Introduction

The health benefits that the State of Alaska provides to its eligible employees is commonly referred to as AlaskaCare. AlaskaCare Health Plans can help you and your eligible dependents pay for medical, dental, pharmacy and vision expenses.

A dental third-party claim administrator is a company the Division hires to process AlaskaCare dental claims. Delta Dental of Alaska is the AlaskaCare dental claim administrator. Medical, vision, and pharmacy claims are processed by Aetna and OptumRx, respectively.

Contact Delta Dental of Alaska toll free at (855) 718-1768.

When you enroll in dental benefits you’re part of the Delta Dental of Alaska family and have access to great dental care, close to home and when you’re traveling. Delta Dental of Alaska is part of the Delta Dental Association — the nation’s largest and most trusted dental benefits carrier.

Delta Dental of Alaska Dental Claim Form .

Dental Plans at a Glance

AlaskaCare offers two dental plan options: the standard plan and the economy plan.

1. Standard Plan
   The Standard Plan has greater coverage for more than just preventive dental visits, higher maximum annual benefits, includes limited orthodontic coverage, and includes Preventive services covered at 100% with no deductible for In-Network Dentists.

   View the Standard Dental plan summary for detailed service class coverages.

2. Economy Plan
   The Economy Plan has no monthly premium, has a lower maximum annual benefit and covers Preventive services covered at 100% with no deductible for In-Network Dentists and a lower.

   View the Preventive/Economy Dental plan summary for detailed service class coverages.

Premiums

AlaskaCare 2022 Dental Plan Summaries
Group	Standard	Economy
Monthly Plan Premiums
Employee Only	$37.00	$0.00
Employee and Family	$102.00	$0.00
Calendar Year Costs
Annual Maximum Benefit Per Person	$1,500	$500
Deductible Per Person	$25	$25
Deductible Per Family	$75	$75
Service	Benefit Amount	Benefit Amount
Preventive	100%1	100%1
Basic	80%	10%
Major	50%	10%
Orthodontics
Eligible employees and their covered dependents	50% coinsurance up to a $1,000 lifetime maximum	N/A
1 Deductible waived, does not apply to annual maximum benefit. Premiums are subject to change. Note that although the Preventive plan offers limited coverage for non-preventive procedures, it will still save you money by restricting the cost for those services to Delta Dental's negotiated rates. This only applies when you see a provider in the Delta Dental Premier or PPO networks. AlaskaCare has provided the above benefit summaries. Moda Health/Delta Dental of Alaska are not responsible, in any way, for the accuracy of such information. For a more detailed description refer to your Member Handbook. If you have any questions about this information, please contact your AlaskaCare plan administrator at (800) 821-2251.
Effective: Jan. 1 - Dec. 31, 2022

Additional Programs

Oral health is an essential part of staying healthy. Studies have linked oral health to several chronic diseases, including diabetes, heart disease and stroke. Pregnant women who have periodontal disease are more likely to have a premature and underweight baby. Lower your risks by keeping up with your preventive dental services.

No cost for preventive care from network dentists!

Seeing your dentist regularly can help you avoid serious and expensive services down the road. To help you avoid costly dental care in the future, both dental plan options cover preventive care at no cost to you if you use a network provider:

• Preventive (Class I) services, such as cleanings, periodontal maintenance, and routine oral exams, are covered at 100% when using a network provider.
• Preventive services do not count towards your maximum annual dental benefit, giving you more to spend each year on other services that you may need.

Reduce your costs by using a network dentist!

Your dental plan lets you see any licensed dentist you want. But when you see a network provider, you’ll save money. AlaskaCare members have access Delta Dental’s broad Premier network of providers, AND to an additional, narrower network of dental providers: Delta Dental’s PPO network.

When you visit a PPO dentist, you’ll pay less out-of-pocket. You do not need to do anything to enroll in this benefit, but if you want to take advantage of the discounted services, use the dentist locator tool to search for providers who participate in the PPO network, or call Delta Dental of Alaska toll-free at (855) 718-1768.

Oral Health, Total Health Program and Benefits

If you are diabetic or pregnant in your third trimester, the Oral Health, Total Health program offers more ways to care for your teeth and mouth—and keep the rest of your body healthy, too.

If you have diabetes

Diabetes increases the risk of cavities, periodontal (gum) disease, tooth loss, dry mouth and infection. If you have been diagnosed with this disease you may be eligible for four prophylactic (preventive) cleanings or periodontal maintenance visits per year through the Oral Health, Total Health program. Protect your teeth and gums by enrolling today.

