Benefits At a Glance

January 1, 2022 Update to PHCS Network – NOTICE TO EMPLOYEES

Medical Plan Summary Presentation – Reminders 

Claims processing is with a Third-Party Administrator. The TPA is EBMS.

ProCare Rx is the pharmacy benefit manager.  The prescription plan gives you the opportunity to save on your copays by using preferred pharmacies – grocery store chains and locally-owned neighborhood pharmacies.

There is no network – any facility or provider can be utilized.

Medical Plan Premiums

Medical Insurance premiums will be paid under the Cafeteria plan and paid with pretax dollars.

Biweekly Premiums are listed below:

Plan Tier July 2023 – June 2024
Non-Tobacco Tobacco
Employee Only $66.63 $112.78
Employee + Child(ren) $120.83 $166.98
Employee + Spouse $191.58 $237.73
Family $251.97 $298.12

Preferred Provider Agreements

You can use any facility or provider at the same benefit level; however, if you use a direct contracted/preferred providers, you will not be balance billed.

Preferred Facility

Preferred Providers

Employees are requested to use the physicians and facilities in these groups to help reduce medical plan costs for themselves and the County.

ELAP

For a non-preferred provider or facility, ELAP will review the claim and then EBMS will process the claim and send payment, if applicable.

After the provider receives an adjusted payment, they have 2 Options:

  1. Provider accepts payment
  2. Provider does not accept payment and they appeal to the plan or “Balance Bill” the member

If you receive a balance bill, send it to ELAP to work with the provider.

If you have questions about your bill, contact Elap Services or visit their website

ELAP Services
1550 Liberty Ridge Drive, Suite 330
Wayne, PA 19087
Phone: 1-800-977-731
Fax:  1-888-560-2447
balancebills@elapservices.com

Watch a video from ELAP explaining the process.

Federal Transparency

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

https://caa.ebms.com/Troup%20County%20Board%20of%20Commissioners/index.html 

Online Access to Benefits

EMBS has an online portal called miBenefits, as well as an app, that employees can use to review claims or benefits.  Information on how to set up your miBenefits account will be included when you receive your new ID Card.

Watch an introductory video about the miBenefits member portal

Medical Benefits at a Glance

A brief summary of your medical benefits is shown in the table below.

Please review the summary plan description for the legal description of all medical benefits.

Active Employee Summary of Benefits and Coverage

Active Employee Plan Document and Summary Plan Description

Benefits Amount
Office Visit- Primary Care $50 copayment
Office Visit- Specialist Care $70 copayment
Office Visit- Chiropractor $50 copay/visit
We Care Clinic Physicians Free to Employees, County Pays
Plan Year Deductible $1,250 individual or $3,750 family
Out-of-Pocket Maximum $2,500 individual; $7,500 family
Preventive Services Paid 100%, no deductible
Urgent Care $70 copayment
Emergency Room $250 copay/visit, plus 25% after deductible
Co-Insurance 75% after deductible

Qualifying Events to Add/Delete Dependents

To add dependents to the County’s Medical or Dental Plans, employees must provide copies of documentation to verify dependent eligibility.  Spouse verification needs marriage license, Dependent child verification requires birth certificate.  First page of most current tax  return can also be used to verify dependents.

Qualifying event benefit changes are allowable during the year, if completed with Human Resources within 30 days of the event and proper documentation is received within that time period. 

Qualifying events include newborn children, adoptions, death, marriage, divorce, legal separation, gaining/losing employment, gaining/losing eligibility for benefits, etc.