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Member Handbook2020-2021with Open Enrollment InformationPublic Education Employees’ Health Insurance Plan
How toreach us.Phone877.517.0020 or 334.517.7000Fax877.517.0021 or 334.517.7001Emailpeehipinfo@rsa-al.govMailPublic Education Employees’ Health Insurance PlanBecause email submissions are unsecured, do not include confidential informationlike your Social Security number. Please include your full name, employer, home mailingaddress, and daytime phone number.P.O. Box 302150Montgomery, AL 36130-2150Website www.rsa-al.govMember Online Services (MOS Login)Enroll in PEEHIP coverage onlinehttps://mso.rsa-al.govBuilding Location201 South Union StreetMontgomery, AlabamaFlexible Spending Accounts877.517.0020 or p/flex-account/Business Hours8:00 a.m.-5:00 p.m.Monday-Friday
Hospital Medical PlansBlue Cross Blue Shield of Alabama (PPO)www.alabamablue.com/peehip/450 Riverchase Parkway EastP.O. Box 995Birmingham, AL 35298Customer Service 800.327.3994Preadmission Certification 800.248.2342Subrogation 205.220.2744Fraud Hot Line 800.824.4391Rapid Response 800.248.5123Wellness ProgramsAlabama Department of Public Health (ADPH)Vendor for Wellness Screenings and Flu Flu Shots 844.842.2954Tobacco Cessation Quitline 800.QUIT.NOWor 800.784.8669www.quitnowalabama.comBCBS Health Coaching800.327.3994, option 3(to order ID cards, claim forms, & directories)Baby Yourself 800.222.4379 - Maternity ProgramPack HealthTeladoc om/alabamaCustomer Service 855.255.2362VIVA Health Plan (HMO)Naturally /peehip417 20th Street North, Suite 1100Birmingham, AL 35203Sharecare - through 9/30/2020Customer Service 205.558.7474 or 800.294.7780Administrator of Wellness ProgramsDelta Dental Customer Service 800.521.2651peehip.sharecare.com(dental provider for VIVA Health Plan)Customer Service 855.342.6809Teladoc 800.TELADOC (835.2362)www.teladoc.comOptional Coverage PlansSupplemental Medical PlanSee Blue Cross Blue Shield of Alabama information above.(Cancer, Dental, Indemnity, & Vision)Southland Benefit Solutionswww.southlandbenefit.com/peehip2200 Jack Warner Pkwy, Suite 150Group Medicare Advantage (PPO) PlansHumana P.O. Box 1250Tuscaloosa, AL 35401Customer Service 800.476.0677https://our.humana.com/peehipP.O. Box 14601Lexington, KY 40512-4601Customer Service 800.747.0008 - 7 a.m.-8 p.m.; TTY 711Go365Rewards 866.677.0999Virtual Visits 888.673.1992Core/Specialty Pharmacy ProgramsMedImpacthttps://mp.medimpact.com/ala - through 9/30/2020www.medimpact.com/ala - effective 10/01/202010181 Scripps Gateway CtFlexible Spending tomer Service 877.288.0719 - 24 hours/daySan Diego, CA 92131Customer Service 877.606.0727 - 24 hours/dayPharmacy Help Desk 800.788.2949 - 24 hours/dayStep Therapy Prior Authorization 800.347.5841(for physicians)Fax 877.606.0728www.rsa -al.gov 1Plan Administrator Contact InformationPlan Administrator Contact Information
PEEHIP Member HandbookPEEHIP Member Handbookwith Open Enrollment InformationThe Public Education Employees’ Health Insurance Plan, or PEEHIP for short, was established in 1983 to provide qualityhealthcare insurance benefits for the health and well-being of our members.View your PEEHIP coverage information on our Member Online Services website https://mso.rsa-al.gov.Use Member Online Services to:View current coverage(s)Enroll in PEEHIP or change coverage(s)Upload required documentsMake PEEHIP paymentsSummary of Benefits and Coverage Availability of Summary Health InformationThe Patient Protection and Affordable Care Act (PPACA) of 2010 created a new federal requirement for group health plans toprovide the Summary of Benefits and Coverage (SBC) document to health plan members. Health benefits represent a significantcomponent of your compensation package. The benefits also provide important protection for you and your family in the case ofillness or injury.PEEHIP offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you makean informed choice, PEEHIP makes a Summary of Benefits and Coverage (SBC) available, which summarizes important informationabout health coverage options in a standard format, to help you compare across coverage options available to you in both theindividual and group health insurance coverage markets. The SBC is available at www.rsa-al.gov/peehip/publications/. A paper copy isalso available, free of charge, by calling Member Services toll-free at 877.517.0020.The SBC is meant as a summary only and the coverage examples in the SBC on page 7 are for illustration purposes only and maynot be representative of the actual charges for copayments or out-of-pocket expenses for the PEEHIP plan. For more