Medical
LGC HealthTrust is strongly committed to managing the rising cost of healthcare and improving the quality of life for members and their families. With years of insight and experience, our team of highly trained experts can help groups offer affordable, high-quality medical plans that help support the good health of our members.
At LGC HealthTrust, our goal is to provide more than competitive rates and extensive coverage options. Our knowledgeable representatives are committed to adding the value, service, and expertise that every Member Group needs to help employees achieve productive lifestyles and general well-being.
Available benefits programs include the following:
INDEMNITY PLANS
Administered through Anthem Blue Cross and Blue Shield, one of the most trusted names in the healthcare industry, our traditional indemnity (or "fee-for-service") plans give employees the freedom to make their own healthcare decisions.
Members may choose their own doctors, arrange for covered specialty care that is medically necessary, or select a hospital that meets their specific needs. By using one of the more than 2,900 doctors who participate with Anthem Blue Cross and Blue Shield, filing claims forms or reimbursement requests is not required.
A variety of indemnity plan options are available. While all provide similar coverage for a broad range of services, each plan's deductible and coinsurance percentage varies. Following are some commonly used terms to help with a better understanding of the indemnity plans:
Deductible is the amount an Individual Member pays each calendar year before benefits are paid. For example, the Comp 100 plan includes a $100 annual deductible for medical expenses.
Maximum allowable benefit is the amount the plan contract allows for a particular service in the member's geographical area. If a member's non-participating healthcare provider charges more than the maximum allowable benefit, the Individual Member is responsible for the difference; this difference does not apply to the annual out-of-pocket limit. To ensure that the maximum allowable benefit is paid in full, members are encouraged to use a participating provider. The maximum allowable benefit is an important feature for controlling claims costs, limiting out-of-pocket expenses to covered members.
Coinsurance percentage is the portion of eligible medical expenses that the plan covers once the annual deductible is satisfied. For example, the coinsurance amount for our Comp 100 plan is 80 percent: The plan covers the first 80 percent, then the member pays the remaining 20 percent of eligible medical expenses, up to the maximum allowable benefit.
The out-of-pocket limit provides Individual Members with protection for expenses that may result from serious illness. Once an Individual Member's out-of-pocket limit is met, the plan pays 100 percent of eligible medical expenses, up to the maximum allowable benefit, for the remainder of the year. For example, the out-of-pocket limit for our Comp 100 plan is $500 per year for an individual and $1,000 per year for a family.
Managed Care Guidelines are designed to ensure that employees receive the most appropriate level of quality care available. Guidelines apply when members receive certain inpatient, outpatient, or mental health and substance abuse services.
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POINT-OF-SERVICE (POS) PLANS
Providing coverage for preventive care, doctor visits, emergency room visits, prescriptions, hospitalization, and more, the BlueChoice ® point-of-service plans offer the flexibility of being able to obtain care with a provider of choice, while maintaining the benefits of a low copayment structure.
Administered through Anthem Blue Cross and Blue Shield, LGC HealthTrust offers two BlueChoice options: One provides a three-tier approach to accessing healthcare, while the other is structured as a two-tier approach. Both combine the freedom of a traditional plan with the cost savings of an HMO.
Once enrolled, an Individual Member selects a primary care provider (PCP) for him- or herself and any covered family members. The lowest out-of-pocket costs are realized when the PCP provides or arranges medical care (usually through network providers). While most benefits are covered subject to a low copayment (or in some cases, no copayment at all), members may also by-pass their PCP and still have benefits covered at a higher out-of-pocket cost.
Experience has shown that in most cases, members choose to have their care provided by or arranged through their PCP, thus controlling claims costs. This option provides a further benefit with the ability to utilize favorable contracting arrangements available through Anthem.
A variety of BlueChoice plans are available with varying levels of copayments and deductibles. Because the LGC has always offered a wide array of benefit options to meet every budget, LGC HealthTrust has additional plans that provide even further cost savings.
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HEALTH MAINTENANCE ORGANIZATION (HMO) PLAN
By managing members' total healthcare within a network and emphasizing preventive care, our HMO option, Matthew Thornton BlueSM, is focused on keeping Member Groups' costs low.
Offered through Anthem Blue Cross and Blue Shield, the plan works like a traditional HMO. Members pay a monthly contribution in exchange for comprehensive care from providers who belong to the HMO network. As with the POS plan option, new members first select a PCP, who then provides or arranges for medical care.
By providing access to an extensive network of more than 800 participating PCPs, the HMO option ensures that members receive the benefit of consistent and coordinated care before problems have a chance to become serious. Preventive and early detection care services, such as routine physical examinations and immunizations, are made as affordable and easy to access as possible.