If you’re pregnant

Pregnant women who have periodontal (gum) disease are more likely to have a premature and underweight baby. Bacteria can enter the bloodstream through the mouth, and the body’s response to the infection can trigger early labor. If you are expecting, you can enroll in the Oral Health, Total Health program to help prevent gum disease. If you’ve already had two cleanings for the year, you may be eligible for another cleaning or checkup during your third trimester. This added preventive (prophylactic) visit is covered regardless of normal plan frequency limits. That way, you can receive a dental cleaning during the third trimester, no matter what.

To learn more or to enroll, call Delta Dental of Alaska (MODA) toll-free at (855) 718-1768.

Vision is an optional plan offered to AlaskaCare members and their families. Vision Service Plan (VSP) is the administrator for the employee vision plan. If you enroll in the vision plan, the VSP information is located on the back of your Aetna ID card.

VSP

• Aetna Concierge: (855) 784-8646
• Online access: VSP.com

Most experts estimate that over 64% of adults need some sort of vision correction. Depending on how often you need new lenses, getting vision insurance may be a good financial fit.

Many hidden medical problems can be detected through an eye exam, so even those with perfect vision should have regular eye exams. If this routine exam is all you need, the vision plan may not be the right financial fit for you.

Review the premiums and the coverage offered under the vision plan before making a decision if this vision coverage is the right fit for you.

AlaskaCare 2022 Vision Plan Summary
--	Description	Copay	Frequency
Monthly Employee Contribution
Employee Only	$15.00	--
Employee and Family	$40.00	--
Well Vision Exam
WellVision Exam	Focuses on your eyes and overall wellness.	$10	Every calendar year
Prescription Glasses
Frame	$130 allowance for frames 20% off amount over your allowance $70 allowance at Costco	$25 (Prescription Glasses Benefit)	Every other calendar year
Lenses	Single vision, lined bifocal, and lined trifocal Polycarbonate lenses for dependent children	Included in prescription glasses	Every calendar year
Lens Options	Anti-reflective coating – covered in full Polycarbonate lenses – covered in full Progressive lenses – covered in full Scratch-resistant coating – covered in full Average 35-40% off other lens options	Included in prescription glasses	Every calendar year
Contacts
Contacts (instead of glasses)	$130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation)	Up to $60	Every calendar year
Diabetic Care
Diabetic Eyecare Plus Program	Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal Screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask you VSP doctor for details.	$20	As Needed
Extra Savings and Discount
Glasses & Sunglasses	30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same day as your WellVision exam. Or, get 20% off from any VSP doctor within 12 months of your last WellVision exam.
Effective: Jan. 1 - Dec. 31, 2022

To learn more about the coverage available under the vision plan, refer to the Vision Service Plan (VSP) Brochure .

What Plan Am I In?

AlaskaCare

The following employee groups are entitled to the AlaskaCare Health Benefits provided by the State:

• AVTECTA – AK Vocational Teachers Union (TA)
• CEA – Confidential Union (KK)
• APEA – Supervisory Union (SS)
• ACOA – Correctional Officers Union (GC)
• MEBA – Marine Engineers Union (BB)
• TEAME – Mt. Edgecumbe Teachers Union (TM)
• IBU – Inlandboatman’s Union (MM)
• Employees not covered by collective bargaining (Exempt)

Union Health Trusts

The following employee groups are covered by Union health trusts and should contact the trust for details and enrollment in health benefits. Please note all trusts, except Labor Trades and Crafts, are eligible to enroll in Voluntary Supplemental Benefits provided by the state.

• General Government (GGU)
• Labor, Trades and Crafts (LTC)
• Public Safety Employees Association (PSEA)
• Masters, Mates & Pilots

Open Enrollment

Open Enrollment is the annual time of year when you can make changes to your current benefits. Typically, Open Enrollment occurs during the first three weeks of November. Unless you are a new hire or have had a Qualified Status Change, then this is the only time during the year where you may make changes to your current benefit. Open Enrollment for employees includes the following:

• AlaskaCare Benefits: For eligible State of Alaska employees who participate in the AlaskaCare health plan to choose medical, dental, and vision benefits as well as to choose to participate in a Health Flexible Spending Account (HFSA).
• Voluntary Supplemental Benefits (VSB): For any eligible employee of the State of Alaska or participating Political sub-divisions to choose VSB, including Life insurance, Critical Illness, and Disability insurances.

If you are unsure what plan you participate in, click here.

Benefit Highlights for

COBRA

For definitions of any terms used in this information page please refer to the AlaskaCare Health Plan Document. This information is only a summary. The AlaskaCare Health Plan Document will prevail whenever there is a difference in interpretation between this information page and the plan document.

