State Health Plan Savings Plan. Clemson University October 2018

Transcription

1 State Health Plan Savings Plan Clemson University October 2018

2 State Health Plan PEBA manages the State Health Plan. Self-funded insurance plan: Members and employers premiums are held in a trust fund and these funds are used to pay claims. BlueCross BlueShield of South Carolina processes medical claims. View the State Health Plan benchmarks at 2

3 Savings Plan State Health Plan administered by BlueCross BlueShield of SC 3

4 State Health Plan options Savings Plan. Standard Plan. View comparison chart on Pages 2-3 of the Insurance Summary. 4

5 Savings and Standard Plans Common features. Worldwide coverage. In- and out-of-network benefits. In-network includes the Patient-Centered Medical Home (PCMH) network. Pharmacy network. Preauthorization for certain services. Online access available at statesc.southcarolinablues.com. 5

6 Savings Plan Take greater responsibility for your health care costs and accept a higher annual deductible. Save money on lower monthly premiums. Pay the full cost of services until you meet your deductible. Then pay your coinsurance. Eligible to contribute to Health Savings Account (HSA). 6

7 Provider network Provider files claims and accepts amount allowed by State Health Plan even if charges are higher than allowed amount. Subscriber pays deductible and coinsurance. Search the provider network (Find a Provider) at statesc.southcarolinablues.com. 7

8 Patient-Centered Medical Home (PCMH) Provides a health care team to provide comprehensive, coordinated care. Once the deductible is met, pay only 10 percent coinsurance. Search for a PCMH near you at 8

9 Out-of-network services Subscriber: May have to file claims. Can be balance billed. Pays higher coinsurance. No benefits paid for out-of-network prescription drugs. 9

10 State Health Plan Once the annual deductible is met: In-network Plan pays 80 percent, subscriber pays 20 percent. Coinsurance maximum. PCMH Plan pays 90 percent, subscriber pays 10 percent. Out-of-network Plan pays 60 percent, subscriber pays 40 percent. Coinsurance maximum. 10

11 Prescription benefits Express Scripts is the pharmacy benefits manager. Formulary is a list of preferred drugs. Changes to the formulary may occur annually. Coverage reviews: Prior authorizations. Drug quantity management. Step therapy. Pay the allowed amount until you meet your annual deductible. 11

12 Preauthorization A decision that a service, prescription drug or piece of equipment is medically necessary. Certain services or medications require preauthorization before you receive them, except in an emergency. View Page 22 of the Insurance Summary and refer to the Insurance Benefits Guide for more information: Medi-Call. National Imaging Associates. Companion Benefit Alternatives. 12

13 Tobacco surcharge $40 per month for subscribers. $60 per month for subscribers who cover at least one dependent. Must be tobacco free for six months to certify as nontobacco user. Automatically charged unless subscriber certifies no one uses tobacco or completes a tobacco cessation program approved by PEBA. May certify by completing a Certification Regarding Tobacco Use form. 13

14 MoneyPlus Flexible benefits program 14

15 MoneyPlus features Pretax Group Insurance Premium feature. Flexible spending accounts: Dependent Care Spending Account (DCSA). Limited-use Medical Spending Account. Health Savings Account (HSA). View more information on Pages 8-9 of the Insurance Summary. 15

16 Pretax insurance premiums Pay insurance premiums before taxes for: State Health Plan and TRICARE Supplement Plan; State Dental Plan & Dental Plus; State Vision Plan; Up to $50,000 of Optional Life coverage; and Tobacco surcharge. Once enrolled, no need to re-enroll each year. 16

17 Dependent Care Spending Account (DCSA) Pay dependent care expenses with pretax income. Maximum annual contribution amounts for: Married, filing separately. Single and head of household or married, filing jointly. Contribution limit capped for highly compensated employees. Monthly administrative fee. Use it or lose it account. Grace period through March 15 of next Plan year. See the complete list of eligible expenses at 17

18 Health Savings Account (HSA) Savings Plan members only. Carry over funds from one year to the next. Pay for future qualified medical expenses pretax. Account is portable. Provides option to invest funds at a certain account balance and earn investment income tax-free. 18

19 Health Savings Account (HSA) Maximum annual contribution amounts for individuals and family coverage. Set annually by IRS. Additional $1,000 catch-up for ages 55 and older. Monthly fee(s) may apply. Annual bank fee. Set up HSA bank account with contracted bank. 19

20 Limited-use Medical Spending Account Only for Savings Plan members with a Health Savings Account (HSA). Similar to Medical Spending Account but limited to cover dental and vision care expenses only. Maximum annual contribution amount. Monthly administrative fee. Use it or lose it account. 20

21 What s new for 2019? 21

22 What s new for 2019? ASIFlex is new MoneyPlus vendor. Enroll or re-enroll in MoneyPlus through MyBenefits. Health Savings Account (HSA) with Central Bank. Current HSA participants must re-enroll during Open Enrollment for 2019 (vendor change requires reenrollment). Must open bank account with Central Bank. View more information on Pages 8-9 of the Insurance Summary. 22

23 What s new for 2019? Adult well visit benefit available to all adult State Health Plan primary members. Subject to copayments, deductibles and coinsurance for Standard Plan members. Covered services subject to United States Preventive Services Task Force A and B recommendations. Including Savings Plan annual visits. View more information on Pages of the Insurance Summary. 23

24 Resources 24

25 Open enrollment Open enrollment is October Verify and update your insurance benefits each year. Use MyBenefits or talk to your employer. Changes made during open enrollment are effective January

26 Insurance Summary A high-level overview of insurance benefits, including: Plan comparisons; and Promotion of benefits like PEBA Perks, Rally and Blue CareOnDemand. Employers distribute new plan year guides to active employees before open enrollment and to new hires throughout the plan year. 26

27 Insurance Benefits Guide Available online for active employees. Mailed directly to retirees, COBRA subscribers and survivors for whom PEBA does not have an address before open enrollment. 27

28 Benefits Advantage Mailed directly to all retirees, COBRA subscribers and survivors before open enrollment. Content specific to targeted population includes: Benefits descriptions; Plan comparisons; and Premium rates. 28

29 Navigating Your Benefits Plain-language explanations of insurance and retirement benefits. Flyers and videos. 29

30 MyBenefits Available to members with internet access. Accessible 24/7. Review benefits statement; Make changes during open enrollment; Upload supporting documentation; Update life insurance beneficiaries; Update coverage in special eligibility situations; and Change contact information. 30

31 Get social with PEBA

32 Disclaimer This presentation does not constitute a comprehensive or binding representation regarding the employee benefits offered by the South Carolina Public Employee Benefit Authority (PEBA). The terms and conditions of the retirement and insurance benefit plans offered by PEBA are set out in the applicable statutes and plan documents and are subject to change. Please contact PEBA for the most current information. The language used in this presentation does not create any contractual rights or entitlements for any person. 32