Human Resources Open Enrollment Training

Transcription

1 Human Resources Open Enrollment Training

2 Agenda 1. Welcome and Introductions 2. Review Health Plan Designs 3. Online Enrollment Process (PlanSource) 4. Review Health Savings Accounts Wellness Incentive Program 6. Added Value Programs

3 Welcome and Introductions

4 Open Enrollment PASSIVE Enrollment. ONLY those wanting to make a change need to take action Plan year OCT to SEP Online enrollment preferred Begins August 1 st for online changes OE DEADLINE: Friday, September 8, 2017

5 District Communication Medicare retirees have a separate Open Enrollment meeting: August 22, :00am SCOE Professional Development Center 2895 Innsbruck Dr., Redding

6 PPO MEDICAL PLAN COMPARISON Plan Name 80C 80G 80K 80M Deductible Calendar Year Member Coinsurance after Deductible Out of Pocket Maximum Doctor Visits Copay (Deductible waived) Ambulance Copay (In addition to ded. & Coinsurance) ER Copay (In addition to ded. & coinsurance) One person $200 Family Each $200 Family Max $500 One person $500 Family Each $500 Family Max $1,000 One person $1,000 Family Each $1,000 Family Max $2,000 One person $3,000 Family Each $3,000 Family Max $6,000 20% 20% 20% 20% One person $1,000 Family Each $1,000 Family Max $3,000 One person $2,000 Family Each $2,000 Family Max $4,000 One person $3,000 Family Each $3,000 Family Max $6,000 One person $4,000 Family Each $4,000 Family Max $8,000 $20 $30 $30 $40 $100 $100 $100 $100 $100 - waived if admitted $100 - waived if admitted $100 - waived if admitted $100 - waived if admitted Prestige Office Fee $0 $0 $0 $0 Preventive Care $0 $0 $0 $0 MDLIVE Copay $5 $5 $5 $5

7 PPO PHARMACY PLAN COMPARISON Plan Name 80C 80G 80K 80M Out of Pocket Maximum Individual $2,500 Family $3,500 Individual $2,500 Family $3,500 Individual $2,500 Family $3,500 Individual $2,500 Family $3,500 Brand Name Deductible Costco Generics $0 $0 $0 $0 (30 or 90 day) $0 (30 or 90 day) $0(30 or 90 day) Individual $200 Family $500 $5 (30 day) $15 (90 day) Generics - 30 day $9 $9 $9 $15 Brand - 30 day $35 $35 $35 $50 after deductible Brand name pharmacy and medical deductibles run from January 1 to December 31 every year. Any amount you pay towards your PPO plan s deductible in the fourth quarter of a calendar year (between October 1 and December 31) will be credited to the current year AND the next year s deductible. Members can only obtain a 90-day supply of medication at COSTCO retail pharmacy or COSTCO mail-order for the mail order copay. Specialty Pharmacy: Navitus SpecialtyRX is mandatory.

8 4 th Quarter Carry-Over The 80%/20% plans feature Fourth Quarter Carryover on the Deductible: Covered charges incurred from October through December and applied toward the Calendar Year Deductible for that year also count towards Calendar Year Deductible for the next year Out of Pocket Maximum does not have Fourth Quarter Carryover HSA plans do not have Fourth Quarter Carryover

9 HDHP Medical Comparison Deductible Calendar Year HSA - A One person $1,500 Family Each $2,600 Family Max $3,000 HSA - B One person $3,000 Family Each $3,000 Family Max $5,200 Coinsurance after Deductible 10% 10% Out of Pocket Maximum One person $3,000 Family Each $3,000 Family Max $6,000 One person $5,000 Family Each $5,000 Family Max $10,000 Doctor Visits Copay Deductible Applies Deductible Applies Prestige Office Visit $20 ($0 for wellness exam) $20 ($0 for wellness exam) Preventive Care $0 $0 MDLIVE Copay $40 (after deductible) $40 (after deductible) JPA HSA Contribution for first time enrollees $500/$1,000 $500/$1,000 JPA HSA Contribution for existing or former enrollees None None Note: Ambulance copay $100 towards deductible or $100 after deductible met.

10 Pharmacy Plan Cost-Sharing HSA - A HSA - B Out of Pocket Max see medical OOP max see medical OOP max Deductible medical deductible applies medical deductible applies Costco Generics $0 (30 day) after deductible $0 (30 day) after deductible Generics - 30 day $9 after deductible $9 after deductible Special/Brand - 30 day $35 after deductible $35 after deductible

11 Pharmacy Benefits Please refer to the Navitus Health Solutions Prescription Drug Coverage handout for details on Prior Authorization and Step Therapy coverage.

12 Pharmacy Network The Pharmacy network includes most network and independent pharmacies EXCEPT Walgreens Walgreens

13 MEDICAL REVIEW Physical Therapy or Physical Medicine. Physical Therapy Physical Medicine Chiropractic Care Occupational Therapy A medical review process with American Specialty Health (ASH) is required after 5 visits. Providers must contact Anthem to start the review process if expecting more than 5 visits.

14 Non-Par Providers (1 of 2) Claims for eligible services with non-participating providers are paid according a fee schedule. If a non-participating provider s charges exceed the schedule, that amount is not covered and will be the member s responsibility to pay. Non-emergency services not covered through nonparticipating providers: Routine preventive care, diagnostic services, physical medicine services, durable medical equipment. Members may request an Authorized Referral* to access non-emergent care with a non-participating provider.