Introduction

If you and/or your dependents lose coverage due to a qualifying event, you and/or your dependents may continue coverage under the plan by electing COBRA coverage and paying the required premium as described in this section. You may elect coverage under the plan that is the same or less than the level of coverage that you or your dependents had at the time your coverage terminates under the plan. For example, if you are covered under the medical plan and have elected the standard plan, you may elect COBRA continuation coverage under either the standard plan or the economy plan. Additionally, you may elect COBRA continuation coverage:

• under the medical plan only; or
• under the medical plan and under the dental plan and/or the vision plan

You may not elect COBRA continuation coverage under the dental plan or the vision plan without also electing COBRA continuation coverage under the medical plan.

Right to Continuation Coverage

If you are a qualified beneficiary, you may elect to continue coverage under the plan after a qualifying event. Only those persons who are covered under the plan on the day before the event which triggered termination of coverage are eligible to elect COBRA continuation coverage, except that dependent children born to or placed for adoption with you while you are on continuation coverage may be added to your coverage if the child is otherwise eligible under the plan. A qualified beneficiary is a person who is covered under the plan on the day before a qualifying event (but also including dependent children born to or placed for adoption with you during the continuation coverage) who is:

• an eligible employee;
• a spouse; or
• a dependent child

The right to continued coverage is triggered by a qualifying event, which, but for the continued coverage, would result in a loss of coverage under the plan. A "loss of coverage" includes ceasing to be covered under the same terms and conditions as in effect immediately before the qualifying event or an increase in the premium or contribution that must be paid by a covered person. Qualifying events include:

• Your death.
• The termination (other than by reason of gross misconduct) of your employment or reduction of your hours that would result in a termination of coverage under the plan.
• Your divorce or legal separation from your spouse.
• Your becoming entitled to Medicare benefits under Title XVIII of the Social Security Act (42 USC § 1395-1395ggg).
• Your child ceasing to be a dependent child under the eligibility requirements of the plan.

If a qualifying event occurs to a qualified beneficiary, then that qualified beneficiary may elect to continue coverage under the medical plan, dental plan and/or vision plan.

Election of Continuation Coverage

Continuation coverage does not begin unless it is elected by a qualified beneficiary. Each qualified beneficiary who loses coverage as a result of a qualifying event has an independent right to elect continuation coverage, regardless of whether any other qualified beneficiary with respect to the same qualifying event elects continuation coverage.

The election period begins on or before the date the qualified beneficiary would lose coverage under the plan due to the qualifying event, and ends on or before the date that is 60 days after the later of:

• the date the qualified beneficiary would lose coverage due to the qualifying event; or
• the date on which notice of the right to continued coverage is sent by PayFlex.

The election of continuation coverage must be made on a form provided by PayFlex and payment for coverage, as described in the notice, must be made when due. An election is considered to be made on the date it is sent to PayFlex.

Period of Continuation Coverage

Termination of Employment or Reduction in Hours

In the case of a qualifying event caused by termination of employment or reduction in hours, the qualified beneficiary may elect to extend coverage for a period of up to 18 months from the date of the qualifying event.

Second Qualifying Event

If a second or additional qualifying event occurs during the initial 18 month continuation coverage period (or during a 29 month maximum coverage period in the case of a disability), the qualified beneficiary may elect to extend the continuation coverage period for a period of up to 36 months from the date of the earlier qualifying event.

If you became entitled to Medicare within 18 months prior to a qualifying event caused by termination of employment or reduction in hours, qualified beneficiaries (other than you) may elect to extend coverage for a period of 36 months from the date of your entitlement to Medicare benefits.

Disability

If a qualified beneficiary is determined under Title II or XVI of the Social Security Act to be disabled within 60 days of the initial continuation coverage period due to termination of employment or reduction of hours (even if the disability commenced or was determined to be a disability before the first 60 days of the initial 18 month continuation coverage period), coverage may be continued for all qualified beneficiaries for a period of up to 29 months from the date of the qualifying event.

You must provide notice of a disability determination to PayFlex within 18 months of the qualifying event and within 60 days after the latest of:

• the date of the disability determination by the Social Security Administration;
• the date the qualifying event occurs;
• the date you lose or would lose coverage due to the qualifying event; or
• the date on which you are informed, via the plan or the general COBRA notice, of your obligation to provide such notice and procedures for providing such notice.

You are also responsible for notifying the Division within 30 days of the later of:

• the date of the final determination by the Social Security Administration that you are no longer disabled; or
• on the date which you are informed, via the plan or the general COBRA notice, of your obligation to provide such notice and procedures for providing such notice.

