2019 State Health Benefits Plan Annual Open Enrollment (OE)

Transcription

1 2019 State Health Benefits Plan Annual Open Enrollment (OE) Presentation to Active Employees 1 Date: October 2018

2 Making Your 2019 Benefit Election Website Open & Close Dates Website opens at 12:00 a.m. October 15, 2018 Website closes at 11:59 p.m. November 2, 2018 Online Election - Members make their health election at 2

3 2019 Open Enrollment (OE) Open enrollment is from October 15, 2018 thru November 2, 2018 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 2019 Plan Year 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 2019 election 3

4 SHBP Enrollment Portal myshbpga.adp.com Save Time! Update Your Password Before Open Enrollment Your password expires every 45 days. Login to the SHBP Enrollment Portal now to update your password. 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 Need additional help? Call for assistance. Call center hours 8:30a-7:30p, Monday-Friday and 8:00a-5:00p Saturday 4

5 Open Enrollment (OE) and Your Responsibilities Read and make sure you understand the Decision Guide, Plan Documents, Plan Options and Rates 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 in December 2018 to verify that the correct deduction amount has been made. If you are not being charged the correct amount, immediately contact HR/Payroll. If your home/mailing address has changed, visit Employee Self Service and notify HR. Notify SHBP whenever you have a change in covered dependents (within 31 days of a Qualifying Event) 5

6 2019 Qualifying Events and Dependent Verification Process For Employees with Qualifying Events after January 1, 2019: Dependents will not be added to coverage until verification of eligibility is complete. Documentation to demonstrate eligibility must be submitted to SHBP within 45 days of the Qualifying Event. Qualifying Events Include: Marriage/Divorce Gain/Lose Other Coverage Dependent Gains/Loses Medicaid/PeachCare Gain/Lose Guardianship Qualifying Events due to Birth/Adoption/Death will be processed immediately, but verification must occur within 45 days of the event. 6

7 What Happens If I Don t Do Anything? 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 plan option previously selected for If you do not make an election and are currently paying the Tobacco Surcharge, your coverage will default to the 2018 plan option, and the Tobacco Surcharge you are currently paying will continue to apply. If you do not make an election and are currently enrolled in TRICARE Supplement in 2018, you will be enrolled in TRICARE Supplement for

8 Blue Cross/Blue Shield is now Anthem Blue Cross/Blue Shield now branded as Anthem. Anthem and HCA Hospital Contract Negotiation: In October 2018, the Anthem/Blue Cross contract with physicians and hospitals affiliated with Hospital Corporation of America (HCA), to include Memorial Health, was under negotiation. An agreement was reached, Memorial and all affiliated physicians are considered in-network, without interruption in coverage. 8

9 Plan Options 2019 SHBP will continue to offer Anthem/Blue Cross and UnitedHealthcare plan options for 2019, with NO CHANGES to premiums, copays, co-insurance, or deductibles. Health Maintenance Organization (HMO) Statewide, In-Network Only Anthem/Blue Cross United Healthcare High Deductible Health Plan (HDHP) United Healthcare CVS Caremark administers prescription drug pharmacy benefits for all plans. Health Reimbursement Arrangement (HRA) Anthem/Blue Cross Sharecare provides well-being resources and incentive programs for all plans.. * Additional Options: TRICARE Supplement, PeachCare for Kids 9

10 2019 Enhanced Benefits All Plans Wellness Incentive Credits 2018 credits can still be earned through November 30, 2018 Wellness incentive credits will continue to roll over in Rollover credits will be available in April 2019; this allows for processing of any claims submitted at the end of 2018 to apply credits. If you do NOT change Vendor or Plan option, your credits will be available January 1, UnitedHealthcare members with Employee + Spouse or Family coverage can earn a bonus 480 credits in 2019, when both the employee and spouse complete wellness requirements. Incentive credits will be matched for the employee and spouse, up to the 480 bonus credit maximum, total 1,440 credits. Starting in 2019, Anthem/Blue Cross and UnitedHealthcare members will control how their wellness credits are used, via the Sharecare Redemption Center. Credits may be allocated dollar-for-dollar to healthcare expenses, or 480 wellness credits can be redeemed for $150 Visa Gift Card. 10

