Paulding County School District

Transcription

1 Paulding County School District 2018 BENEFITS OPEN ENROLLMENT REVIEW

2 Employee s Responsibility Review Open Enrollment material Update demographic and beneficiary information on both the State Health Benefit Plan Enrollment website and the bswift enrollment website. Complete enrollment via on-line enrollment systems between October 16, 2017 at 12:00am and November 3, 2017 at 11:59 pm. Notify State Health at or ShawHankins at if you have problems enrolling.

3 Qualifying Life Event Changes What is a Qualifying Life Event (QLE) Marriage Divorce Birth of a child Loss of other coverage Loss of dependent status You must notify the ShawHankins, provide proof of your qualifying event, and enroll within 31 days from the date of the qualifying event.

4 New for 2018 Dental deductions will increase slightly Healthcare Flexible Spending Maximum has increased to $2,600

5 State Health Benefit Plan

6 State Health Open Enrollment Open enrollment is from October 16 th (opens at 12:00 a.m.) November 3 rd (closes at 11:59 p.m.) Members must make their health election at If you do not login to enroll or make changes, you will be defaulted to your current plan, coverage tier and tobacco status. If you are not currently covered and do not enroll, you will continue with no coverage. You may go online as many times as you like but the last election confirmed at the time OE closes will be your election for the 2018 Plan Year. All employees are encouraged to log in and review demographic information including verification of dependent social security numbers and dates of birth. You should print and keep a copy of the confirmation page which will contain a confirmation number - once OE is closed, you will be able to go online at and view your 2018 election.

7 SHBP Enrollment Portal Your Password expires every 45 days. Log in to the SHBP Enrollment Portal now to set up your new Password. Log in using your current Password If it s been over 45 days since the last time you logged in, you ll be prompted to create a new Password (which will expire every 45 days) If you do not know your current User Name or Password: Click the Forgot User ID? or Forgot Password? from the Login page Links are located to the right of the User Name and Password blocks

8 SHBP Open Enrollment Employee Responsibilities Read and make sure you understand the plan materials posted at and other information provided by your employer and take the required actions Confirm that you answered the Tobacco Surcharge question appropriately Check your payroll deduction to verify that the correct deduction amount has been made. If you are not being charged the correct amount, immediately contact your Payroll/Human Resources Department To update any changes in your address, notify your Human Resources Department Notify SHBP whenever you have a change in covered dependents (within 31 days of a Qualifying Event)

9 What If I Do Nothing? Members who do not make an election, either through the web portal or by calling the SHBP Member Services Center, will be defaulted to the same plan option previously selected for 2017 If you do not make an election and are currently paying the Tobacco Surcharge, your coverage will default and the Tobacco Surcharge you are paying in 2017 will continue to apply If you do not make an election and are currently enrolled in TRICARE Supplement in 2017, you will be enrolled in TRICARE Supplement in 2018

10 SHBP 2018-Plan Options 2018 Vendors and Plan Option Offerings SHBP will continue to offer Blue Cross and Blue Shield of Georgia (BCBSGa), UnitedHealthcare and Kaiser Permanente (KP) plan options for However, please keep in mind that if you are retired and over age 65, you will pay the full cost of the unsubsidized premium for these plans as the State will only subsidize the MA Plan Options. Health Maintenance Organization (HMO) BCBSGa (Statewide/In-Network only plan) UnitedHealthcare (Statewide/In-Network only plan) KP (Metro Atlanta Service Area/In-Network only plan) Health Reimbursement Arrangement (HRA) BCBSGa High Deductible Health Plan (HDHP) UnitedHealthcare Medicare Advantage (MA) Preferred Provider Organization (PPO) Standard and Premium UnitedHealthcare BCBSGa CVS Caremark administers prescription drug pharmacy benefits for members who choose BCBSGa or UnitedHealthcare (non- MA). Sharecare provides wellbeing resources and incentive programs for members who choose BCBSGa or UnitedHealthcare (non- MA). *Additional Options: TRICARE Supplement, PeachCare for Kids