Other Qualifying Events

In the case of any qualifying event not otherwise described above, the qualified beneficiary may elect to extend coverage for a period of up to 36 months from the date of the qualifying event.

Health Flexible Spending Account (HFSA)

Notwithstanding the above, continuation coverage under the health flexible spending account (HFSA) will extend only until the end of the benefit year in which the qualifying event occurs.

End of Continuation Coverage

Continuation coverage will end upon the dates of the following occurrences, even if earlier than the periods specified under section 8.4, Period of Continuation Coverage

• Timely payment of premiums for the continuation coverage is not made (including any grace periods).
• You first become covered under any other group health plan, after the date on which continuation coverage is elected, as an employee or otherwise, unless such other plan contains a limitation (other than a limitation which does not apply by virtue of HIPAA with respect to any pre-existing condition).
• You first become entitled to benefits under Medicare, after the date on which continuation coverage is elected.
• The State ceases to provide any group health plan to any employee
• You cease to be disabled, if continuation coverage is due to the disability.

Notwithstanding the foregoing, the plan may also terminate the continuation coverage of a qualified beneficiary for cause on the same basis that it could terminate the coverage of a similarly situated non-COBRA beneficiary for cause (e.g., in the case of submitting fraudulent claims to the Division).

Cost of Continuation Coverage

You are responsible for paying the cost of continuation coverage. The premiums are payable on a monthly basis. By law, premiums cannot exceed 102% of the full premium cost for such coverage (or 150% for any extended period of coverage due to disability). After a qualifying event, PayFlex will provide a notice with amount of the premium, to whom the premium is to be paid, and the date of each month that payment is due. Failure to pay premiums on a timely basis will result in termination of coverage as of the date the premium is due. Payment of any premium will only be considered to be timely if made within 30 days after the date due.

A premium must be paid for the cost of continuation coverage for the time period between the date of the event which triggered continuation coverage and the date continued coverage is elected. This payment must be made within 45 days after the date of election. PayFlex will provide you notice specifying the amount of the premium, to whom the premium is to be paid, and the date payment is due. Failure to pay this premium on the date due will result in cancellation of coverage back to the initial date coverage would have terminated.

Notification Requirements

General Notice to Covered Eligible Employee and Spouse

The plan will provide, at the time of commencement of coverage, written notice to you and your spouse of your rights to continuation coverage. This general notice will be provided no later than the earlier of:

• 90 days after your coverage commencement date under the plan; or
• the date on which the Division is required to furnish a COBRA election notice.

Employer Notice to Division

Your employer will notify the Division in the event of your death, termination of employment (other than gross misconduct), reduction in hours, layoff, or entitlement to Medicare benefits within 30 days after the date of the qualifying event.

Covered Eligible Employee/Qualified Beneficiary Notice to Administrator

You must notify the Division of:

• your divorce or legal separation from your spouse;
• a child ceasing to be a dependent child under the eligibility requirements of the plan;
• a second qualifying event; or notice of disability entitlement or cessation of disability.

You must give notice as soon as possible, but no later than 60 days after the later of:

• the date of such qualifying event;
• the date that you lose or would lose coverage due to such qualifying event; or
• the date on which you are informed, via the plan or the general COBRA notice, of your obligation to provide such notice and the plan procedures for providing such notice.

See Election of Continuation Coverage, for timing of notices applicable to disability determinations.

You or another qualified beneficiary, or a representative acting on behalf of you or another qualified beneficiary, may provide this notice. The provisions of notice by one individual satisfies any responsibility to provide notice on behalf of all related qualified beneficiaries with respect to the qualifying event. Failure to provide timely notice will result in your loss of any right to elect continuation coverage.

Division's Notice to Qualified Beneficiary

Upon receipt of a notice of qualifying event, PayFlex will provide to each qualified beneficiary notice of their right to elect continuation coverage, no later than 14 days after the date on which PayFlex received notice of the qualifying event. Any notification to a qualified beneficiary who is your spouse will be treated as a notification to all other qualified beneficiaries residing with such spouse at the time such notification is made.

Unavailability of Coverage

If PayFlex receives a notice of a qualifying event or disability determination and determines that the person is not entitled to continuation coverage, PayFlex will notify the person with an explanation as to why such coverage is not available.

Notice of Termination of Coverage

PayFlex will provide notice to each qualified beneficiary of any termination of continuation coverage which is effective earlier than the end of the maximum period of continuation coverage applicable to such qualifying event, as soon as practicable following PayFlex's determination that continuation coverage should terminate.

