Mandatory Online Open Enrollment November 9-23, 2015

Transcription

1 Mandatory Online Open Enrollment November 9-23, 2015 MVPOE16

2 All enrollees eligible for coverage must enroll. If you want to keep your current coverage, you must enroll online. If you waive your insurance benefits, you must complete a waiver online. Enrollments not completed during Open Enrollment will result in a loss of coverage. 2

3 Discussion Items What is Open Enrollment? Who is Eligible? Medical Plan Options Dental Plan Options Steps to Enroll 3

4 Open Enrollment is The only time you can enroll or drop in the medical and/or dental plans without a qualifying event. 4

5 A Qualifying Event is Loss of medical and/or dental coverage due to: Divorce Death Spouse s coverage ends with employer due to termination or reduction of hours COBRA benefits exhausted Marriage Adoption Qualified Medical Child Support Order Newborn Special provisions allows enrollment within 60 days of the event Please Note: You must enroll within 31 days of a qualifying event; otherwise, you will need to wait until the next Open Enrollment. 5

6 Dependent Eligibility Who is Eligible? Spouses and children up to age 26. New: Dental Plan Eligibility Changes for 2016 A dependent child may stay in the Dental Plan until the end of the month of their 26th birthday. The full-time student status requirement is removed. You may add eligible dependents into the Dental Plan during Open Enrollment. 6

7 Dependent Eligibility Spouses for Medical Plan Only Spouses who have access to group health coverage must take that coverage on an individual basis as primary insurance in order to be covered with Butler Health Plan as a secondary insurance, unless they pay more that 55% of the single premium. This includes employed and retired spouses who have access to group health plans or a group retiree health plan such as STRS or SERS. 7

8 Dependent Eligibility Adding a Dependent for First Time? Legal Documentation must be provided to your Treasurer or Personnel Department for dependents at the time of enrollment. You may upload documents during the online enrollment. 8

9 Good News for 2016! No Rate Increase For Medical and Dental Plans! Get your premium rate share from your Treasurer or Personnel Department or at online enrollment. 9

10 Medical Plan Options EPO PPO HDHP Minimum Value Plan Preventive Care Annual Deductible* This is the dollar amount you must pay first in a year before the plans begin paying specified benefits. Annual Maximum Out-of-Pocket Includes deductibles and copays. This is the most you will pay toward your in-network medical and prescription expenses. Doctor Office Visit Primary care includes family practice, internist, pediatrician, OB/GYN, mental health and chiropractor. Preventive services covered 100% for all plans $650 /person $1,300 /family You do not have to meet the deductible before copays apply. $2,650 /person $5,300 /family $15 for primary care $30 for specialist $650 /person $1,300 /family You do not have to meet the deductible before copays apply. $2,650 /person $5,300 /family $30 for primary care $50 for specialist Urgent Care $40 copay $40 copay Emergency Room $200 copay (waived if admitted) Inpatient Hospital and Outpatient Surgery Ded, then Plan pays 80% Radiology MRI, X-ray, CT, ultrasound Prescription Drugs ** Retail (Up to 30 day) Mail Order (Up to 90 day) Specialty (Up to 30 day) Pharmacy Network Ded, then Plan pays 80% $15 generic $35 preferred brand $35 generic $85 preferred brand Tier 1 Network Ded, then Plan pays 80% Ded, then Plan pays 80% Deductible does not apply $200 copay (waived if admitted) Tier 2 Network Ded, $300 copay, then Plan pays 70% Ded, then Plan pays 70% $15 generic $35 preferred brand $35 generic $85 preferred brand $75 $75 Express Scripts Prime Network (More than 32,000 pharmacies nationwide including CVS, Kmart, Kroger, Meijer, Sam s Club, Target and Wal-Mart.) Preventive services covered 100% for all plans $2,600 /person $5,000 /family You must meet the deductible before prescription copays apply $5,000 /person $10,000 /family $6,550 /person $13,100 /family $6,550 /person $13,100 /family Ded, then Plan pays 80% Ded, then Plan pays 100% Ded, then Plan pays 80% Ded, then Plan pays 100% Ded, then Plan pays 80% Ded, then Plan pays 100% Tier 1 Network Tier 2 Network Ded, then Plan pays 100% Ded, then Plan pays 80% Ded, $300 copay, then Plan pays 80% Ded, then Plan pays 100% Ded, then Plan pays 80% Ded, then Plan pays 100% After the deductible is reached $15 generic $35 preferred brand $35 generic $85 preferred brand $75 Deductible does not apply After medical deductible, Plan pays at 100% After medical deductible, Plan pays at 100% Express Scripts Prime Network (More than 32,000 pharmacies nationwide including CVS, Kmart, Kroger, Meijer, Sam s Club, Target and Wal-Mart.) 10 See your 2016 medical plan rates online or ask your Treasurer or Personnel Department.

