2019 Open Enrollment

Transcription

1 2019 Open Enrollment

2 Health Care Commission (HCC) Changes to the State Employee Health Plan are voted upon annually by members of the Kansas State Employees Health Care Commission. The HCC is composed of (5) members. The Secretary of Administration and the Commissioner of Insurance serve as members of the HCC as mandated by statute, while the Governor appoints the other three members. K.S.A requires one member to be a representative of the general public, one member to be a current state employee in the classified service, and one member to be a retired state employee from the classified service. Sarah Shipman Chair and Secretary of Administration Ken Selzer Commissioner of Insurance Heather Young Current Employee from the Classified Service Steve Dechant Retiree from the Classified Service J. Scott Day Representative of the General Public

3 NEW for 2019 Plan Year PREMIUMS The HCC voted to increase premiums for both employees and employers: Employee / EE + Child = +3.3% EE + Spouse / EE + Family = +16.7% (Final year of phased spousal cost adjustment) DENTAL Dental coverage can be elected as a stand-alone benefit for 2019 HSA/HRA PROVIDER NueSynergy will replace Optum as the provider for HSA/HRA accounts. Members with Optum HSA s will can roll balances into the NueSynergy account after Jan 1 st (optional). NEW ID CARDS BCBSKS & Caremark new cards to all enrolled members NueSynergy new cards to all HSA/HRA participants and new FSA account holders Aetna/Delta/Surency/Quest new cards to members who make coverage changes

4 NOT Changing in 2019 ACTIVE ENROLLMENT Members must log into the member portal ( during the month of October to choose their 2019 plan. Members who do not enroll will be defaulted into Plan N (HRA option) with their current carrier. Exceptions: members who waived coverage, or members only enrolled in vision and/or supplemental (MetLife) coverage for CARRIERS Medical Aetna / BlueCross BlueShield of Kansas Preferred Lab Quest Diagnostics / Stormont Vail Health Pharmacy Caremark Dental Delta Dental of Kansas Vision Surency Vision Supplemental MetLife

5 NOT Changing in 2019 (Cont d) PLAN/COVERAGE OPTIONS The same five medical plans (A, J, Q, C, N) will be offered in 2019 with no changes. No changes to preferred lab, vision, dental, or supplemental benefits. EXISTING ID CARDS Aetna/Delta/Surency/Quest no new cards if coverage doesn t change for 2019 HEALTHQUEST No changes to HealthQuest Rewards premium discount or HRA/HSA incentives.

6 Choosing Your Carrier Members can choose between Aetna or BlueCross BlueShield of Kansas for any of the five plans offered (A, J, Q, C, N). Each carrier has a unique, nationwide network of contracting providers. Provider directories are available on the SEHP website: No matter which carrier/plan you choose, your coverage will include: - 100% coverage for many preventive care services - No lifetime benefit maximums - Prescription drug coverage through Caremark - Virtual office visits available 24/7 via internet or smartphone - Preferred Lab benefits through Quest / Stormont-Vail

7 Virtual Office Visits For all plans, both medical carriers offer virtual office visit service with licensed medical providers via internet or smartphone, 24 hours a day. These providers can treat many common conditions (cold & flu, pink eye, allergies, skin, etc.), and send medically necessary Rx to a pharmacy of your choice. They can also provide info to your primary care physician for follow up. Virtual office visits have a lower out-of-pocket cost to members compared to urgent care or ER visits ($10 copay on Plan A, $40 or less on Plan J/Q/C/N; payment due a time of service). Registration with the service is required prior to utilization: TELEDOC (AETNA) AMWELL (BCBSKS) or download the Amwell app from the App Store / Google Play

8 Preferred Lab Benefit Same benefits through either medical carrier: Plan A 100% coverage for eligible out-patient lab services Plan J/Q/C/N discounted lab services until deductible is met, then covered at 100% QUEST DIAGNOSTICS - Statewide preferred lab vendor - Physicians can draw labs and send to Quest - Members can have lab work drawn at a Quest location with doctor s lab orders - Access test results through MyQuest portal - STORMONT-VAIL HEALTH - Regional lab vendor for Topeka, Emporia, Manhattan, Wamego - Show your medical card to access benefit