11 State Health 2018 Plan Comparison NOTE: Gold, Silver & Bronze = BCBS HRA Plans BCBS/UHC HMO = BCBS & United Healthcare HMO Plans HDHP = United Healthcare High Deductible Health Plan Kaiser HMO = Kaiser Permanente HMO In = In-Network / Out= Out-of - Network

12 How the HRA Plans Works The HRA provides first-dollar coverage for eligible medical and pharmacy expenses and is funded by SHBP. When going to the doctor, you will not pay a co-payment. Instead, you pay the applicable deductible and co-insurance. If you have remaining wellness credits in your current HRA account, those credits will roll over to the next Plan Year. Plan pays 100% of covered services provided by in-network providers that are properly coded as preventive care. You must meet separate in-network and out-ofnetwork deductibles and out-of-pocket maximums You are not required to select a Primary Care Physician (PCP) or obtain referrals to a Specialist (SPC) The credits in your HRA account are used to help meet your deductibles and out-ofpocket maximums The medical and pharmacy out-of-pocket maximums are combined Certain drug costs are waived if SHBP is primary and you actively participate in one of the Disease Management Programs for diabetes, asthma and/or coronary artery disease

13 How the HDHP Works The HDHP offers in-network and out-of-network benefits, and has a low monthly premium. However, you must satisfy a high deductible that applies to all covered medical and pharmacy expenses (except preventive care). Plan pays 100% of covered services provided by in-network providers that are properly coded as preventive care Before you can use well-being incentive credits, members must meet a threshold ($1,300 individual; $2,600 other tiers) You must meet separate in-network and out-of-network deductibles and out-of-pocket maximums You pay co-insurance after meeting the entire deductible for covered medical and pharmacy expenses The medical and pharmacy out-of-pocket maximums are combined There are no co-pays The HSA cannot be combined with a Flexible Spending Account (FSA) The entire family deductible no longer has to be met before benefits are paid for any covered family member.

14 How the Statewide HMO Works An HMO allows you to receive covered medical services from in-network providers only (except for emergency care). It is important to verify your current provider is in-network when selecting an HMO Plan Option. If you have remaining well-being incentive credits in your current BCBSGa MyIncentive Account (MIA) or UnitedHealthcare Health Incentive Account (HIA), those credits will roll over to the Plan Option and/or vendor you select during OE. Plan pays 100% of covered services provided by in-network providers that are properly coded as preventive care Certain services are subject to a deductible and co-insurance You are not required to obtain referrals to see a Specialist (SPC), but are encouraged to select a Primary Care Physician (PCP) to help coordinate your care The medical and pharmacy out-of-pocket maximums are combined Co-pays count toward your out-of-pocket maximum Certain drug costs are waived if SHBP is primary and you actively participate in one of the Disease Management Programs for diabetes, asthma and/or coronary artery disease

15 How the Regional HMO Works The KP Regional HMO Plan Option is available to SHBP eligible members who live or work in one of the 27 counties within the defined Metro Atlanta Service Area.* The 27 covered counties are: Barrow, Bartow, Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Haralson, Heard, Henry, Lamar, Meriwether, Newton, Paulding, Pickens, Pike, Rockdale, Spalding, Walton KP administers the benefits for medical, pharmacy and wellness Plan pays 100% of covered services provided by in-network providers that are properly coded as preventive care Co-pay only option No deductibles The medical and pharmacy out-of-pocket maximums are combined

