Fully insured health plans specifically for small businesses.
Freedom. Choice. Flexibility.
Starmark Signature Plans
Starmark Consumer Health Plans
Health Plan
Starmark® is the perfect choice for the healthcare needs of small businesses:
• Easy paperless enrollment for employees online or via
phone through Express Connect®.
• Unparalleled personal service, including a personal welcome call for each new group. Plus, Starmark follows up to ensure customer satisfaction continues throughout the year and personally assists in plan renewal.
• Health and wellness management tools to help members get and stay healthy.
• Truly flexible plan designs your clients can customize to meet their needs and reach desired premium, including
HSA-friendly plans.
• Starmark HRA features seamless integration of claims processing and HRA administration, and encourages the cost-effective use of healthcare services.
• Quick claims turnaround with one of the fastest, most efficient systems in the industry.
Flexible plan designs to meet client needs and budget.
Starmark Signature and Starmark Consumer Health Plans feature:
• Plan design flexibility to meet employer needs and budget • Resources to simplify healthcare and promote employee health
and wellness
• Freedom to choose any provider Starmark Signature Plans
Choice of three traditional plans provides familiarity through office visit features -- with or without labs, and offers true flexibility.
Starmark Consumer Health Plans
Choice of three consumer-directed plans gives members more control over their healthcare decisions. Plans can be paired with an HSA for tax advantages.
All plans feature:
• Preventive care benefits • Lab programs
• CareChampion 24/7® health advocacy program • YourCare health and wellness outreach program • 24-hour nurse line
• MaternaLink® maternity wellness program • Cost-saving prescription drug programs
• Discounts on vitamins, and vision and hearing services/supplies1 1 The discount program, provided by New Benefits, Ltd., a discount medical plan organization, is not
Signature Plans Consumer Health Plans
Lifetime Maximum Benefit
Individual Calendar-Year Deductible Signature AdvantageSM
(in-network/out-of-network) • $ 0/$3,000 • $ 250/$750 • $ 500/$1,500 • $ 750/$1,500 • $ 1,000/$2,000 • $ 1,500/$3,000 • $ 2,000/$4,000 • $ 2,500/$5,000 • $ 3,000/$6,000 • $ 4,000/$8,000 • $ 5,000/$10,000 • $ 10,000/$20,000 In- and out-of-network deductibles accrue separately.
Signature SelectSM
(combined in- and out-of-network)
• $ 250 • $ 500 • $ 750 • $ 1,000 • $ 1,500 • $ 2,000 • $ 2,500 • $ 3,000 • $ 4,000 • $ 5,000 • $ 10,000 Signature FreedomSM • $ 250 • $ 500 • $ 750 • $ 1,000 • $ 1,500 • $ 2,000 • $ 2,500 • $ 3,000 • $ 4,000 • $ 5,000 • $ 10,000
Consumer Health AdvantageSM
(in-network/out-of-network) • $ 1,200/$2,400 • $ 1,500/$3,000 • $ 2,000/$4,000 • $ 2,500/$5,000 • $ 3,000/$6,000 • $ 4,000/$8,000 • $ 5,000/$10,000
Consumer Health SelectSM
(combined in- and out-of-network)
• $ 1,200 • $ 1,500 • $ 2,000 • $ 2,500 • $ 3,000 • $ 4,000 • $ 5,000
Consumer Health FreedomSM
• $ 1,200 • $ 1,500 • $ 2,000 • $ 2,500 • $ 3,000 • $ 4,000 • $ 5,000
Family Calendar-Year Deductible
In- and out-of-network deductibles accrue separately.
Coinsurance Signature Advantage
(in-network/out-of-network) • 100/80 • 90/70 • 80/60 • 70/50 • 60/40 • 50/50 Signature Select (in-network/out-of-network) • 100/80 • 90/70 • 80/60 • 70/50 • 60/40 Signature Freedom • 100 • 90 • 80 • 70 • 60
Consumer Health Advantage
(in-network/out-of-network) • 100/80 • 90/70 • 80/60 • 70/50 • 60/40
Consumer Health Select
(in-network/out-of-network) • 100/80 • 90/70 • 80/60 • 70/50 • 60/40
Consumer Health Freedom • 100
• 90 • 80 • 70 • 60 Two times the individual calendar-year deductible.