9 Choosing Your Plan Five different plan designs provide flexibility in deciding how to pay for healthcare. Each plan covers the same healthcare services, but with a different combination of premium, deductible, coinsurance, and out-of-pocket maximum: - One traditional plan with copays for office visits (Plan A) - Two low-deductible plans with HRA for optional HealthQuest Rewards (Plan J/Q) - Two high-deductible plans with Health Savings Account (Plan C/N) See Coverage Examples later in this presentation for application of these plans to common scenarios. See Ask Alex later in this presentation for information on a new online interactive coverage advisor tool that can help you choose a plan.

10 Choosing Your Plan* In-Network* A J Q C N DEDUCTIBLE (Many preventive-care services covered at 100%) $1,000 (1) $2,000 (2) $3,000 (3+) $500/$1,000 $500/$1,000 $2,750/$5,500 $2,750/$5,500 COINSURANCE 20% 25% 50% 20% 35% OOP MAX $6,250/$12,500 $7,350/$14,700 $6,650/$13,300 $5,500/$11,000 $6,650/$13,300 OFFICE VISIT* $40/50/60 Copay Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Rx COINSURANCE 20/40/65% Deductible, then 20/40/65% Deductible, then 20/40/65% Deductible, then 20/40/65% Deductible, then 20/40/65% LAB SERVICES (Preferred Provider)* Covered 100% Deductible, then 100% Deductible, then 100% Deductible, then 100% Deductible, then 100% HQ REWARDS* Discount Only $500/$1,000 $500/$1,000 $500/$1,000 $500/$1,000 Annual Employer HSA/HRA Contribution (Full-Time)* N/A N/A N/A Employee - $1,000 EE+Children - $1,750 EE+Sp/Family - $1,250 Employee - $500 EE+Children - $875 EE+Sp/Family - $625

11 Plan A DEDUCTIBLE: $1,000/$3,000 COINSURANCE: 20% OUT-OF-POCKET MAX: $6,250/$12,500 Rx COINSURANCE: 20/40/65%* SPECIALITY Rx COPAY: $100 max OFFICE VISITS: $40/60/50 copay* LAB SERVICES: 0% coinsurance* (In-Network) *Plan A is the ONLY plan with office visit copays, no prescription deductible, and lab services covered at 100% by the preferred vendor HEALTHQUEST REWARDS Premium Discount Only ANNUAL EMPLOYER HSA/HRA CONTRIBUTION N/A

12 Plan J* w/ HRA (In-Network) DEDUCTIBLE: $500/$1,000 COINSURANCE: 25% OUT-OF-POCKET MAX: $7,350/$14,700 Rx COINSURANCE: Deductible, then 20/40/65% OFFICE VISITS: Deductible & Coinsurance LAB SERVICES: Deductible, then covered 100% HEALTHQUEST REWARDS Premium Discount; up to $500 for each employee/covered spouse in HRA ANNUAL EMPLOYER HSA/HRA CONTRIBUTION HSA not available in this plan *Plan J is the only plan that meets the requirements for J-1/J-2 visas

13 Plan Q w/ HRA DEDUCTIBLE: $500/$1,000 COINSURANCE: 50% OUT-OF-POCKET MAX: $6,650/$13,300 (In-Network) Rx COINSURANCE: Deductible, then 20/40/65% OFFICE VISITS: Deductible & Coinsurance LAB SERVICES: Deductible, then covered 100% HEALTHQUEST REWARDS Premium Discount; up to $500 for each employee/covered spouse in HRA ANNUAL EMPLOYER HSA/HRA CONTRIBUTION HSA not available in this plan

14 Plan C w/ HSA or HRA DEDUCTIBLE: $2,750/$5,500 COINSURANCE: 20% OUT-OF-POCKET MAX: $5,500/$11,000 (In-Network) Rx COINSURANCE: Deductible, then 20/40/65% OFFICE VISITS: Deductible & Coinsurance LAB SERVICES: Deductible, then covered 100% HEALTHQUEST REWARDS Premium Discount; up to $500 for each employee/covered spouse in HRA/HSA ANNUAL EMPLOYER HSA/HRA CONTRIBUTION for FT EMPLOYEES Employee Only $1,000 Made in quarterly installments Employee + Spouse/Family $1,250 Employee +Children $1,750 Minimum employee HSA contribution of $25/paycheck required on Plan C

