2016 State Health Plan Annual Enrollment

Transcription

1 2016 State Health Plan Annual Enrollment

2 Agenda Annual Enrollment Changes Overview of the 2016 changes Wellness Premium Credits Review of 2016 Plan options 2016 NCFlex Changes 2

3 Log In to enroll at: hr.unca.edu/2016-insurance-enrollment

4 There are several health insurance terms to understand: Premium: The monthly fee for your insurance. Deductible: How much you must kick-in for care first, before your insurer pays. Co-pay: Your cost for routine services to which your deductible does not apply. Co-insurance: The percentage you must pay for care after you ve met your deductible. Out-of-pocket maximum: The absolute max you ll pay annually.

5 2016 Benefit Changes Consumer-Directed Health Plan (CDHP) with HRA Increase premium approximately $40 with the opportunity to earn it down to $0 Modify healthy activities to earn premium credits Increase HRA contribution by $100 to help offset member cost share Increase out-of-pocket max by $500 Establish Health Engagement Program to earn additional contributions to HRA: Increase credits for PCP visits and use of Blue Options Designated Providers Engage members with chronic conditions Healthy lifestyle program for all members New CDHP Rx Debit Card Enhanced 80/20 Plan Increase premium approximately $40 with the opportunity to earn it down to approximately $14.20 Modify healthy activities to earn premium credits Increase Tier 5 (non-preferred specialty medications) pharmacy coinsurance maximum Traditional 70/30 Plan Increase member cost share copays, deductible, coinsurance max, and pharmacy out-of-pocketmax 5

6 2016 Plan Design Changes Annual Contribution to Health Reimbursement Account (HRA) Annual Deductible Coinsurance Maximum Out-of-Pocket (OOP) Maximum Current CDHP 2016 CDHP Current 2016/80/20 Current 70/ /30 $500 Individual $1,500 Family $600 Individual $1,800 Family $1,500 Individual $4,500 Family $1,500 Individual $4,500 Family $700 Individual $2,100 Family N/A N/A $3,210 Individual $9,630 Family $3,000 Individual $9,000 Family $3,500 Individual $10,500 Family N/A N/A N/A $933 Individual $2,799 Family $3,793 Individual $11,379 Family $1,054 Individual $3,162 Family $4,282 Individual $12,846 Family N/A N/A N/A Pharmacy Out-of- Included in OOP Included in OOP $2,500 $2,500 $3,294 Pocket Maximum Preventive Care $0 ACA Services $0 ACA Services $0 ACA Services $35 PCP $81 Specialist $39 PCP $92 Specialist PCP Visit 15% after deductible; $15 added to HRA if you use PCP on ID 15% after deductible; $25 added to HRA if you use PCP on ID $30 for primary doctor; $15 if you use PCP on ID card $35 $39 Specialist Visit 15% after deductible; $10 added to HRA if you use Blue Options Designated specialist 15% after deductible; $20 added to HRA if you use Blue Options Designated specialist $70 for specialist; $60 if you use Blue Options Designated specialist $81 $92 Urgent Care 15% after deductible 15% after deductible $87 $87 $98 Chiro/PT/OT 15% after deductible 15% after deductible $52 $64 $72 Emergency Care 15% after deductible 15% after deductible $233, then 20% after deductible Inpatient Hospital 15% after deductible; 15% after deductible; $233 copay, then 20% $50 added to HRA if $200 added to HRA if after deductible; copay you use Blue Options you use Blue Options not applied if you use Designated hospital Designated hospital Blue Options Designated hospital $291, then 30% after deductible $291, then 30% after deductible $329, then 30% after deductible $329, then 30% after deductible

7 If had hospitalization employee only coverage under the plan options: Consumer Directed- $1,500 deductible minus the $600 HRA credit = $900 Gap between the $900 and $3,500 converts to 85/15 (RX EE pays 100% during this gap unless on CDHP 15% or ACA list free) $3,500 out of pocket max (includes deductible and RX) $0.00 annual premium (if complete all wellness credits) = $2,900 is the Total Cost ($600 HRA credit) 80/20 $700 deductible $233 hospital copay Then 80/20 $3,210 coinsurance max (does not include copays or deductible) $ is annual premium (if complete all wellness credits) = $4, is the Total Cost 70/30 $1,054 deductible $329 hospital copay Then 70/30 $4,282 coinsurance max (does not include copays or deductible) $0.00 is annual premium from your paycheck = $5, is the Total Cost