16 2018 Pharmacy Benefits For Blue Cross and Blue Shield of Georgia (BCBSGa) and UnitedHealthcare Elections Effective January 1, 2018 CVS Caremark will administer the pharmacy benefits for the State Health Benefit Plan (SHBP) members and their covered dependent(s) enrolled in Blue Cross and Blue Shield of Georgia (BCBSGa) and UnitedHealthcare Plan Options. This change does NOT mean Members will have to go to a CVS pharmacy location for their prescriptions. CVS Caremark has a broad pharmacy network. Members and their covered dependent(s) can continue to use local retail and/or chain pharmacies to obtain their prescription medications. Use CVS Caremark s pharmacy locator tool to find a network pharmacy near you. Members receiving specialty medications through Accredo Specialty Pharmacy will be transitioned over to CVS Caremark Specialty Pharmacy. You do not have to obtain a new prescription to continue to obtain your medication(s), unless your prescriptions have expired and/or you don t have any refills left. CVS Caremark Specialty will be contacting all members receiving specialty medications through Accredo Specialty Pharmacy to assists with setting up your medications through mail order and working with your physicians to get new prescriptions, if applicable. Pharmacy paper claims for prescription medication received on or before December 31, 2017 must be filed with Express Scripts no later than December 31, Any requests for appeals and claim adjustments for 2017 pharmacy claims must be submitted by December 31, 2018.

17 2018 Wellness For Blue Cross and Blue Shield of Georgia (BCBSGa) and UnitedHealthcare Elections For the past four (4) years the Be Well SHBP Wellness program administrator has been Healthways. Healthways is now owned by Sharecare. Health actions must be completed between January 1, 2018 and December 15, 2018 in order to earn the well-being incentive credits Members who elect BCBSGa and UnitedHealthcare will have access to a variety of Sharecare tools, activities and services such as the Well-Being Assessment (WBA), wellness incentives, Well-Being Coaching, Biometric Screenings, and onsite activities Members can earn up to 480 well-being incentive credits toward eligible medical and pharmacy expenses, plus up to an additional 480 for a covered spouse (total of 960 per household)

18 2018 Wellness Continued Assess Your Health Complete your 2018 Sharecare Well-Being Assessment (WBA) a confidential, online questionnaire that will take about 20 minutes. Know Your Numbers Complete a biometric screening (body mass index, blood pressure, cholesterol and glucose). At a SHBP-sponsored screening event or, With your Physician using the Sharecare 2018 Physician Screening Form Take Action Complete your WBA, then use the tools that make sense to you. Phone Coaching Get support to eat better, lose weight, stress less, get active, feel happier, or quit tobacco with a Sharecare well-being coach. Complete your WBA and actively engage in telephonic coaching. Earn 60 well-being incentive credits for completing one (1) coaching call in a calendar month - up to four (4) times in a Plan Year, for a maximum of 240 wellbeing incentive credits. NOTE: Only one call in a calendar month qualifies for the 60 well-being incentive credits. Online Resources Complete your WBA and record five online well-being activities using the same tracker within a calendar month and earn 40 well-being incentive credits. Sample activities: track exercise five (5) times, record daily steps five (5) times, track food five (5) times. You can earn these incentive credits up to six (6) times in a Plan Year for a maximum of 240 wellbeing incentive credits. What You Will Earn* Complete BOTH and earn 240 well-being incentive credits Earn up to 240 wellbeing incentive credits

19 2018 Wellness Continued For Kaiser Permanente (KP) Election SHBP is again excited to partner with KP, to provide members who elect KP with wellness resources and incentive programs Members that elect KP will have access to a variety of their tools, activities and services such as the Total Health Assessment (THA), Biometric Screenings and Online and Onsite Healthy Living Classes As a part of the KP Wellness Program, if you sign up on and complete all four health activities* (e.g., completing a biometric screening, completing all age/gender appropriate preventive cancer screenings, completing one online health education class, and completing your THA), you will receive a $500 Visa gift card (up to $1,000 per household for you and your covered spouse) Health activities must be completed between January 1, 2018 and November 30, 2018 in order to earn the $500 Visa gift card