11 Medical Plan Options Preferred Provider Organization PPO With the PPO, you pay more out of your paycheck to buy the coverage, and then less out of your pocket because you pay flat copays for routine office visits and prescriptions. The PPO has a lower deductible compared to the HDHP. 11

12 Medical Plan Options High Deductible Health Plan HDHP With the HDHP, you pay less out of your paycheck to buy the coverage, and then more out of your pocket for services. You can set up a health savings account (HSA) that lets you build up tax-deductible money to pay medical expenses. You pay a lower premium, but are subject to a higher deductible and maximum out-of-pocket. Check with your local bank or employer to see if they offer an HSA. 12

13 Medical Plan Options Mercy Preferred EPO If you use the Mercy Health System or don t mind changing your doctor, you may want to choose this plan. It can save you money! The Mercy Preferred Plan is an exclusive provider organization (EPO) plan. It is a smaller network of doctors and hospitals. There is no out-of-network coverage except for emergencies. Care coordination with a team of people who work with you and your doctor. Easier to make appointments and, in some cases, extended office hours. Lower office visit copays. Online access to your medical record and for ing your doctor and care team. 13

14 Medical Plan Options Minimum Value Plan MVP With the MVP, there is a higher deductible. Once the deductible is met, the Plan pays at 100%. There are no copays. This plan offers basic coverage and has the following exclusions: No out-of-network coverage except for emergencies. No coverage for treatment of temporomandibular joint dysfunction (TMJ). No coverage for chiropractic care. No coverage for certain medications such as lifestyle medications. 14

15 Prescription Drug Coverage 15

16 Dental Plan Options Dental Networks Delta Dental Provider Search Annual Deductible Basic Standard Premium $75 /person $150 /family Delta Dental PPO Network Delta Dental Premier Network $50 /person $100 /family $25 /person $50 /family Annual Maximum Benefit $1,000 /person $1,500 /person $2.500 /person Lifetime Maximum Benefit Orthodontia Preventative Not Covered $1,500 /person $1,800 /person 80% Covered Deductible Waived 100% Covered Deductible Waived 100% Covered Deductible Waived Basic Care Covered at 80% Covered at 80% Covered at 80% Major Care Covered at 50% Covered at 50% Covered at 60% Orthodontia Care Not Covered 60% 60% Adult Orthodontics Not Covered Yes Yes Sealants Covered to age 16 Covered to age 16 Covered to age 16 See your 2016 dental plan rates online or ask your Treasurer or Personnel Department. 16

17 BHP Wellness Program The intent of the Butler Health Plan Wellness program is to support employees to live healthier and more productive lives by getting in front of potential health issues. The free benefit allows you to have a convenient way of getting your health screening at your work place in the spring of each year. We all know that lifestyle choices have consequences and making healthy choices helps employees and the Plan spend less on health care. 17 *Watch for free health evaluation at your district.

18 BHP Wellness Program Employees and spouses, enrolled in the Medical Plan will have the opportunity to earn a $150 credit toward next year s medical plan deductible. Year 1 baseline: The first time you have a health screening completed is considered the baseline year. You qualify for the incentive simply by participating. Year 2 and beyond: In years two and later, your goals will be set from the previous year (based on your baseline). You must meet the goals in order to keep the incentive. 18 *Watch for free health evaluation at your district.

19 Open Enrollment Enrollment is Mandatory For Everyone (even if you are waiving coverage)! The Butler Health Plan Open Enrollment will take place starting November 9, 2015 through November 23, ALL employees eligible for medical and dental benefits must enroll, even if they are waiving coverage. Before you enroll, you will need the following information about you and your dependents: - Social Security Number - Date of Birth - Information on other medical or dental coverage that you and your dependents may have 19

20 How to Enroll Online Log on to Enter your UserID: First Initial and Last Name with Last four of SSN (For Example, John Doe would be: jdoe1234) Your Password is your Date of Birth (MMDDYYYY). Change your password (if you log into the website again, you will need this new password). Follow the instructions on the website and enroll in your 2016 benefits or waive coverage. Click on the Finish button to save your elections. Print your confirmation statement. 20

21 How to Enroll Online You may make changes on the enrollment website until 11:59 p.m. EST on November 23, The last elections that you save will be your benefits beginning January 1,

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23 MARK YOUR CALENDAR November Open Enrollment is Mandatory For Everyone. All employees eligible for medical and dental benefits must enroll, even if they are waiving coverage. Share your enrollment materials with your family. Enroll before November 23 at 11:59 p.m.

24 Your Open Enrollment Changes for Medical and Dental Plan Begin January 1, 2016 ID cards will be mailed before December 31 for new BHP enrollees and for employees making Plan changes. Everyone will receive new Express Scripts Prescription cards with a new ID number. 24

25 Questions?