Calendar Year 2018 Benefits Program. Johns Hopkins Health System

Transcription

1 Calendar Year 2018 Benefits Program Johns Hopkins Health System 1

2 Benefits Strategy Philosophy Benefits positioned to be competitive Benefit menu designed to provide choice, affordability and access Comparative Markets Academic Medical Centers Non-Academic Medical Centers Non-Healthcare Maryland Mid-Atlantic Region National 2

3 Benefits Structure Affordable care for employees Long term strategy for sustained viability Competitive and delivers value Focused on equity and cost management 3

4 Who is Affected? All employees in these participating organizations: Johns Hopkins Health System Corporation Johns Hopkins Bayview Medical Center Johns Hopkins HealthCare Johns Hopkins Community Physicians Johns Hopkins Home Care Group Johns Hopkins Medicine International Johns Hopkins Intrastaff The Johns Hopkins Hospital 4

5 2018 Benefits Program Summary Medical Dental Pharmacy Vision, Life, Disability, Retirement Time Off (PTO) Simplify plan design to one plan 90/80/70 Employee contributions increasing minimally to align with market median New vendor - Delta Dental PPO Additional services provided Tighten formulary by transitioning to the CVS/Caremark Advanced Control Formulary No change in design or employee contributions No changes Other Dependent tuition 4 year eligibility Wellness/wellbeing continuing with future enhancements 5

6 New Enrollment Platform SmartSource is new platform Active Enrollment for 2018 If you do not enroll during Open Enrollment Oct 16-Oct 31, you will not have medical, dental, or vision benefits for 2018 Any existing documentation on currently enrolled dependents will transfer over for example, marriage and birth certificates 6

7 Overview of Medical Benefits Changes Medical Employee premiums based on comparison to market and tiered for salary One single plan with co-insurance 7

8 JHHS Health Plan JHHS Health Plan Hopkins Preferred 90% of allowed amount after deductible and any applicable co-pay EHP Network 80% of allowed amount, after deductible and any applicable co-pay Out of Network 70% of R&C, after deductible and any applicable co-pay Medical ONE SINGLE PLAN FOR

9 Preventative Care Preventive services, immunizations, and lab test provided by Hopkins Preferred or EHP Provider will continue to be paid at 100%. Medical 9

10 Deductible Hopkins Preferred / EHP Network Annual Salary Under $50,000 Individual decreasing from $200 to $150 Family decreasing from $400 to $300 Medical Annual Salary $50,000 and over No change 10

11 Out-of-Pocket (OOP) Maximum Hopkins Preferred / EHP Network Annual Salary Under $50,000 Individual decreasing from $2,000 to $1,500 Family decreasing from $4,000 to $3,000 Medical Annual Salary $50,000 and over No change 11

12 Office Visits Co-pay to Co-insurance In 2018, co-pays for the following will be replaced with co-insurance (90/80/70). Radiology Procedures Acupuncture Chemo & Radiation Therapy Specialty Care Office Visit only Chiropractic Care Nutritional Counseling Biofeedback Therapy Medical Co-pays for PCPs and Urgent Care have not changed 12

13 Please Note: Medical These scenarios are examples only Actual billed amounts are dependent upon what the provider submits to EHP. Facility fees, if applicable, depend upon whether a service is provided in a regulated or non-regulated space. Deductibles and out of pocket maximums are dependent on salary. Actual cost to employee will depend upon meeting deductible. 13

14 Scenario 1 Rose is sick and visits her Hopkins Preferred Network Provider PCP - Rose s PCP charges $250 for this visit - JH pays $240 - Rose pays $10 co-pay Medical JH Pays $240 Employee Pays $10 NOTE: This is an example. Employees should contact EHP with questions about any bill. 14

15 Scenario 2 Marcos sees a Hopkins Preferred Network Provider Specialist Medical - Marcos s provider charges $300 for his services and his facility charges $220 for using their facility - Marcos has already met his $150 annual deductible - JH pays $468 - $270 for the professional fee - $198 facility fee - Marcos pays $52 - $30,10% co-insurance for the professional fee - $22, 10% co-insurance for the facility fee JH Pays $468 NOTE: This is an example. Employees should contact EHP with questions about any bill. Employee Pays $52 15