detailedbenefit information, see the PEEHIP Summary Plan Description (SPD) at www.rsa-al.gov/peehip/publications/.The information in this handbook is based on the Code of Alabama, 1975, Title 16, Chapter 25A. This handbook is not intended as asubstitute for the laws of Alabama governing PEEHIP nor will its interpretation prevail should a conflict arise between its contentsand Chapter 25A. Furthermore, the laws summarized here are subject to change by the Alabama Legislature. Do not rely solely uponthe information provided in this handbook to make any decision regarding your healthcare benefits, but contact PEEHIP with anyquestions you may have about your healthcare benefits.2 877.517.0020
ContentsPlan Administrator Contact Information. 1PEEHIP Member Handbook with Open Enrollment Information.2Benefit Policy & Premium Changes Effective October 1, 2020.4Updating Personal Contact Information.6Insurance Eligibility.7Open Enrollment.10New Employee Enrollment.12Enrollment Procedures & MOS.14Dependent Eligibility Verification Required Documentation.17HIPAA Special Enrollment Outside of Open Enrollment.19Employer Contributions.23PEEHIP Hospital Medical Plan (PPO).27VIVA Health Plan (HMO).31PEEHIP Supplemental Medical Plan.34Optional Coverage Plans.35Comparison of In-Network Benefits.38Teleconsultation Benefits.45Coordination of Benefits (COB).46Wellness Programs.47Premium Rates.52Premium Assistance Program.53Flexible Spending Accounts (FSA).55Leave of Absence (LOA) & Family Medical Leave Act (FMLA).58COBRA.59Provision for Medicare-Eligible Active Members.63Health Insurance Policies for Retired Members.65PEEHIP Coverage for Medicare-Eligible Retired Members.69Retiree Premium Rates.70Retiree Sliding Scale Legislation .71Surviving Dependent Benefits.74Health Insurance Portability & Accountability Act (HIPAA) Notice of Privacy Practices.75Important Notices.79www.rsa -al.gov 3Table of ContentsTable of Contents
Benefit Policy and Premium ChangesBenefit Policy & Premium Changes Effective October 1, 2020Benefit Policy & Premium ChangesEffective October 1, 2020Hospital Medical Plan Changes - Administered by Blue Cross Blue Shield of Alabama (Group#14000)Annual Out-of-Pocket Amounts/Mental Health & Substance Abuse Benefit EnhancementsThe combined medical and prescription drug in-network maximum annual out-of-pocket amounts will increase to 8,550 perindividual and 17,100 per family for calendar year 2021. This is an enhanced benefit for our members enrolled in PEEHIP’sHospital Medical Plan Group #14000 coverage, as they will pay no more than these annual out-of-pocket amounts. Outpatient Behavioral Health Providers (BCBS Blue Choice Behavioral Network ) Reduced 50 office visit copy to 15 per visit Increased the 12 visit per plan year limit to 24 visits per plan year. Additional visits will be available if deemed clinicallynecessary by BCBS and their behavioral health partner, New Directions. Inpatient Facility Services For mental health: removed the 30-day per plan year limit for covered inpatient days For substance abuse: removed the 2-admit per lifetime maximum and removed the 1-admit per plan maximum, so thatmembers have more access if needed to use their 30 inpatient days within a plan year. For both: separated the count of days so that mental health days no longer aggregate toward a combined 30-day limitwith substance abuse days. Inpatient Physician Services Now covered at 100% of allowed amount with a 0 copay for both inpatient mental health and substance abuse physicianservices. For mental health: removed the 30-day per plan year limit for covered inpatient physician days to align with the removal ofthe 30-day per plan year limit for covered inpatient facility days. Outpatient Facility Services Added Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) as covered benefits for PEEHIPmembers. These were previously provided on a case-by-case basis requiring single case agreements between all partiesand were provided as deemed necessary by Blue Cross Blue Shield and their behavioral health partner, New DirectionsHealth Benefit. Predetermination for clinical necessity will still apply. If no available in-state PPO facility is available, coverage will be available out-of-state at that state’s in-network benefitlevel. Changed copay structure from 20 per day to 150 per treatment episode to match the out-of-pocket amount to themedical outpatient facility benefit.Wellness Program Health Coaching will no longer be a required activity to earn the 50 wellness premium waiver. Health Coaching will still be available as an optional activity for those members that would