Benefits Open Enrollment

Transcription

1 Benefits Open Enrollment Plan Year: July 1, 2017 June 30, 2018 Presented by: Greg St. Geme, Account Executive Date: June 6,

2 BSI Benefits 8% 7% 6% 5% 4% 3% 2% 1% 0% BSI Average Annual Rate Increases 7% 5% 5% 4% 3% Did you know Since 2013, the average annual cost per employee for BSI to provide health care coverage has increased from $9,208 to $11,582. These numbers illustrate medical, dental, vision, life and disability benefits. BSI continues to subsidize 77.83% of the total premium associated with the benefits program. This equates to annual costs of $1.9 million dollars 2

3 Our Role: 1. Help BSI evaluate the entire benefits market to design and negotiate high quality, cost effective benefits 2. Assist BSI with managing the Open Enrollment and ongoing support of the benefits program 3. Assist employees with questions, life events, claim problems, etc. via the Benefits Help Desk 3

4 Our Benefits Benefit Carriers Remain the Same! Blue Shield & Kaiser Medical Delta Dental VSP Vision Lincoln Financial Life and AD&D Lincoln Financial Short Term Disability Lincoln Financial Long Term Disability Lincoln Financial Voluntary Life Lincoln Financial Worldwide Travel Assistance WageWorks Commuter Benefits CONCERN Employee Assistance Program 4

5 Open Enrollment & Qualifying Events 3 things to know.. 1 Open enrollment is your annual opportunity to Enroll, waive you and/or your eligible dependent(s) without a qualifying life event Switch medical plans Open enrollment begins on June 6 th and concludes on June 20 th. 2 Enrollment elections for medical, dental, vision, STD, LTD, voluntary life and commuter benefits are effective July 1, 2017 (FSA health care / dependent care open enrollment is in December) 3 After OE, you must have a qualifying life such as marriage, divorce, birth of a child, or loss of coverage to make changes. Changes must be made within 30 days of event date. 5

6 What s changing for the new Plan Year? 1. Blue Shield will mandate changes to the current medical benefits: Access+ HMO /day: New Teladoc service PPO 90: New Teladoc service Increase in non-network coinsurance from 50% to 70% for rehabilitative therapy (occupational, physical and respiratory) benefits and chiropractic services. PPO 80: New Teladoc service For inpatient hospitalization services, the in-network per admit copay has been reduced from $250 to $100 For outpatient surgical services, the $125 per admit copay has been eliminated Increase in non-network coinsurance from 50% to 60% for rehabilitative therapy (occupational, physical and respiratory) benefits and chiropractic services. Acupuncture benefits are now offered within the PPO 80 All Blue Shield members will be getting new ID cards with a unique alpha prefix but their 9-digit ID number won t change. Current ID cards will still be valid but it s advisable to utilize the new ID cards once they receive them 6

7 Employee Contributions July 1, 2017 June 30,

8 Your Benefits Costs Employee Per Pay Period Costs Employee Only (EE) EE + Spouse-DP EE + Child(ren) EE + Family Blue Shield PPO 90 $52.57 $ $ $ Blue Shield PPO 80 $36.51 $ $ $ Blue Shield HMO $46.60 $ $ $ Kaiser CA $37.70 $ $ $ Kaiser OR $30.38 $ $ $ Delta Dental $4.29 $13.85 $15.23 $22.38 VSP $0.61 $1.50 $1.50 / $2.38 $2.38 Life/AD&D, STD, LTD and EAP Plans 100% company paid 8

