Blue Directions SM A New Solution for Health Care Benefits

Transcription

1 Blue Directions SM A New Solution for Health Care Benefits Enclosed please find information regarding your Blue Directions offering. In addition to the Blue Directions information in your renewal exhibit, this packet contains information about the health product package options available to you through Blue Directions. What you need to know To select Blue Directions: o Submit the Blue Directions Employer Administrative Information form to box smgrp1@bcbsil.com or fax it to at least 45 days prior to your effective date. o Once the form has been received, you will receive additional information regarding the next steps and the benefit selection time period for employees to enroll on the Blue Directions platform. o Please note: The Blue Directions enrollment tool is only for actively-at-work employees. Any employees on State Continuation/COBRA or retiree coverage will need to complete a paper application outside of Blue Directions. Please submit the paper application for these individuals to box smgrp1@bcbsil.com or fax it to at least 15 days prior to your effective date. HMO Medical Group Assignment: o For current HMO members, their active medical group selection will remain as is. They will not need to take any further action. For those newly enrolling in an HMO product, a letter will be sent shortly thereafter to the member to select a medical group. Automated Eligibility Processing: o The Blue Directions feed for health enrollment to the Blue Cross and Blue Shield of Illinois (BCBSIL) membership system will replace any feeds you may currently have with an automated eligibility processing (AEP) vendor. To use the Blue Directions platform you will need to discontinue using an AEP vendor for medical enrollment. The vendor can still be used for any ancillary enrollment (e.g., dental, vision, life, etc.) or COBRA administration. Default Plan: o You will have the option to offer a default plan that any actively-at-work employees will be assigned to if they do not enroll during the benefit selection window. If you do not offer a default plan option, those who have not enrolled by the end of the benefit selection window will not be enrolled in a health plan. Please contact your broker or your BCBSIL representative with any questions.

2 Blue DirectionsSM A New Solution for Health Care Benefits Bringing health care benefits to employees can be a challenge. Affordability, flexibility and choice are critical elements in the evolving health care benefits marketplace. Look to the private exchange solution from Blue Cross and Blue Shield of Illinois (BCBSIL) to give your employees an easy way to shop for benefits while you control your health care spending. A Different Model: Defined Contribution The heart of the new option is the defined contribution model, which gives employers greater control over health care expenses by establishing a pre-determined amount for each employee s health care coverage. The traditional defined benefit model doesn t offer this type of cost control. We Do All the Work Let BCBSIL transform your health care benefits program to one that is simple and affordable. With the Blue Directions private exchange option, employer groups can continue to provide employees with a choice of health care benefits while helping temper costs. Reasons to choose the BCBSIL Private Exchange: Defined contribution model helps employers manage rising health care costs with lower, fixed dollar contributions Clearly sets employer s financial responsibility and decreases administrative overhead Allows employers to maintain a competitive level of benefits Creates a positive buying experience for employees because the model is easy to understand, increases employee choice and offers decision-making support Why the private exchange is revolutionizing employer-paid health care benefits: Uses a defined contribution model, not a defined benefits plan Decreases employer costs and lessens administrative responsibilities Lets the consumer make the buying decisions with member-friendly technology and support

3 Steps for employers and employees are easy! Employer Employer 1. Completes the Employer Set Up document 2. Validates employee eligibility 3. Determines the dollar amount they will contribute to the employees health plan needs $ $$$ Employee Employee plan plan plan plan plan plan plan plan plan plan plan 1. Using the online tool or by telephone, each employee completes a survey that helps match health plan options with employee s needs 2. Employee chooses a plan, enrolls and pays for it through payroll deduction 3. A summary lets the employees see what he or she has purchased Shopping and enrollment can be done online or by telephone. Take the Next Step You can offer your employees innovation and high quality health care benefits while reducing overall health care expenses and administrative complexities. Contact your Blue Cross and Blue Shield of Illinois representative today to learn more. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

