Health Benefits Open Enrollment

Transcription

1 10/14/ Open Enrollment October 19 October 30, 2015 Health Benefits Open Enrollment Enroll in any of the health benefit plans Change your medical plan Change your dental or vision plan Add/drop coverage for you or your eligible dependents Elect your Health Savings Account (HSA) or Dependent Care Flexible Spending Account (FSA) elections for 2016 (form required) 2 1

2 October 19 October 30, 2015 Call People Strategy Benefits Department Monday Friday 8:00 a.m. to 5:00 p.m. CST 3 Open Enrollment Process Step 1 If applicable, review benefits statement of current elections in Open Enrollment (OE) packet. Step 2 Review the 2016 Open Enrollment highlights in your OE packet which includes plan information, changes and costs. Step 3 If no changes (except for medical, HSA, and Dependent Care FSA), no need to call. YOU DO NOT NEED TO DO ANYTHING TO KEEP ALL BENEFIT COVERAGES THE SAME. Step 4 - Call People Strategy Benefits at to enroll or if you have any changes to coverage elections for medical, dental, vision, group life or LTD benefits. If electing or changing Voluntary Life or STD coverage, please visit the Lincoln website at This website will be available only during open enrollment. Step 5 Must complete forms to enroll in the HSA or Dependent Care FSA for 2016 (Open Enrollment forms are available at 4 2

3 Tobacco Testing: November 2-13, 2015 Tobacco Testing ONLY applies to: Employee Partners and spouses who are enrollingfor the 1 st time and who wish to receive contribution discounts for the Medical Plan. If you and your spouse are currently enrolled in the Medical Plan and are NOT receiving the non-tobacco user discounts, you will also have an opportunity to take the tobacco test. Note: If you and your spouse already tested negative for tobacco or you completed the tobacco cessation program ANDyou are currently receiving the non-tobacco user discounts, you DO NOTneed to re-test. Other things you should know: Tobacco testing is free at an approved LabCorp lab. Review information and instructions in your OE packet in the Newsletter or at 5 Health Benefit Plans Offered Medical Only Blue Cross and Blue Shield providers Preventive Care Wellness Incentives RX with Mail Order Health Savings Account option (All medical plans) Two Dental Plans Dental PPO DHMO Vision Plan (new provider in 2016) Superior Vision Group Term Life Supplemental Life Long Term Disability Short Term Disability Flexible Spending Account (FSA) Dependent Care FSA only 6 3

4 Who May Enroll Employee Partners All regular full-time, who work 30+ hours per week on a continuous basis, and have completed 90 days of continuous service. Spouses Your legal spouse who is recognized for U.S. Federal Tax purposes and is a U.S. citizen or legal resident, or a common law spouse may be eligible if the state recognizes common law marriage. Children For Medical & Vision Only -Your child who is a U.S. citizen or legal resident under age 26 or who is 26 or older and physically or mentally handicapped. Other Plans Your child up to age 25 who is primarily dependent on you for financial support. 7 Notice of Dependent Verification Proof of dependent status is required for all newly added dependents to the Medical Plan. Documents are due between November 5 th -27 th. Please refer to the instructions in your OE packet. All information will need to be sent electronically, via a secure website or . If dependents are not verified, they will not have Medical coverage on January 1,

5 NEW FOR Medical Plan New for 2016: Plan Enhancements/Changes MDLiveTelemedicine is a new feature added to the Medical Plans for non-emergent conditions. You can speak with a Doctor from your home or on the go and the Doctor may prescribe medication, if appropriate, for a $40 consultation fee. MDLiveDoctors can generally treat the following conditions 24/7/365: allergies, cold, flu, insect bites, sinus infections, headaches, fever, skin infections and other non-emergent conditions. Telehealth may not be available in all jurisdictions. 10 5

6 Medical Plan New for 2016 : Plan Enhancements/Changes We are bringing Compass back based on your feedback! Compass can help simplify the complexity of health care and help you save money too. ClubCorp pays the full cost of the Compass program so you can use services whenever you need them and as often as you would like for free. Compass will help you to select doctors, to save money, to understand your health insurance, and to review Explanation of Benefits (EOB) statements. 11 Medical Plan New for 2016: Plan Enhancements/Changes The out-of-pocket maximum for all Medical Plans (HDHP 1350/2000/5000) will be $6,550 for an individual and $13,100 for a family. Out-of-pocket maximums are the most you would pay before covered medical expenses are paid at 100%. The Plans have an embedded out-of-pocket maximum. Once any individual out-of-pocket maximum is reached for the year, that individual is not responsible for additional cost sharing for the remainder of the year. All Medical Plans will pay 50% of covered Specialty Prescription drug expenses after you satisfy the deductible. Covered Compound Prescription drugs will be excluded from the Plan for ages 13 and older. 12 6