11 2019 Enhanced Benefits All Plans Applied Behavior Analysis (ABA) for Autism SHBP provides limited coverage for medically necessary ABA for the treatment of Autism Spectrum Disorder (ASD) Maximum benefit of $35,000 per year per approved member. Applicable co-pays, deductibles and/or co-insurance may apply to all covered services Children s Hearing Aids Benefit The benefit allowance for hearing aids for children (up to age 19) is $3,000 per hearing impaired ear every four (4) years. Expanded Mental Health Benefits 2019 Mental Health Benefits will be expanded to include coverage for Methadone Clinics and Residential Treatment Centers. Prior approval is required. Telemedicine/Virtual Visits SHBP will continue to provide access to physicians through telemedicine/virtual visits in 2019 Face-to-face consultations with physicians will be available 24/7, 365 days a year Services will be available from home, office or on the go from a computer, tablet or smartphone that has a web camera There is a Co-Pay for the Anthem/Blue Cross and UnitedHealthcare HMO Plan Options, Co-Insurance for the HRA- Gold, Silver and Bronze Plan Options, Co-Insurance subject to Deductible for the UnitedHealthcare HDHP. 11

12 2019 Enhanced Benefits All Plans Preventive Care Benefits All plans include 100% coverage for services provided in-network, that are properly coded as Preventive Care, as defined by the Affordable Care Act. Disease Management Programs Certain drug costs are waived if you actively participate in the Disease Management Program for diabetes, asthma and/or coronary artery disease. (High Deductible Plan members must first satisfy deductible) Out-of-Pocket Maximums Combined All plans combine medical and pharmacy expenses, when calculating progress toward the out-of-pocket maximum. 12

13 Health Reimbursement Arrangement (HRA) Plan How the Health Reimbursement Arrangement (HRA) Works Offered by Anthem/Blue Cross only. The HRA is funded by SHBP and provides an up-front credit to be used for eligible medical and pharmacy expenses. When going to the doctor, you pay the applicable deductible and co-insurance. There are separate in-network and out-of-network deductibles and out-of-pocket maximums. No specialist referral required, but it is encouraged to have a Primary Care Physician coordinating care. If you have remaining wellness credits in your current HRA account, those credits will roll over to the plan option and/or vendor you select for the 2019 Plan Year. Plan Features Credit: Use HRA Credits to pay for initial medical or pharmacy expenses. No out of pocket expense Deductible: Credits are exhausted. Pay 100% out-of-pocket for medical or pharmacy expenses until deductible is met. Co-Insurance: Deductible is met. Pay co-insurance percentage until out-ofpocket maximum is met. 85% 80% 75% in-network. 13

14 Health Reimbursement Arrangement (HRA) Plan 14

15 High Deductible Health Plan (HDHP) How the High Deductible Health Plan (HDHP) Works Offered by UnitedHealthcare only. Lowest monthly premium of all plans offered. There are separate in-network and out-of-network deductibles and out-of-pocket maximums.. You must pay 100% out of pocket, until you satisfy a high deductible that applies to all covered medical and pharmacy expenses. After the deductible is met, you pay co-insurance for medical/pharmacy services. If you have dependents, the entire family deductible does not have to be met before benefits are payable for any family member. The individual deductible for each family member is $3,500 in-network/$7,000 out-ofnetwork. You may qualify for a Health Savings Account (HSA) through an external banking institution to set aside taxfree dollars to pay for eligible health care expenses. NOTE: Per IRS Rules, the Health Savings Account cannot be used in conjunction with a Flexible Spending Account. If you have remaining well-being incentive credits in your 2018 HIA wellness account, those credits will roll over to the plan option and/or vendor you select for the 2019 plan year. Before you can use well-being incentive credits, you must meet a threshold of $1,350 for individual coverage or $2,700 for other tiers. Co-Insurance: Deductible: Pay co-insurance percentage until out-of- pocket maximum is met. Pay 100% out-of-pocket for medical or pharmacy expenses until deductible is met. Deductible is met. 75% in-network/50% out-ofnetwork 15

16 Health Maintenance Organization (HMO) Plan How the Statewide Health Maintenance Organization (HMO) Works Offered by Anthem/Blue Cross and United Healthcare. The difference is the provider network both plans operate identically. In-network coverage only (except for emergency care). Verify your current provider is innetwork when selecting an HMO Plan Option. Co-pays: $35 Primary Care/Urgent Care, $45 Specialist, $150 Emergency Room Co-pays do not count toward deductible, but do count toward out-of-pocket maximum. Certain services are subject to deductible and 85% co-insurance. Ex. Surgery, non-routine services. No specialist referral required, but it is encouraged to have a Primary Care Physician coordinating care. All physicians must be in-network. If you have remaining well-being incentive credits in your account, those credits will roll over to the plan option and/or vendor you select for

17 2019 Premium Rates *$80.00 Additional surcharge applies to monthly premium for tobacco users 17