Employees benefit even further from a comprehensive healthcare plan that features favorable coverage for inpatient hospital care, low copayments for office visits, fully covered medical and surgical care, and worldwide coverage for emergency and urgently needed care.
Although a PCP must coordinate most of an individual's care, and the Anthem network is extensive, we recognize that there are some exceptions when other network doctors must be seen directly. Examples include routine Ob/Gyn care, chiropractic care, or emergency situations. As long as the Individual Member's PCP provides a referral, even care received from outside the network (as well as use of urgent care facilities) is covered with LGC HealthTrust's HMO option. In the event that a member requires immediate care while out-of-network, a referral is also acceptable after care has been provided.
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MEDICARE SUPPLEMENT
While Medicare provides a basic healthcare foundation for individuals age 65 and older, LGC HealthTrust offers supplemental medical coverage to retirees and covered family members.
When 75 percent of an active group's members participate in LGC HealthTrust-sponsored medical plans, we are able to provide a Medicare supplemental benefits plan. The plan provides retirees with comprehensive benefits which include LGC HealthTrust's prescription drug coverage and wellness programs.
The Medicare supplemental benefits plan provides a variety of retiree medical benefits, including the following:
- Coverage for additional days of a hospital stay
- Payment of Medicare deductibles and coinsurance
- A mail-order prescription drug program through LGC HealthTrust which offers a 90-day supply of medication for a low copayment
- A retail prescription drug program through LGC HealthTrust which offers short-term medications
Member Group retirees are eligible to maintain benefits no matter where they live in the country. Retirees can also participate in our Slice of Life Health Management program that is designed to provide LGC HealthTrust members with tools for better living.
An LGC HealthTrust Retiree Advocate is available to help Individual Members transition their benefits plans from employment to retirement. The Retiree Advocate also maintains open lines of communication with the New Hampshire Retirement System to facilitate retirees' benefits processing and payments. LGC HealthTrust members simply call 800.527.5001 to obtain whatever help they may need, from filling out forms to enrolling in a health management program.
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DISCOUNT VISION PLAN
LGC HealthTrust provides members and their covered family members with important access to quality eye care services through EyeMed
Vision Care, an extensive network of private practicing
optometrists, ophthalmologists, opticians, and participating
retailers LensCrafters®, Target® Optical and Pearle
Vision®.
Receiving an EyeMed discount is as easy as visiting an EyeMed provider. LGC HealthTrust members simply present an ID card to take advantage of a wide variety of vision care discounts on frames, lenses, and vision correction procedures.
Download our
EyeMed Access Plan D flyer to view discount specifics.
EyeMed's locator service is easily accessible by calling 866.939.3633 or visiting
www.eyemedvisioncare.com.
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SURVIVOR AND TRANSITION CARE PLANS
At LGC HealthTrust, we recognize that employees of New Hampshire towns, cities, counties, schools, and quasi-municipal organizations are dedicated to serving others - and that this can oftentimes put them in dangerous situations.
When the death of a family member occurs, survivors must be prepared for the unexpected; critical financial, housing, and caregiver decisions that are difficult, even under normal circumstances, must be made in the midst of grief.
With Survivor Care and Transition Care plans, LGC HealthTrust continues to provide health and/or dental coverage at no cost to help ease family members' peace of mind. Here is what each plan offers:
Survivor Care Plan
Families covered through a LGC HealthTrust-sponsored plan receive extra protection through our Survivor Care plan. In the event that a covered employee dies while performing his or her job responsibilities, Survivor Care provides extended health and/or dental benefits at no charge to dependents of the covered employee's family.
In order to be eligible for Survivor Care , the covered employee's surviving dependents must be enrolled in a LGC HealthTrust-sponsored health and/or dental plan at the time of the employee's death. Death must have resulted from an eligible workers' compensation death claim, and the employee must have been actively at work with their LGC HealthTrust Member Group at the time of death.
As long as the Member Group continues to participate in LGC HealthTrust, Survivor Care coverage will continue until the employee's dependents become eligible for any other health and/or dental plan; the surviving spouse becomes eligible for Medicare coverage; or minor children reach age 19 (or full-time students reach age 25), whichever occurs first.
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Transition Care Plan
Transition Care provides extended health and/or dental benefits at no cost to dependents of a covered employee's family for the first 12 months of COBRA continuation coverage, no matter what the cause of the covered employee's death.
This 12-month transition period provides time for the surviving spouse to either enroll in his or her own employer's benefits plan, or to arrange for payment of COBRA coverage or another individual policy after the 12-month period.
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