15 Non-Par Providers (2 of 2) *Authorized referral: Occurs only only when: 1. There is no participating provider who practices in the appropriate specialty, which provides the required services, or which has the necessary facilities within a 50-mile radius of your residence; 2. You are referred in writing to the non-participating provider by the physician who is a participating provider, and 3. The referral has been authorized by the claims administrator before services are rendered. -You or your physician must call the toll-free telephone number printed on your identification card prior to scheduling an admission to, or receiving the services of, a non-participating provider.

16 Dental and Vision Dental rates are reduced and a third cleaning per calendar year is added to all dental plans. Vision rates are reduced. No plan changes.

17 Online enrollment Active and Early Retiree members are encouraged to use PlanSource online enrollment!

18 PlanSource Login USERNAME: Your user name is the following: the first initial of your first name, up to the first six characters of your last name, and the last four of your SSN. Jane Anderson = Last four of your SSN is 1234 janders1234 All passwords will reset to the birthday format on July 29, 2017 PASSWORD: Your birthdate in YYYYMMDD format. Birthdate is August 14, 1962 = At initial login, you will be prompted to change your password

19 Health Savings Accounts STSIG uses PayFlex for Health Savings Accounts Handouts available

20 STSIG HSA Contribution New Enrollee Contribution: New HSA-A and HSA-B enrollees are eligible for a $500/$1000 STSIG health savings account contribution with a 100% payment at the end of November.

21 What is a Health Savings Account? Savings account for healthcare expenses Must be enrolled in HSA-A or HSA-B plan to participate Contributions are tax-free 2017 = $3,400 annual max individual (2018 = $3,450 annual max individual) 2017 = $6,750 annual max family (2018 = $6,900 annual max family) Withdrawals for eligible expenses is tax-free Money is 100% employee owned and portable

22 Qualifying for an HSA You must be enrolled in a qualified high deductible health plan (HDHP). You have no other health coverage (dual coverage on 2 HDHP s OK). You are not enrolled in Medicare or Tri-Care. You cannot be claimed as a dependent on someone else's tax return.

23 Wellness Incentive Program Activities between Nov 1, 2017 October 31, 2018 will earn Wellness Incentives award for 2018

24 2018 Wellness Award Those who complete the wellness incentive requirement by October 31, 2018, will receive a $100 gift card payable in January. Member s spouse can also complete the wellness incentive requirements for a $100 gift card payable in January. Each person must use a Wellness Tracker as Anthem and Navitus will not be providing reports.

25 Wellness Exam Eligibility: Primary subscribers must complete three incentive activities including the annual wellness exam. A subscriber s spouse may also earn the 2018 wellness incentive by completing the same requirements and submitting a separate wellness tracker. Wellness exam between November 1, 2017-October 31, Although not required, we encourage wellness exams be done at Prestige Clinic Necessary labs determined by physician Exam to include prostate screening for age appropriate males and well women screening for females Approved wellness labs done at Prestige will be at no cost to the member. Labs done at any other lab will be processed through the medical program and member costs may apply

26 Wellness Options Pick 2 Mammogram screening Bone Density test and screening for osteoporosis Colonoscopy screening Annual vision screening Two dental cleanings with oral assessment Flu Shot between September 1 and October 31, done at pharmacy or District sponsored on-site flu shot clinic. STSIG Health Fair Healthy Biometrics (Blood Pressure 130/85 or less AND BMI 29.9 or less) Accumulate 400 points on FitThumb for exercise JPA-Approved Health Seminar: listed on STSIG website JPA or District Approved Health Challenge JPA or District Open Enrollment Meeting Please note: All wellness activities are tracked completing and submitting via the Wellness Tracker Neither Anthem nor pharmacies will be providing reports for wellness activities. It is the employee responsibility to submit proof of all activities to STSIG by October 31, 2017.

27 Added Value Programs MD Live EAP (Employee Assistance Program) Prestige Advance Medical

28 MDLIVE

29 MDLive 24/7 Physician Access Provides PPO members with on-demand access to boardcertified physicians by online video, phone, or secure e- mail. Doctor visits are available to PPO Members for a $5 copay regardless of the plan s regular office visit co-pay. Great alternative if considering the ER or urgent care for a non-emergency medical issue or when a Primary Care Physician is not available. Also when traveling and in need of medical care Available weekends and even holidays The service is secure, confidential and compliant with all medical privacy regulations

30 MDLive Perfect for: Non-emergency consultations Flu/cold symptoms Sinus infection NOT appropriate for: Managing chronic pain Emergency Preventative care

31 Employee Assistance Program Districts find value in the Employee Assistance Program Voluntary program offered to employees & their families No cost to use EAP, Available 24 hrs/7 days per week Confidential service by Licensed Professionals 6 brief counseling sessions per incident Resources for Managers and Supervisors Comprehensive website Program name: SISC

32 Prestige Medical Clinic Access to a medical care with extended and weekend hours. STSIG Active and Early Retiree Members enrolled in a PPO plan or an HDHP without a HSA will receive access at no cost. Enrollees on a HDHP with an HSA will have $20 office fee per visit due to IRS regulations. Urgent care, wellness care, chronic disease management, digital x-rays.

33 NEW! Free new benefit for you and your family, 100% covered by SISC. (Replaces Grand Rounds) Use to receive second opinions and schedule office visits with top doctors. Learn about a new diagnosis, confirm a course of treatment, find a great specialist in your insurance network we can help. Advance Medical connects you with world-class doctors for expert medical guidance. WHAT THEY DO: Matching you to a top physician for your exact medical needs Scheduling appointments for you and your family Collecting health records from previous doctors Providing support and guidance throughout the process (advance-medical.net/sisc)

34 Questions