8 2016 Plan Design Pharmacy Changes Pharmacy Benefit Current CDHP 2016 CDHP Current 80/ /20 Current 70/ /30 Tier 1 15% after 15% after $12 $12 $12 $15 Tier 2 deducible for in deducible for in network network $40 $40 $40 $46 Tier 3 benefits, 35% benefits, 35% after deductible after deductible $64 $64 $64 $72 Tier 4 out of network out of network 25% up to $100 25% up to $100 25% up to 25% up to $100 $100 Tier 5 25% up to $125 25% up to $132 25% up to $125 25% up to $132 OOP Integrated with Medical Integrated with Medical $2,500 Rx Only $2,500 Rx Only $2,500 Rx Only $3,294 Rx Only ACA Preventive Medications Covered 100% Covered 100% Covered 100% Covered 100% No No CDHP Preventive Medications Waive deductible, 15% coinsurance only Waive deductible, 15% coinsurance only N/A N/A N/A N/A 8

9 Wellness Premium Credits N/A N/A 9

10 Wellness Premium Credits Wellness Activity How to Complete It When Members Can Take It Subscriber attests to being a non-tobacco user or commits to enroll in QuitlineNC s multi-call program and attests for spouse if applicable Subscriber updates or completes a confidential Health Assessment (HA) Subscriber selects a Primary Care Provider (PCP) and selects PCP for each dependent covered on the State Health Plan. Even if members attested during last year s Annual Enrollment, they will need to reattest. -AND- Subscriber watches a brief video on Patient Centered Medical Homes Log into eenroll, and the attestation question will be included in the enrollment flow. Through the State Health Plan website ( click on Personal Health Portal. Health Assessments can also be completed by telephone at Log into eenroll system to select a PCP and watch the video. If members have trouble locating a provider, they can call During Annual Enrollment, Oct. 15-Nov. 18, If subscribers have taken or updated their Health Assessment between Nov. 1, 2014, and Nov. 18, 2015, through the Personal Health Portal or by phone, it will count toward your premium credit, so encourage people to take it now! If members selected a PCP during the last Annual Enrollment or at some other time throughout this year, they will receive the premium credit. Video will be available beginning Oct. 15, 2015, in eenroll in the enrollment process. 10

11 2016 Plan Changes Consumer-Directed Health Plan 11

12 CDHP Highlights in 2016 Coverage In-Network Out-of-Network Plan-Provided HRA Contribution $600 employee/retiree $1,200 employee/retiree + 1 dependent $1,800 employee/retiree + 2 or more dependents Annual Deductible $1,500 individual/$4,500 family $3,000 individual/$9,000 family Coinsurance (after deductible is met) Out-of-Pocket Maximum for medical and pharmacy (includes deductible) Office Visits (after deductible is met) Inpatient Hospital (after deductible is met) ACA Preventive Medication List CDHP Preventive Medication List 15% of eligible expenses 35% of eligible expenses $3,500 individual/$10,500 family $7,000 individual/$21,000 family 15% of eligible expenses; $25 added to HRA if the PCP on the ID card is utilized; $20 added to HRA if a Blue Options Designated specialist is utilized 15% of eligible expenses; $200 added to HRA if a Blue Options Designated hospital is utilized 35% of eligible expenses 35% of eligible expenses $0 coinsurance, $0 deductible $0 coinsurance, $0 deductible 15% coinsurance, $0 deductible 15% coinsurance, $0 deductible 12