Use of a Single Notice

Required notices must be provided to each qualified beneficiary or individual; however:

• a single notice can be provided to you and your spouse if you both reside at your address; and
• a single notice can be provided to you or your spouse for a dependent child if the dependent child resides with you or your spouse.

For more information contact the Division at (907) 465-4460 or email .

Introduction

The Health Flexible Spending Account (HFSA) provides an opportunity for you to save by setting aside money for health care on a pre-tax basis. You can then use these funds to pay for qualified health care expenses not covered by the plan.

Each benefit year, you decide if you would like to enroll in a HFSA and determine the amount you want to contribute, within the limit, on a pretax basis. During the benefit year, you file claims for eligible medical expenses, and are reimbursed with tax-free dollars from the account. You benefit from reduced taxes because you don’t pay taxes on the dollars you contribute to your account. The federal government imposes certain restrictions on HFSA plans to give you these pre-tax advantages, such as you cannot enroll in, cancel, or change your HFSA amount at any time during the year except during Open Enrollment.

You may carry forward up to $550 from year to year. Otherwise, you must spend down the account for qualified expenses in each benefit year. You have until March 31 of the following year to file claims for the current benefit year.

Premiums

2022 Health Flexible Spending Account Rates
Minimum Monthly Amount	$25.00
Maximum Monthly Amount	$225.00
Effective: Jan. 1 - Dec. 31, 2022

Streamlining

If you do not have any other health coverage, you can elect to have your HFSA set up to “streamline”. This means that any unpaid portion of a claim you incur during the plan year (deductible, your portion of the coinsurance, etc.) is directed to your HFSA account for reimbursement.

You may not elect streamlining if you have other coverage that will coordinate with AlaskaCare.

Please refer to the AlaskaCare Employee Insurance Information Booklet, section 6.8 Submitting Claims for Reimbursement, for additional information.

Your Choice: Once a Year, Every Year!

A HFSA might be a great choice for you – but here are some things to keep in mind:

• You cannot enroll in, cancel, or change your HFSA amount at any time during the year except during Open Enrollment or a qualifying status change.
• You must elect these benefits each open enrollment period. Your HFSA does not automatically continue from one benefit year to the next.
• The benefit year runs from January 1 to December 31. You must budget contributions carefully.
• You may carry over up to $550 of unused funds in your HFSA to the next benefit year, but unused amounts over $550 are forfeit.
• Any amount you carry over to the next year will be added to any HFSA contributions you choose to make in the new benefit year.
• Services for eligible expenses must be received while you are covered by the plan—coverage stops during most periods of leave without pay (LWOP) (your coverage will not stop if you are on FMLA and are in LWOP status) and at termination. Under HFSA, coverage also stops when you move to a bargaining unit which does not participate in the Select Benefits/AlaskaCare health plan.
• Except for the $550 carry over in the HFSA plan, services must be received prior to the end of the benefit year, December 31.
• Claims for the benefit year must be filed within 90 days of the end of the benefit year.

Did you know you can use your HFSA for the following common items?

• Allergy Medicine
• Analgesics
• Antibiotics
• At-home COVID-19 tests *new in 2021
• Birth control
• Cold medicine
• Feminine hygiene products- include, but are not limited to: sanitary napkins, pads, liners, tampons, cups, sponges.
• Fever reducing medicine
• Hand sanitizer *new in 2021
• Masks *new in 2021
• Pain relievers
• Sanitizing wipes *new in 2021
• Sleep deprivation treatment

Visit payflex.com and find the entire list of eligible expenses categorized by eligible, eligible with a letter of medical necessity, and not eligible.

Submitting a Claim

You can submit HFSA claim multiple ways:

• Paper form: Health Flexible Spending Account (HFSA) claim form (PayFlex)
• Online: PayFlex.com
• PayFlex Mobile App

You can submit claims for any approved expenses by filling out the claim information and providing the Explanation of Benefits (EOB) or receipts. Eligible reimbursements will be paid directly to you, not your provider. You have until March 31 after the benefit year ends in which you incurred the claims to request reimbursement.

Effective January 1,

• AlaskaCare Employee Insurance Information Booklet
• Your Rights and Protections Against Surprise Medical Bills

The AlaskaCare Employee Health Plan booklet reflects revisions to the previous Select Benefits Information Insurance booklet for State of Alaska employees covered under the AlaskaCare health plan.