7 Medical Plan Reminder for 2016: Health Insurance required per Affordable Care Act (ACA) Medical Plan C (HDHP 5000) with an individual annual deductible of $5,000/family annual deductible of $10,000 satisfies the individual mandate under ACA that requires most individuals to have health insurance or potentially pay a penalty for noncompliance. In 2016, the penalty is $695 per uninsured person and $ per uninsured child, per year (family max of $2,085) or 2.5 percent of your household income that is above the tax return filing threshold for your filing status, whichever is greater. 13 Medical Plan New for 2016: Tobacco Cessation Program End Date Starting on January 1, 2016, the current company-sponsored smoking/tobacco cessation program known as Smokeless will be available to EP s and covered spouses until January 31 st, 2016 only. The program is available for a limited time only, please determine if you and/or your spouse are interested in enrolling in the Smokeless Program for medical premium discounts. The program must be completed and diploma submitted to People Strategy no later than January 31, Please refer to the Open Enrollment Newsletter for more information or online at

8 Plan Features Medical Plan A(HDHP 1350) HSA Option 2016 Medical Plan Medical Plan B(HDHP 2000) HSA Option Medical Plan C(HDHP 5000) HSA Option Annual Deductible Annual Out-of- Pocket Maximum Coinsurance (amount Plan pays after deductible) EP Only - $1,350 EP + Dependents - $4,000 (Note : this deductible must be met by one participant or a combination of two or more participants before benefits are paid). In-Network Individual - $6,550 Family - $13,100 (Embedded Self-only OOP maximum applies to all individuals including those enrolled in an other-than-self-only i.e. family plan coverage) 75% in-network only No Coverage for non-network EP Only - $2,000 EP + Dependents - $6,000 (Note : this deductible must be met by one participant or a combination of two or more participants before benefits are paid). In-Network Individual - $6,550 Family - $13,100 (Embedded Self-only OOP maximum applies to all individuals including those enrolled in an other-than-self-only i.e. family plan coverage) 70% in-network only No Coverage for non-network EP Only - $5,000 EP + Dependents - $10,000 (Note : this deductible must be met by one participant or a combination of two or more participants before benefits are paid). In-Network Individual - $6,550 Family - $13,100 (Embedded Self-only OOP maximum applies to all individuals - including those enrolled in an other-than-self-only i.e. family plan coverage) 70% in-network only No Coverage for non-network ER Services $250 co-pay/visit after deductible $250 co-pay/visit after deductible $250 co-pay/visit after deductible 15 Medical Plan Coverage Tiers You have 6 coverage options: Employee Partner Only Employee Partner + Spouse Employee Partner + Children (2 or less) Employee Partner + 3 or More Children Employee Partner + Spouse + Children (2 or less) Employee Partner + Spouse + 3 or More Children Please review the plan costs in the 2016 Open Enrollment highlights newsletter. 16 8

9 Prescription Drug Benefits changes for 2016 Plan Features Medical Plan A Medical Plan B Medical Plan C At a Retail Network Pharmacy (up to a 30 day supply) OR Mail Order Pharmacy (Mandatory Maintenance Medications up to a 90 day supply) You Pay: $20 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* & Specialty Drugs You Pay: $40 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* & Specialty Drugs You Pay: $20 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* & Specialty Drugs You Pay: $40 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* & Specialty Drugs You Pay: $20 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* & Specialty Drugs You Pay: $40 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* & Specialty Drugs *When there is a generic available, you will pay the coinsurance, plus the cost difference between the brand and the generic 17 Prescription Drug Benefits changes for 2016 Specialty Drugs Specialty medications are generally prescribed to treat chronic, complex medical conditions, such as multiple sclerosis, hepatitis C and rheumatoid arthritis. These medications are typically received by injections or infusion, but may be topical or taken by mouth. Step Therapy Program For certain specialty prescription drugs, a step approach is required to receive coverage for certain high-cost medications. This means that to receive coverage you may need to first try a proven, cost-effective medication before using a more costly treatment, if needed. Remember, treatment decision are always between you and your doctor. No need to renew in 2016 Prior Authorization Program Applies to certain high-cost drugs that have the potential for misuse. Before medications included in the prior authorization program can be covered under the plan, your doctor will need to get approval through BCBSTX. *Prime Specialty Pharmacy supports members who require specialty medication and helps them manage their therapy. 18 9

