Your 2013 Renewal Guide

Transcription

1 The signs of a healthier Vermont Your 2013 Renewal Guide Small Group

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3 Dear Employer, Thank you for renewing your coverage with Blue Cross and Blue Shield of Vermont. We are honored to provide your employees and their families with health coverage. This is a pivotal time for health benefits decisionmakers. The federal Affordable Care Act and Vermont s health care reform will drive changes in how your employees and other Vermonters get coverage. Businesses employing fewer than 50 employees will soon purchase health plans on Vermont s health care exchange, recently named Vermont Health Connect. In the next year, you will need to make decisions about how your employees will get their coverage. Some employers will purchase on the Exchange; others may decide to let employees purchase on the exchange as individuals. We at Blue Cross and Blue Shield of Vermont are working hard to ensure that our group benefits managers and our members make the transition to the new Vermont health care system easily and efficiently. In this Renewal Guide, we have included answers to frequently asked questions about the Exchange. We hope they help you make decisions about your health plan in In the meantime, we will continue to concentrate on providing you and your employees with the best coverage and service we can. Thank you again for choosing Blue Cross and Blue Shield of Vermont, and we look forward to working with you over the coming months to provide you with the information and support you will need for the significant changes that are under way for Sincerely, Kevin Goddard Vice President External Affairs and Sales

4 2013 Benefit Updates State Mandates Beginning with your next renewal, Blue Cross and Blue Shield of Vermont (BCBSVT) will implement the following state mandates: Your pharmacy benefits will have no annual maximum (most of our plans never had one). Your out-of-pocket limit for prescription drugs may also change. State law sets a cap on out-of-pocket limits at $1,250 for individuals or $2,500 for families in Most of our plans do not include a specific out-of-pocket maximum for prescription drugs. If your current combined medical and drug out-ofpocket maximum is higher than the state limits, however, you will now have a lower limit that applies just to drugs. We will provide benefits for some telemedicine services at a facility (e.g. skilled nursing facility or hospital). Your cost-sharing (co-payment, deductible, etc.) will be the same for telemedicine as for an in-person consultation. Our autism benefit will now cover members up to age 21. Coverage will expand to include diagnosis of developmental delays for autism spectrum disorders (ASD), Asperger s syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS) HSA Contribution Limits For 2013, the IRS has increased the contribution limit for a health savings account (HSA) for an individual from $3,100 to $3,250 and for a family from $6,250 to $6,450. The maximum annual out-of-pocket increased as well. The individual out of pocket maximum is going from $6,050 to $6,250. The family out-of-pocket maximum is increasing from $12,100 to $12,500. The minimum deductible on an HSA-qualified plan is increasing to $1,250 for individuals and $2,500 for families.

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6 Promoting Good Health through Preventive Care At Blue Cross and Blue Shield of Vermont, we want you to get preventive care so you can find out about health problems early and get the treatment you need. What is preventive care? Preventive care includes screenings, tests, medicines and counseling performed or prescribed by your doctor or other health care provider when you don t have signs or symptoms of an injury or illness. Your provider delivers some care to prevent you from getting sick. Other preventive care helps detect health conditions early, so you can change your lifestyle or get treatment to improve your health. We encourage you to get appropriate preventive care for your age and gender.

7 Women s Health We will provide coverage with no cost-sharing (like deductibles, co-insurance and co-payments) for certain women s health services. These include: Well-women visits Gestational diabetes screening Human papilloma virus (HPV) testing Sexually transmitted infections counseling Human immunodeficiency virus (HIV) counseling and screening Generic female contraception methods (drugs, devices or brand name methods if no generic is available) and contraceptive counseling Breastfeeding support and counseling from a network provider * Breastfeeding supplies from a network provider.* Members must get prior approval for hospital-grade breast pumps. Domestic violence screening *Some plans may have out-of-network benefits. 7

8 Solutions for Employee Health & Wellness Introducing My Blue Health Wellness Center As part of a team commitment to the health and wellness of our members, which includes employer, health plan, provider and member, BCBSVT helps our members achieve and maintain the best health for every stage of life. This includes providing tools and resources that empower our members to take control of their health. Beginning November 1, 2012, you and your employees will have access to My Blue Health Wellness Center on. My Blue Health Wellness Center is a web-based wellness portal that you can also access on your mobile devices making it easier and more convenient to get the information, resources and tools you need to manage your health goals and live a healthy lifestyle. My Blue Health Wellness Center will feature a fully integrated, NCQA-certified health assessment that will generate a personalized action plan and educational content that is completely relevant to an individual. Your employees will have a personalized dashboard where they can find health-related materials and activities that are specifically tailored to them based on their health assessment results. In the My Blue Health Wellness Center, your employees will also have many useful tools like: Health logs enter and track biometric data Progress report track health and wellness goals Incentives earn points for completing tasks Logs nutrition and physical activity Wellness workshops interactive tasks about weight and stress management, diabetes, nutrition, smoking cessation and high blood pressure Wellness challenges track competitions between individuals, groups or locations Nutrition recipe assistance, meal planning and assessing nutritional needs Exercise exercise planner

