Ingham County HRA/ Bundled Products

Purchase Plan PHP Deductible Single/Family $5,000/$10,000 $500/$1,000 Coinsurance % 20% Max Out of Pocket Single/Family $6,350/$12,700$2,000/$4,000 Office Visit $20 Chiro Copay/18 Visit Max $20 Urgent Care Copay/ER $50/$100 Rx $5/$30/$60/40% MOPD 2x $5/$30/$60/40% MOPD 2x ($1200 OOP Max per person)

Purchase Plan PHP Deductible Single/Family $5,000/$10,000$0 Coinsurance % 0% Max Out of Pocket Single/Family $6,350/$12,700 $1,000/$2,000 Office Visit $20 Chiro Copay/18 Visit Max $20 Urgent Care Copay/ER $50/$100 Rx $5/$30/$60/40% MOPD 2x $5/$30/$60/40% MOPD 2x ($1200 OOP Max per person)

1. Present PHP ID Card & CIC HRA Promise Card to the provider to explain the HRA process. 2. Provider will submit claim to Physicians Health Plan (PHP). 3. After CIC receives your claim from PHP, CIC claims specialists will ensure the processing of your medical provider claim within 7 to 10 days. 4. You will then receive by mail a CIC explanation of benefits (EOB), showing the medical provider’s bill has been processed. 5. DON’T FORGET TO PAY PROVIDER FOR ANY REMAINING CHARGES IF ANY (Copay, etc). Participating Provider Claims Process

0% Coinsurance $0 Deductible $5,000 Deductible 0% Coinsurance PHP High Plan HRA Surgery Diagnostic Test Lab Test Hospital Stay Pathology Physical Therapy The following are a few examples of medical procedures that are subject to deductible and coinsurance

$5,000 Deductible 20% Coinsurance PHP Standard HRA Surgery Diagnostic Test Lab Test Hospital Stay Pathology The following are a few examples of medical procedures that are subject to deductible and coinsurance 20% $1,500 Coinsurance $500 Deductible

Q: I received an invoice, should I just pay it? A: Before you pay any invoice, please make sure that you have received PHP and CIC/ABS Explanation of Benefits. This way you can be sure the claims had been processed. Q: I received an invoice and it looks really high, is it correct? A: If you have any questions regarding your claims, please contact CIC/ABS to double check that the claims were processed properly. When in doubt, give CIC/ABS a call. Q: My provider requested pre-payment before surgery? Would CIC/ABS pre-pay the provider? A: Unfortunately the IRS requires that services are received before any reimbursement is made. If your provider asks for a pre-payment, contact CIC/ABS to see if we can make an arrangement and explain the HRA process.

Employer Info 2.Member Info 3.Provider Info 4.Date of Service 5.PHP Approved Amount 6.Purchased Plan Deductible 7.PHP Paid 8.HRA Deductible 9.HRA Coinsurance 10.Reimbursed Amount to Pay to Provider 11.Amount Employee Must Pay Provider 1.Employer Info 2.Member Info 3.Provider Info 4.Date of Service 5.PHP Approved Amount 6.Purchased Plan Deductible 7.PHP Paid 8.HRA Deductible 9.HRA Coinsurance 10.Reimbursed Amount to Pay to Provider 11.Amount Employee Must Pay Provider 6 PHP Purchased Plan EOB CIC Reimbursed Plan EOB 11

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* $10 Gift Card per call for elective procedure pricing information * 25% of the service savings if you go to one of the lower cost providers within 75 miles of Lansing * Does not need to be the lowest cost option, just one of the lower cost options! *Includes Providers in Grand Rapids, Mount Pleasant, and Lansing* Common non-emergent procedures eligible for comparisons: MRIs Ultrasounds CT Scans Mammograms Colonoscopies Contact an analyst to see if yours can be quoted!

A²CT Recommended Physician Referred Transparency: Knee MRI w/o contrast FacilityLocationCost McLaren – Central Michigan Community Hospital South Drive Mt. Pleasant $2, Open MRI Crapo Street Mt. Pleasant $ Mecosta County Medical Center Oak Street Big Rapids $1, MidMichigan –Midland Wellness Drive Midland $1, MidMichigan – Clare McEwan Street Clare $1, Same Physicians Same Neighborhood Savings of $1,340.50

A²CT Recommended Transparency: Lung Cancer Screenings FacilityLocationCost McLaren – Central Michigan Community Hospital South Drive Mt. Pleasant $1,423 Mid Michigan Health – Gratiot Cancer Center Warwick Drive Alma $1,549 Mercy Health Grand Rapids – Lacks Cancer Center Jefferson Ave Grand Rapids $99 McLaren Health – Greater Lansing Greenlawn Ave Lansing Charter Twp FREE Savings of $1,549!

24/7/365 Access to U.S. Board-Certified Doctors & Pediatricians When should you use: Instead of going to Urgent Care or ER; When you are on vacation.

24/7/365 Access to U.S. Board-Certified Doctors & Pediatricians

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Amanda Lutke Claims Analyst Ext Your Personally Dedicated CIC Team Automated Options Operator Dial 0 Claims Questions, inc. HRA ClaimsDial 1 Employer Benefit Administration QuestionsDial 2 Individual Coverage Questions Dial 3 COBRA Questions Dial Phone Fax Brian Cote Group Benefit Consultant Ext Lise Hoppe Account Manager Ext Lynda Roby Customer Service Rep Ext Rachel Parsons Wellness Coordinator Ext. 1088

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