10 Understanding the Medical Plan Additional Programs From BCBSTX (at no cost to you) Age/Gender Specific Recommended Screenings Outbound calls for breast cancer screening based on age and gender; annual cervical cancer mailing for members based on age; e-messaging for colon cancer screening based on age Expanded Wellness Advice Birthday card mailings for women age 40+, men age 50+ and immunization reminder mailings go to 4 month and 14 month old children Special Beginnings (prenatal management) 24/7 Nurseline Discounts and special offers are available for Jenny Craig, health and fitness memberships and alternative health 19 Understanding the Medical Plan Use the BCBSTX Plan Selector and Health Plan Cost Estimator! Asks a series of questions to help you make a decision A budgeting feature to assist in the plan selection process Go to click on the quick link for BCBSTX or go to BCBSTX at

11 Medical Plan Discounts Employee Partners pay discounted Medical Plan costs if they and their covered spouses are non-tobacco users. ClubCorp offers a company-paid tobacco cessation program to give covered participants and/or spouses an opportunity to quit and receive the discounted Medical Plan costs. This program is available through January 31, 2016 Discounted over-the-counter tobacco cessation aides are available. For Employee Partners who use tobacco products, ClubCorp also covers with $0 co-pay two 90-day treatment regimens for tobacco cessation medications per benefit period. This coverage includes a variety of FDA-approved tobacco cessation medications (including both prescription and over-the-counter medications) when prescribed by a healthcare provider. 21 Wellness Incentives Health Risk Assessment -$50 for the first 400 covered Employee Partners only Special Beginnings (prenatal management program) -$50 for covered Employee Partner or spouse who enrolls during first 12 weeks of pregnancy 22 11

12 Wellness Incentives Incentives Deposited into a LIMITED PURPOSE Health Care Account Funds can be used to pay for eligible dental or vision expenses Because all of the medical plans in 2016 are high deductible health plans (HDHP), funds can only be used for dental and vision expenses Visit call BCBSTX at or directly access the vendor website at more information on wellness incentives under the Medical Plan 23 Health Savings Account Available for any HDHP Plan enrollment Tax savings fund with pre-tax dollars and earn tax-free interest No use it or lose it rule Take it with you Save it or spend it you decide to use dollars for medical expenses now or in the future Investment options 24 12

13 Best Doctors offers you access to advice from the world s leading physicians. It s for everything from minor surgery to serious issues like cancer and heart disease. With Best Doctors, you can have an expert physician review your diagnosis and treatment plan, ask basic medical questions, and even get help finding a local physician who is right for you. Best Doctors is 100% free and confidential. It is included in your Medical Plan and available at no cost to you and any of your dependents enrolled in the ClubCorp health plan. 25 Dental Plan Options no plan changes for 2016 Delta DHMO -DeltaCare USA must designate the contract dentist that you will use and receive referrals for other dental specialists or providers. Be sure to check your state some states do not offer the DHMO plan or have a limited number of providers. Delta DPO a dental provider organization with in-network and non-network benefits 26 13

14 Comparison of Dental Plans DHMO DeltaCare USA DPO States where Plan is offered Alabama, Arkansas, Arizona, California, Colorado, DC, Florida, Georgia, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Nevada, New York, Ohio, Pennsylvania, South Carolina (limited number of providers in this state),tennessee, Texas, Washington, Wisconsin, & West Virginia All States Annual maximum per individual None $1,500 Annual Deductible Per Individual Per Family None None $50 $150 Preventive Services Benefit Offices Visits Cleanings X-rays Basic Services Benefit Filling Amalgam Filling Resin You pay $5 per visit No charge No charge No charge You pay $75 Covered at 100%, no deductible Covered at 80%, after deductible Major Services Benefit Crown- high noble metal You pay $355 Covered at 50%, after deductible Orthodontia Adult Child You pay: $2,100 $1,900 Not covered 27 Understanding the Vision Plan: Accessing Benefits 1) Call Superior for a doctor list or visit the Superior website Superior Vision ) Visit the doctor and pay only the co-payment; No claim filing Superior PATIENTS 2) Call a Superior doctor for an appointment Superior DOCTORS 28 14