4 Introducing Blue Directions SM Blue Cross and Blue Shield of Illinois is excited to offer a new health plan benefit option Blue Directions, from Blue Cross and Blue Shield of Illinois (BCBSIL), helps control health care expenses using a defined contribution model. Employers establish a pre-determined amount for each employee s health care coverage. Employees then use the funds contributed by their employer to select and purchase a plan from the Blue Directions platform. Blue Directions plan options: Network DEDUCTIBLE OPX Package N Coinsurance In/Out Office Visit Copay General/Specialist Emergency Room Copay Prescription Drug Benefit Prescription Drug Copay/Coinsurance Plan ID 1 PPO $250 $1,000 80% / 60% $20 / $40 $150 3-Tier $15/$30/$50 NPP PPO $500 $1,000 90% / 70% $20 / $40 $150 3-Tier $10/$40/$60 NPP Select $500 $1,000 80% / 50% $30 $150 3-Tier $10/$40/$60 NBP PPO $1,000 $2,000 80% / 60% $30 / $50 $150 4-Tier $8/$35/$75/$150 NPP8343C 5 PPO $2,500 $5, % / 80% NA NA BlueSCRIPT SM 100% NPSC Select $1,000 $2,000 80% / 50% $30 $150 4-Tier $8/$35/$75/$150 NBP8343C 7 HMO NA $1, % $20 / $40 $150 3-Tier $10/$40/$60 NHHB106 8 HMO NA $1, % $30 / $50 $150 4-Tier $8/$35/$75/$150 NHHB19C Package S 1 PPO $500 $1,000 90% / 70% $20 / $40 $150 3-Tier $10/$40/$60 NPP PPO $500 $2,000 80% / 60% $30 / $50 $150 3-Tier $10/$40/$60 NPP PPO $1,000 $2,000 80% / 60% $30 / $50 $150 4-Tier $8/$35/$75/$150 NPP8343C 4 Select $1,000 $2,000 80% / 50% $30 $150 4-Tier $8/$35/$75/$150 NBP8343C 5 PPO $2,500 $5, % / 80% NA NA BlueSCRIPT 100% NPSC PPO $1,500 $3,000 80% / 60% NA NA BlueSCRIPT 80% NPS PPO $3,500 $5,800 80% / 60% NA NA BlueSCRIPT 80% NPSE3A05 8 HMO NA $1, % $20/$40 $150 3-Tier $10/$40/$60 NHHB106 continued on back

5 Blue Directions plan options: (continued) Network DEDUCTIBLE OPX Package E Coinsurance In/Out Office Visit Copay General/Specialist Emergency Room Copay Prescription Drug Benefit Prescription Drug Copay/Coinsurance Plan ID 1 PPO $250 $1,000 80%/60% $20 / $40 $150 3-Tier $15/$30/$50 NPP PPO $500 $2,000 80%/60% $30 / $50 $150 3-Tier $10/$40/$60 NPP PPO $1,000 $1,000 90%/70% $20/$40 $150 3-Tier $10/$40/$60 NPP PPO $1,000 $2,000 80%/60% $30/$50 $150 4-Tier $8/$35/$75/$150 NPP8343C 5 PPO $1,500 $2,000 80%/60% $30/$50 $150 4-Tier $8/$35/$75/$150 NPP9343C 6 PPO $2,500 $2,000 80%/60% $30/$50 $150 3-Tier $10/$40/$60 NPPC PPO $1,500 $3,000 80%/60% NA NA BlueSCRIPT 80% NPS PPO $2,500 $5, %/80% NA NA BlueSCRIPT 100% NPSC1807 Package W 1 PPO $500 $2,500 70% / 50% NA NA BlueSCRIPT 70% NPV PPO $1,000 $2,000 80% / 60% $30 / $50 $150 3-Tier $10/$40/$60 NPP PPO $1,000 $2,500 80% / 60% NA NA BlueSCRIPT 80% NPV Select $1,500 $2,000 80% / 50% $30 $150 4-Tier $8/$35/$75/$150 NBP9343C 5 PPO $2,500 $5,000 80% NA NA BlueSCRIPT 80% NPSC PPO $3,500 $5,800 80% / 60% NA NA BlueSCRIPT 80% NPSE3A05 7 HMO NA $1, % $20 / $40 $150 3-Tier $10/$40/$60 NHHB106 8 HMO NA $3, % $40 / $60 $250 4-Tier $8/$35/$75/$150 NHVBV02C For more information on Blue Directions, please contact your BCBSIL representative. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

6 Blue Directions Employer Administrative Information Employer Information The employer name must match name as shown on the Blue Cross and Blue Shield of Illinois (BCBSIL) Benefit Program Application.. Employer Name: Mailing Address Line 1: Address Line 2: Tax ID Number: City: State: Zip: Telephone Number: Fax: Health Plan Information The benefit selection period is the period of time in which employees will have access to make benefit selections via the Blue Directions Administrative portal. Upon receipt of the paperwork, the benefit selection date will be provided to the employer by BCBSIL. If employer designates a default health plan, those employees who do not enroll during the benefit selection period will be assigned the default health plan determined by the employer (identified below). Employer acknowledges that designation of a default plan may have various legal, tax and other consequences and BCBSIL has not provided any advice, or accepted any responsibility with respect thereto. Policy effective date: Who is eligible for coverage? Employee Spouse (or Civil Union) Dependent Child Domestic Partner Tiers Offered: Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Package Selected: N S E W Employer elects to designate a default health plan? Yes No If yes, Default Health Plan #: Contact Information & Blue Directions Administrative Portal Access Complete the information below for individuals who are designated as primary contacts and who will need access to the Blue Directions Administrative portal. At least one employer contact and one producer contact is required. Additional resources can be accommodated. Employer Contact Name: Title: Phone: Date of Birth: Last 4 digits of SSN: Zip Code: Employer Contact Name: Title: Phone: Date of Birth: Last 4 digits of SSN: Zip Code: Producer Contact Name: Title: Phone: Date of Birth: Last 4 digits of SSN: Zip Code: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

