State Tiered Health Plans. Horizon OMNIA Aetna Liberty

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1 State Tiered Health Plans Horizon OMNIA Aetna Liberty

2 Introduction Created in 2016 by a committee of state employee union leaders and representatives from health insurance companies and NJ government Union involvement from the beginning gave us a strong bargaining position leading to lower premiums and (just created over the summer) an incentive for switching Some aspects important for our union: A salary raise for calendar year TAs/GAs would increase percentage of premium paid. Lower premiums soften this effect Can keep incentive money if moved from TA/GA to fellow or PTL A possible step toward good health benefits for PTLs and fellows

3 Overview The plan is designed to encourage us to use some providers over others, creating two tiers, tier 1 being less expensive and tier 2 being more expensive Horizon OMNIA examples (See for a complete listing): Tier 1 includes Robert Wood Johnson in New Brunswick Tier 2 includes St. Peter s Hospital in New Brunswick Aetna Liberty examples (See St. Peter s is tier 1 and Robert Wood Johnson is tier 2

4 Provider Comparison Primary care physicians accepting new patients within 5 miles of NJ Direct: 457 providers Tier 1 Omnia : 336

5 Provider Comparison Primary care physicians accepting new patients within 5 miles of NJ Direct: 457 providers Tier 1 Omnia : 336

6 Provider Comparison Primary care physicians within 5 miles of Aetna Freedom:31 2 Tier 1 Aetna Liberty: 193

7 Provider Comparison Primary care physicians within 5 miles of Aetna Freedom: 312 Aetna Liberty tier 1: 193

8 Costs for OMNIA and Liberty See chart on next slide for cost comparison between plans This chart does not include premiums, an important cost to have in mind when choosing plans Highlights from the chart: Primary care copays for tier 1 decreased to $5 for tier 1 and increased to $20 for tier 2 (compare to $15 for NJ Direct 15/Aetna Freedom 15) No coinsurance for tier 1 providers (compare to 10% for NJ Direct 15/ 15)

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10 Premiums Each plan has associated premiums, for both the plan and the prescription drug program We pay a percentage depending on the level of coverage and salary Annual salaries between $25,000 and $29, pay 7.5% of the premium for single coverage Salaries between $30,000 and $34, pay 10% for single coverage The tables on the next slides estimate the premium paid per paycheck for Academic Year TAs/GAs

11 Medical Premiums for Academic Year Appointments Type Plan Single State Tiered PPO Member & Partner/Spouse Family Parent & Child Horizon Omnia and Aetna Liberty $29.26 $35.12 $44.64 $32.66 NJ Direct 15 and 15 $39.02 $46.82 $59.52 $43.55 NJ Direct 1525 and 1525 $37.93 $45.51 $57.85 $42.33 NJ Direct 2030 and 2030 $35.66 $42.80 $54.40 $39.80 NJ Direct 2035 and 2035 $30.57 $36.80 $46.78 $34.23 HMO Horizon HMO $37.38 $44.86 $57.02 $41.72 Aetna HMO $37.76 $45.32 $57.60 $42.14

12 Medical Premiums for Calendar Year Appointments Type Plan Single State Tiered PPO Member & Partner/Spouse Family Parent & Child Horizon Omnia and Aetna Liberty $18.01 $21.61 $27.47 $20.10 NJ Direct 15 and 15 $24.01 $28.81 $36.63 $26.80 NJ Direct 1525 and 1525 $23.34 $28.01 $35.60 $26.05 NJ Direct 2030 and 2030 $21.94 $26.34 $33.48 $24.49 NJ Direct 2035 and 2035 $18.81 $22.65 $28.79 $21.06 HMO Horizon HMO $23.00 $27.61 $35.09 $25.67 Aetna HMO $23.24 $27.89 $35.45 $25.93

13 Prescription Drug Premiums for AY Appointments Type Plan Single State Tiered PPO Member & Partner/Spouse Family Parent & Child Horizon Omnia and Aetna Liberty $9.70 $11.64 $14.80 $10.83 NJ Direct 15 and 15 $10.70 $12.84 $16.32 $11.94 NJ Direct 1525 and 1525 $9.70 $11.64 $14.80 $10.83 NJ Direct 2030 and 2030 $9.88 $11.85 $15.06 $11.02 NJ Direct 2035 and 2035 $8.89 $10.67 $13.56 $9.92 HMO Horizon HMO $10.70 $12.84 $16.32 $11.94 Aetna HMO $10.70 $12.84 $16.32 $11.94

14 Prescription Drug Premiums for CY Appointments Type Plan Single State Tiered PPO Member & Partner/Spouse Family Parent & Child Horizon Omnia and Aetna Liberty $5.97 $7.16 $9.11 $6.66 NJ Direct 15 and 15 $6.58 $7.90 $10.04 $7.35 NJ Direct 1525 and 1525 $5.97 $7.16 $9.11 $6.66 NJ Direct 2030 and 2030 $6.08 $7.29 $9.27 $6.78 NJ Direct 2035 and 2035 $5.47 $6.57 $8.34 $6.10 HMO Horizon HMO $6.58 $7.90 $10.04 $7.35 Aetna HMO $6.58 $7.90 $10.04 $7.35

15 Premiums The state tiered plans offer a 25% decrease from NJ Direct 15/Aetna Freedom 15 on the medical premium Note that prescription drug copays are larger, but premiums are lower for the tiered plans For calendar year TAs/GAs, the annual premium is the same, but is paid over 26 instead of 16 paychecks Even a small raise for calendar year TAs/GAs would put them in the 10% bracket Switching from NJ Direct 15 to OMNIA would offset this increase in premium costs

16 Incentives Our unions were also able to negotiate for an incentive for switching to the state tiered plan $1,000 for single $1,250 for member & partner/spouse and parent & child $2,000 for family To keep the money, we need to remain enrolled for 2 years if eligible If we become a fellow or PTL, we keep the incentive Comes in the form of a gift card that we should receive before April 2017

17 How the Tiered Plan Saves Money We were able to get the lower premium and incentive because the plan is designed to save the state money The health insurance companies made a deal with their tier 1 providers: Tier 1 providers lower costs in exchange for the insurance companies driving more patients to tier 1 This is in contrast to HMO plans, which keep costs low by disincentivizing primary care physicians from providing tests, treatments and making referrals The tiered plans don t require referrals for specialists

18 Links to More Information For more information, visit the NJ department of treasury division of pensions and benefits website The site provides good summaries of the different plans Human resources also has overviews of benefit plans Doctor finders: en

19 Open Enrollment The open enrollment period ends October 31 To change plans, fill out forms found here Medical Application - State Health Benefits Programs edicalapplication.pdf Either fax or return in person to human resources Keep a signed and dated copy Fax: Address: ASB II, 57 US Highway 1