Amendments

• AlaskaCare Employee Health Plan Amendment 2018-2: SurgeryPlus

  Effective August 1, 2018

• AlaskaCare Employee Health Plan Amendment 2018-1

  Effective March 1, 2018

• AlaskaCare Employee Health Plan Amendment 2020-1: Medical Foods

  Effective August 1, 2020

• AlaskaCare Employee Health Plan Amendment 2021-1: Carryover of Unused Amounts in HFSA

  Effective January 1, 2021

• AlaskaCare Employee Health Plan Amendment 2021-2-Hinge Health

  Effective July 15, 2021

• AlaskaCare Employee Health Plan Amendment 2021-3: Teladoc Behavioral Health

  Effective August 1, 2021

Archived Booklets

• 2021 Plan Booklet
• 2020 Plan Booklet
• 2019 Plan Booklet
• 2018 Plan Booklet
• 2018 Plan Booklet
• 2017 Plan Booklet
• 2016 Plan Booklet
• 2014 Plan Booklet
• 2013 Plan Booklet

Facilities

Anchorage Network Hospitals

Providence Alaska Medical Center and Alaska Regional Hospital are part of the AlaskaCare network beginning January 1, 2021!

AlaskaCare is committed to providing benefits to help you affordably access the care you need and stay healthy, when and where you need it. Your health care keeps getting better and better! AlaskaCare expanded the Anchorage-area network to include Providence Alaska Medical Center, Alaska Regional Hospital—offering you more convenience and choices in your area! By having both hospitals in-network, you will save no matter where you go. Preferred hospitals and facilities have partnered with the State to control health care costs by setting a fair rate for medical services. By visiting in-network facilities, you keep your out-of-pocket maximum low, and the plan will pay for more on your behalf.

It doesn’t stop there—this network expansion also adds a host of ambulatory surgical and imaging centers, helping you find the right fit for the services you require.

Providence Alaska Medical Center

Providence Alaska Medical Center, a nationally recognized trauma center and Magnet hospital, is part of Providence St. Joseph Health, a not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health services, affiliated services, and educational facilities.

Visit Providence.org for more information.

Alaska Regional Hospital

Alaska Regional Hospital is proud of the partnership with the State of Alaska and its AlaskaCare health plan members. From providing preventive healthcare and treatment to hosting free health fairs, seminars, and screenings, we are committed to providing plan members and all Alaskans with high quality, cost effective healthcare.

Visit AlaskaRegional.com for more information.

You will also have network access to many more Anchorage-area ambulatory surgical centers. To find an in-network provider, or to see if your provider is in-network, call the Aetna Concierge at (855) 784-8646, or use the online DocFind tool .

It is important to use an in-network facility when you obtain services in Anchorage or outside of Alaska.

Out-of-Network Information

When you use an out-of-network facility, the plan benefit percentage for most facility fees at the out-of-network facility will be reduced by 20%, and in most cases, your annual out-of-pocket limit will double. The plan benefit percentage (coinsurance) is the allowed amount that the plan will pay after you meet your deductible.

The allowed amount for out-of-network facilities services will be 185% of Medicare rates. Remember, out-of-network facilities can charge any amount they choose. So, if the facility does not accept the 185% of Medicare rate, they can balance bill you for the rest.

Below is an example of the difference in out-of-pocket costs between using an in-network, preferred provider facility, and an out-of-network (OON) facility in Anchorage for someone who has elected the AlaskaCare economy medical plan:

2022 OUT-OF-NETWORK COSTS EXAMPLES
--	In Network Facility	OON Facility
Billed Charges	$27,000	$27,000
Network Facility Rate in-network or Plan Allowed	$22,950	$22,950
185% of Medicare for OON
Deductible	$600	$600
Coinsurance	70%	50%
Plan Coinsurance Total	$15,645	$11,175
Member’s coinsurance	30%	50%
Member Coinsurance Total	$6,705	$11,175
Out of Pocket Maximum (includes deductible)	$2,850	$5,700
Potential Balance Bill (Billed charges – Plan Allowed)	$0	$4,050 *
Member Pays	$2,850	$9,750
Plan Pays	$20,100	$17,250
Effective: Jan. 1 - Dec. 31, 2022

* In addition to your cost share portion of the plan allowed amount, OON facilities may balance bill you the difference between their billed charges and the plan’s Medicare-based rate for the services.

If you need emergency treatment, please go to the nearest emergency room without regard to the network. Penalties are not applied in the case of emergency treatment or for services not offered at Alaska Regional. Before receiving services in Anchorage that you believe are not offered at Alaska Regional, or if an out-of-network facility sends you a balance bill for the emergency services, contact the Aetna Concierge at (855) 784-8646 for assistance.

Information on network facilities options outside of Alaska contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool online. It is important to use the custom AlaskaCare DocFind tool tool when searching for facility options; Aetna’s public DocFind tool will not accurately reflect AlaskaCare’s preferred facilities.