In- and out-of-network deductibles accrue separately on Consumer Health Advantage.
The 100 coinsurance cannot be selected with the $1,200 individual calendar-year deductible. The 100 coinsurance can be selected only with individual calendar-year deductibles of $1,000 or higher.
Deductible Type Employers choose one.
Aggregate: Benefits are payable once the entire family deductible is met.
Embedded: Benefits are payable for a member once either the individual deductible is met, or for
the entire family once the family deductible is met.
For the plan to be qualified for use with an HSA, the embedded deductible must be selected only with individual deductibles of $2,500 ($5,000 for families) or higher.
Two times the individual calendar-year deductible.
In- and out-of-network deductibles accrue separately on Signature Advantage.
Benefits are payable for a member once either the individual deductible is met, or for the entire family once the family deductible is met.
The $0/$3,000 deductible can be selected only with the 50/50 coinsurance.
Coinsurance Limit Signature AdvantageSM (in-network/out-of-network) • $ 5,000/$15,000 • $ 10,000/$20,000 • $ 15,000/$30,000 • $20,000/$40,000 Signature SelectSM
(combined in- and out-of-network)
• $ 5,000 • $ 10,000 • $ 15,000 • $ 20,000 Signature FreedomSM • $ 5,000 • $ 10,000 • $ 15,000 • $ 20,000
Consumer Health AdvantageSM
(in-network/out-of-network)
• $ 5,000/$10,000 • $ 10,000/$20,000 • $ 15,000/$30,000
Consumer Health SelectSM
(combined in- and out-of-network)
• $ 5,000 • $ 10,000 • $ 15,000
Consumer Health FreedomSM
• $ 5,000 • $ 10,000 • $ 15,000
The percentage of covered charges the member must pay each year. The family out-of-pocket limit is one or two times the individual out-of-pocket limit, depending on the multiplier selected. The annual out-of-pocket limit does not include the deductible.
Refer to the rate proposal for the annual out-of-pocket limits applicable to the plan. In- and out-of-network out-of-pocket limits accrue separately on Consumer Health Advantage. The percentage of covered charges the member must pay each year. The family out-of-pocket
limit is one or two times the individual out-of-pocket limit, depending on the multiplier selected. The annual out-of-pocket limit does not include the deductible.
Refer to the rate proposal for the annual out-of-pocket limits applicable to the plan. In- and out-of-network out-of-pocket limits accrue separately on Signature Advantage. Annual Out-of-Pocket Limits
Emergency Room Access Fee $75 per occurrence; waived if admitted as inpatient to the hospital. After the additional emergency room access fee is paid, covered charges are subject to the calendar-year deductible and coinsurance. The emergency room access fee does not apply toward individual or family calendar-year deductibles, or toward out-of-pocket limits.
No emergency room access fee. Covered charges are subject to the calendar-year deductible and coinsurance.
Prescription Benefit The Price Assurance Program is included and provides prescription drug savings at thousands
of participating pharmacies nationwide. When members present their medical ID card at a participating pharmacy, they receive:
• The lowest price available in that store, on that day • Generic drug savings
• Drug utilization review
The Price Assurance Program includes most drugs that, by federal law, require a prescription. If a prescription drug is excluded from coverage under the health plan, members may still receive a discount on their prescription through this program.
Covered prescription drugs are subject to the in-network calendar-year deductible and coinsurance on Consumer Health Advantage and Consumer Health Select.
Prescription Calendar-Year Deductible Choices:
• $0 per person • $250 per person • $500 per person
Prescription deductible must be met in full every year by each member; does not apply to generics. The $0 generic prescription drug copays can be selected only with the $0 prescription calendar-year deductible.
The prescription copay and calendar-year deductible do not apply toward the individual or family calendar-year deductibles, or toward out-of-pocket limits. Credit from prior plan drug card deductibles and carryover provisions do not apply to the prescription calendar-year deductible.
