On this page you can find:

• Provider Access & Contacts

• Benefits Frequently Asked Questions (FAQ)

• Information on Qualifying Life Events

• Pre-Certification

• Prescription Drug Program

• Benefits Definitions

• HSA & HDHP Information - Is this right for you?

Provider Access & Contacts

Kleen Test Products, in partnership with the following carriers, strives to meet your benefit needs.  If you have any questions regarding your benefits, please contact the corresponding carrier listed below or your KTP Human Resources Representative.  The below buttons will link to the provider websites, and a full list of contact information for all benefits providers is listed below.

Benefits Frequently Asked Questions

When can I make changes to my coverage?

Open Enrollment (every November) and qualifying life events are the only time that changes can be made to your coverage.   If a qualifying event occurs and you need to change your elections, you MUST notify HR within 31 days of the qualifying event.  Documentation may be required as proof of qualifying life event.  For more information about Qualifying Events, click here to visit the Anthem website.

How long will a dependent child be covered?

Under Health Care Reform, your child will be covered until the end of the month that your child reaches the age of 26, regardless of eligibility of other coverage.

How does an HDHP/HSA Work?

You contribute money to the HSA (either a lump sum payment or monthly through payroll deductions). You can use HSA dollars to pay your health insurance deductible, along with other qualified medical expenses such as dental or vision services. Once you meet your deductible, your insurance pays additional covered expenses in accordance with our plan.

What are qualified medical expenses?

Qualified medical expenses include:

• Most medical care expenses (deductibles, coinsurance, doctors visits, etc.)

• Prescription drugs

• Over-the-counter drugs, with prescription

• Insulin

• Dental or vision care

• Some insurance premiums

  • Health insurance premiums wile receiving unemployment benefits

  • Qualified long-term care premiums

  • Any health insurance premiums paid (other than for a Medicare supplement policy) by individuals age 65 and over

Are there any medical expenses that can not be paid with my HSA?

The following medical expenses cannot be reimbursed from HSA tax-free:

• Most insurance premiums

• Over-the-counter drugs without a prescription (except insulin)

• General health items (example: hand sanitizer, toiletries)

• Most cosmetic surgery or cosmetic procedures

• Expenses covered by another health plan

• Expenses incurred before HSA was established

Are there limits to my HSA contributions?

Yes!  The IRS sets limits each year for HSA contributions.  See our Benefits Summary for the current contribution limits.  If you’re 55 or older anytime during the plan year, you’ll continue to be able to contribute an additional $1,000 catch-up contribution.

What is Anthem Care Comparison?

Anthem Care Comparison is an innovative tool designed to help take some of the mystery out of health care and maximize the value of your health insurance plan. Having a clear understanding of cost and quality can help you make more informed decisions which can lead to better health. With the Care Comparison tool you can see real price ranges for common services at different places in your area. You can also compare quality factors to help you evaluate experience and expertise. Learn more about this helpful tool at www.anthem.com or call the customer service number on the back of your health plan ID card.

Prescription Drug Benefits

Prescription Drug coverage is provided in conjunction with the medical plan and is administered by Express Scripts.  For prescription drug coverage questions, Express Scripts can be reached at (800) 879-9911. Learn more about generic drugs, obtain further information about a specific drug, place a mail order refill request, or locate an in-network pharmacy online at www.express-scripts.com.  This benefit summary highlights plan benefits.  Benefits are subject to change without notice.

Generic Drugs $15

Formulary Brand Drugs $50

Non-Formulary Brand Drugs $75

Specialty Drugs $120

Deductible per calendar year and Maximum Out-of-Pocket per calendar year are included with Medical Plan

NOTE - Pick 'N Save/Kroger has been removed from the Rx network effective 1/1/2023.  Affected members received notification of this via mail.

Accredo Specialty Medication Management Program

Administered through Express Scripts, Accredo provides convenient tools to help manage specialty medications for long-term conditions. Through this one-of-a-kind clinical model, Accredo connects patients with specialist pharmacists, nurses and other pharmacy experts who have extensive training and experience in specific disease states and medications.  *Not available for all specialty medications.