Most Alaska hospitals and facilities outside of the Anchorage area are network providers, but outside of Alaska there are some out-of-network facilities, so its important to check before receiving services. For a list of network providers, please contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool to help you find a provider that is part of the AlaskaCare network.

Why out-of-network facilities are paid at 185% of Medicare

We use Medicare as our base because they are the largest payer in the county, and they have established a standard measure that accounts for differences like size, location, and the types of patients treated. The Medicare rate is set to pay facilities for their costs plus a profit.

Conquer Back and Joint Pain with Hinge Health!

Whether you have chronic or sudden joint pain, are recovering from an injury, or just want more strength and flexibility—Hinge Health can help. Hinge Health offers innovative digital care programs that connect you with a physical therapist or personalized health coach to help you manage musculoskeletal conditions such as back, knee, hip, neck and shoulder pain. The exercise therapy programs are designed to help you get back to the activities you love.

Hinge Health’s programs are available at no cost to you and your family members age 18+ who are covered by the AlaskaCare Employee Health Plan starting July 15, 2021!

Hinge Health has tailored programs to help you with:

• Conquering musculoskeletal pain or limited movement—Whether you have an occasional dull ache or frequent sharp pain, Hinge Health can help you move freely again.
• Recovering from an injury—Whether you were injured yesterday or years ago, get expert help and recover better than ever.
• Keeping your joints healthy and pain free—Get expert support tailored to your specific needs.

Hinge Health provides the tools you need to get moving again from the comfort of your home. When you enroll, you will receive the Hinge Health welcome kit which, based on your care program, may include:

• A tablet computer
• Wearable sensors that give live feedback in the Hinge Health app
• Access to personalized exercises

You will also be connected with a personal care team including a physical therapist or health coach who will tailor your program to your needs and work with you along the way.

How to use Hinge Health

If you or an eligible dependent would like to enroll, start by contacting Hinge Health:

• Call a Member Care Advocate: (855) 902-2777
• Enroll in Hinge Health Now!

For more information, please read the Hinge Health FAQs.

Legal Notices

1. Transparency in Coverage
2. Children’s Health Insurance Program (CHIP)
3. COBRA Coverage Reminder
4. Creditable Coverage Notice - Prescription Drug Coverage and Medicare
5. HIPAA Privacy Practices
6. Mental Health Parity and Addiction Equity Act (MHPAEA)
7. Newborns’ and Mothers’ Health Protection Act Notice
8. Primary Care Provider Designation
9. Special Enrollment Rights
10. Summary of Benefits and Coverage (SBC)
11. Surprise Medical Bills - Your Rights and Protections
12. Taxpayer Identification Number (TIN) or Social Security Number (SSN) of Each Enrollee in a Health Plan
13. Women’s Health and Cancer Rights Act of 1998 (WHCRA)

Transparency in Coverage

The Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to create a member-facing price comparison tool and post publicly available machine-readable files that include in-network negotiated payment rates and historical out-of-network charges for covered items and services. This machine-readable price transparency file is intended to comply with the CMS price transparency rules at 45 C.F.R. § 180.50. The rules apply to the AlaskaCare Employee Health plan, the AlaskaCare Retiree Health Plan is exempt.

Publicly Available Machine-Readable Files: The files disclose detailed information on the costs of covered items and services such as negotiated rates for in-network providers, historical allowed amount and billed charges for out-of-network providers.

• Aetna Provider Pricing Files
  These files are not designed as a consumer tool. Members are encouraged to use the more member-friendly price estimator tool located on the Aetna member webpage or call the Aetna Concierge at (855) 784-8646.


• SurgeryPlus Provider Pricing Files

Employee Assistance Program

The AlaskaCare Employee Assistance Program (EAP), administered by Aetna, provides responsive, caring and effective services to help balance your personal and professional life. Some of the areas the EAP can help with include:

• Personal balance
• Emotional wellness
• Marital/relationship issues
• Family issues
• Communication skills
• Stress management
• Alcohol and drug issues
• Work-related issues
• Grief issues
• Financial and legal concerns

For more information, please visit the Employee Assistance Program webpage.

Supplemental Non-Emergent Surgery Coverage

AlaskaCare has partnered with SurgeryPlus to offer employees covered by the AlaskaCare Employee Health Plan and their eligible dependents convenient travel benefits for non-emergent surgeries. You get access to a network of top quality medical providers with proven experience in more than 350 procedures types across 40 states.

What’s included with this new benefit?

Surgeons of Excellence
Each board-certified provider has undergone rigorous screening, including specialized training and fellowships, reducing your risk of complications and preventable costs.