13 Consumer-Directed Health Plan (CDHP): Medical Benefits As a reminder, instead of copays, members will have to meet a deductible. After meeting the deductible members pay a 15% coinsurance on all in-network medical and pharmacy benefits except for ACA preventive services and ACA preventative medications, which are covered at 100%. The deductible and coinsurance are included in the out-of-pocket maximum. Medical and pharmacy expenses both apply to the out-of-pocket maximum. The CDHP is paired with a Health Reimbursement Account (HRA) to assist members with out-of-pocket expenses (deductible and coinsurance) The type of coverage (employee-only) determines the amount placed in the member s HRA account. 13

14 Consumer-Directed Health Plan (CDHP): Pharmacy Benefits For Prescription Drugs: You will pay in full for prescription drugs if your deductible has not been met. Pay in full means, you will pay the allowed amount for the drug Once your deductible has been met, you will pay a 15% coinsurance for prescriptions until your out-of-pocket maximum has been met. Once your out-of-pocket maximum has been met, your prescription will be covered at 100%. NEW in 2016: Rx Debit Card for CDHP members ACA and CDHP Preventive Medications ACA Medications covered at 100% Preventive Medications on the CDHP Preventive Medication list are subject to a 15% coinsurance with no deductible. Examples of medications include those used to treat heart disease, stroke, asthma, and diabetes. A list of these medications is available on the Plan s website at: When HRA funds are available, this card will work like a debit card and take funds out of your HRA. 14

15 New Health Engagement Program for CDHP Members Health Engagement Program In 2016, if you re enrolled in the CDHP, you will have the opportunity to earn additional HRA contributions by working with an NC HealthSmart lifestyle coach and by tracking your daily physical activity and/or nutrition. You can work with an NC HealthSmart lifestyle coach by phone and track your physical activity and nutrition through the Personal Health Portal. You can do this by using a wearable device (e.g., Fitbit, Garmin) or by using a free app (e.g., MapMyFitness, MyFitnessPal). If you have a chronic health condition, you can earn additional HRA contributions while obtaining the regular care you need to manage your condition. Chronic conditions include diabetes, asthma, high cholesterol, chronic obstructive pulmonary disease (COPD), high blood pressure (hypertension), coronary heart disease, and congestive heart disease. Greater HRA Wellness Incentives for 2016 As in past years, you can earn additional HRA contributions when you choose high quality provider options, as shown below. These smart choices can earn you more in your HRA in See your selected Primary Care Provider (or see another provider in your PCP s office) $25 See a Blue Options Designated specialist $20 Use a Blue Options Designated hospital for an inpatient stay $200 Members enrolled in CDHP will receive more information about this program in early

16 Consumer-Directed Health Plan Premium Rates Coverage Type Employee/ Retiree Monthly Premium Dependent Monthly Premium Total Monthly Premium Monthly Wellness Premium Credit Total Monthly Premium* Employee/Retiree $80.00 N/A $80.00 ($80.00) $0.00 Employee/Retiree + Child(ren) $80.00 $ $ ($80.00) $ Employee/Retiree + Spouse $80.00 $ $ ($80.00) $ Employee/Retiree + Family $80.00 $ $ ($80.00) $ *Assumes completion of all three wellness activities. 16

17 2016 Plan Changes Enhanced 80/20 and Traditional 70/30 17

18 /20 & 70/30 Plan Changes Annual Deductible Coinsurance Maximum Out-of-Pocket (OOP) Maximum Current 2016/80/20 Current 70/ /30 $700 Individual $2,100 Family $3,210 Individual $9,630 Family $933 Individual $2,799 Family $3,793 Individual $11,379 Family $1,054 Individual $3,162 Family $4,282 Individual $12,846 Family N/A N/A N/A Pharmacy Out-of- $2,500 $2,500 $3,294 Pocket Maximum Preventive Care $0 ACA Services $35 PCP $81 Specialist $39 PCP $92 Specialist PCP Visit Specialist Visit $30 for primary doctor; $15 if you use PCP on ID card $70 for specialist; $60 if you use Blue Options Designated specialist $35 $39 $81 $92 Urgent Care $87 $87 $98 Chiro/PT/OT $52 $64 $72 Emergency Care $233, then 20% after deductible Inpatient Hospital $233 copay, then 20% after deductible; copay not applied if you use Blue Options Designated hospital $291, then 30% after deductible $291, then 30% after deductible $329, then 30% after deductible $329, then 30% after deductible

