Benefits Summary State of Utah
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2020-21 Benefits Summary State of Utah Look inside for important information about how to use your PEHP benefits. PROUDLY SERVING UTAH PUBLIC EMPLOYEES State of Utah 2020-21 » Introduction State of Utah 2020-21 State of Utah Benefits Summary STATE OF UTAH Benefits Summary Effective July 2020 © 2020 Public Employees Health Program This Benefits Summary should be used in conjunction with the PEHP Master Policy. It contains information that only applies to PEHP subscribers who are employed by the State of Utah and their eligible dependents. Members of any other PEHP plan should refer to the applicable publications for their coverage. It is important to familiarize yourself with the information provided in this Benefits Summary and the PEHP Mas- ter Policy to best utilize your medical plan. The Master Policy is available by calling PEHP. You may also view it at www.pehp.org. This Benefits Summary is for informational purposes only and is intended to give a general overview of the benefits avail- able under those sections of PEHP designated on the front cover. This Benefits Summary is not a legal document and does not create or address all of the benefits and/or rights and obligations of PEHP. The PEHP Master Policy, which creates the rights and obligations of PEHP and its members, is available upon request from PEHP and online at www.pehp.org. All questions concerning rights and obligations regarding your PEHP plan should be directed to PEHP. The information in this Benefits Summary is distributed on an “as is” basis, without warranty. While every precaution has been taken in the preparation of this Benefits Summary, PEHP shall not incur any liability due to loss, or damage caused or alleged to be caused, directly or indirectly by the information contained in this Benefits Summary. The information in this Benefits Summary is intended as a service to members of PEHP. While this information may be copied and used for your personal benefit, it is not to be used for commercial gain. The employers participating with PEHP are not agents of PEHP and do not have the authority to represent or bind PEHP. 5/13/20 WWW.PEHP.ORG PAGE 1 State of Utah 2020-21 » Table of Contents Table of Contents Introduction Other Benefits WELCOME/CONTACT INFO . 3 PEHP DENTAL BENEFIT CHANGES . 4 »Preferred Dental . .25 »Traditional Dental . 25 AUTISM PROGRAM . 5 »Basic HSA Dental . 27 PEHP VALUE PROVIDERS . 6 »Discount HSA Dental . 27 PEHP ONLINE TOOLS . 9 »Regence Expressions Dental . 28 PEHP LIFE AND AD&D Medical Benefits »Group Term Life Coverage . 31 »Accidental Death and Dismemberment . .33 MEDICAL NETWORKS . 10 »Accident Weekly Indemnity . .34 UNDERSTANDING YOUR BENEFITS GRID . .11 »Accident Medical Expense . 34 UNDERSTANDING IN-NETWORK PROVIDERS 12 VISION HEALTH SAVINGS ACCOUNTS . 13 »Eyemed plans . 35 » PEHP FLEX . .14 Opticare plans . .39 BENEFITS GRIDS »The STAR HSA Plan . .15 External Vendors »Traditional . .18 UTAH RETIREMENT SYSTEMS . .42 »Consumer Plus . 21 BLOMQUIST HALE . 44 WELLNESS AND VALUE-ADDED BENEFITS MET LIFE . 45 »PEHP Healthy Utah . 24 UTAH EDUCATIONAL SAVINGS . .47 »PEHPplus . 24 »PEHP WeeCare . .24 MOUNTAIN AMERICA CREDIT UNION . .49 »Life Assistance Counseling . .24 LIBERTY MUTUAL . .51 SECURITY SERVICE FEDERAL CREDIT UNION . .53 THE STANDARD . .55 WWW.PEHP.ORG PAGE 2 State of Utah 2020-21 » Contact Information Welcome to PEHP We want to make accessing and understanding your healthcare benefits simple. This Benefits Summary contains important information on how best to use PEHP’s comprehensive benefits. Please contact the following PEHP departments or affiliates if you have questions. ON THE WEB PEHP FLEX$ » . www .pehp .org » PEHP FLEX$ Department . 801-366-7503 Create a PEHP for Members account at www .pehp .org . or 800-753-7703 to review your claims history, get important information through our Message Center, see a comprehensive list of HEALTH SAVINGS ACCOUNTS (HSA) your coverages, find and compare providers in your network, » PEHP FLEX$ Department . 801-366-7503 access Healthy Utah rebate information, check your FLEX$ . or 800-753-7703 account balance, and more . » HealthEquity . 866-960-8058 . .www .healthequity .com/stateofutah CUSTOMER SERVICE . 801-366-7555 . or 800-765-7347 PRENATAL AND POSTPARTUM PROGRAM » PEHP WeeCare . 801-366-7400 Weekdays from 8 a .m . to 5:30 p .m . or 855-366-7400 Have your PEHP ID or Social Security number on hand for . www. .pehp .org/weecare faster service . Foreign language assistance available . WELLNESS AND DISEASE MANAGEMENT PREAUTHORIZATION » PEHP Healthy Utah . 801-366-7300 » Inpatient hospital preauthorization . 801-366-7755 . or 855-366-7300 . or 800-753-7754 . .www .pehp .org/healthyutah PEHP Health Coaching . 801-366-7300 MENTAL HEALTH/SUBSTANCE ABUSE » . or 855-366-7300 PREAUTHORIZATION » PEHP Customer Service . .801-366-7755 . or 800-765-7347 VALUE-ADDED BENEFITS PROGRAM » PEHPplus . www .pehp .org/plus PRESCRIPTION DRUG BENEFITS » Blomquist Hale . 