9 Occupational Health and Wellness Management Rutland Regional Medical Center Immunizations Influenza, Hepatitis B Influenza, Hepatitis A and B, DTAP, Twinrix Employer Health Management at Fletcher Allen Health Care Influenza, TDAP Flu nasal mist No No No Onsite employer clinics Yes Yes Yes Retail clinics No No No Preferred scheduling lead time Two weeks Two weeks Two weeks Age requirements 18 and older 18 and older 18 and older Employer cost No, unless fewer than No set up cost. No set up cost. 10 participate, then $25/half hour fee. Member cost No up-front cost. No up-front cost. No up-front cost. Members with preventive benefits covered at 100%. Members without preventive benefits will have a copay or cost share. Processed through BCBSVT. Member may be billed co-pay or cost share. Processed through BCBSVT. Member may be billed co-pay or cost share. Non-member cost $27 $20 $20 35 pp Online registration No No No BCBSVT ID card required Yes Yes Yes Processed through BCBSVT. Member may be billed co-pay or cost share. Prior verification with BCBSVT to assure preventive benefit. Flu Immunizations Help keep your employees healthy this flu season by encouraging them to get their flu vaccine. The Centers for Disease Control and Prevention (CDC) recommends a yearly flu vaccine as the first and most important step in protecting against flu viruses. Blue Cross and Blue Shield of Vermont partners with a few different vendors to provide on-site employerflu clinics making it easy for your employees to get their flu vaccine. Contact Cassandra Ricard, (603) ext 15 Dick Trono, occupational health coordinator, at (802) or dtrono@rrmc.org Craig Stevens, (802) or craig.stevens@vtmednet.org 9

10 Improving the Health of Your Community In addition to health management and support programs, Blue Cross and Blue Shield of Vermont has many programs designed to promote healthy behavior, such as: WalkingWorks ȘM a program that makes it easy and fun to keep track of your success at walking for fitness. At Blue Cross and Blue Shield of Vermont, we care about the health of our members and our other neighbors and friends in Vermont. Each year, we hold many events that help Vermonters get up and moving. They range from walking challenges at Vermont worksites to Hike, Bike and Paddle events at Vermont lakes and ponds to Family Days and Snow Days at some of our state s most beautiful venues. While Blue Cross and Blue Shield of Vermont improves our members health, we show our enthusiasm to your sons and daughters, too, through our sponsorship of Girls on the Run and Velocity, our very own all-boys program. Be sure to check the community events section of our website or talk to your employer to see what we re doing in your area. For more information on events in your community, visit the calendar of events page at /calendar. Mobile Apps Our National Provider finder app is a FREE app that allows BCBSVT members to locate a doctor, hospital or urgent care center quickly and easily while on the go! Express Rx (Express Scripts Pharmacy/ESI) is a FREE Rx app that allows members to access their pharmacy benefits account from their mobile device to order refills, check order status, look-up drug information and much more. Members have access to a GPS Activity app through My Blue Health Wellness Center. The GPS Activity App allows the user to choose from 16 activities, track their distance, speed, and calories burned and have all data synchronized.

11 Exchange 101 the Basics What exactly is the Exchange? The federal Affordable Care Act, enacted in 2010, requires that each state have a health benefit exchange where individuals and small business can compare and purchase health benefit plans. In order to be offered on the Exchange, plans must be approved as qualified health plans and comply with federal and state laws. Qualified health plans must offer essential health benefits as defined by federal and state law. Beginning in late 2013, Vermonters who work for small business and self-employed Vermonters will enroll through the Exchange. The self-employed, with no employees, will enroll in individual plans. Large employer groups with more than 50 employees will continue to purchase coverage directly from health plans like Blue Cross and Blue Shield of Vermont. Who creates this exchange and what will it look like? The State of Vermont is creating the Exchange. It will be called Vermont Health Connect. Each state s Exchange will be different depending on decisions of that state s legislature and public officials. Vermont s Exchange will look essentially like an online shopping web portal. Can I purchase coverage directly from a health plan, rather than on Vermont Health Connect? No, not if you have fewer than 50 employees. Vermont Health Connect When does it all happen? Small businesses will have to buy insurance on the Exchange for plan years that begin on or after January 1, What are the details of the small business tax credit? Do I qualify? If you have up to 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. These credits will increase in 2014 for qualifying employers. For more information about small business tax credits: Can I give my employees funds they can use to buy as individuals on Vermont Health Connect? No. However, you can offer your employees a specific amount of money to buy insurance on the Exchange as part of your group. Each employee can shop on the Exchange and choose the plan of his or her choice. The Exchange will manage the billing for you and you won t have to interface with multiple health plans. 11

12 The signs of a healthier Vermont Blue Cross and Blue Shield of Vermont PO Box 186 Montpelier, VT Phone: (800) SalesandRetention@bcbsvt.com (10/2012)