Compare your plan options

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SMALL BUSINESS GROUP

Compare your plan options

2014 plans for businesses with 1–50 employees

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We know there’s a lot that’s new for 2014. We’re ready to help you.

Please call us with your questions at 1-800-542-6312.

Our 2014 plans are all new and designed to meet your needs. All of our plans for small businesses include the 10 essential health benefits required by health care reform. But since they’re from Group Health, our plans offer something more.

You can choose the level of coverage you want, with different plans offering options for how costs are shared between the plan member and the health plan. You also have a clear choice in the size of provider network. Whatever choice you make, and wherever your employees live, they will have access to a large network that includes primary care, specialty care, allied health and alternative care practitioners, and community hospitals in 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 systems that are more patient centered and deliver care that keeps people healthier.

Group Health plans offer value, choice, and more

A well-run business takes a lot of time, focus, and energy. We know that’s your priority.

Ours? It’s helping you find a health care plan that’s right 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.

1 2 Decide which provider networks you want to offer.

Determine whether you’ll offer 1 or 2 plans.

Decide which provider network you want to offer.

Choose the coverage level you want.

1 2 3

Your plan choices

You’ll want to familiarize yourself with the choices you have by reviewing the health plan grids on pages 6–9.

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

Why choose Core?

Your highest priority is value.

With Core, members have in-network access to physicians at Group Health Medical Centers, our high-performing group practice, an additional 9,000 network providers, and 50 hospitals in our service area. It’s our most cost-effective option.

Why choose Connect?

Your highest priority is choice.

Connect gives you access to many additional providers, both in network and out of network. This is the largest physician network available to small group employers.

When members use in-network providers, they’ll enjoy 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:

• 1,100 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:

• 1,100 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.

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The 10 essential health benefits

All small group plans include the 10 essential health benefits.

They are:

1. Ambulatory patient services. The care you receive without being admitted to a hospital.

For example, at a clinic, a physician’s office, or a same-day surgery center.

2. Emergency care. Care for conditions which, if not immediately treated, could lead to serious disability or death.

3. Hospitalization. The care and services you receive as a patient in a hospital, such as care from doctors and nurses, tests and drugs administered during your stay, and room and board.

4. Maternity and newborn care. The care provided to women during pregnancy, during and after labor and delivery, and care for newborn children.

5. Mental health and substance abuse disorder services, including behavioral health treatment.

This is care to evaluate, diagnose, and treat mental health and substance abuse issues.

6. Prescription drugs. These are drugs prescribed by a doctor to treat an acute illness like an infection, or to treat an ongoing condition like high blood pressure.

7. Rehabilitative and habilitative services and devices. The former refers to relearning skills lost due to disease or injury, and the latter to keeping and learning age-appropriate skills and functioning.

8. Laboratory services. The testing of a patient’s blood, tissues, etc., to help a doctor diagnose a medical condition or monitor the effectiveness of a treatment.

9. Preventive and wellness services, including chronic disease management. This includes routine physicals, screening, and immunization. Chronic disease management is an integrated approach to manage an ongoing condition like asthma or diabetes.

10. Pediatric services for children under age 19 including the nine benefits already listed, and dental services such as preventive and restorative care, and vision care such as eye exams and prescription glasses.

Benefit definitions

Below are definitions of some of the terms you’ll find on pages 6–9.

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.

Outpatient surgery

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

Pediatric dental

For children up to and including age 18.

Pediatric vision

For children up to and including age 18.

Prescription drugs

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

Preventive care services

For children and adults. Includes wellness visits and immunizations, as established in Group Health’s well-care schedule, formulary contraceptive drugs including counseling, contraceptive devices, and female sterilization. Devices and supplies related to contraception are covered as preventive as required by federal law and covered in full. Also includes drugs and medicines such as aspirin, fluoride, and folic acid.