9 Medical 9

10 Medical Plan Comparison Blue Shield PPO Blue Shield HMO Kaiser Do I need to designate a Primary Care Physician (PCP)? No Yes, can change PCP once per month (prior to the 15 th of month, effective 1 st of month following) Yes, changes to PCP are made immediately Do I have to stay innetwork to receive coverage? No Yes, HMO s don t offer care from OON physician, hospital or facility except in the case of a true medical emergency Yes, HMO s don t offer care from OON physician, hospital or facility except in the case of a true medical emergency Do I need a referral for a specialists? No, PPO plans do not require a referral in order to see a specialist. Yes, written approval is required for most specialists Yes, written approval is required for most specialists Can I access care nationwide? Yes, members can access care from in-network and non-network providers No, emergency care only No, emergency care only Best for you if: You want more provider options and no required referrals You want lower out-ofpocket costs and a more guided health care experience You want lower out-ofpocket costs and a more guided health care experience 10

11 Blue Shield PPO 90 / PPO 80 PPO 90 PPO 80 In Network Out of Network In Network Out of Network Individual Deductible $250 $500 Family Deductible $500 $1,000 Individual OOP Max $2,250 $10,250 $3,500 $10,500 Family OOP Max $4,500 $20,500 $7,000 $21,000 Co-insurance 10% 30% 20% 40% Office Visit Copay $15/visit 30% after ded $35/visit 40% after ded Specialist Office Visit Copay $15/visit 30% after ded $35/visit 40% after ded Teladoc consultation $5 per consultation Not covered $5 per consultation Not covered Inpatient Hospital 10% after ded 30% up to $600/day + all charges in excess of $600 (after ded) $100/admit + 20% after ded 40% up to $600/day + all charges in excess of $600 (after ded) Outpatient Surgery 10% after ded 30% up to $350/day + all charges in excess of $350 (after ded) 20% after ded 40% up to $350/day + all charges in excess of $350 (after ded) Emergency Room $100/visit + 10% (not subject to deductible) $100/visit + 10% (not subject to deductible) $100/admit + 20% (not subject to deductible) $100/admit + 20% (not subject to deductible) Urgent Care $15 30% after ded $35 40% after ded Physical Therapy $15/visit after ded 30% after ded $35/visit after ded 40% after ded Lab/X-Ray $15/visit after ded / 10% after ded 30% up to $350/day + all charges in excess of $350 (after ded) $35/visit after ded / 20% after ded 40% up to $350/day + all charges in excess of $350 (after ded) Chiropractic $25/visit after ded (12 visits / CY) 30% after ded (12 visits / CY) $25 after ded (12 visits / CY) 40% after ded (12 visits / CY) Acupuncture $25/visit after ded (20 visits / CY) 30%+ all charges in excess of allowable amount (after ded) (20 visits/cy) $25 after ded (20 visits / CY) 40% after ded + all charges in excess of allowable amount (20 visits / CY) Rx Generic $10 25% + $10 $10 25% + $10 Rx Preferred $25 25% + $25 $25 25% + $25 Rx Non-Preferred $40 25% + $40 $40 25% + $40 Rx Specialty 30% ($200 Max) Not Covered 30% ($200 Max) Not Covered Rx Mail Order (90-day supply) $20/$50/$80 Not Covered $20/$50/$80 Not Covered 11

12 Accessing Health Coverage under the Blue Shield PPO 1. Confirm physician / facility is participating in the Blue Shield network Contact physician office If non-participating, proceed with CAUTION 2. Provide physician office with Blue Shield ID card 3. Receive and review EOB to confirm accuracy Contact Melita Group Help Desk for assistance 4. Pay provider for services received 12

13 Blue Shield HMO (CA only) In Network Individual Deductible None Family Deductible None Individual OOP Max $2,500 Family OOP Max $5,000 Co-insurance None Office Visit Copay $15/visit Specialist Office Visit Copay $15/visit Teladoc consultation $5 per consultation Inpatient Hospital $500/day for up to 3 days per admission Outpatient Surgery $200 per surgery (Ambulatory Surgery Center) $400 per surgery (Hospital/facility) Emergency Room $100/visit (waived if admitted) Urgent Care Benefits $15/visit Physical Therapy $15/visit Lab/X-Ray No charge Chiropractic / Acupuncture Not covered Rx Generic $10 Rx Preferred $25 Rx Non-Preferred $40 Rx Specialty 20% (up to $200 copayment) Rx Mail Order (90-day supply) $20/$50/$80 13

