Open Enrollment For Gemini North Employee Benefits. January 1, 2015 through December 31, 2015

Transcription

1 Open Enrollment For Gemini North Employee Benefits January 1, 2015 through December 31, 2015

2 Agenda Our Strategy Our Benefits Package Open Enrollment & Qualifying Events Online Open Enrollment What s Changing Medical/Vision Plans Dental Plans Other Benefits Taking Action 2

3 Our Strategy Plan enhancements Benefits survey indicated a need to enhance dental plans Benefits offered for consistency across plans Healthcare landscape is changing Changes required by carriers because of legislation AURA/Gemini needs to balance employee needs vs. the increasing costs Survey indicated that employees are willing to share in cost to keep similar benefits Create equity of employer contributions while still offering choice 3

4 Our Benefits Package EMPLOYER PROVIDED Life Insurance Accidental Death & Dismemberment Insurance Hawaii TDI Supplemental Short Term Disability Long-Term Disability Employee Assistance Program Travel Accident Medical Benefits Abroad 401(a) Contributions ELECTIONS Medical/Vision Plans (Choice of 4 plans) Dental (Choice of 2 Plans) Flexible Spending Accounts Voluntary Employee & Dependent Life Insurance Voluntary Employee & Spouse Accidental Death & Dismemberment Insurance 403 (b) and 457(b) Contributions 4

5 Open Enrollment November 3 rd through 21 st Your Opportunity to: Add or drop dependents from coverage Change a benefit option or coverage category Participate in a Flexible Spending Account: Health Care Flexible Spending Account Dependent Care Flexible Spending Account 2014 Elections will continue for 2015 except for FSA contributions which must be re-elected Changes are effective January 1, 2015 through December 31, 2015 Only other time you can make changes is at a qualifying event 5

6 Qualifying Events All Qualified Events must be reported to Human Resources within 30 days from time of event, to make a change (add or drop) Marriage, divorce, or legal separation Birth, adoption or placement for adoption of child Death of a spouse or child Change of eligibility Change in Spouse s employment 6

7 Information Sources Informed Healthcare Consumer Open Enrollment Materials Benefits Guide Summary of Benefits and Coverage (SBC) for each medical plan as required by Healthcare Reform Open Enrollment Website Log-In for Open Enrollment materials, summaries of benefits, etc. HMSA Login to Kaiser Login to UltiPro Enroll and look up your current benefit elections 7

8 To View Your Current Benefits 1) Go to: Enter: username & password 2) Hover over Myself 3) Select Current Benefits from the list.

9 To Add or Change Benefits 1) Go to: Enter: username & password 4) Select Link to access your Open Enrollment Session 2) Hover over Myself 3) Select Open Enrollment TIP: These resources are available for you to review for detailed session navigation, including making your elections.

10 Special Enrollment Notes Tips for a seamless enrollment experience: Use Internet Explorer (IE) 9.0 for the best Ultipro Experience. For an Ultipro Browser Compatibility Guide, visit Make sure to read ALL messaging in the session for important information and instructions Scroll through the entire page for all benefit plan options Benefit end date for current benefits is 12/31/2014. New benefit elections will begin effective 01/01/2015. Dependent SSN, Date of Birth, and Gender are required fields in order to add dependents to a plan

11 What s Changing Required plan changes on both HMSA and Kaiser HMO plans HMSA HMO plan adjusted to follow the state s most prevalent HMO plan Kaiser HMO enhancement Medical plan contributions Enhanced dental plans Increased 2015 Healthcare FSA Contribution limit New Provider HealthSmart Benefit Solutions Healthcare and Dependent Care FSA Administrator 11

12 2015 Medical Contributions 2015 Employee 2014 Employee 2015 TOTAL MONTHLY 2015 Employer Cost Cost PREMIUM Semi-Monthly Semi-Monthly Semi-Monthly H M S A Health Plan Hawaii Plus (HMO) EE Only $ $ $0.00 $0.00 EE + One Dependent $ $ $84.32 $81.20 EE + Family $1, $ $ $ Preferred Provider Plan (PPO) EE Only $ $ $9.63 $0.00 EE + One Dependent $ $ $ $86.76 EE + Family $1, $ $ $ K A I S E R Kaiser HMO Plus EE Only $ $ $12.85 $0.00 EE + One Dependent $ $ $ $90.74 EE + Family $1, $ $ $ Kaiser Added Choice EE Only $ $ $86.24 $0.00 EE + One Dependent $ $ $ $ EE + Family $1, $ $ $