15 Plan N w/ HSA or HRA DEDUCTIBLE: $2,750/$5,500 COINSURANCE: 35% OUT-OF-POCKET MAX: $6,650/$13,300 (In-Network) Rx COINSURANCE: Deductible, then 20/40/65% OFFICE VISITS: Deductible & Coinsurance LAB SERVICES: Deductible, then covered 100% HEALTHQUEST REWARDS Premium Discount; up to $500 for each employee/covered spouse in HRA/HSA ANNUAL EMPLOYER HSA/HRA CONTRIBUTION for FT EMPLOYEES Employee Only $500 Made in quarterly installments Employee + Spouse/Family $625 Employee +Children $875 Employee HSA contribution optional but not required on Plan N

16 HSA vs HRA HEALTH SAVINGS ACCOUNT (Plan C/N Only) Portable account that is yours to keep; entire balance rolls over every year CANNOT be covered by TRICARE, Medicare, or claimed as a dependent Contribution limit = $3,500/$7,000 (including employer contribution and HealthQuest) Plan C: employee must contribute at least $25/paycheck Plan N: employee contribution optional, but not required Contribution amount can be changed at any time HEALTH REIMBURSEMENT ACCOUNT (Plan C/J/N/Q) Use-it or lose-it account that only holds employer funds Same employer contribution as HSA, but balance does not roll over Plan J/Q: members will have an HRA for any HealthQuest dollars earned Plan C/N: members can elect the HRA in lieu of the HSA if not HSA-eligible Tax dependent expenses qualify for HSA/HRA reimbursement, even if the dependent is not covered by the health plan!

17 Flexible Spending Accounts HEALTHCARE FSA Contribute up $2650 pre-tax to pay for eligible medical, dental, prescription, vision expenses not covered by insurance. - Entire elected amount available on Jan 1 st - Can be elected without medical coverage - Limited to vision/dental if enrolled in HSA - $500 rollover maximum $32,000 Salary No FSA FSA Gross Wages $1, $1, FICA/Fed/State Tax ($275.48) ($203.24) FSA Contribution ($250.00) ($250.00) Net Earnings $ $ Savings Per Paycheck $72.24 Savings Per Month $ Savings Per Year $1, DEPENDENT CARE FSA Contribute up to $5,000 pre-tax per calendar year for dependent care costs for a child under 13 or a spouse/dependent who is unable to care for themselves. - Both spouses/parents must be employed or looking for work - Daycare, preschool, before/after school programs, tutoring, etc. - NO rollover!

18 Dental DELTA DENTAL 2 cleanings/exams per member, per plan year covered at 100% Annual benefit maximum: $1,700 ($1,000 lifetime orthodontic) Restorative services deductible: $50 Individual / $150 Family Restorative Coinsurance (In-Network) PPO Network Premier Network Basic Benefit Basic Restorative 50% 50% Major Restorative 60% 70% Enhanced Benefit (1 exam/cleaning in prior 12 months required) Basic Restorative 20% 40% Major Restorative 50% 50% PREVENTIVE COST SAVINGS Retail cost of 2 cleanings/exams per person = $250 ($1,000 for family of 4) Employee only annual premium = $146 ($525 for family of 4)

19 Vision SURENCY VISION NOT needed for eye exam coverage $25 copay for standard eyeglass lenses (single/bifocal/trifocal/lenticular) $35 copay for contact lens fitting; Up to $150 contact lens allowance (1x, single purchase) Contacts and frames can be claimed in same year (but not contacts and eyeglass lenses) Eyeglass Hardware Basic Advanced Frames Up to $100 Up to $150 Progressive Lenses Not Covered Up to $165 High-Index Lenses Not Covered Up to $116 Polycarbonate Lenses Up to $40 Covered in Full Scratch Coating Up to $15 Covered in Full UV Coating Up to $15 Covered in Full