Retail Copay
(up to a 30-day supply) (up to a 90-day supply)Mail Service Copay Generic Preferred
Brand Nonpreferred Brand
$ 0 $ 30 $ 50 $ 0 $ 75 $150 $ 0 $ 45 $ 75 $ 0 $110 $225 $10 $ 30 $ 50 $20 $ 75 $150 $15 $ 45 $ 75 $30 $110 $225
•
$20 $60 $100 $40 $150 $300 Generic PreferredBrand Nonpreferred Brand
Signature Plans Consumer Health Plans
Office Visit Feature Signature AdvantageSM and Signature SelectSM
In-Network Encounter Fee: • $20
• $30 • $40
• No office visit feature
Signature FreedomSM
Office Visit Deductible: • $20
• $30 • $40
• No office visit feature
The Office Visit Feature is not available. Physician office visits are subject to the calendar-year deductible and coinsurance.
The first $500 of covered charges per office visit is paid in full after the encounter fee or office visit deductible. This includes charges for the visit, necessary x-rays and nonsurgical injections performed at the same office visit and billed by the attending physician. Any balance – as well as covered charges when no office visit feature is selected – is subject to the calendar-year deductible and coinsurance. The office visit feature does not apply to preventive care services or any surgical procedure. Coverage for preventive care services is described in the Preventive Care Services section of this brochure. Surgical procedures are subject to the calendar-year deductible and coinsurance.
Outpatient Laboratory Testing Options: • Labs included under the office visit feature • Labs not included under the office visit feature
When labs are not included under the office visit feature, they are subject to the calendar-year deductible and coinsurance.
Lab Card® Program
This voluntary program offers 100 percent coverage for covered outpatient laboratory testing when testing is directed to a participating Quest Diagnostics laboratory as part of the Lab Card Program. Provider collection and handling fees may apply, and are subject to health benefit plan provisions. For more information, visit www.labcard.com.
Note: Quest Diagnostics Incorporated is a provider of laboratory testing, information and services, and is not affiliated with the Trustmark Companies.
All Signature Series plans include the Lab Card Program whether or not laboratory testing is included under the office visit feature.
Covered charges are subject to the calendar-year deductible and coinsurance. Lab Card® Select Program
This voluntary discount program offers outpatient laboratory testing at significant savings compared with other labs when testing is directed to a participating Quest Diagnostics laboratory as part of the Lab Card Select Program. For more information, visit www.labcardselect.com. Note: Quest Diagnostics Incorporated is a provider of laboratory testing, information and
services, and is not affiliated with the Trustmark Companies. Outpatient Laboratory Testing
Preventive care services, as defined by federal regulation, are paid at 100 percent when received in-network. Age and frequency schedules apply. Covered preventive care services include, but are not limited to: physician office visits for preventive care services (adult physicals, routine ob/gyn visits, well-child visits), routine mammograms, PSA (prostate-specific antigen), colonoscopy, and adult and child immunizations (including flu and pneumonia shots).
Benefit Options
(available on all plans) Maternity OptionThe maternity option provides members with peace of mind when planning for pregnancy and delivery. Normal maternity and nursery care covered charges are payable the same as any other covered service.
Supplemental Accident Option
Supplemental accident coverage helps prepare members
for an unexpected accident or injury by providing first-dollar coverage. — The first $500 of covered charges per accident is paid at 100 percent.
— Additional covered charges are subject to the calendar-year deductible and coinsurance. — Coverage includes medical charges resulting from accidental injury incurred within 90 days
of the accident.
Dual Plan Designs
Marketing Materials Signature Plans Brochure:
— MK74 — MK80 (used in select states) Signature Select Flyer: MK110
Signature Freedom Flyer: MK111
Consumer Health Plans Brochure:
— MK75 — MK81 (used in select states) Consumer Health Select Flyer: MK112
Consumer Health Freedom Flyer: MK113 Mental Illness,
Nervous Disorders, Substance Abuse and Alcohol Abuse
Groups with up to 50 employees • Outpatient expenses
— 40-visit limit per calendar year; 120 visits per lifetime
— Covered charges are paid at 60 percent for an in-network provider; 50 percent for an out-of-network provider or Signature FreedomSM. • Inpatient expenses
— 20 days per calendar year; 40 days per lifetime. These limits do not apply to inpatient alcohol abuse treatment.