13 2015 Dental Contributions HMSA Plans D90 and L TOTAL 2015 Employee 2014 Employee 2015 Employer MONTHLY Cost Cost PREMIUM Semi-Monthly Semi-Monthly Semi-Monthly EE Only $35.74 $17.87 $0.00 $0.00 EE + One Dependent $71.48 $26.81 $8.94 $7.89 EE + Family $ $35.74 $17.87 $

14 Changes for HMO plans for Kaiser and HMSA HMO HMSA ER copay increase to $100 Outpatient lab/x-ray now $10 copay Inpatient lab now 10% Inpatient now 10% instead of $75 copay PPP ER 20% instead of $75 copay Kaiser HMO Out-of-network access added Office visit copay increase to $20 ER copay increase to $100 Outpatient lab/x-ray $10 copay Outpatient imaging 20% Inpatient now 10% RX copays $5/$10/$45 Added Choice Out-of-pocket maximum lowered Office visit copay increase to $20

15 What HMSA Provides Choice of providers. Large network with more than 6,700 doctors, hospitals, and other providers. Access to quality care. We work closely with doctors and hospitals so they can provide the right care at the right time. Choice of medical plans Preferred Provider Plan and Health Plan Hawaii Plus. Choice of dental plans HMSA Dental Network Program and Participating Provider Dental Program. 15

16 Top Specialty Hospitals 16

17 Preferred Provider Plan Large provider network. Nearly 70 percent of HMSA members. Choose your own doctor. All major hospitals in Hawaii. Receive Mainland and worldwide coverage. 17

18 Preferred Provider Plan Doctor s Office Visit Participating providers: Office visits: $12. Vast majority of services are 10% out of pocket. Maximum Out of Pocket: $2500 for major medical expenses. Nonparticipating providers: Providers who don t have an agreement with HMSA. You pay 30% of eligible charge after $100 deductible. 18

19 Health Plan Hawaii Plus Health Maintenance Organization (HMO). Routine physical exams and preventive screenings at no charge. $20 for office and Urgent Care visits. $100 for emergency room. 10% for hospitalization per day. 10% lab and pathology services. 19

20 Health Plan Hawaii Plus Choosing a Primary Care Provider Search for Providers: hmsa.com. HMSA s mobile app. Directory of Health Centers and Providers. 20

21 Health Plan Hawaii Plus Kauai Aloha State IPA Kauai Medical Associates Kauai Medical Clinic Maui Hawaii IPA - Maui Physicians The Maui Medical Group Hawaii Island West Hawaii Independent Physicians Community Clinics of Hawaii East Hawaii IPA Five Mountain Healthcare Straub Clinic & Hospital 21

22 Health Plan Hawaii Plus What if I need a specialist? What happens if I go to a specialist outside my health center? Self-referrals: Emergencies. Mental health or substance abuse. Vision exam. 22

23 Health Plan Hawaii Plus Emergency Care You pay $100 Urgent Care Call BlueCard at 1 (800) 810-BLUE (2583) Guest Membership on Oahu 23

24 Prescription Drugs $7 for generic. $30 for preferred brand. $30 plus additional member cost for the other brand name cost share. Mail-Order and 90-day at Retail Prescription Drug Programs. $11 for generic. $65 for preferred brand. $200 for other brand. 24

25 Vision Care Exams $10-Preferred Provider Plan and CompMED $20-Health Plan Hawaii Plus Eye glasses and contact lenses $10 for lenses $15 for frames $25 for contact lenses - up to $130 maximum 25

26 HMSA Dental Network Program Plan L95 Network dentists only, including Hawaii Family Dental Centers statewide. Set Schedule of Benefits Copays some lowered No deductible No maximums for preventive, basic and major services Plan pays up to a lifetime maximum of $1,000 or adult and child orthodontia 26

27 Participating Provider Dental Program D90 Choose from a large network of participating dentists. Comprehensive benefits for preventive and major services includes implants. Calendar year max: $2,000 w/rollover $600 Orthodontia max: $1,500 lifetime $25 Individual/$75 Family Deductible o Preventive care: 100 percent no deductible o Routine care: 70 percent after deductible o Major care: 50 percent after deductible 27

28 Enhanced Dental Benefits Condition Cleaning or periodontal maintenance visits every 3 months Periodontal scaling once per quadrant every 24 months* Prediagnostic oral cancer screening every 6 months** Fluoride treatment every 3 months Diabetes Coronary Artery Disease Pregnancy Oral Cancer * Periodontal maintenance and scaling available in plans that offer periodontal benefits. ** Oral cancer screening is a benefit for members who have had oral cancer. Deductible, copayments, coinsurance, and calendar-year benefit maximum provisions don t apply to these in-network services. 28