Choose the coverage level you want

Health insurers offer different levels of coverage under health care reform. They’re called “metal tiers” and offer options for how costs are shared between the health plan member and the health plan. We’re offering Gold, Silver, and Bronze plans to small group employers.

All of our small group plans include the same benefits. What’s different are the monthly premiums versus the member’s cost shares (deductibles, copays, coinsurance, and out-of-pocket limits).

Compare the coverage levels

• Bronze plans have lower premium costs and higher out-of-pocket costs.

• Gold plans have higher premium costs and lower out-of-pocket costs.

• Silver plans land between these two.

• Core3 and Connect3 plans include three primary care office visits before the deductible applies.

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GOLD SILVER BRONZE

Monthly premium $$$ $$ $

Cost to enrollees when they get care

(copays, deductible, coinsurance)

$ $$ $$$

Good choice for

enrollees who ... Expect to use a lot of

health care services Want a balance between premium costs and out-of-pocket costs

Don’t expect to use a lot of health care services

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This is a summary 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. Core plans offered by Group Health Cooperative.

NOTE: There is a 90-day benefit wait period for transplants. This wait period may be fully or partially based on current or prior coverage.

2014 Core plans

PLAN NAME

CORE3 GOLD CORE3 SILVER CORE GOLD CORE SILVER CORE BRONZE

COVERAGE

Annual deductible

Deductible does not apply to services

noted with u $500 per member or $1,000 per family $1,250 per member or $2,500 per family $750 per member or $1,500 per family $1,500 per member or $3,000 per family $2,650 per member or $5,300 per family

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

Out-of-pocket limit $6,350 per member or $12,700 per family $6,350 per member or $12,700 per family $6,350 per member or $12,700 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: After deductible is met, you pay: After deductible is met, you pay:

Office visits

Deductible does not apply to first 3 primary care visits per year Primary: $10 copay per visit

Specialty: $15 copay per visit

Primary: $20 copay per visit Specialty: $30 copay per visit

Primary: 40% coinsurance per visit Specialty: 40% coinsurance 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

Maternity care Routine outpatient prenatal and postpartum visits Labor and delivery

Covered in full ^u 20% coinsurance

Covered in full ^u

40% coinsurance Chiropractic/Manipulative therapy

10 visits per calendar year $10 primary / $15 specialty copay per visit $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $30 specialty copay per visit 40% coinsurance Acupuncture

12 visits per calendar year $10 primary / $15 specialty copay per visit $20 primary / $30 specialty copay per visit $10 primary / $15 specialty copay per visit $20 primary / $30 specialty copay per visit 40% coinsurance

Lab/X-ray services 20% coinsurance 30% coinsurance 10% coinsurance 20% coinsurance 40% coinsurance

Devices, equipment, and supplies

(including prosthetics) 20% coinsurance 30% coinsurance 10% coinsurance 20% coinsurance 40% coinsurance

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

Emergency care $100 copay + 20% coinsurance $150 copay + 30% coinsurance $100 copay + 10% coinsurance $150 copay + 20% coinsurance 40% coinsurance

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

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

Skilled nursing

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

Adult vision

1 routine exam per year; annual hardware allowance

$10 primary / $10 specialty copay per visit

$100 toward glasses or contact lenses ^u

40% coinsurance

$100 toward glasses or contact lenses ^u Pediatric vision

1 routine exam per year; Hardware–1 pair

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

Preventive and restorative services (See separate pediatric dental benefit summary available online at ghc.org/sbg)

Preventive services covered in full ^u Other services subject to dental deductible

and coinsurance

and coinsurance Prescription drugs

Cost per 30-day supply

(Note lower cost through mail order)

Filled at pharmacy:

$10 preferred generic û; 20% preferred brand û, including specialty brand û

Filled by mail order:

Filled at pharmacy:

Prescription drug coverage begins after plan deductible is met

Filled at pharmacy:

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

35% preferred generic; 35% preferred brand, including specialty brand

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 •

SPECIALTY CARE COPAYS APPLY TO: Allergy and Immunology • Anesthesiology • Cardiology (pediatric and cardio vascular disease) • Critical Care Medicine • Dentistry • Dermatology

• Endocrinology • Gastroenterology • Genetics • Hematology • Hepatology • Infectious Disease • Neonatal-Perinatal Medicine • Nephrology • Neurology • Oncology • Ophthalmology •

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PLAN NAME

CONNECT3 GOLD CONNECT3 SILVER CONNECT GOLD CONNECT SILVER

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

COVERAGE

Annual deductible

Deductible does not apply to services

noted with u $400 per member or $800 per family $1,250 per member or $2,500 per family $600 per member or $1,200 per family $1,300 per member or $2,600 per family

Member coinsurance 20% 40% 30% 50% 10% 30% 20% 40%

Out-of-pocket limit $6,350 per member or $12,700 per family $6,350 per member or $12,700 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: After deductible is met, you pay:

Office visits

Deductible does not apply to first 3 primary care visits per year Primary: $10 copay per visit Specialty: $15 copay per visit

Primary: 40% coinsurance Specialty: 40% coinsurance

Deductible does not apply to first 3 primary care visits per year Primary: $20 copay per visit Specialty: $30 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 Covered in full û Covered in full û

Maternity care

Routine outpatient prenatal

and postpartum visits Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û Covered in full û

Labor and delivery 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Chiropractic/Manipulative therapy

10 visits per calendar year $10 primary / $15 specialty

copay per visit 40% coinsurance $20 primary / $30 specialty

copay per visit 40% coinsurance Acupuncture

12 visits per calendar year $10 primary / $15 specialty

copay per visit 40% coinsurance

Lab/X-ray services 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Devices, equipment, and supplies

(including prosthetics) 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Outpatient surgery 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Emergency care $100 copay + 20% coinsurance $100 copay + 20% coinsurance $150 copay + 30% coinsurance $150 copay + 30% coinsurance $100 copay + 10% coinsurance $100 copay + 10% coinsurance $150 copay + 20% coinsurance $150 copay + 20% coinsurance

Ambulance 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Hospital stays – inpatient 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Skilled nursing

60 days per calendar year 20% coinsurance 40% coinsurance 30% coinsurance 50% coinsurance 10% coinsurance 30% coinsurance 20% coinsurance 40% coinsurance

Adult vision

1 routine exam per year; shared annual hardware allowance

40% coinsurance

50% coinsurance

30% coinsurance

40% coinsurance

$100 toward glasses or contact lenses ^u Pediatric vision

1 routine exam per year; Hardware–1 pair

of lenses and frames or contacts per year Covered in full û 40% coinsurance Covered in full û 50% coinsurance Covered in full û 30% coinsurance Covered in full û 40% coinsurance

Preventive and restorative services (See separate pediatric dental benefit summary available online at ghc.org/sbg)

Preventive services covered in full ^u Other services subject to dental

deductible and coinsurance

deductible and coinsurance Prescription drugs

Cost per 30-day supply

(Note lower cost through mail order)

Filled at pharmacy:

$10 preferred generic û; 20% preferred brand û, including specialty brand û Filled by mail order:

Prescription drug coverage begins after plan deductible is met

Filled at pharmacy:

40% preferred generic;

50% preferred brand, including specialty brand

Filled at pharmacy:

Prescription drug coverage begins after plan deductible is met Filled at pharmacy:

Filled at pharmacy:

This is a summary 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

SPECIALTY CARE COPAYS APPLY TO: Allergy and Immunology • Anesthesiology • Cardiology (pediatric and cardio vascular disease) • 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).

NOTE: There is a 90-day benefit wait period for transplants. This wait period may be fully or partially waived depending on current or prior coverage.

2014 Connect plans

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FOR MORE INFORMATION

• Contact your producer (agent/broker)

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

• Visit ghc.org/sbg