20 State Health 2018 Premiums

21 Questions or Additional Information Resource Member Services Website Blue Cross and Blue Shield of Georgia (BCBSGa) Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET Kaiser Permanente (KP) Member Services: Monday thru Friday, 7:00 a.m. to 7:00 p.m. ET UnitedHealthcare Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET Sharecare (formerly known as Healthways) Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET CVS Caremark Member Services: 24 hours a day/7 days per week SHBP Member Services Member Services: Monday thru Friday, 8:30 a.m. to 5:00p.m. ET, Saturday, 8:00 a.m. to 5:00 p.m. ET PeachCare for Kids TRICARE Supplement Social Security Administration Centers for Medicare & Medicaid Services (CMS)

22 Important Notice The information provided in this presentation is a summary of changes for the 2018 Plan Year. It is intended only to highlight principle benefits Please refer to the Active Decision Guide for more details Premium rates, Decision Guides and other information is available at

23 Dental Coverage

24 2018 Dental Plan Option Administered by MetLife Plan Provisions Low Plan High Plan Deductible (cal. Year) Single Family Max $50 $150 $50 $150 Annual Benefit Max $500 calendar year $1,000 calendar year Diagnostic/Preventive Services Basic Treatment 100% coverage; no deductible 100% coverage; no deductible 40% coverage; subject to deductible 80% coverage; subject to deductible Major Treatment Orthodontia (child only children up to age 26) 25% coverage; subject to deductible Not covered 50% coverage; subject to deductible 50% coverage up to lifetime benefit maximum of $1,000

25 2018 Dental Payroll Deductions Coverage Tier Low Plan High Plan Employee Only $17.98 $26.90 Employee + 1 Dependent $50.46 $75.54 Employee + Family $72.04 $ Log on to metlife.com and go to I Want To Find a MetLife Dentist. Enter your zip code and select the PDP Plus network. Enter your search criteria and click on the SEARCH button. For additional assistance contact: (800)

26 Vision Coverage

27 2018 Vision Plan Administered by Avesis Benefit In-Network Out-of-Network Frequency Vision Exam $10 copay Up to $35 allowance Contacts Fitting Standard Covered in full Not covered Contact Lenses * Elective Medically Necessary Standard Plastic Lenses Single Vision Bifocal Trifocal Frames Up to $130 allowance Covered in full Covered in full after a $20 copay Up to $50 wholesale (approximate retail value is $100-$150) Up to $130 allowance Up to $250 allowance Up to $25 allowance Up to $40 allowance Up to $50 allowance Up to $45 allowance Once every 12 months Once every 12 months Once every 12 months Once every 12 months Once every 24 months

28 2018 Vision Payroll Deductions Coverage Tier Vision Employee $6.56 Employee + 1 Dependent $11.80 Employee + Family $17.34 To locate an in-network provider log on to avesis.com and go to Provider Search. Enter your zip code and desired radius then click on SEARCH BY RADIUS. For additional assistance contact: (855)

29 Basic Life

30 Employer Paid Life Insurance Administered by Unum Basic Life & Accidental Death and Dismemberment Full Time Administrators & Technical Professional Employees = $30,000 All Other Full Time Employees = $15,000 Paulding County School District provides this benefit at no cost to you. Dependent Basic Life Insurance with AD&D may be purchased for your spouse and/or children: $5,000 for Eligible Spouse $3,000 for each Eligible Child up to age 19 or to age 26 if a full time student The cost for family coverage is $2.00, which will apply regardless of the number of dependents covered

