Open Enrollment for Health Benefit Plans

Transcription

1 Open Enrollment for Health Benefit Plans October 20 October 31, 2014

2 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 2015 (form required) 2

3 Open Enrollment October 20 October 31, 2014 Call People Strategy Benefits Department Monday Friday 8:00 a.m. to 5:00 p.m. CST 3

4 Open Enrollment Process Step 1 If applicable, review benefits statement of current elections in Open Enrollment (OE) packet Step 2 Review the 2015 Open Enrollment highlights in your OE packet which includes plan information, changes and costs Step 3 Call People Strategy Benefits at to enroll or if you have any changes to coverage elections Step 4 - If no changes (except for medical, HSA, and Dependent Care FSA), no need to call Step 5 Must complete forms to enroll in the HSA or Dependent Care FSA for 2015 (Open Enrollment forms are available at or if you want to enroll, change or drop Short Term Disability or supplemental life coverage then complete the personalized form in your OE packet. 4

5 Tobacco Testing: November 3-14, 2014 Tobacco Testing ONLY applies to: Employee Partners and spouses who are enrolling for 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 AND you are currently receiving the non-tobacco user discounts, you DO NOT need 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 5

6 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 Group Term Life Supplemental Life Long Term Disability Short Term Disability Flexible Spending Account (FSA) Dependent Care FSA only 6

7 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 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 Non-Medical Plans Your child up to age 25 who is primarily dependent on you for financial support 7

8 Notice of Dependent Verification Proof of dependent status is required for all newly added dependents to the Medical Plan Documents are due no later than November 28. Please refer to the instructions in your OE packet If dependents are not verified, they will not have Medical coverage on 1/1/15 8

9 Open Enrollment NEW FOR

10 Medical Plan New for 2015: Deductible Changes Plan 1000 will become Medical Plan A (HDHP 1350) with an individual annual deductible of $1,350 and an annual family deductible of $4,000. HDHP 1600 Plan will become Medical Plan B (HDHP 2000) with an individual annual deductible of $2,000 and an annual family deductible of $6,000. A third plan is added for 2015 Medical Plan C (HDHP 5000) with an individual annual deductible of $5,000 and an annual family deductible of $10,000. This plan satisfies the individual mandate under ACA that requires most individuals to have health insurance or potentially pay a penalty for noncompliance. In 2015, the penalty is $325 per uninsured person or 2 percent of household income over the filing threshold. 10

11 Medical Plan: HDHP Plans New for 2015: HDHP Coinsurance The cost share for covered participants after meeting the annual deductible will be 25% for Medical Plan A (HDHP 1350) and 30% for Medical Plan B (HDHP 2000) and Medical Plan C (HDHP 5000). The Medical Plan will pay 75% of the cost of covered medical expenses under Medical Plan A (HDHP 1350) and 70% of the cost of covered medical expenses under Medical Plan B (HDHP 2000) and Medical Plan C (HDHP 5000). 11

12 Medical Plan New for 2015: Out-of-Pocket Maximums Out-of-pocket maximums are the most you would pay before covered medical expenses are paid at 100%. The out-of-pocket maximum for Medical Plan A (HDHP 1350) will be $6,000 for an individual and $12,500 for a family. The out-of-pocket maximum for Medical Plan B (HDHP 2000) will be $6,000 for an individual and $12,500 for a family. The out-of-pocket maximum for Medical Plan C (HDHP 5000) will be $6,450 for an individual and $12,900 for a family. 12

13 Medical Plan Reminders/Updates for 2015: Other Changes Plan 1000 and HDHP 1600 plan are no longer being offered. If an Employee Partner is enrolled in either one of these two medical plans and does not call in to change his/her enrollment elections, then the enrollment election will be changed based on the following : If an Employee Partner is currently enrolled in the Plan 1000 medical option then he/she will automatically be enrolled into Medical Plan A (HDHP 1350). If an Employee Partner is currently enrolled in the HDHP 1600 Plan medical option then he/she will automatically be enrolled into Medical Plan B (HDHP 2000). There is a new medical plan Medical Plan C (HDHP 5000). RX applies to out of pocket maximum in

14 Medical Plan New for 2015: New provider networks in California Covered Employee Partners and dependents in California will have a new BCBS provider network called Select PPO. Network providers must be utilized in order to receive benefits. Please refer to the Open Enrollment Newsletter for more information. 14

15 Plan Features Medical Plan A(HDHP 1350) HSA Option Medical Plan B(HDHP 2000) HSA Option Medical Plan C(HDHP 5000) HSA Option 2015 Medical Plan Annual 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). Annual Out-of- Pocket Maximum In-Network Individual - $6,000 Family - $12,500 (OOP must be met by one participant or a combination of two or more participants) 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 - $6,000 Family - $12,500 (OOP must be met by one participant or a combination of two or more participants) 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 - $6,450 Family - $12,900 (OOP must be met by one participant or a combination of two or more participants) Coinsurance (amount Plan pays after deductible) 75% in-network only No Coverage for nonnetwork 70% in-network only No Coverage for nonnetwork 70% in-network only No Coverage for nonnetwork ER Services $250 co-pay/visit after deductible $250 co-pay/visit after deductible $250 co-pay/visit after deductible 15

16 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 2015 Open Enrollment highlights newsletter 16

