some or all of the premiums on this plan, and you do not see deductions for it being taken out of your paycheck, check with your company’s plan administrator as quickly as possible to ensure you have coverage.
What happens if I am not at work for a week and miss a deduction?
You must keep your premiums current so that your claims can be paid. If you miss a payroll deduction, be sure to talk with your plan administrator to determine the best way for you to catch up on any premiums you may have missed.
My policy was guaranteed issue. Does that mean it covers pre-existing conditions? Your policy may or may not cover pre-existing conditions. Therefore, it is important that you check your certificate for provisions regarding coverage of pre-existing conditions.
Is chiropractic care covered?
Chiropractic office visits are covered under this policy’s Doctor’s Office Visit benefit. However, there is no additional benefit for specific chiropractic services such as manipulations. Are pregnancy and childbirth covered? Benefits provided by your Colonial Health Advantage plan would be payable for services relating to pregnancy and childbirth provided to the named insured and spouse, if covered. For example, the Doctor’s Office Visit, Hospital Confinement and Surgical benefits could apply, depending on the services needed. See your certificate for more information. Pre-existing condition limitations may apply.
What happens after I enroll?
After you enroll, you should receive your Welcome Packet from Harrington Health within 30 days of your policy’s effective date. The packet will include your Colonial Health Advantage ID card, your certificate of insurance and other reference documents.
When does my coverage begin?
Your coverage effective date should be indicated on your Colonial Health Advantage ID card, or you can check the certificate of coverage included in your Welcome Packet.
Colonial Life
1200 Colonial Life Boulevard Columbia, South Carolina 29210
Who do I contact for what?
For your claims, ID cards and coverage or benefit information for Colonial Health Advantage, contact Harrington Health:
1.877.737.0769
300 W Douglas Ave. 8th Floor Wichita, KS 67202
www.harringtonhealth.com
As always, be sure to review the certificate for complete details on these and other important points of your policy.
The Group Limited Benefit Hospital Confinement Indemnity and Accidental Death & Dismemberment Insurance Certificate is not comprehensive major medical, and is not a substitute or replacement for major medical insurance. This is limited coverage. The certificate does not provide a reimbursement for all medical expenses you may incur.
Certificates have exclusions and limitations that may affect benefits payable. Benefits vary by state and may not be available in all states. See your certificate for complete details.
©2008 Colonial Life & Accident Insurance Company.
Colonial Life products are underwritten by Colonial Life & Accident
For billing or general service for Colonial Health Advantage, contact Colonial Life:
1.866.858.8978 P.O. Box 1365
Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. “Colonial Health Advantage” is a service mark of Colonial Life & Accident Insurance Company.
Colonial Life
1200 Colonial Life Boulevard Columbia, South Carolina 29210 coloniallife.com
This is Group Hospital Confinement Indemnity Insurance Coverage. It is not designed to replace a major medical, other comprehensive and/or catastrophic plan.