31 Voluntary Term Life

32 Voluntary Term Life Insurance Administered by Unum Benefit Employee Voluntary Life/AD&D Spouse Voluntary Life/AD&D Child(ren) Voluntary Life Annual Enrollment Coverage You can purchase coverage in increments of $10,000 up to a maximum of $500,000 not to exceed 6x your annual salary. New Hires: You will have a guarantee issue (GI) amount of $300,000 (not to exceed 6x your annual salary). Employee elections over GI will require Evidence of Insurability. You can purchase coverage in increments of $5,000 to a maximum of $500,000 not to exceed 100% of the employee amount. New Hires: You will have a guarantee issue amount of $50,000 not to exceed 100% of the employee amount. You can purchase coverage in increments of $2,000 to a maximum of $10,000 for children 6 months or older. Children are eligible up to age 19 or age 26 if a full time student. If you and your eligible dependents elect coverage when initially eligible and wish to increase the amount at the following open enrollment, you may apply for any amount up to $300,000 or 6 x salary for yourself and any amount up to $50,000 for your spouse. Any coverage over the Guarantee Issue amount will be subject to Evidence of Insurability (EOI). All new employees will be defaulted to $10,000 of coverage. If you wish to waive this coverage or elect a different amount, you must complete the election via the bswift enrollment portal or contact a ShawHankins benefit consultant at

33 Short Term Disability

34 Short Term Disability Administered by Unum Benefit Weekly Benefit Amount Benefits Begin After (Elimination Period) Maximum Benefit Duration Contributions Pre-Existing Condition Coverage You can choose a benefit that is 40%, 50%, or 60% of your before tax weekly earning to a maximum of $1,500 per week. The later of your accumulated Sick Leave or 14 days (for sickness or injury) 11 Weeks Standard Pregnancy 6 Weeks Payroll deductions are based on salary and age. Note: Rates are age banded and will change at policy anniversary if you move into a new age band. None NOTE: YOU MUST EXHAUST YOUR ACCUMULATED SICK LEAVE BEFORE SHORT TERM DISABILITY BENEFITS WILL BEGIN TO PAY.

35 Long Term Disability

36 Long Term Disability Administered by Unum Benefit Monthly Benefit Amount Coverage 60% of your monthly salary to a maximum of $10,000 per month Benefits Begin After (Elimination Period) Maximum Benefit Duration Contributions 90 days SSNRA (Social Security Normal Retirement Age) Payroll deductions are based on salary and age. Note: Rates are age banded and will change at policy anniversary if you move into a new age band. Pre-Existing Condition 3/12 NOTE: YOU MUST EXHAUST YOUR ACCUMULATED SICK LEAVE BEFORE LONG TERM DISABILITY BENEFITS WILL BEGIN TO PAY. Pre-Existing Conditions are those conditions which you received medical treatment, care or consultation, including diagnostic measures or took prescribed drugs or medications during the 3 months preceding the effective date of this policy. Pre-Existing Conditions are not covered during the first 12 months of coverage. Note: Credit will be given to those that have satisfied or partially satisfied the provision with the prior carrier.

37 Flexible Spending Accounts

38 Flexible Spending Account Administered by Continuon Services, LLC. Flexible Spending Account (FSA) Medical Flexible Spending Account Set aside as much as $2,600 Deductibles, co-payments, co-insurance, vision, dental May rollover up to $500 in unused healthcare FSA funds to next plan year Members will receive a debit card to use for payment of eligible expenses. Dependent Care Spending Account Up to $5,000 if head of household or are married filing joint return Or up to $2,500 if you are married filing a separate return Employees must log into bswift and enroll in order to continue participation in the flexible spending accounts for 2018.

39 Supplemental Benefits

40 Accident Insurance Administered by Unum Paulding County School District offers voluntary Group Accident Insurance through Unum. Unum s Accident Insurance is designed to help you through the different stages of care for an accidental injury by providing benefits directly to you for initial care and treatment, in addition to the followup care you may need. The accident plan is guaranteed issue, so no health questions are required. Coverage is also available for your spouse and children. Examples of covered injuries include: broken bones burns ruptured discs torn ligaments concussion cuts repaired by stitches Some covered expenses include: emergency room treatment occupational therapy outpatient surgery facility doctor office visit chiropractic visit hospitalization Per Pay Period Deductions Employee $11.36 Employee + Spouse $17.49 Employee + Child(ren) $21.13 Family $27.26