800-926-9619 » PEHP Customer Service . .801-366-7555 . www .blomquisthale .com . or 800-765-7347 » Express Scripts . 800-903-4725 ONLINE ENROLLMENT HELP LINE . www .express-scripts .com . 801-366-7410 . or 800-753-7410 SPECIALTY PHARMACY » Accredo . 800-501-7260 CLAIMS MAILING ADDRESS PEHP 560 East 200 South GROUP TERM LIFE AND AD&D Salt Lake City, UT 84102-2004 » PEHP Life and AD&D . 801-366-7495 WWW.PEHP.ORG PAGE 3 State of Utah 2020-21 » Benefit Changes Benefits Changes & Reminders Chronic Medications Covered Health Benefit Advisors Before Deductible Need help deciding which plan to choose, This is a benefit for STAR HSA Plan whether to be covered by more than one members who no longer have to meet plan, or different cost options for a service? their deductible before getting certain Call a PEHP Health Benefit Advisor at 801- chronic medications covered under the 366-7555. plan. www.pehp.org for details. E-Care New Prescription Cost Tool Consider consulting a doctor remotely Find drug options for your health with your smartphone from Intermountain condition, compare prices at different Connect Care (all networks) or University of pharmacies, and see if cash back is Utah Health Virtual Visits (Summit only). It’s available for your medication. Visit convenient and costs less. www.pehp.org for details. Crisis & Life Assistance Get Up to $2,000 in Cash Back Counseling You can now share in the savings when You have access to counseling services you choose a lower-cost provider. Find with Blomquist Hale Employee Assistance. out about cash back services using PEHP’s Crisis counseling is also available 24/7 new Cost Comparison Tool. Look for and always confidential. PEHP pays 100% the green phone with a dollar sign. Visit of the cost. Call 1-800-926-9619 for an www.pehp.org for details. appointment. Send Secure Messages to PEHP Have a question or can’t find what you’re looking for online? Log in to PEHP for Members and send us your questions via the Message Center. Click the Message Center icon after you login to your PEHP account. WWW.PEHP.ORG PAGE 4 State of Utah 2020-21 » Autism Program Autism Spectrum Disorder Benefit The benefit covers behavioral health treatment (ABA Therapy). A brief overview of PEHP’s Autism Spectrum Disorder coverage: » Please call PEHP (801-366-7555 » Mental health and speech therapy services or 800-765-7347) for information require Preauthorization. about which autism spectrum disorders » No benefits for services received from and services are covered. out-of-network Providers. List of » Therapeutic care includes services in-network providers is available provided by speech therapists, at PEHP for Members or by calling occupational therapists, or physical PEHP (801-366-7555 or 800-765-7347). therapists. » Regular medical benefits will apply (see » Eligible Autism Spectrum Disorder benefits grid for applicable co-pay and services do not accrue separately, coinsurance). and are subject to the medical plan’s visit limits, regular cost sharing limitations – deductibles, co-payments, and coinsurance – and would apply to the out-of-pocket maximum. WWW.PEHP.ORG PAGE 5 State of Utah 2020-21 » PEHP Value Providers PEHP Value Providers PEHP MEDICAL Value Providers The STAR PlanMEDICAL » 25% discount on what you would normally pay an in-network provider Traditional Plan » $10 office co-pay TheSALT STAR LAKE Plan CITY » 25% discount on what you would normallyOREM pay an in-network provider TraditionalMidtown Clinic Plan » $10 office co-pay Blendtec Health and Wellness Clinic 230 South 500 East, Suite 510 | 801-320-5660 1206 S 1680 W | 801-225-1281 SALT LAKE CITY OREM RC Willey Employee Clinic Midtown Clinic BlendtecLEHI Health and Wellness Clinic 2301 South 300 West | 801-464-7900 230 South 500 East, Suite 510 | 801-320-5660 OnSite1206 S 1680 Care W at | Mountain801-225-1281 Point Medical 3000 Triumph Blvd, Ste. 320 | 801-753-4600 RCWesTech Willey Wellness Employee Center Clinic 3605 S West Temple | 801-506-0000 LEHI 2301 South 300 West | 801-464-7900 OnSite Care at Mountain Point Medical 3000 Triumph Blvd, Ste. 320 | 801-753-4600 WesTechNORTH SALT Wellness LAKE Center Orbit3605 S Employee West Temple Clinic | 801-506-0000 845 Overland St. | 801-951-5888 NORTH SALT LAKE OrbitFJM Clinic Employee Clinic 84531 N Overland Redwood St. Rd, | 801-951-5888 Suite 2 | 801-624-1634 E-CARE/TELEMEDICINE Visit a doctor online anytime, anywhere. FJMCLEARFIELD Clinic 31 N Redwood Rd, Suite 2 | 801-624-1634 » EyeE-CARE/TELEMEDICINE infections Futura Onsite Clinic » Painful urination Visit a doctor online anytime, anywhere. 11 H Street | 801-774-3265 » Joint pain or strains CLEARFIELD » MinorEye infections skin problems FuturaLAYTON Onsite Clinic » Painful urination Onsite11 H Street Care | 801-774-3265at Davis Hospital STAR» Joint HSA pain Plan or strains » $59 per visit or $10 per visit 1580 W. Antelope Dr., Suite 110 | 801-807-7699 after» Minor deductible; skin problems For UofU virtual visits: $49 per LAYTON visit or $10 per visit after deductible STAR HSA Plan » $59 per visit or $10 per visit OnsiteOGDEN Care at Davis Hospital Traditional Plan » $10 per visit 1580 W.