19 /20 & 70/30 Pharmacy Changes Pharmacy Benefit Current 80/ /20 Current 70/ /30 Tier 1 $12 $12 $12 $15 Tier 2 $40 $40 $40 $46 Tier 3 $64 $64 $64 $72 Tier 4 25% up to $100 25% up to $100 25% up to $100 Tier 5 25% up to $125 25% up to 25% up to $132 $125 OOP $2,500 Rx Only $2,500 Rx Only $2,500 Rx Only ACA Preventive Medications Covered 100% Covered 100% No No 25% up to $100 25% up to $132 $3,294 Rx Only 19

20 Enhanced 80/20 Plan Premium Rates Coverage Type Employee/ Retiree Monthly Premium Dependent Monthly Premium Total Monthly Premium Monthly Wellness Premium Credit Total Monthly Premium* Employee/Retiree $ N/A $ ($90.00) $14.20 Employee/Retiree + Child(ren) $ $ $ ($90.00) $ Employee/Retiree + Spouse $ $ $ ($90.00) $ Employee/Retiree + Family $ $ $ ($90.00) $ *Assumes completion of all three wellness activities. 20

21 Traditional 70/30 Plan Premium Rates Coverage Type Employee/ Retiree Monthly Premium Dependent Monthly Premium Total Monthly Premium Employee/Retiree $0.00 N/A $0.00 Employee/Retiree + Child(ren) $0.00 $ $ Employee/Retiree + Spouse $0.00 $ $ Employee/Retiree + Family $0.00 $ $

22 Member Scenarios Meet Holly A State Health Plan member with two children covered on her plan trying to decide which plan is right for her and her family. How much will I have to pay under each plan option in 2016? As an active employee, she has three plan options: Consumer-Directed Health Plan Enhanced 80/20 Plan Traditional 70/30 Plan A typical year of medical and pharmacy services for Holly and her children might include the following: 3 Preventive Care Visits with PCP 2 Additional Primary Care Visits 1 Specialist Visit 2 Urgent Care Visits 1 Monthly Maintenance Prescription (Tier 1, ACA Preventive Medication) 1 Tier 1 Prescription 22 Photo credit: Thinkstock Images

23 Holly's Projected Health Care Costs for 2016 Annual Member Costs Traditional 70/30 Plan Enhanced 80/20 Plan CDHP If Holly s Engaged * Premium Payments $3,305 $3,617 $2,326 Out-of-Pocket Costs $680 $276 $0** Engaged Member Total $3,985 $3,893 $2,326 Holly s lowest-cost option If Holly s Non-Engaged * Premium Payments $3,305 $4,697 $3,286 Out-of-Pocket Costs $680 $316 $0** Non-Engaged Member Total $3,985 $5,013 $3,286 The CDHP has lower dependent premiums, and Holly s projected 2016 out-of-pocket costs are less than the initial CDHP starting balance of $1,800. The CDHP is Holly s best option. A willingness to engage in healthy activities and to use selected PCPs and Blue Options Designated providers reduces member out-of-pocket costs in the CDHP and Enhanced 80/20. *An engaged member has completed all wellness activities to receive premium credits and uses their selected PCP and Blue Options Designated providers. A non-engaged member has earned no premium credits and does not use a selected PCP or Blue Options Designated providers. **Holly s HRA will cover all of her out-of-pocket expenses, and Holly will have an estimated $1,125 in her HRA to use in 2017 if she is engaged or approximately $980 if she is not. 23