41 Critical Illness Administered by Unum Paulding County School District offers employees the option to enroll in Critical Illness offered by Unum. This benefit is designed to help employees offset the financial effects of a catastrophic illness with a lump sum benefit if an insured is diagnosed with a covered critical illness. All eligible employees my elect this coverage for themselves or their family. Child coverage is automatically included with Employee coverage. Pays a lump sum amount at time of diagnosis of a covered illness. Benefit Choices: From $5,000 to $50,000 for Employees and $5,000 to $30,000 for Spouse coverage. Some covered illnesses are: Heart Attack, Stroke, Coronary Artery Bypass, Major Organ Transplant, End State Renal Failure. Wellness Benefit: Pays you a $75 benefit when you have an annual preventive screening: Ex) colonoscopy, EKG, Stress Test, Mammogram, PSA.

42 Hospital Indemnity Administered by Unum Hospital Indemnity is offered through UNUM. This coverage pays a cash benefit directly to you when admitted to the hospital. Coverage is guaranteed issue, so no medical questions are required. Benefit Coverage Hospital Confinement Daily Confinement Intensive care Waiting period $1,000 per insured per calendar year $100 per day (maximum 15 days) $100 per day (maximum 15 days) 30 days for new employees Monthly Premiums Employee $21.32 Employee + Spouse $40.59 Employee + Child(ren) $28.72 Family $47.99 Portability Not Included

43 Whole Life Administered by Unum While Term Life Insurance is an important benefit to maintain through your working years, Whole Life Insurance can also provide you with an additional level of Life Insurance coverage. This coverage is available through Unum. FLEXIBILITY TO MEET YOUR NEEDS Employee Coverage amount: $2,000 - $300,000 Spouse Coverage amount: $2,000 - $75,000 (not to exceed employee s coverage) Children Coverage amount: $5,000 - $50,000 BUILDS CASH VALUE In addition to having valuable life insurance protection, you can accumulate savings at a guaranteed rate of return. You have access to your cash value and have the ability to make loans or withdrawals. ACCELERATED DEATH BENEFIT Terminally ill policy holders can request benefits early to help pay expenses. PERMANENT INSURANCE PROTECTION Once your insurance application has been approved and payroll deductions have started, the coverage is yours to keep by continuing to pay premiums. Your premium will never increase. PORTABILITY Take your coverage with you if you leave the company (with certain stipulations).

44 Legal Coverage Administered by ARAG In-Office Attorney Services: reviewing and preparing documents, providing legal advice and consultation, representation in court Telephonic Advice: assistance in reviewing and preparing documents, will preparation, financial education and counseling Online Resources: Guidebooks and videos, DIY Docs- state specific legal documents, online financial tools Identity Theft Protect- No additional cost

45 Resource Center & Enrollment

46 Benefit Resource Center The Benefit Resource Center provides you with the most up-to-date information on the many valuable benefit options available to you through Paulding County School District. Here you can easily access your Benefit/Enrollment Guides and summaries; connect to your enrollment portal(s), both State Health and ShawHankins as well as access forms & customer service resources. Website: net/pcsd/

47 bswift Enrollment Portal HOW TO ENROLL Go to At this time, make sure to disable your pop up blocker At the enrollment website enter your Username and Password. Username is your first initial of your first name, last name and last four digits of your social security number. Example ( jdoe4567) Password is the last 4 digits of your social security number ( ex. 4567) You will then be prompted to create a new password. You MUST enroll in the Flexible Spending Accounts in order to continue your participation. All employees are encouraged to verify your demographic and dependent information (including dependent social security numbers and dates of birth), and your beneficiaries for life insurance.

48 ShawHankins Call Center The Call Center is available from 8:30 a.m. to 5:00 p.m. Monday through Friday to assist you. We have an afterhours voice mailbox and your call will be returned the next business day

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