14 Blue Shield Teladoc - How does it work? Imagine this It is Friday night and you are experiencing flu-like symptoms. You do not want to wait in an emergency room. What can you do? Step 1. Contact Teladoc. Visit Teladoc.com/bsc and complete the required info & click Set up Account or call for assistance. Log into your Teladoc account or call Teladoc, 24/7/365, to request either a phone or online video consultation. Step 4. Settle up. $5 per consultation for HMO and PPO plans (lower cost than a doctor s office visit) Step 2. Talk with a doctor. A U.S. board-certified doctor licensed in your state reviews your Electronic Health Record (EHR) and consults with you, just like an in-person visit. Step 5. Smile. Your medical issue gets resolved, and you save time and money! Step 3. Resolve the issue. The doctor recommends the right treatment for your medical issue. If a prescription is necessary, it is sent electronically to the pharmacy of your choice 22 Minute Average Call Back Time Common uses include: Sinus problems; ear infection; nasal congestion; upper respiratory infection; cough; urinary tract infection; flu; bronchitis; allergies; and pink eye 14 14

15 Blue Shield Employee Resources blueshieldca.com Access plan and benefit information Find participating doctors, hospitals, urgent care centers, pharmacies Check claims status Order new ID cards Information to help understand and manage health conditions Blue Shield Mobile App Provides quick and easy access to important benefits information anytime, anywhere View ID cards, plan summaries,; claims information; Find urgent care facilities NurseHelp 24/7 15

16 Kaiser HMO (CA only) In Network Individual Deductible None Family Deductible None Individual OOP Max $1,500 Family OOP Max $3,000 Co-insurance None Office Visit Copay $15/visit Specialist Office Visit Copay $15/visit Inpatient Hospital $500/admit Outpatient Surgery $15/procedure Emergency Room $100/visit Urgent Care $15/visit Physical Therapy $15/visit Lab/X-Ray No charge Rx Generic $10 Rx Preferred $30 Rx Mail Order (100-day supply) $20/$60 16

17 Kaiser HMO (OR only) In Network Individual Deductible None Family Deductible None Individual OOP Max $2,000 Family OOP Max $4,000 Co-insurance None Office Visit Copay $15/visit Specialist Office Visit Copay $25/visit Inpatient Hospital $250/admit Outpatient Surgery $100/procedure Emergency Room $150/visit Urgent Care $25/visit Physical Therapy $15/visit (20 visits/calendar year) Lab/X-Ray $15/$50 Rx Generic $15 Rx Preferred $30 Rx Mail Order (90-day supply) $30/$60 17

18 Kaiser Employee Resources Healthy Resources On-site health classes and seasonal farmers markets kp.org/classes Healthy lifestyle programs kp.org/healthylifestyles Personal wellness coaching kp.org/wellnesscoach Reduced rates for members kp.org/choosehealthy Multiple ways to connect to care In person - kp.org/kpfacilities Phone By typically receive replies within 2 days By video face-to-face by video from your computer, smartphone or tablet Travel Care If you get sick or injured while traveling, you can access care 24/7 via the Home Travel Line at or kp.org/travel 18

19 Dental 19

20 Delta Dental PPO Delta Preferred Delta Premier Out of Network* Annual Maximum $1,500 $1,500 $1,500 Individual Deductible $50 $50 $50 Family Deductible $150 $150 $150 Deductible Waived for Preventive? Yes Yes Yes Preventive Coinsurance (Cleanings, X-rays) 100% 100% 100% Basic Coinsurance (Oral surgery, Root canal therapy, Fillings and Periodontal surgery) Major Coinsurance (Bridges, Dentures, Crowns, Implants) 90% 80% 80% 60% 50% 50% Ortho Coinsurance 50% 50% 50% Orth Max Lifetime Benefit $1,500 $1,500 $1,500 Adult Ortho Coverage? Yes Yes Yes Items to Remember: 1. Teeth cleanings are provided once per six months. 2. Pre-determination of benefits should be requested for services exceeding $ Enhanced benefits provided by Delta Dental for pregnant members. 4. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and the program allowance for non Delta Dental dentists. 5. Non-Delta Dental dentists may balance bill the difference between the contracted rate and their usual fee for services* 6. Once an employee elects to discontinue dependent coverage, dependents may not be re-enrolled unless there is a qualifying event. 20