29 hmsa.com My Account 29

30 Customer Relations Oahu: Preferred Provider Plan CompMED Health Plan Hawaii Plus Neighbor Islands: 1 (800) Hilo: Kona: hmsa.com 30

31 Kaiser Permanente Hawaii Today Care for 1 in 5 Hawaii residents 230,000 members 5 th largest non-gov t employer in Hawaii 4,400 employees 6,100 group customers Caring for our community 31

32 Big Island 32

33 Expanding access to care New Kona Medical Office 40,000 sq.ft. Primary & specialty care 30 exam rooms Pharmacy Lab X-ray + more services 33

34 Maui 34

35 Expanding access to care New Maui Lani Elua Clinic 9,300 sq.ft. Physical therapy Occupational therapy Moanalua Physiatry Road Neurology Occupational health services 35

36 Access to care On mainland: 500+ Kaiser Permanente facilities with access to Hawaii member electronic records Urgent care access in Las Vegas Worldwide coverage for initial urgent and emergency care 36

37 Concierge service Highest quality care 24/7/365 specialty coverage Support for all of our members before, during, and after their stay Complimentary concierge service Air and ground transportation to and from Moanalua Medical Center 37

38 Your Doctors Lead care delivery for Hawaii members Largest multi-specialty group in the State of Hawaii Doctors must be board certified to become an HPMG associate Leading recruitment candidate process Rigorous and ongoing peer and patient satisfaction review 38

39 Easy Access to Care In-person appointments Phone appointments consults for non-urgent matters After-hours and same day appointments Nurse advice line 24/7 Physicians in all medical specialties available 24/7 39

40 Your health plan options 40

41 AURA This chart highlights some of your group s HMO benefits: Covered service Preventive care Doctor s office visits HMO Plus Outpatient lab and X-rays Outpatient surgery Urgent care Emergency care Hospitalization Outpatient prescription drugs (30-day supply) Outpatient prescription drugs (mail order 90-day supply) Annual out-of-pocket maximum You pay No charge $20 copay per visit $1000 allowance for non-kaiser Permanente Primary Care Providers $10 copay / 20% Specialty $10% coinsurance $20 copay per visit at a Kaiser Permanente facility within service area $100 copay per visit 10% coinsurance $5 copay (generic tier 1) /$10 copay (generic tier 2) /$45 copay (brand) $10 copay (generic tier 1) /$20 copay (generic tier 2) /$90 copay (brand) $2,500 individual / $7,500 family This is a summary of some benefits and their copayments and/or coinsurance. This chart does not describe benefits. Please see your Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary. 41

42 AURA This chart highlights some of your group s Point of Service benefits: Covered service In-network You pay Out-of-network contracted You pay Out-of-network non-contracted You pay Preventive care No charge No charge No charge Doctor s office visits $20 copay per visit 20% coinsurance 20% coinsurance Outpatient basic lab and X-rays $20 copay 20% coinsurance 20% coinsurance Outpatient surgery $50 copay per visit 20% coinsurance 20% coinsurance Hospitalization $50 copay / day 20% coinsurance 20% coinsurance Outpatient Prescription Drugs $15 copay / 30 day supply 20% coinsurance Not covered Deductible None $100 individual / $300 family $100 individual / $300 family Annual out-of-pocket maximum $2000 individual / $6000 family $2000 individual / $6000 family $2000 individual / $6000 family Benefit payments are based on the Maximum Allowable Charge (MAC). The MAC is the lesser of (1) the usual and customary charge, (2) the negotiated rate, or (3) the actual billed charges. The member is responsible for charges that exceed the MAC when receiving services from non-participating providers. This is a summary of some benefits and their copayments and/or coinsurance. Please see your Evidence of Coverage and KPIC Certificate of Insurance for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary. 42

43 AURA This chart highlights additional group benefits, both plans: Covered service Optical Chiropractic / Acupuncture / Massage Therapy You pay $150 allowance for glasses or contacts every calendar year The Added Choice plan has a $50 allowance for out-ofnetwork services $20 office visit co-pay, 12 visits per year Active & Fit $100 gym / $10 home fitness program membership Out-of-Area College Student Covers routine primary care for out-of-state full-time college students outside of Kaiser s service area within the U.S. $20 office visit co-pay $10 copay basic lab & imaging 20% coinsurance for testing & prescription drugs This is a summary of some benefits and their copayments and/or coinsurance. This chart does not describe benefits. Please see your Evidence of Coverage for information about coverage, limitations, and exclusions for all benefits, including those not listed in this summary. 43