Groups with 51 or more employees • Outpatient and inpatient expenses
— Covered charges are paid the same as any other covered service.
Groups with up to 50 employees • Outpatient expenses
— 40-visit limit per calendar year; 120 visits per lifetime
— Covered charges are paid at 60 percent for an in-network provider (100 percent if the 100 in-network coinsurance is selected); 50 percent for an out-of-network provider or Consumer Health FreedomSM. • Inpatient expenses
— 20 days per calendar year; 40 days per lifetime. These limits do not apply to inpatient alcohol abuse treatment.
Groups with 51 or more employees • Outpatient and inpatient expenses
— Covered charges are paid the same as any other covered service.
Dual plan designs offer flexibility for today’s employers. Employers simply combine currently marketed plans using the established guidelines to create a plan to meet their business needs and budget. Employers should consult with their tax advisor to ensure that their multiple-plan offerings comply with applicable non-discrimination rules.
Therapies Chronic Pain Treatment Programs:
— Maximum of 10 visits per calendar year Speech, Occupational and Physical Therapies:
Resources to Help Members
Get and Stay Healthy
Starmark® offers resources to help simplify healthcare and maximize the health potential of plan members.
• CareChampion 24/7®, is a health advocacy service that
supports members as they navigate through the healthcare system. Advisors are available anytime, day or night, and can help members find a doctor or hospital in-network, understand healthcare benefits and claim payments, identify cost-saving opportunities, handle eldercare issues and more!
• Healthy Foundations® provides a comprehensive suite of
health and wellness management tools to help maximize the health potential of every plan member. Healthy Foundations includes the YourCare health and wellness
outreach program, MyNurse 24/7®, MaternaLink®
maternity wellness program, online support tools and the Healthy Foundations wellness e-newsletter.
To learn more about CareChampion 24/7 and Healthy Foundations, visit www.starmarkinc.com.
An expert in small group healthcare benefits.
Why Starmark
Small business is our only business.
For more than 25 years, Starmark’s sole focus has been serving small businesses. This expertise enables us to help you work with your clients to achieve their needs.
Robust benefits, tailored to fit.
Starmark offers a wide range of benefit plans employers can customize to meet their needs and budget, including HSA- and HRA-friendly plans and dual plan designs.
Greater provider choice.
Strong network access nationwide allows clients freedom of choice in provider care, exceptional negotiated arrangements when using in-network providers and PHCS-negotiated discounts when outside the primary PPO service area through PHCS Healthy Directions.
Financial strength.
©2010 Star Marketing and Administration, Inc. MK77 (12-10)
The information contained in this brochure is a general summary of plan highlights only, and all benefits are subject to the plan conditions and limitations of Trustmark Life Insurance Company policy number SMP/1003. Limitations, exclusions, renewability and pre-existing condition limitations apply and are described in the product brochures. For detailed product information, please refer to the applicable product brochure and Certificate of Insurance. The Certificate of Insurance is the prevailing document and the basis for benefit payment. Federal IRS restrictions and state mandates may apply. Plan benefits are subject to change to comply with federal healthcare reform, as necessary. Plan availability and/or coverage may vary by state. For more details, refer to the separate state insert page (MK10) or ask your Starmark distribution partner. Coverage is not effective without written notification from Trustmark Life Insurance Company or Star Marketing and Administration, Inc.
Starmark is a distinguished leader in small group healthcare benefits. By offering flexible health plans, unparalleled personal service, innovative, paperless employee enrollment, comprehensive health and wellness management tools, nationwide network access, and seamless HRA administration, Starmark is the choice to meet the diverse needs of small businesses today.
Use this insert in conjunction with the Starmark Signature and Consumer Health Plans Comparison brochure [MK77 (12-10)] and the Starmark Healthy Incentives® Health Plan Comparison brochure [MK99 (2-11)]. These brochures will be revised at reprint to incorporate the information contained in this insert.
Lab Vendor Programs