7 Payroll Deduction Schedule Please check the applicable box below to identify when premium contributions are taken from employee s paycheck. Employee Class Medical Premium Deduction Schedule All employees Weekly Bi-weekly Monthly Other, explain: If different by employee class, complete below: <enter employee class> Weekly Bi-weekly Monthly Other, explain: <enter employee class> Weekly Bi-weekly Monthly Other, explain: <enter employee class> Weekly Bi-weekly Monthly Other, explain: List the 1st pay date of the plan year: List the 2nd pay date of the plan year: Defined Health Plan Contribution Amounts - Monthly Enter the defined EMPLOYER CONTRIBUTION amounts for each rating tier (e.g., employee only, employee+spouse, employee+child(ren), employee+family ). If contributing the same amount for all employee classes, enter the employer contribution amounts for each tier in the column titled All employees. If the contribution amounts differ based on employee class (e.g., salaried, hourly, etc), identify the employee class(es) in the space(s) provided. This is not applicable to retirees, and/or individuals covered through COBRA or State of Illinois Continuation provisions. If employer has determined that its tax status requires the designation of a separate employee class for owner-employees with a contribution amount of $0, such class should be designated below and the owner-employees identified to BCBSIL. Employee Class (e.g., All, Hourly Only, Salaried Only, Management, Owners or other (as defined by Employer)) Tier All employees <enter employee <enter employee <enter employee class> class> class> Employee Only $ $ $ $ $ Employee + Spouse $ $ $ $ $ Employee + Child(ren) $ $ $ $ $ Employee + Family $ $ $ $ $ <enter employee class> Contribution Rollover Will employer premium contribution amounts be allowed to rollover from year to year (active employees only)? Yes If rollover is allowed, will the rollover contain limitations? Yes, provide rollover details below No Rollover dollar amount or percentage 100% or other: % Maximum annual rollover amount $ Rollover Maximum Cap - Rollover may not exceed this amount at any given time $ No Additional Provisions By completing and signing this form, employer is contracting to receive private exchange services from BCBSIL (a web portal, decision support system, and online and telephonic services), either directly or through one or more affiliates or subcontractors, to assist employer s employees in making enrollment elections with respect to group health plan coverage options sponsored by employer under separate policies or contracts with BCBSIL. Employer acknowledges that BCBSIL does not guarantee that any option selected by an individual will provide the greatest benefits or lowest cost under the particular facts and circumstances. No information provided in connection with such private exchange services will modify or amend the terms of the group health plan or summary plan description. Employer acknowledges that neither BCBSIL nor any subcontractors providing services on its behalf are acting as a fiduciary of any employee welfare benefit plan. Under this agreement, BCBSIL does not exercise any discretionary authority or control regarding (i) management or administration of employer s welfare benefit plans or (ii) funding or disposition of any assets under any such plan. Employer will provide enrollment and eligibility data to BCBSIL in an electronic format consistent with data and formatting specifications provided by BCBSIL, and will provide any additional information that BCBSIL determines it needs to administer the private exchange services. Employer remains responsible for all applicable law and regulations relating to its plans, including, without limitation, ERISA, the Internal Revenue Code, COBRA and HIPAA Privacy and Security Regulations, as well as plan design choices and other decisions that may affect tax treatment of its Health Reimbursement Arrangement and other benefit plan elections. Employer acknowledges that BCBSIL is not an attorney, tax advisor or investment advisor and does not render legal, tax or investment advice in connection with the creation, adoption or operation of any employee benefit plan. Employer will seek the advice of counsel as it deems advisable.

8 Employer acknowledges that BCBSIL, or its affiliate or vendor, will provide employer s plan participants with a nontransferable, limited right, without right of sublicense, to access and use its hosted system comprised of a web portal from which a participant can use the private exchange services. Use of such portal, systems and services by employer and participants will be subject to separate terms of service and terms of use. BCBSIL and/or its licensors reserve all rights in and to the system, data and other services not expressly granted to a participant under the applicable terms of use. Employer will indemnify, defend and hold BCBSIL, its directors, officers, employees, agents, affiliates and subcontractors from and against any and all damages, claims, losses, liabilities, judgments and expenses (including attorney s fees and court costs) arising out of Employer s breach of this agreement or the terms of use/terms of service relating to the private exchange services, breach of applicable laws, negligence, criminal conduct, reckless acts or fraud. This agreement shall be governed by the laws of the State of Illinois, excluding its choice of law principles which would cause the laws of another state to apply. This Employer Setup Form is incorporated into and made a part of the Group Contract/Agreement. These provisions are in addition to (and do not take the place of) the BPA or other terms and conditions of coverage between the parties. Comments Please enter any additional information below. Authorized Signature The undersigned is authorized to execute and deliver this form on behalf of the employer and attests that the employer has carefully reviewed the responses and represents and warrants that this form accurately reflects the accounts and services that the employer has requested BCBSIL to administer on its behalf and otherwise agrees to the provisions set forth in this form. Name: Date: Title: Signature