HEALTH PLANS

Overview

VISTA HEALTHPLAN is our sole health provider for 2008. The plans offered by VISTA are:

• CDH High Plan with $1,000 indiv/$2,000 family Deductible
• CDH Low Plan with $2,000 individ/$4,000 family Deductible
• CDH with Out-of-Network benefit
• HMO (only offered to employees benefit-eligible prior to 10/02/07)
• Visit VISTA
• Current Provider Directory (.pdf)

Important Note: Pharmacy coverage is provided by Walgreens Health Initiatives not your health provider so remember to use your Walgreens card at the pharmacy and not your health ID card. For more information see section on “Pharmacy”.

Preventative/Wellness care

Under the HMO and in-network CDH plan designs, wellness and preventative care including physical exams, well-child to age 16 including immunizations, well-woman exams, pap smears, routine mammography and health education and counseling are provided at No Copay. Wellness and preventative care under the CDH with Out-of-Network plans is covered at 70% of usual and customary and these services are Not Subject to the annual deductible.

Consumer Driven Health (CDH) Plans

The County's CDH program is rather unique in that it provides most services for a set co-pay, except for hospital-based diagnostic, outpatient surgery, and inpatient services which are subject to the deductible and co-insurance.

This program is also unique in that it provides “first dollar” reimbursement for your out-of-pocket health expenses such as co-pays, co-insurance, deductibles and RX from your “Health Reimbursement Account”.

Health Reimbursement Account under the CDH plans

The Consumer Driven Health plans include a Health Reimbursement Account (HRA) which is a pool of money available at the beginning of the plan year, or upon enrollment in a health plan to reimburse you for health care expenses not reimbursed by your health plan for you and any enrolled family members (excluding Domestic Partners or children of DP) up to the HRA limit per the tier of coverage enrollment.

CALENDAR YEAR HRA*

• Employee Only $ 750
• Employee + Child(ren) $1,500
• Employee + Spouse $1,500
• Employee + Family $1,750

* HRA prorated for new hires and newly benefit eligible employees

What expenses* are reimbursable from the HRA?

• Co-pays incurred under the CDH plan
• Deductible incurred under the CDH plan
• Co-insurance incurred under the CDH plan
• Pharmacy co-pays (see guidelines governing this item under FSA & HRA section)

* requires an Explanation of Benefits (EOB) for reimbursement

What expenses are not reimbursable from the HRA?

• Dental claims
• Vision claims
• Non-covered health services
• Complimentary and alternative medicine

How do I submit claims to my HRA account?

See section on “FSA & HRA Accounts”

Other “facts” about your HRA:

•  Unused monies “roll over” each year you continuously re-enroll in a CDH health plan. This allows you to accumulate/bank monies to offset future health expenses and/or enroll in a higher deductible program which has lower premiums.

•  When vested, unused monies are placed in a tax deferred retirement account in your name when you leave employment. These monies are then yours to pay future health insurance expenses allowed under the program. The program is administered by ICMA.

To view the benefits provided to you under VISTA Healthplan click on the link below…..

To set up your personal, secure, account to access your health benefits and search for providers,
visit VISTA

HMO
Exclusions & Limitations -- (pdf)