17 Prescription Drug Benefits changes for 2015 Plan Features Medical Plan A Medical Plan B Medical Plan C At a Retail Network Pharmacy (up to a 30 day supply) OR You Pay: $20 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* You Pay: $20 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* You Pay: $20 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* Mail Order Pharmacy (Mandatory Maintenance Medications up to a 90 day supply) You Pay: $40 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* You Pay: $40 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* You Pay: $40 copay - Generic, after deductible 30% coinsurance after deductible, for Preferred Drugs* 50% coinsurance after deductible, for Non- Preferred Drugs* *When there is a generic available, you will pay the coinsurance, plus the cost difference between the brand and the generic 17

18 Prescription Drug Benefits changes for 2015 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 2015 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. All previous prior authorizations must be renewed for *Prime Specialty Pharmacy supports members who require specialty medication and helps them manage their therapy. 18

19 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 19

20 Medical Plan Discounts Employee Partners pay discounted Medical Plan costs if they and/or their dependents are non-tobacco users. ClubCorp offers a company-paid tobacco cessation program to give covered participants an opportunity to quit and receive the discounted Medical Plan costs. Discounted over-the-counter tobacco cessation aides are available through the American Institute for Preventive Medicine. 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. 20

21 BCBS Blue Value Advisor (BVA) Program A new service vendor program designed to simplify the complexity of your healthcare needs and serve as your personal healthcare advisor. BVA will help you select doctors, save money, understand your health insurance and review Explanation of Benefits (EOB) statements. For more information, review the information in your Open Enrollment packet. 21

22 Understanding the Medical Plan Additional Programs From BCBSTX (at no cost to you) Condition Management support and resources for daily management to prevent serious illness (conditions include diabetes, asthma, metabolic syndrome, high blood pressure and high cholesterol, low back pain, coronary artery disease) Blue Distinction Centers Centers demonstrated to have superior expertise in delivering specialty care Special Beginnings (prenatal management) 24/7 Nurseline Weight Management Program (BCBSTX) Blue Access - online personal health manager (coaching, weight loss, nutrition, exercise plan) Discounts and special offers are available for Jenny Craig, health and fitness memberships and alternative health 22

23 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 and click on the quick link for BCBSTX. Or, go direct to website 23

24 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 Condition Management - $50 per covered employee partner/ $75 per covered family 24

25 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 2015 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 for more information on wellness incentives under the Medical Plan 25

26 Dental Plan Options no changes for 2015 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. Delta DPO a dental provider organization with in-network and non-network benefits 26

27 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 Preventive Services Benefit Offices Visits Cleanings X-rays Basic Services Benefit Filling Amalgam Filling Resin None None You pay $5 per visit No charge No charge No charge You pay $75 $50 $150 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

28 Understanding the Vision Plan: Accessing Benefits 1) Call VSP for a doctor list or visit the VSP website VSP SYSTEMS ) Visit the doctor and pay only the co-payment; No claim filing VSP PATIENTS 2) Call a VSP doctor for an appointment VSP DOCTORS 28

29 Vision Plan at a Glance no changes for 2015 If You Receive From a VSP Provider You Pay... From a Non-VSP Provider You Pay... Eye Exams (every 12 months) $15 copay Up to $50 Eyeglasses (every 12 months) Lenses (per pair) Single Bifocal Trifocal $15 co-pay $15 co-pay $15 co-pay Up to $50 Up to $75 Up to $100 Frames (every 24 months) $15 copay on frames up to $120, 20% discount over this allowance Up to $70 Medically Necessary Contact Lenses (in lieu of eyeglasses) Nothing. Plan pays 100% Up to $210 Elective Contact Lenses Any charges above plan allowance of $120 for contacts and fitting exams. Up to $105 Vision correction surgery, special lenses, prescription sunglasses Discounts are available from certain VSP providers 29

30 Understanding Dependent Care Flexible Spending Accounts (FSA) Eligible Employee Partners do not have to be enrolled in ClubCorp Health 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

31 Additional Health Benefit Plans Group Term Life/AD&D coverage is for Employee Partners only and is available at 1 1/2 times your annual salary up to a maximum of $50,000. Minimal cost to purchase. Supplemental Term Life coverage is available for you and your dependents. EP pays 100% of premium costs. You may add one or two levels of coverage now during open enrollment without having to complete any Evidence of Insurability (EOI) for you or your spouse. Long Term Disability (LTD) coverage is income replacement should you not be able to work due to an illness or injury and is available for eligible Employee 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 Employee Partners who are not eligible for LTD. (If you are eligible, personalized enrollment forms can be found in your OE packet). You may add one level of coverage now during open enrollment without having to complete any EOI. 31

32 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 $

33 Supplemental Life Remember, you may add up to two levels without completing EOI. 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 information and enrollment form in your Open Enrollment packet. 33

34 Open Enrollment for 2015 YOUR RESPONSIBILITY AS AN EMPLOYEE PARTNER 34

35 Your Responsibility as the Employee Partner Review the plan information and costs in your Open Enrollment packet - additional information is available at To enroll or make changes, call People Strategy Benefits at during the enrollment period, M F, 8am to 5pm, CST If no changes (except for medical, HSA, and Dependent Care FSA), no need to call Complete and return the Dependent Care FSA,HSA, STD or Supplemental Life enrollment form, Designation of Beneficiary form, and Authorization form to your OA no later than October 31, Forms are available at Complete the tobacco testing for you and your spouse between November 3 14, 2014 if you wish to receive the medical contribution discounts in 2015, and do not currently have them. 35

36 Open Enrollment is October 20 October 31, 2014 People Strategy Benefits Department: Monday Friday 8:00 a.m. to 5:00 p.m. CST 36