20 Supplemental Insurance MetLife ACCIDENT PROTECTION Coverage for 150+ accidents and related treatments Includes $25k accidental death benefit MetLife HOSPITAL INDEMNITY Coverage for hospital admission due to accident or illness Low & high plan options MetLife CRITICAL ILLNESS Lump sum payment upon diagnosis of covered condition $10k and $20k benefit options 50% recurrence benefit cancer, heart attack, stroke, etc. 1 Agency for Healthcare Research and Quality. Emergency Room Services-Mean and Median Expenses per PersonWith Expense and Distribution of Expenses by Source of Payment: United States, Medical Expenditure Panel Survey Household Component Data. 2 Agency for Healthcare Research Quality, Statistical Brief #146, Healthcare Cost and Utilization Project, MetLife s Accident and Critical Illness Impact Study, Did You Know? $1,354 1 Average cost of emergency room visit $9,700 2 Average cost of hospital stay 39 Million 3 Injury-related ER visits in Million 3 ER visits resulting in hospital admission in % 4 Survey respondents who reported withdrawing from savings to cover costs associated with a critical illness

21 Rates (Full-Time) SEMI-MONTHLY Plan A Plan J Plan Q Plan C Plan N Dental Employee Only $39.90 $52.56 $26.35 $35.20 $23.25 $6.07 EE + Children $ $91.27 $48.91 $65.02 $43.92 $13.07 EE + Spouse $ $ $ $ $93.38 $14.83 EE + Family $ $ $ $ $ $21.86 MONTHLY Basic Vision Enhanced Vision MetLife Accident MetLife Hospital (L) MetLife Hospital (H) Employee Only $3.68 $7.24 $8.42 $9.12 $17.87 EE + Children $6.51 $12.89 $17.47 $16.19 $32.02 EE + Spouse $7.21 $14.29 $16.64 $17.39 $34.41 EE + Family $10.05 $19.99 $21.94 $27.52 $54.45 MetLife Illness Online at stateofks (Age Rated) See if you qualify for the Kansas HealthyKIDS income-based reduced premium program at Applications must be submitted annually.

22 HealthQuest Employees and covered spouses can participate in wellness activities to earn HealthQuest Rewards in two ways: PREMIUM DISCOUNT Employees and covered spouses who earn 40 HealthQuest credits are entitled to a discount on semi-monthly premium amounts. - Employee / EE + Child = $20/paycheck ($480/year) - EE + Spouse / EE + Family = $10/paycheck for each employee/spouse (up to $480/year) HSA/HRA DOLLARS (PLANS J/Q/C/N) In addition to any premium discounts earned, employees and covered spouses also receive $10/credit in HealthQuest Rewards deposited into their HSA/HRA, up to a maximum of $500 each. HealthQuest Rewards are deposited during the plan year they are earned in. Register online (after SEHP coverage is in effect) at:

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24 Coverage Example #1 Services Included Cost # Total Primary Care Physician Visit $100 2 $200 Generic Prescription $20 2 $40 Total Cost of Care $240 Cost Sharing Plan A Plan J Plan Q Plan C Plan N Copays $80 Prescription Coinsurance $8 Medical Deductible $0 $240 $240 $240 $240 Coinsurance $0 $0 $0 $0 $0 Required Annual HSA Contributions N/A N/A N/A $600 $0 Annual Plan Premium $478 $781 $152 $365 $78 Total Out of Pocket $566 $1,021 $392 $1,205 $318 SCENARIO: Healthy individual with (2) minor illnesses during the year: Employee only coverage HealthQuest discount Estimate only! Actual costs may differ! Potential Cost Mitigation HSA Employee Contributions N/A N/A N/A $600 $? Annual Employer HSA/HRA Contributions N/A N/A N/A $1,000 $500 HealthQuest Dollars N/A $500 $500 $500 $500 Total Potential Cost Mitigation $0 $500 $500 $2,100 $1,000+