Retailer Discounted Prescription Drug Programs

Walmart and Target are just a couple of retailers that offer Discounted Retailer Drug Programs.  Costs are generally $4 for a 30-day supply or $10 for a 90-day supply. Visit their websites for more details on the program and to review a list of eligible prescriptions. 

Definitions

To help you understand and compare coverage options, here are definitions of some key benefits terms:

Co-insurance is the percentage you are responsible for paying after your deductible is met, but before you have reached your plan maximum.

Co-pay is the amount you pay for a specified medical service, whether or not you’ve reached your plan’s annual deductible. Co-pays do not apply toward the annual deductibles.

Deductible is the part of eligible expenses you must pay before the plan begins to pay a percentage of your eligible expenses.  After the deductible is met, the Plan pays the benefit percentage of covered expenses incurred during the balance of the calendar year for each individual up to the out-of-pocket maximum.  Office visit co-pays and prescription drug deductible co-pays do not apply to the medical deductible.

An Embedded Deductible is a system that combines individual and family deductibles in a family health insurance policy. When a health plan has embedded deductibles, it just means that a single member of a family doesn’t have to meet the full family deductible for after-deductible benefits to kick in.

Under a Non-Embedded Deductible plan, the total family deductible must be paid out-of-pocket before the insurer starts paying for healthcare services for any individual member.

Formulary is the list of prescription drugs covered under your plan. It is created, reviewed, and updated regularly by a team of qualified doctors and pharmacists. Your plan’s formulary contains a wide range of generic and brand-name drugs that have been approved by the U.S. Food and Drug Administration (FDA) because the drugs are safe, effective, and less expensive.

Out-of-Pocket Maximum is the maximum amount you have to pay each year for most covered expenses, including your deductible, medical co-pays, and co-insurance, but not including co-pays for prescriptions. Your out-of-pocket limit does not cover amounts over “approved” or “reasonable and customary.” After you reach this amount, the plan will pay 100 percent of most covered expenses for the remainder of the plan year.

In-Network Provider is a physician, hospital, facility or other medical provider that participates with a preferred provider network, also called a Preferred Provider Organization (PPO). Preferred providers agree to accept your co-pay plus your medical plan payment as payment in full; you are responsible for your plan co-insurance payments, deductibles, and payment toward your annual out-of-pocket maximum. Preferred providers will never pass on to you any amounts over “approved” or “reasonable and customary.”

Out-of-Network Provider is a physician, hospital, facility, or other provider that does not participate with a PPO; you are responsible for any balance not covered by the medical plan. Because of this, you should talk to providers before you receive services from them to see if they participate with your medical plan’s network, and if they don’t, whether you will be billed for the balance.

PPO is a Preferred Provider Organization that has contracted with a network of physicians and hospitals, providing access to healthcare services at a discounted rate. Every time you seek medical services, you choose whether you want to use an “in-network” or “out-of-network” provider. Using an “in-network” provider results in lower costs for you and the plan due to agreed upon discounts for medical services and lower deductibles and co-insurance levels.

High Deductible Health Plan (HDHP) is a health plan that provides significant benefits and satisfies requirements for minimum deductibles and out-of-pocket maximums. HDHPs can provide family coverage or self-only coverage. Except for preventive care, no benefits can be paid until annual deductible is met. Prescription drugs must be subject to deductible and coinsurance.

Health Savings Account (HSA) is an employee-owned account that may be used to pay your health insurance deductible along with other qualified medical expenses such as dental or vision services. HSAs must be used in conjunction with a HDHP.

Is an HDHP & Optional HSA Right for You? 

If you elect an HDHP (high deductible health plan), you may be eligible to also contribute to an HSA (health savings account), which allows you to set aside pre-tax dollars for qualified medical expenses.  HDHP premiums are lower each paycheck, but your deductible and out-of-pocket maximums will be higher than a traditional PPO plan.  The content below may help you decide if this is right for you.