18 2019 Pharmacy Benefits Pharmacy Services for Anthem/Blue Cross and UnitedHealthcare Plans CVS Caremark has been selected to administer the pharmacy benefits for members who choose Anthem/Blue Cross and UnitedHealthcare. CVS Caremark has a broad pharmacy network for retail prescription drug products, mail order, home delivery and specialty pharmacy services. CVS Caremark offers a variety of ways to manage your prescriptions: Get up to a 90-day supply of your maintenance medication through CVS Caremark home delivery pharmacy services or at a participating 90-day retail pharmacy Mobile app for easy refills, track expenses, cost comparison, refill reminders, and more. Co-Pay/Co-Insurance Waiver for members enrolled in Disease Management programs for asthma, diabetes or coronary artery disease. You may be eligible to receive management prescription products at no cost. 18

19 ShareCare Wellness 2019 ShareCare Wellness Benefits SHBP will continue partnership with Sharecare to provide Anthem/Blue Cross and UnitedHealthcare members with well-being resources and incentive programs. Anthem/Blue Cross members can earn up to 480 well-being incentive credits, plus an additional 480 for a covered spouse, up to 960 per household. NEW for 2019: UnitedHealthcare members and covered spouses can earn an additional 240 bonus credits each, up to 1,440 maximum credits per household. Health actions must be completed and submitted between January 1, 2019 and November 30, 2019 in order to earn 2019 well-being incentive credits. Current members have until November 30, 2018 to earn incentive credits in the 2018 Plan Year. Remember credits will roll into 2019! All members will have access to a variety of Sharecare s tools, activities and services such as the Sharecare RealAge assessment, personalized profile, personalized content to help improve your health habits, earn green days with daily tracking, wellness resources, well-being coaching, biometric screening, tobacco cessation and more! 19

20 ShareCare Wellness

21 ShareCare Wellness

22 ShareCare Wellness 2019 Online Tracking - Green Days & 5K Steps Challenge Green Days: Tracking of 12 key RealAge health indicators: Stress, activity, sleep, relationships, weight, blood pressure, blood glucose, cholesterol, smoking, drinking, diet, and fitness The Goal: to get at least 8 of12 indicators from a red/yellow status to in the green per day. 60 green days in a 90-day period = 120 wellness incentive credits. 5K Steps Challenge Track steps daily. 5K steps per day for one month = 120 wellness incentive credits. **You must track every day, and cannot enter responses retroactively** 22

23 ShareCare Redemption Center Wellness credits will now be posted to the ShareCare Redemption Center at Two options for redeeming credits: credits earned in 2019 may be redeemed for a $150 Visa gift card. (OR) 2. Increments of 120 credits may be redeemed to your Health Incentive/HRA account for use towards medical/pharmacy expenses. 23

24 Tricare Supplement The Tricare supplement is available for families who are covered under Tricare military insurance coverage. To be eligible, the STC employee and dependents must be: Under age 65 Ineligible for Medicare Registered in DEERS (Defense Enrollment Eligibility Reporting System) How it works: Tricare remains your primary insurance coverage - The supplement is considered secondary coverage. Members have flexibility in selecting civilian physicians, specialists, hospitals and pharmacies. Covers unmarried dependent children under 21, or under 23 if enrolled as a full time student. No tobacco surcharges apply. No COBRA rights, but a portability feature is offered. 24

25 PeachCare for Kids Eligibility Questions? Contact PeachCare: Don t forget, State of Georgia employees are eligible for PeachCare Coverage! Program is income based. Visit for income requirements and income calculator tool. Monthly premiums are incremental based on income. $0-$36 for one child; $72 household max for two or more children. Most services require $0.50-$12.50 co-pay based upon medical services received. No co-payments for: Emergency services Preventive Care Services Immunizations Routine preventive and diagnostic dental services 25

26 If you think you might be eligible for PeachCare Start the enrollment process now! DO NOT drop your children s health coverage under State Health. PeachCare will notify you if you are accepted into the program. Upon being accepted into the program, you may drop your children s State Health insurance coverage. You must notify State Health of your acceptance into PeachCare within 60 days of acceptance. If you are accepted into PeachCare, but lose the coverage in the future, you have 60 days to notify State Health of the loss and add your children to your current health plan. 26

27 Questions or Additional Information 27

28 Important Notice The information provided in this presentation is a summary of changes for the 2019 Plan Year. It is intended only to highlight principal benefits. Please refer to the Active Member Decision Guide for more details. Premium rates, decision guides and other information will be available at THANK YOU! 28