21 Delta Dental Website Portal ( 21

22 Vision 22

23 VSP Vision Plan In Network Out of Network Exam $20 Up to $45 Materials $20 Varies Eye Exam - Frequency 12 Months 12 Months Lenses - Frequency 12 Months 12 Months Frames - Frequency 24 Months 24 Months Frame Allowance Up to $150 Up to $70 Contacts (instead of glasses) Up to $150 Up to $105 Items to Remember: 1. Coverage identified with SSN and DOB 2. Services received are based upon a service year 3. 20% discount on additional pair of glasses 4. 20% discount on Laser Eye Surgery 23

24 VSP Website Portal ( 24

25 Life & Disability 25

26 Life and AD&D Insurance Coverage Details Life/AD & D Coverage 1 x Annual Salary Maximum Benefit $175,000 Guarantee Issue Amount $175,000 26

27 Disability Insurance Short Term Disability (pre or post-tax) 7 Days for Injury/Illness Elimination Period (1 st day for Inpatient Hospitalization) Benefit Percentage 66.67% Maximum Weekly Benefit Benefit Duration $2,308/Week 13 Weeks Elimination Period Long Term Disability (pre or post-tax) 90 Days Benefit Percentage 66.67% Maximum Monthly Benefit Benefit Duration $10,000/Month Later of 65 or Normal Social Security Retirement Age How the Post-tax election Works 1. BSI pays the STD and LTD premium directly to Lincoln Financial 2. Disability premium paid by BSI is reported as taxable income 3. Employee pays taxes on the premium, while never actually paying for the premium out of pocket 4. Employee receives tax-free benefit, as if the premium was already taxed 27

28 Voluntary Life Insurance Benefit Amount Employee Spouse/Domestic Partner Child(ren) Minimum $25,000 $10,000 $10,000 (6 months to age 26) Choice of $25,000; $50,000; Choice of $10,000; $25,000; $100,000; $150,000; $50,000; $75,000; or $200,000; or $300,000 $100,000 $300,000, not to exceed 5x earnings Employees age 70+, max benefit is $50,000 $100,000 limited to 50% of employee amount $250 Child: 14 days to 6 months $10,000 Child: 6 months to age 26 $10,000 maximum % of Employee coverage is 50% Guarantee Issue Limit $100,000 $25,0000 $10,000 Items to remember: 1. Rates based upon the employee and spouse s current age (adjusted once per year on the program anniversary date). 2. Employees electing voluntary life coverage may be required to complete the Evidence of Insurability form and undergo the underwriting process. 3. Employees must elect Optional Life coverage in order to cover spouse and/or children 4. Amounts of Life insurance reduced at the following ages: At age 70, benefits are reduced to 65% At age 75, benefits are reduced to 40% 28

29 Worldwide Travel Assistance 29

30 Worldwide Travel Assistance Assistance for you or your immediate family members on any single trip (business or leisure) up to 90 days in length, and more than 100 miles from home. Pre-trip assistance Passport, visa and other required documentation for foreign travel Travel, health advisories and inoculation requirements Emergency travel support services Translation and interpreter services Baggage Document replacement 30

31 Commuter Program 31

32 What Are Commuter Benefits? Allows employee to defer money on a pre-tax basis to be used to pay for: Public transit as part of your daily commute to work Qualified parking as part of your daily commuter to work Eligible expenses include: Bus, light rail, regional rail, streetcar, trolley, subway, or ferry Vanpool Parking at or near work Parking at or near public transportation Simple and Flexible: Sign up two times per year July and January No use-it-or-lose-it provision like FSA 32