15 Superior Vision Plan - at a Glance (New provider) If You Receive Eye Exams (every 12 months) Eyeglasses Lenses (per pair every 12 mo) Single Bifocal Trifocal Frames (every 24 months) Medically Necessary Contact Lenses (in lieu of eyeglasses) From a Superior Provider You Pay... $15 copay Comprehensive exam $25 copay Standard contact lens fitting exam Materials co-pay of $15 applies to lenses and frames only. Covered in full Covered in full Covered in full $125 retail allowance, 20% discount over this allowance Nothing. Plan pays 100% Elective Contact Lenses Any charges above plan allowance of $120 for contacts and fitting exams. Vision correction surgery, special lenses, prescription sunglasses Discounts are available from certain Superior providers From a Non-Superior Provider You Pay... Up to $37 or $42 (depending on doctor seen) Up to $26 retail Up to $34 retail Up to $50 retail Up to $50 retail Up to $210 retail Up to $100 retail 29 Understanding Dependent Care Flexible Spending Accounts (FSA) Eligible Employee Partners do not have to be enrolled in ClubCorp Medical Plans to participate in the Dependent Care FSA. Please see the Newsletter in your OE packet. Allows Employee Partners the ability to pay for certain dependent care expenses with pre-tax dollars when it is necessary for you and your spouse to work or attend school full time. Dependent care expenses may include : In-home baby-sitting services Care of a preschool child by a licensed nursery or day care provider Before-and after-school care 30 15

16 Additional Health Benefit Plans Group Term Life/AD&D coverage is for EP s only and is available at 1 1/2 times your annual salary up to a maximum of $50,000 (minimal cost). Supplemental Term Life coverage is available for you and your dependents. EP pays 100% of premium costs. During this special enrollment period, you can elect or increase your Supplemental Term Life insurance up to $380,000, or 3 times your salary, whichever is less, on yourself withoutevidence of insurability. Same with eligible spouses, you can increase your Supplemental Term Life insurance up to $30,000 (not to exceed 50% of your amount) on your spouse withoutevidence of insurability. Rates are 10% lower than last year s rates. Please see information included in your open enrollment packet for enrolling online for this benefit. Long Term Disability (LTD) coverage is income replacement in the event you are unable to work due to an illness or injury and is available for eligibleemployee Partners only (see Benefits Guide or call People Strategy Benefits for more details). Short Term Disability (STD) coverage is income replacement also and is available for EP s who are not eligible for LTD. You have a one-time opportunity to enroll in this plan now during open enrollment without having to answer any medical questions for evidence of insurability. Coverage is subject to a pre-existing condition limitation. Please see information included in your open enrollment packet for enrolling online for this benefit. 31 Group Term Life & AD&D Plan How to calculate your bi-weekly cost an example: Annual Base Earnings $30, Benefit = 1.5 earnings $45, Basis per $ Total Monthly Cost $5.40 (45 x $0.12) Employee Partner Pays 50% $2.70 Biweekly Deduction $

17 Supplemental Life Remember, you may elect or increase your Voluntary Supplemental Term Life insurance on yourself (up to $380,000 or 3 times your salary, whichever is less) or your eligible spouse (up to $30,000, not to exceed 50% of your amount) during this special enrollment period without Evidence of Insurability. If you do not enroll during this open enrollment or when you are eligible as a new hire, you will be subject to evidence of good health. Please refer to the informational flyer included in your Open Enrollment packet to enroll online. Prices for the coverages is available on the Lincoln website as noted in the flyer. 33 YOUR RESPONSIBILITY AS EMPLOYEE PARTNER 34 17

18 Your Responsibility as Employee Partner Review the plan information and costs in your Open Enrollment packet -additional information is available at YOU DO NOT NEED TO DO ANYTHING TO KEEP ALL BENEFIT COVERAGES THE SAME. To enroll or make changes for medical, dental, vision, group life or long term disability (LTD), call People Strategy Benefits at during the enrollment period, M F, 8am to 5pm, CST. To enroll or make changes for supplemental voluntary life insurance or short-term disability insurance, please go online to the Lincoln website at during the enrollment period. If no changes (except for medical, HSA, and Dependent Care FSA), no need to call Complete and return the Dependent Care FSA and/or HSA, Designation of Beneficiary form, and Authorization form to your OA no later than October 30, Forms are available at Complete the tobacco testing for you and your covered spouse between November 2 13, 2015if you wish to receive the medical contribution discounts in 2016, and do not currently have them. Proof of dependent status is required by November 27, 2015for all newly added dependents to the Medical Plan. Verification will be completed via online at or by , and will start on November 5, Please see your open enrollment packet for details. 35 Open Enrollment is October 19 October 30, 2015 People Strategy Benefits Department: Monday Friday 8:00 a.m. to 5:00 p.m. CST 36 18