16 Scenario 3 Mary has Inpatient Surgery and an Inpatient Hospitalization at a Hopkins Preferred Network Provider Medical - Mary s provider charges $1000 for her service and her facility charges $6000 for using their facility - Mary has already met her $200 annual deductible - JH pays $ Mary pays $150 co-pay for the facility - Mary also pays - $100, 10% co-insurance for the $1000 professional fee - $585, 10% co-insurance for the remaining $5850 facility fee ($6000 less the $150 co-pay) JH Pays $6165 Employee Pays $835 NOTE: This is an example. Employees should contact EHP with questions about any bill. 16

17 Dental Coverage Change Dental Delta Dental PPO (currently United Concordia) May use Premier dentist at extra charge Minimal or no increase in premium Improvements Dental implants Resin/composite Additional cleaning for pregnant women 17

18 Prescription Drug Formulary Change CVS/Caremark Advanced Control Formulary (currently Standard Formulary) Considered the mid-level formulary with regard to excluded drugs EHP will reach out to those affected Pharmacy 18

19 Other Benefits Changes Other FSA Limit increasing to $2,600 (please note that FSA applies only to non-represented employees) Group voluntary benefits through the Enrollment Exchange Accident (Unum) Critical Illness (Aflac) Hospital Indemnity (Aflac) Whole Life with LTC Option (Unum) Dependent Tuition (effective 1/1/18) Increase from 2 year to 4 years of continuous employment Grandfather those active as of 12/31/

20 What can we do? More than you think. The healthier we are, the lower our health care costs. We have world-class resources to help employees take control of individual health and health care. Annual physicals, immunizations, and other preventive services and exams, which will continue to be paid at 100%, are among the most important steps employees can take to stay healthy and lower costs. programs/resources will continue to be offered and Human Resources will continue to strengthen and support those offerings. 20

21 Help Managing Your Care EHP provides care management support for patients with diabetes and asthma, COPD, and Cardiovascular Disease, as well as cancer, HIV/AIDS, and several other conditions. Ongoing monitoring and support is available to members with less complicated conditions. Other population health-based services are available, from educational materials to Treatment Coaches and a TeleWatch Patient Monitoring System. 21

22 Resources and Information Your supervisor, Human Resources team and EHP customer service representatives are available to help. More communications between now and Open Enrollment that begins October 16: - Schedule of Benefits and Coverage - Frequently Asked Questions online - Open Enrollment Newsletter - InsideHopkins announcements - Departmental and general meetings HR website EHP Customer Service

23 Questions? 23

24 Appendix 24

25 Health Plan Definitions Billed Allowed The amount the provider or facility billed for the services the patient received. The maximum amount the network will allow for the service the patient received. Any copay/coinsurance that the patient is responsible for paying are deducted from the allowed charge. Reasonable and Customary (R&C) Deductible Co-pay Co-insurance Member Total Out of Pocket (OOP) Maximum The usual fee charged by similar providers for the same services or supplies in the same geographic area Johns Hopkins EHP determines what is a Reasonable and Customary Charge. Non-network providers can charge more. The amount that the patient must pay within the plan year before the plan begins to pay benefits. A flat fee the patient must pay at the time of service. Percentage of medical costs that the patient shares with the plan. The amount the member is responsible for paying (up to the out-of-pocket maximum). The maximum amount the member pays for medical expenses during a plan year. After the member has paid the annual out-of-pocket limit, the Plan pays any additional covered expenses at 100% for the remainder of that plan year. 25

26 Health Plan Definitions Plan Pays Member Pays EOB Professional Fee Facility Fee Regulated Space Non-regulated Space The amount the plan pays for the member s services. The amount the member is responsible for paying. An Explanation of Benefits document outlines The fee submitted to your insurance by the provider of services. The fee submitted to your insurance by the facility where the services were provided. This generally refers to services that are provided in a hospital. This generally refers to services that are provided outside of the hospital environment, for example in free-standing clinics. 26