24 Member Scenario Cost Detail Active Employee Holly Traditional 70/30 Enhanced 80/20 Consumer-Directed Health Plan Medical Services # Unit Copay/ Cost Non-Engaged Engaged Non-Engaged Engaged Non-Engaged Engaged Mbr Unit Mbr Unit Mbr Unit Mbr Unit Mbr Unit Total Copay/ Total Copay/ Total Copay/ Total Copay/ Total Copay/ Cost Cost Cost Cost Cost Preventive Visits with PCP 3 $39 $117 $39 $117 $0 $0 $0 $0 $0 $0 $0 $0 Primary Care Visits 2 $39 $78 $39 $78 $30 $60 $15 $30 $140 $280 $140 $280 Specialist Visit 1 $92 $92 $92 $92 $70 $70 $60 $60 $200 $200 $200 $200 Urgent Care Visit 2 $99 $198 $99 $198 $87 $174 $87 $174 $150 $300 $150 $300 Drugs ACA Preventive Drugs (Tier 1) 12 $15 $180 $15 $180 $0 $0 $0 $0 $0 $0 $0 $0 Tier 1 Prescription 1 $15 $15 $15 $15 $12 $12 $12 $12 $40 $40 $40 $40 Total (before considering HRA) $680 $680 $316 $276 $820 $820 HRA Funds Provided by SHP Starting Balance $1,800 $1,800 HRA Incentive Dollars Identified PCP $0 $125 Blue Options Designated Specialist $0 $20 Blue Options Designated Hospital $0 $0 Engagement Activities $0 $0 Total HRA Dollars to Use $1,800 $1,945 Member Cost-sharing with HRA $680 $680 $316 $276 $0 $0 HRA Balance for Use in $980 $1,125 Annual Premium $3,305 $2,825 $4,697 $3,617 $3,286 $2,326 Total Member Cost $3,985 $3,505 $5,013 $3,893 $3,286 $2,326 Red numbers in the Unit Copay/Cost column indicate a copayment amount. Green numbers in the Unit Copay/Cost column indicate estimated actual allowed cost for a service that could be subject to copay (in 70/30 and 80/20), deductible, and/or coinsurance. Mbr Total 24

25 2016 Premiums

26 Online Resources Videos Podcasts Rate Calculator Health Benefits Est. Tool Rate Sheets Plan Comparisons 26

27 Who Do I Call? ELIGIBILITY AND ENROLLMENT Support Center BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and HRA) EXPRESS SCRIPTS (PHARMACY QUESTIONS for Active/Non-Medicare Retirees) QuitlineNC (Tobacco Cessation Programs) 800-QUIT-NOW ( ) 27

28 Questions? Contact Human Resources at

29 2016 NCFlex Annual Enrollment

30 2016 NCFlex Plan Options and Changes Health Care Flexible Spending Account Limit increase to $2,550 per year Dependent Care Flexible no changes annual limit remains $5,000 Dental Care new lower premiums and no waiting periods for new enrollees on high option except for orthodontia which requires a one year waiting period Vision Care new lower premiums Core Wellness Exam Basic Plan Enhanced Plan Critical Illness new vendor and lower rates 30

31 2016 NCFlex Plan Options and Changes Cancer lower rates for this plan and guaranteed issue. This plan has 3 levels of coverage and includes a screening benefit. Core Accidental Death & Dismemberment - This is a FREE benefit to the employee; however, you must enroll to in the plan. This includes a Worldwide Emergency Travel Assistance Services plan. Voluntary Accidental & Dismemberment This plan has no changes. This includes a Worldwide Emergency Travel Assistance Services plan. Group Term Life Insurance if you/your spouse are not currently enrolled in this plan, you may purchase $20k of coverage on a guaranteed issue basis (if you were not previously denied coverage). Amounts over $20k require EOI. 31

32 2016 NCFlex Plan Options and Changes Group Term Life Insurance (continued) If you/your spouse are currently enrolled in the plan, you may add $10k of additional coverage at each annual enrollment up to the guaranteed issue amount of $100k for employees and $50k for spouse (no EOI required). Children may elect $10k without EOI for TRICARE Supplemental Insurance This is a new plan available to employees who serve or have served in the military. If you currently have TRICARE Standard/Extra, Prime, or TRS benefits offer to the Military Community, you may be eligible for this plan. This plan pays a benefit for costs not covered by TRICARE. 32

33 Who Do I Call? NCFlex website NCFlex Enrollment Guide See Page 44 for vendor contacts ELIGIBILITY AND ENROLLMENT Support Center

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35 Questions? Contact Human Resources at