like to participate on a voluntarybasis. PEEHIP will still offer multiple health coaching options to fit members’ personalized needs. Members are encouragedto apply for one of these programs (i.e. Naturally Slim, Pack Health, BCBS Health Coaching) early in the plan year in order tosecure a spot, due to limited availability. The screening will remain a required activity in the plan year beginning October 1, 2020. Screenings can be obtained as earlyas August 1, 2020 to count for credit. The Alabama Department of Public Health (ADPH) will continue to provide screeningsat members’ workplaces and at county health departments. Screenings can also be obtained at members’ primary care physician offices. The wellness screening will be the only required activity to earn the 50 wellness premium waiver and will be dueeach year by the annual deadline of August 31.4 877.517.0020
benefit enhancement. The Dependent Care Reimbursement Account (DCRA) annual maximum contribution remains unchanged at 5,000 ( 2,500each if married filing separately). Carryover limit will increase from 500 to 550. See Flexible Spending Accounts section for more information.VIVA Health Plan Benefit Changes The combined medical and prescription drug in-network maximum annual out-of-pocket amounts will remain 7,350 forindividual and 14,700 per family for the 2021 calendar year. Maximum out-of-pocket amounts are a benefit to membersbecause they limit the total amount members will pay out-of-pocket for their in-network healthcare expenses. Teledoc copay decreased from 45 to 25 per consult.Supplemental Medical Plan Changes The annual maximum amount of claims paid under Group #61000 will increase to 8,550 per individual and 17,100 perfamily for calendar year 2021. This is a benefit enhancement. Members enrolled in High Deductible Health Plans (HDHP) are not eligible for the PEEHIP Supplemental Medical Plan. TheIRS defined the minimum deductibles for HDHPs for calendar year 2021 will remain as 1,400 for individual and 2,800 forfamily. You must provide a copy of your primary plan document for verification of the deductibles.Premium Rate Changes for Fiscal Year 2021COBRA and Leave of Absence Hospital Medical orVIVA Health Plan RatesIndividual 547Family 1,365Supplemental Medical Plan (Individual or Family) 170Surviving Spouse/Dependent Hospital Medical or VIVA Health Plan RatesIndividual/Non-Medicare-eligible (NME) Survivor 920Family/NME Survivor & More Than 1 Dependent or Only Dependent NME 1,192Family/NME Survivor & Only Dependent Medicare-eligible (ME) 985Individual/ME Survivor 244Family/ME Survivor & More Than 1 Dependent or Only Dependent NME 613Family/Medicare-eligible Survivor & Only Dependent ME 387These changes were also published in the June 2020 PEEHIP Advisor.www.rsa -al.gov 5Benefit Policy and Premium Changes The annual maximum Health FSA contribution amount increased to 2,750 beginning fiscal year October 1, 2020. This is aBenefit Policy & Premium Changes Effective October 1, 2020Flexible Spending Account (FSA) Plan Changes
Updating Personal Contact InformationUpdating Personal Contact InformationUpdating Personal Contact Information(Active and Retired Members)Name and Social Security Number ChangesThe name on all insurance and Teachers’ Retirement System (TRS) forms must be the same as the name on the Social Securitycard. PEEHIP requires a copy of the member’s Social Security card before a name or Social Security Number (SSN) can be changed.Active employees must provide a copy of their current Social Security card to their employer for the employer to correct theirPEEHIP and TRS accounts. The disclosure of your SSN is mandatory for PEEHIP coverage so that PEEHIP may ensure compliancewith the federal Medicare Secondary Payee rules created by 42 USC 1395y(b). Your SSN will be used by PEEHIP for the purpose ofCoordination of Benefits.Address ChangesTo change an address, use the secure online process from the RSA website at www.rsa-al.gov. Select the Member Log In at the topleft of the home page and follow the instructions. This address change will automatically transmit to the insurance carriers and alsoupdate your address with the TRS and RSA-1 if you are a participant in those accounts. The address change you make through theRSA online system will not change your address with your employer. Active members must contact your employer t
The Public Education Employees’ Health Insurance Plan, or PEEHIP for short, was established in 1983 to provide quality healthcare insurance benefits for the health and well-being of our members. View your PEEHIP coverage information on our Member Online