25 Coverage Example #2 Services Included Cost # Total Specialist Visit $ $2,400 Preferred Brand Name Prescription $50 2 $100 Lab Work $250 2 $500 Total Cost of Care $3,000 Cost Sharing Plan A Plan J Plan Q Plan C Plan N Copays $480 Prescription Coinsurance $40 Medical Deductible $0 $500 $500 $2,750 $2,750 Coinsurance $0 $625 $1,250 $50 $88 Required Annual HSA Contributions N/A N/A N/A $600 $0 Annual Plan Premium $478 $781 $152 $365 $78 Total Out of Pocket $998 $1,906 $1,902 $3,765 $2,916 SCENARIO: Individual with chronic illness or maintenance medical needs: Employee only coverage HealthQuest discount Estimate only! Actual costs may differ! Potential Cost Mitigation HSA Employee Contributions N/A N/A N/A $600 $? Annual Employer HSA/HRA Contributions N/A N/A N/A $1,000 $500 HealthQuest Dollars N/A $500 $500 $500 $500 Total Potential Cost Mitigation $0 $500 $500 $2,100+ $1,000+

26 Coverage Example #3 Services Included Cost # Total Hospital Stay $10,000 1 $10,000 Surgery $25,000 2 $50,000 Physical Therapy $ $1,800 Total Cost of Care $61,800 Cost Sharing Plan A Plan J Plan Q Plan C Plan N Copays Prescription Coinsurance Medical Deductible $1,000 $500 $500 $2,750 $2,750 Coinsurance $5,250 $6,850 $6,150 $2,750 $3,900 Required Annual HSA Contributions N/A N/A N/A $600 $0 Annual Plan Premium $478 $781 $152 $365 $78 Total Out of Pocket $6,278 $8,131 $6,802 $6,465 $6,728 SCENARIO: Individual with (1) major medical event requiring surgery and outpatient postoperative treatment: Employee only coverage HealthQuest discount Estimate only! Actual costs may differ! Potential Cost Mitigation HSA Employee Contributions N/A N/A N/A $600 $? Annual Employer HSA/HRA Contributions N/A N/A N/A $1,000 $500 HealthQuest Dollars N/A $500 $500 $500 $500 Total Potential Cost Mitigation $0 $500 $500 $2,100+ $1,000+

27 Additional Coverage Examples FROM THE CARRIERS Aetna and BCBSKS have provided Summary of Benefits and Coverage documents for each plan that include additional coverage examples (see page 7 of each document). These are available online at ASK ALEX Alex is an online, interactive tool that makes plan recommendations based on your answers to questions about circumstance/coverage needs, like: - Family status (number of dependents, income, tax status, etc.) - HSA/HealthQuest participation - Estimated frequency of PCP/Specialist visits - Ongoing/occasional prescription needs; generic vs brand name - Estimated need for big ticket items (maternity, surgeries, ER visits, hospital stays, etc.) Alex will rank the plans by total cost based on your estimated usage and will also calculate the worst case for each plan:

28 Optional Group Life Insurance Optional group life insurance is extra coverage beyond your basic, employer-paid benefit. During the month of October, you have the opportunity to enroll in guaranteed issue coverage without answering medical questions. ENROLLMENT View rates and calculate coverage needs at KPERS members can enroll in coverage through member portal at KBOR members enroll via paper form (handout) Who s Covered Plan Coverage Options Guaranteed Issue (Oct 1 st 31 st ) Employee $5,000 increments, up to $400,000 plan max Up to $50,000 (to $250,000 guaranteed max) Spouse $5,000 increments, up to $100,000 plan max Up to $25,000 (to $25,000 guaranteed max) Child $10,000 or $20,000 (one premium for all children) $10,000 or $20,000

29 Resources Enrollment Book ALEX Online Coverage Advisor Tool Webinar Schedule & Registration Vendor Videos Open Enrollment Presentation Schedule SEHP Member Portal Lab Session Schedule How-To Guides (Optional Group Life Insurance) Coverage Calculator Rates

30 Contacts State Employee Health Plan Wichita State University Aetna BCBSKS CVS/Caremark Delta Dental NueSynergy or Optional Group Life Insurance Quest Diagnostics Rx Savings or Stormont Vail Health Surency Vision MetLife