44 Fitness facility or home exercise? With Active&Fit, you get: Unlimited access at your favorite fitness facility in the Active&Fit network for just $100 per contract year Or, up to two home exercise kits for just $10 per calendar year. Choose from yoga, pilates, aqua aerobics, tai chi, and more. 44

45 Flexible Spending Accounts 2015 Healthcare FSA maximum increases $50 to $2,550 No changes in Dependent Care FSA Two options for reimbursement: Benny Card (Debit Card) Check (Manual Check) $500 Rollover into 2016 New administrator TASC replaced with HealthSmart 45

46 Health Care FSA Why FSA? Pay no taxes on your out of pocket healthcare expenses Healthcare FSA Eligible Expenses include: Medical - office visits, hospitalizations, prescriptions, etc. Dental - office visits, exams, cleanings, x-rays, orthodontia, etc. Vision - prescription glasses, contacts and solutions, reader glasses, etc. Over-the-counter supplies and medications with a prescription Select the amount you believe you will spend during the plan year IRS requires a use it or lose it rule Amended to allow up to $500 in leftover funds to be rolled over into your appropriate account in rollover funds will be calculated after the 60 day run-out period and added to your 2015 elections Limit $2,550 46

47 Health Care FSA OTC Medications Over-the-counter (OTC) medications and drugs are not eligible for reimbursement under Health Care FSA plan unless prescribed by a doctor Any claims submitted for reimbursement that include OTC medications or drugs must be accompanied by a copy of the prescription including patient s name and meets the requirements of a prescription in the state where issued Prescriptions would be valid for one year from the date written Bandages, test kits, and supplies do not require a prescription Vision supplies such as contact solutions do not require a prescription 47

48 Dependent Care FSA Dependent Care FSA Pay for your child care or other qualified dependent care Children through age 12 Not used for dependent medical expenses Limit $2,500/$5,000 for 2015 IRS requires a use it or lose it rule Check out the Child Care Tax Credit Some families benefit more with this option 48

49 Life and AD&D 100% Employer Paid 1 X Salary to $250,000 Age Reductions: To 65% at age 75 To 50% at age 80 Terms at Retirement Travel Assistance (888) Will Preparation 49

50 Voluntary Life Employee $10,000 increments to $500,000 Not to exceed 7X salary Guarantee issue of $100,000 Spouse $10,000 increments to $150,000 Guarantee issue of $30,000 under age 70 Child/Children $10,000 (covers all your children age 6 up to age 26 and financially dependent) If you are currently enrolled for less than the Guarantee Issue Amount, you may increase your coverage $10,000 without Evidence of Insurability during Open Enrollment. 50

51 Voluntary AD&D All Amount are Guarantee Issue Employee $10,000 increments to $500,000 Spouse $10,000 increments to $250,000 Includes Identity Theft Program Support 24/7 This election is separate from the election for voluntary life. 51

52 Hawaii Temporary Disability Insurance (TDI) 100% Employer Paid Benefits begin after 7 days of disability 58% of weekly salary Maximum weekly benefit of $524 (2014 maximum) Benefits may continue for up to 26 weeks 52

53 Supplemental Short Term Disability 100% Employer Paid Benefits begin after 13 days of disability Hawaii TDI integration 60% of weekly salary Maximum weekly benefit of $1,385 Benefits may continue for up to 24 weeks 53

54 Long Term Disability 100% Employer Paid 60% of monthly base pay Maximum monthly benefit of $6,000 Benefits begin after 180 days of disability Benefits can continue to your Social Security Normal Retirement Age (SSNRA) Cost of Living Adjustment (COLA) 3% Retirement Savings 10% Calculated on base salary 54

55 Life Assistance Plan (LAP) Free benefit for you and your family Counseling up to three face to face visits per issue per year. Examples include: Work Related Stress Relationship or Marital Issues Parent/Child Conflicts Depression, Anxiety, Grief issues Work Life Programs Legal Consultation (30 minutes free) Financial Information Elder Care and Child Care Available 24/7/365 (800) Login: lap Password: member 55

56 Taking Action Read your Open Enrollment Materials and other information Decide which plan or plans work best for you and your family Make a decision and complete your enrollment through Ultipro no later than November 21 st 2014 Elections will continue for 2015 except for FSA contributions Flexible Spending Account Elections DO NOT roll over. You must reenroll to participate in these options. If you change from the Kaiser Added Choice to the Kaiser HMO Plus you will receive a new ID card All those that are enrolled in HMSA plans will receive new ID cards 56

57 Questions 57