2025 Tax Year
IMPORTANT HEALTH
COVERAGE TAX DOCUMENTS
NOTICE OF RIGHT TO REQUEST TAX NOTIFICATION FORM
1095-B
In accordance with IRS
regulations , this notice is intended to provide you with information
related to obtaining a copy of your IRS Form 1095-B from the Abatement Workers
National Fringe Benefits Funds (the “Plan”). Form 1095-B
provides you with information about your healthcare coverage, including who was
covered, and when the coverage was in effect.
The Plan has elected not to send
IRS Form 1095-B (“Health Coverage”) for the 2025 tax year, in accordance with
IRS regulations. You do not need to file a Form 1095 with your federal
tax return, but some members may need the form to comply with state reporting
requirements.
Members and beneficiaries may
request that the Plan send a copy of their Form 1095-B to them via U.S.
mail. You may make this request by email, phone, or written
request. The Plan will mail you the form within 30 days of receiving
your request. Please include your name and address in your request. The
contact information to submit a request for Form 1095-B is:
Email to: 1095Bhelp@benesys.com
Calling: (248) 641-4950 between 7:00 AM and 4:30 PM EST
Mail to:
BeneSys, Inc.
700 Tower Drive, Suite 300
Troy, MI 48098-2808
ATTN: 1095-B Requests
Your request MUST include: (1) your Plan’s name, (2) the
member’s name, (3) your name if you are not the primary member, (4) the address
you would like the form sent to and (5) the phone number we can call if we have
any questions.
Please call (800) 572-2525 or (248) 641-4950 with any questions about
Form 1095-B.
MEDICAL BENEFIT
CHANGES
Effective November 1, 2022, the medical and prescription
drug benefits will be fully insured and will be administered under Alliance
Health & Life (“HAP PPO AND AETNA PPO”).
(HAP PPO) combined with AETNA
National Network of Doctors and Hospitals. The network under HAP and Aetna includes most
of the same providers that you have access to today. Visit www.hap.org/find-a-doctor to find
and verify that your doctor or hospital is in the network.
If you are unable to locate your provider on
the portal website, it is important that you notify the Benefits Office at
(800) 772-0459. Be ready to provide the full contact information of the
provider or hospital facility that you are inquiring on, and the Benefits
Office will work with HAP and/or Aetna to try to add the provider to the
network.
HAP Rx will provide your Prescription
Drug Coverage. HAP Prescription Drug coverage is replacing Cigna
(Express Scripts) as the Fund’s prescription drug provider. The coverage is
comparable to the current level, so most participants will not be affected by
this change. However, if your medication
will be changing, you will be notified directly by the Plan and your medication
will be grandfathered for 30 days so that you have time to work with your
doctor regarding any change to your medication.
Visit www.hap.org/prescription-drug to
better understand how your prescription drug coverage works. Visit www.hap.org/prescription-drug/home-delivery for
mail order.
Benefits Comparison. While
the new coverage is comparable, there are some benefit changes, including many
improvements that will save you and your family money on medical expenses. See the table below, which highlights in bold
those areas where the coverage is improved.
|
MEDICAL BENEFITS
|
Current under Cigna
|
Effective 11/1/2022 NEW
under Health
Alliance Plan with
Aetna
|
|
Deductible – In-Network
|
$500 Indiv / $1,000 Family
|
$500 / $1,000
Family
|
|
Deductible – Out
of Network
|
$800 Indiv / $1,600 Family
|
$1,000 Indiv / $2,000 Family
|
|
Co-Insurance (In and Out of
Network)
|
25% / 50%
|
20% / 40%
|
|
Out
of Pocket Maximum
– In- Network
|
$5,800 Indiv / $11,600 Family
|
$6,800 Indiv / $13,600
|
|
Out
of Pocket Maximum – Out of Network
|
No limit
|
$13,600 Indiv / $27,200 Family
|
|
Preventive Care office
Visit
|
Covered
|
Covered
|
|
Specialist Visit
|
$20 copay
|
$20 copay
|
|
Imaging (Advanced Radiology)
|
25%
co-insurance, after deductible
|
20%
co-insurance, after deductible
|
|
Emergency Room
|
$50 copay
|
$150 copay
|
|
In-Patient Hospital
|
25%
co-insurance, after deductible
|
20%
co-insurance, after deductible
|
|
Urgent Care
|
25%
co-insurance, no deductible
|
$30 copay
|
|
PHARMACY
|
Current under Cigna
|
Effective 11/1/2022 NEW under HAP Prescription Drug coverage
|
|
Rx – Retail
|
|
|
|
Generic
|
$15
copay
|
$15 copay
|
|
Preferred Brand
|
$50 copay
|
$40 copay
|
|
Non-Preferred Brand
|
$100
copay
|
$80 copay
|
|
Rx – Mail
Order
|
|
|
|
Generic
|
$45
copay
|
$30 copay
|
|
Preferred Brand
|
$150
copay
|
$80 copay
|
|
Non-Preferred Brand
|
$300
copay
|
$160 copay
|
*Non-Preferred
Specialty Drugs 20% Coinsurance ($300 max) 30 day supply at specialty pharmacy
only*Preferred Specialty Drugs 20% Coinsurance ($200 max)
30 day supply at specialty pharmacy only
In-Network and
Out-of-Network Deductibles and Co-Insurance maximums. All
amounts applied toward your deductible since January 1, 1022 will
carry over from Cigna to HAP for the remainder of 2022. The same applies to your maximum co-insurance
limit, and any amounts applied toward your co-insurance will
apply to claims you incur under HAP for the remainder of 2022. Please watch your EOB’s from HAP, and contact
the Benefits office if there is any discrepancy.