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Lumenos HSA Plan

Lumenos HSA Plan

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Lumenos HSA Plan

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  1. Lumenos HSA Plan Alan Sheketoff Macman Insurance Associates, L.L.C.

  2. Your Lumenos HSA Plan First- Use your HSA to pay for covered services: • Contribute pre-tax dollars to your HSA account • Use these dollars to help meet annual deductible responsibility • Unused dollars can be saved or invested and accumulate through retirement For 2007, contributions can be made to your HSA up to the following: $2,000 Individual Coverage $4,000 Family Coverage

  3. Your Lumenos HSA Plan Plus- To help you stay healthy, use: • 100% coverage for nationally recommended services • No deductions from the HSA or out-of-pocket costs for as long as you receive preventive care from in network provider • Your deductible or Traditional Health Coverage benefits will apply if choose to go to an out-of-network provider

  4. Your Lumenos HSA Plan Your Bridge Responsibility • Bridge is amount you pay out of pocket until meeting your annual deductible responsibility • If you contribute HSA dollars up to the amount of your deductible and use them, your Bridge will equal $0 • HEALTH ACCOUNT + BRIDGE = DEDUCTIBLE Annual Deductible Responsibility $2,000 Individual Coverage $4,000 Family Coverage

  5. Your Lumenos HSA Plan If Needed- • Your Traditional Health Coverage begins after you have met your Bridge responsibility After your Bridge, the plan pays: 100% for in-network providers 70% for out-of-network providers

  6. Your Lumenos HSA Plan Additional Protection • The total amount you spend out of pocket is limited • Once you spend that amount, plan pays 100% for covered services for remainder of plan year Annual Out-of-Pocket Maximum In-Network Providers Out-of-Network Providers $2,000 Individual Coverage $4,000 Individual Coverage $4,000 Family Coverage $8,000 Family Coverage

  7. Your Lumenos HSA Plan And Even- • Lumenos plan rewards you for taking steps to improve your health! Healthy Rewards If you do this: Complete the Health Assessment Online Enroll in the Personal Health Coach Program Graduate from the Personal Health Coach Program Complete our Smoking Cessation Program Complete our Weight Management Program You can Earn: $50 $100 $200 $50 $50

  8. Your Lumenos HSA Plan Healthy Rewards • Health Assessment: You and your family can complete the Health Assessment, an online tool to measure your overall health • One adult family member is eligible to earn $50 • Personal Health Coach: If qualified for program, you’ll receive one-on-one assistance from a registered nurse to manage a health condition • Conditions may include: diabetes, asthma, depression, high blood pressure, heart disease and pregnancy • You’ll receive $100 for enrolling in the program and $200 for achieving health goals and graduating from the program

  9. Your Lumenos HSA Plan Healthy Rewards (Con’t) • Smoking Cessation Program: This program helps you manage withdrawal symptoms and learn new behaviors and skills to remain tobacco free, includes nicotine replacement therapy coverage • You and your spouse are eligible to receive $50 • Weight Management Program: Personalized phone course designed to help you adopt lifestyle changes to lose weight • Team of counselors address eating, exercise, stress and more • You and your spouse are eligible to receive $50

  10. Baby and Child Care (Office Visits through 18) Screening tests for vision, hearing, and lead exposure, pelvic exam and PAP test for females 18 Immunizations: Hepatitis A, Hepatitis B, Diphtheria, Tetanus, Pertussis, Varicella (chicken pox), Influenza, Pneumococcal Conjugate, Human Papilloma Virus, H. Influenza type B, Polio, Measles, Mumps, Rubella Adult Care (Office Visits after 18) Screening tests for coronary artery disease, colorectal cancer, prostate cancer, diabetes, osteoporosis, mammograms, pelvic exams and PAP test Immunizations: Hepatitis A, Hepatitis B, Diphtheria, Tetanus, Pertussis, Varicella (chicken pox), Influenza, Pneumococcal Conjugate, Human Papilloma Virus Your Lumenos HSA Plan Preventive Care

  11. Physician Office Visits Inpatient Hospital Services Outpatient Surgery Services Diagnostic X-rays/Lab Tests Emergency Hospital Services Inpatient and Outpatient Mental Health and Substance Abuse Services Maternity Care Chiropractic Care Prescription Drugs Home Health Care and Hospice Care Physical, Speech and Occupational Therapy Services Your Lumenos HSA Plan Medical Care The following is a summary of covered medical services:

  12. Skilled nursing facility services limited to 100 days per member calendar year Home Health care services limited to 100 visits per member calendar year Inpatient rehabilitation services limited to 100 days per member calendar year PT/OS/ST combined limit of $3,000 per member per calendar year Chiropractic services limited to 12 visits per member per calendar year Some restrictions may apply to infertility services Inpatient hospitalizations require authorizations Your Lumenos HSA plan includes a lifetime maximum of $1,000,000 per member for out-of-network services Your Lumenos HSA Plan Some services may have restrictions, the following services are limited.