Health Insurance Network Providers – LG Health

Why Use Eliance Preferred Network (Tier 1) Providers?
The primary care physicians and specialists in the Eliance Preferred Network deliver to you and your family, the most convenient and cost-effective provider option. Eliance providers follow high quality protocols driven by advanced clinical initiatives that have been shown to improve medical outcomes and reduce health-related costs.

For employees using the Eliance Network co-pays and out-of-pocket expenses are reduced. The vast majority of services are available; however, if a service is not available within the Eliance Network, employees may access additional networks at the Tier 2 benefit level.

Which Providers Participate in the Eliance Preferred Provider Network?
The Eliance Network includes all providers employed by Penn Medicine Lancaster General Health, as well as, the University of Pennsylvania Health System and the Children’s Hospital of Philadelphia.

Tier 2 Providers

Employees may also access additional providers that include the following networks:

To determine if a provider is Tier 1 or Tier 2, or if you have other questions about the provider networks, please call CoreSource Connect at 1-877-848-9997 (24 hours a day/7 days a week). You can also view claims information, print or order ID cards and access insurance-related forms online, by logging onto www.mycoresource.com.

Note: Any healthcare services performed at UPMC Pinnacle Lititz will be subject to a $1500 co-payment, per hospitalization stay or outpatient services.

Health Insurance Network Providers – Affilia Home Health & Horizon Healthcare Services

Affilia Home Health and Horizon Healthcare Services and employees also have Tier 1 benefits through the Eliance Preferred Network.

The Preferred Health Care (PHC) Network is available as Tier 2 benefits. For those employees who reside outside of Lancaster County, out of network claims will process as Tier 2 benefits.

Affilia and Horizon employees may confirm facility and provider levels of coverage before seeking services, by contacting Eliance Health Solutions at 717-553-1124, and selecting option 6.

Always confirm facility and provider levels of coverage before seeking services.

 

LG Consumer Health Insurance Plan – Eligibility: 0.5 FTE and 30 days of service

Group Number 800

The LG Consumer Health Insurance Plan is a High Deductible Health Plan (HDHP) that provides you with the opportunity to participate in a Health Savings Account (HSA). You have significant power and responsibility for your health care decisions when you participate in a HSA-qualified health plan. The LG Consumer Plan requires no employee cost sharing – this means no health insurance premiums will be deducted from your pay! Without the expense of bi-weekly healthcare premiums with this Plan, you are able to deposit money in your HSA. Where you can save on taxes and have flexibility and control over your health care costs. The money in your HSA remains yours, even if you terminate employment, switch health plans or retire.

What Does High Deductible Health Plan (HDHP) Mean?

In a HDHP, your medical and prescription drug expenses must exceed the amount of your deductible in order to receive reimbursement from the Plan. In other words, the Plan pays for all covered expenses incurred after you have met the annual deductible amount and out-of-pocket expense maximum limits for individual and/or family (depending on the elected coverage level).

Benefits of a Healthy Lifestyle

As a participant in the LG Consumer Plan, all of your Preventive Care visits are covered 100% without having to meet your annual deductible.

Note: To be considered “preventive care”, the claim must be coded as a wellness visit and the service must be performed by an in-network provider. Preventive Care visits include annual checkups and screenings for each enrolled member of your family.

Am I Eligible to Participate in the LG Consumer Plan and/or HSA?

Employees who elect to participate in the LG Consumer Plan will be automatically enrolled in the HSA (although you will not be required to contribute to the HSA), and can increase, decrease, start and stop contributions as often as they like. Therefore, you must be eligible to own a HSA before you may participate in the LG Consumer Plan. The IRS has strict guidelines to determine who is eligible to own and contribute to a HSA – see below for further detail:

Individuals eligible to own a HSA:

  • May not also be covered under any health plan that isn’t a qualified HDHP
  • Must not be enrolled in Medicare
  • May not be eligible as a dependent on another individual’s tax return

Who are Eligible Dependents?