33 Commuter Program Enrollment is simple: Determine how much to contribute Funds are taken from your paycheck pre-tax (savings of up to 30%) Contributions can be changed two times annually--july and January Reimbursement options: For all TRANSIT purchases, debit card MUST be used. NOTE: Pay Me Back claims are no longer accepted for transit purchases For PARKING purchases, participants can utilize: Debit card Pay Me Back (traditional claims reimbursement) take care MyFlexsMobile app to submit receipts Contribution Limits Transit is $255 per month Parking is $255 per month 33

34 Employee Assistance Plan 34

35 Employee Assistance Program (EAP) The CONCERN EAP program can help you find solutions for the everyday challenges of work and home, as well as for more serious issues involving emotional and physical wellbeing. All interactions are 100% confidential. Resources available to you include: Short-term Counseling Parenting and Child Care Resources Pet Care Referrals Legal Consultations Financial Counseling Older Adult Services Career Management Online Training courses Videos Specialized forms Calculators Online Education available 24/7 Concern services are free to all BSI employees, their dependents and domestic partners Each eligible person has a 1-5 visit benefit per problem, per 12-month period Contact Concern at and simply tell them you are an BSI employee to access these benefits (company Code: BSI) 35

36 CONCERN Website Portal ( 36

37 Enrollment 37

38 Online Enrollment - Paycom Log onto To log in select Employee. from the drop down box Enter Username, Password and the last four digits of your Social Security number. Select Log In. Chose from the My Benefits tile in the center of the screen or on the left side of the page for 2017 Benefit Enrollment. Click here 38

39 Online Enrollment - Paycom Select Start Enrollment Each screen will have two check boxes: one to enroll and one to decline. You can track the benefits elected and declined on the progress bar on the right side of the screen Please remember, the due date for open enrollment is June 20 th. 39

40 Online Enrollment - Paycom 40

41 BSI Employee Benefit Website ( 1. Log onto: 2. Available 24 x 7 3. Access benefit summaries, SBCs, policy number and customer service numbers 4. Access provider directories 5. Access cost information 41

42 Affordable Care Act (ACA) Affordable Care Act American Health Care Act Proposed Dependent Coverage to age 26 Prohibits exclusions and increased premiums for pre-existing conditions Lifetime and annual limits on essential health benefits were prohibited No proposed change Would allow states to permit insurers to set higher rates for people with preexisting conditions Would allow states to waive essential health benefits this could lead to the return of lifetime and/or annual limits Mandates that employers offer coverage to full-time employees who have worked at a company more than 90 days and at least 30 hours per week (employers with 50+ employees) Insurance plans are subject to nondiscrimination excise tax, know as the Cadillac tax for insurance plans that exceed certain thresholds for high-cost plans ($10, 200/IND; $27,500/FAM) not to occur until 2020 Flexible Spending Accounts are capped at $2,500 per year and adjusted for inflation. Over-the-counter medications became ineligible unless prescribed by physician Imposes an excise tax for failure by an employer offer health coverage to employees (employers with 50+ employees) Cadillac tax would be delayed until 2026 Would repeal annual limits and over-the-counter medications would become eligible. The penalty would be reduced to zero if coverage is not offered by employer Requires minimum preventive benefits without deductibles or other cost sharing. No proposed changes Excise tax for failure to offer affordable coverage for employee only coverage. Employers with at least 50 full-time employees must fill Form 1095-C indicating coverage meets minimum essential benefits and deemed affordable. Penalty may reduce to zero, but requirement to offer affordable coverage will continue to exist. Changes could reduce reporting requirements 42

43 Melita Benefits Help Desk Have questions about benefits? Need help enrolling or adding a dependent? Can t get a claim resolved? We re here to help! Melita Benefits Help Desk helpdesk@melitagroup.com x2 Monday through Friday, 8:00 am 5:00 pm PST 43