Full-Concierge Service
Your dedicated Care Advocate will locate the best-fitting provider, schedule all appointments, coordinate medical record transfers, and follow up with you post-procedure to ensure top satisfaction with your procedure experience.

Low Cost
Each procedure is covered under a bundled rate, and the only cost to you is the remaining balance on your deductible, if applicable. 100% of the coinsurance is waived.

Covered Expenses include:

• Episode of Care received through SurgeryPlus benefits
• Airfare for the eligible patient and a companion
• Hotel or other approved accommodations
• Transportation to/from airports
• Pre-loaded debit card with $25 per diem per patient per day (or $50 per patient and companion per day)

For the full list of what is covered under this benefit, please refer to the AlaskaCare Employee Plan Amendment .

How to use SurgeryPlus

If you or an eligible dependent needs surgery, start by contacting SurgeryPlus:

• Call a Member Care Advocate: (855) 715-1680
• Online Portal: Alaska.SurgeryPlus.com

You will be assigned a dedicated Care Advocate who will assist you with:

• Selecting a surgeon
• Scheduling appointments
• Coordinating and booking travel and accommodations
• Providing a pre-loaded debit card with per diem for expenses
• Transferring medical records
• Reviewing benefits

For more information, please read the Surgery Plus FAQs.

Quality Healthcare at Your Fingertips

Register/Update your account .

Talk to a doctor by phone or video, anywhere, anytime.

Teladoc® is already part of your AlaskaCare Employee Health Plan. You can talk to a doctor in minutes. AlaskaCare Employee Health Plan members have 24/7/365 access to health care for non-emergency conditions by web, phone or mobile app. For example, if you have symptoms of the flu, you can contact Teladoc® and a doctor can evaluate and help with next steps when necessary.

The AlaskaCare Employee Health Plan has partnered with Teladoc® since September 1, 2018 to provide you with a convenient and affordable way to receive quality medical care.

All Teladoc® doctors are board-certified, state-licensed and can treat many health issues, including:

• Cold and flu symptoms
• Allergies
• Bronchitis
• Skin problems
• Respiratory infections
• Sore throat
• Sinus problems
• Dermatology
• Caregiving
• Behavioral Health
• ...and more!

How to use Teladoc®

To utilize the benefit, begin by registering your Teladoc® account. There are three ways to register:

• Online: Teladoc.com/Aetna
• Mobile App: Teladoc.com/mobile
• Phone: (855)-Teladoc (835-2362)

During registration, you’ll complete your medical history so when you need Teladoc®, it will be fast and easy. Watch a short video to discover more.

Services Offered

General Medical Consultation
Teladoc® is another alternative to accessing medical care for your non-emergent symptoms 24/7/365. Teladoc® is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. visits or after-hour periods where care is difficult to find. All Teladoc® doctors are board-certified, state-licensed, and can even send a prescription straight to your nearest pharmacy when medically necessary!

Fee: For General Medical Consultation, the copay is $0.

Behavioral Health Consultation

Feel like yourself again. Choose a therapist or psychiatrist who fits your needs and schedule visits 7 days a week from wherever you're most comfortable. Experts specialize in and support a wide range of needs:

• Anxiety, stress, overwhelmed
• Negative thought patterns
• Depression
• Not feeling like yourself
• Not wanting to get out of bed
• Relationship conflicts
• Trauma and PTSD
• Mood swings
• Medication management

Fee: For Behavioral Health Consultation, the copay is $0.

Dermatology Consultation

There’s no reason to wait weeks for the skin care you need. Teladoc® can resolve your skin issues within days by web or mobile app. Licensed dermatologists can treat ongoing or complex skin conditions like psoriasis, skin infection, rosacea, suspicious moles, and many more—quickly, conveniently, and discreetly.

Fee: For Dermatology Consultation, the copay is $0. The first follow-up within 7 days of initial dermatology consultation also has a copay of $0.

Caregiver Consultation

As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.

Fee: $45 for Caregiver Consultation Fee. This optional service is not covered under the plan and is the members responsibility to pay in full.

For more information, please read the Teladoc FAQs.

The State of Alaska Voluntary Supplemental Benefits (VSB) plan includes life insurance, critical illness, and long & short-term disability. The VSB plan is administered by MetLife and enrollment is managed by BenefitFocus.

Voluntary Supplemental Benefits offer you the opportunity to obtain additional benefits that best suit the needs of you and your family. Please take a moment to watch the video below to learn about all the options offered by the State of Alaska. Note: eligibility or benefits described in this video are subject to change. Please review the individual benefits for up-to-date information.