Quick Links:
Health Savings Account
LG Health Employee Summary of Benefits and Coverage
LGMG/TR Employee Summary of Benefits and Coverage
HHS Employee Summary of Benefits and Coverage
AHH Employee Summary of Benefits and Coverage
LG Health Employee Consumer At-a-Glance
LGMG/TR Employee Consumer At-a-Glance
HHS Employee Consumer At-a-Glance

 

LG Select Health Insurance Plan – Eligibility: 0.5 FTE and 30 days of service

Group Number 800

The LG Select Health Insurance Plan is designed for employees who want the lowest possible deductible, low co-insurance, are willing to pay a bi-weekly premium for their Health Insurance Plan and prefer co-payments for physician office visits and prescription drugs.

See below for some highlights of the LG Select Health Insurance Plan:

  • This plan has co-payments (no deductible) for primary care providers and specialist office visits.
  • At LG Health Outpatient Facilities, employees and families will have zero out-of-pocket expenses for related professional and facility charges for diagnostic tests.
  • LG Health inpatient co-payments are $200. LG Health hospital provider services are subject to the annual deductible* and co-insurance.

*When enrolled members of a family incur covered expenses that are subject to the deductible and they are equal to, or greater than, the dollar amount of the family deductible, then the family deductible will be considered satisfied for all family members for that calendar year. Any number of family members may help to meet the family deductible amount, but no more than each person’s individual deductible amount may be applied toward satisfaction of the family deductible by any family member.

Benefits of a Healthy Lifestyle

Preventive Care is covered 100% without having to meet your annual deductible when participating in the LG Select Plan.

Note: To be considered “preventive care”, the claim must be coded as a wellness visit and the service must be performed by an in-network provider. Preventive Care visits include annual checkups and screenings for each enrolled member of your family.

Paying for Qualified Medical Expenses

Employees enrolling in the LG Select Plan are eligible to enroll in a Health Care Flexible Spending Account (FSA) for out-of-pocket expenses associated with deductibles, co-payments, and co-insurance. See Flexible Spending Accounts [link to Flexible Spending Accounts page] for further information on FSAs.

Who are Eligible Dependents?

Quick Links:
Flexible Spending Accounts
LG Health Employee Summary of Benefits and Coverage
LGMG/TR Employee Summary of Benefits and Coverage
HHS Employee Summary of Benefits and Coverage
AHH Employee Summary of Benefits and Coverage
LG Health Employee Select At-a-Glance
LGMG/TR Employee Select At-a-Glance
HHS Employee Select At-a-Glance

 

Plan Comparison

View Plan Comparison Here

 

Prescription Drug Coverage

The Plan’s benefits—and your prescription drug co-payments—are based on three categories of drugs: generic, formulary, and non-formulary drugs. The Prescription Drug Plan is administered by Express Scripts.
When you enroll in our Health Insurance Plan, you will receive a combined health/prescription drug identification card that you can use at the LGH Convenience Pharmacy, Kissel Hill Convenience Pharmacy, Suburban Outpatient Pavilion LifeCare Pharmacy or any pharmacy in the Express Scripts network.

Applicable to both LG Consumer and LG Select Plans:

  • You may only order specialty medications either through the LGH Convenience Pharmacy or from the Accredo Specialty Pharmacy.
  • Enrollees will have $0 co-payments when purchasing generic contraceptives (both oral & devices) and preventive medications with a prescription. This includes over-the-counter items such as aspirin or fluoride and other medications like Tamoxifen and Raloxifene.

LG Health Insurance Prescription Co-pays*

*LG Consumer co-payments are applicable after annual deductible (Individual and/or Family, if applicable) has been satisfied.

A summarized list of the LG Health prescription drug formularies can be viewed below or access the full list on www.express-scripts.com.

2019 LGH Formulary
2019 AHH & HHS Formulary

Employees receive great discounts at the LG Health Convenience Pharmacy.

 

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