Open Enrollment for 2018 Benefits CITY OF CHESAPEAKE

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Phillip Hutchinson
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1 Open Enrollment for 2018 Benefits CITY OF CHESAPEAKE

2 Benefit Emerging Trends Medical and Pharmacy expenses continue to rise and is a focus of all employers in curtailing cost to keep premiums from continuing to rise at such a high rate. The City conducted a competitive procurement process for pharmacy, dental and vision benefits. Members of the selection committee represented a variety of City Departments. New vendors were selected and the new rates and vendors will be effective February 1, Employee Self Service (ESS) will reflect the 2018 rates for your February through December benefits coverage. Employee Communication Committee Survey - shared trend information with ECC representatives to get feedback from employees in their departments; Friday 11/3/17 regarding decisions was sent to all employees. ESS opened Monday, November 6 th with the beginning of Open Enrollment. Open Enrollment ends at 11:59 p.m. on Tuesday, November 21, 2017.

3 Open Enrollment Highlights (slide 1 of 6) Medical - Changes for 2018 Rate increase just under 7% HDHP only deductibles have increased to comply with IRS requirement Health Savings Account City contribution change: $500 for HDHP individual coverage Health Savings Account - IRS limit changes Pharmacy Benefits are being carved out effective February 2018 Medical - NOT changing for 2018 No changes in co-payments or co-insurance for any of the plans City still offers 4 plans administered by Optima, though the PPO plus plan is closed to new entrants Health Savings Account City contribution remains at $1,000 for HDHP coverage tiers: employee and spouse, employee and child/children or family

4 AD = After Deductible Medical Plan Highlights Options Effective January 1, 2018 No Changes to HMO, POS or PPO Plan Designs In-Network benefits shown here: HDHP PPO with HSA HMO POS PPO Annual Deductible Individual/Family $2,700/$5,400 $600/$1,200 $500/$1,000 $750/1,500 Coinsurance 0% AD 20% AD 15% AD 25% AD MDLIVE Copay/Cost 0% AD $10 copay $10 copay $10 copay Primary Care Copay/Coinsurance Specialist/Urgent Care Copay/Coinsurance Pharmacy Medical and Pharmacy Out of Pocket Maximum Individual/Family 0% AD $25 copay $25 copay $25 copay 0% AD $70 copay $50 copay $70 copay $10/$30/$50/20% up to $250/prescription AD $10/$30/$50/20% up to $250/prescription $3,500/$7,000 $4,000/$8,000

5 Preventive Care Preventive Care is covered at 100% under each Optima Health Plan and includes, but is not limited to: Routine annual exams Breast cancer mammography screenings every one to two years for women over 40 Colorectal cancer screenings for adults over age 50 Immunization vaccines for children from birth to age 18

6 Pharmacy Benefit Changes Pharmacy benefits for each of the City s health plans administered by Optima Health are being carved out. Express Scripts will be our new Pharmacy Benefit Manager effective with coverage starting February 1, All members covered under the City s health plans will receive a separate pharmacy card just prior to February 1, Express Scripts and Optima will share pharmacy history and claim information so out-of-pocket costs will be tracked for each member and family as applicable.

7 Open Enrollment Highlights (slide 2 of 6) Dental Benefits Dental vendor effective February 1, 2018 will be Anthem Dental Larger network and the Prime Network (lower fees) is larger than our lowest fee network with Delta Dental Employees who have dental currently continue to use Delta Dental services in January Employees who choose dental for the first time during open enrollment will get a card from Delta before January only for that month of coverage. All employees who have dental benefits in 2018 will get a new set of cards from Anthem Dental before February Minimal provider/network disruption and Anthem is actively recruiting non-participating dentists to their Complete and Prime Networks. Form available for employees to recommend provider.

8 Anthem Dental effective February 1, 2018 Monthly Rates No Changes Employee Only $13.24 $13.24 Employee & Spouse Employee & Child Employee & Children $22.28 $22.28 $24.20 $24.20 $27.88 $27.88 Family $38.92 $38.92 Plan Design Service In-Network Cost Annual Deductible $50/$150 Annual Benefit Maximum $1,500 Orthodontic Lifetime Maximum (eligible dependent children up to age 26) Diagnostic and Preventative Care (including sealants for dependents under age 16) Basic Dental Care - Fillings, simple extractions Major Dental Care - Bridges, crowns $1,500 Covered at 100% Covered at 80% after deductible Covered at 50% after deductible

9 Open Enrollment Highlights (slide 3 of 6) Vision Benefits Vision vendor effective February 1, 2018 will be Davis Vision with lower premiums Employees who have vision currently continue to use UniCare/UniView services in January Employees who choose vision for the first time during open enrollment will get a card from UniCare/UniView before January only for that month of coverage. All employees who have vision benefits in 2018 will get a new set of cards from Davis Vision before February Benefits for glasses/contacts are equal or better with Davis Vision Retail network is different from what we have used, new network includes Visionworks, Walmart, Sams Club, Costco and many other retailers.

10 Davis Vision effective February 1, 2018 MONTHLY RATES 2017 Employee Premium 2018 Employee Premium Employee Only $4.56 $4.36 Employee & Spouse Employee & Child Employee & Children $8.00 $7.68 $8.00 $7.68 $9.12 $8.72 Family $13.24 $12.68 PLAN DESIGN Service Routine eye exam (once every calendar year) Eyeglass frames (once every 24 months) Eyeglass lenses Standard contact lens fitting In-Network Cost $15 copay $140 allowance then 20% off remaining balance* $15 copay and up No separate contact fitting fee! * No cost Visionworks (excludes Maui Jim)

11 Open Enrollment Highlights (slide 5 of 6) Changes made during open enrollment will be effective January 1, Premiums for medical, dental and vision insurance, as well as pre-paid legal, will be collected beginning in December 2017 weekly premium holiday - December 1 Medical and Vision premium changes will be seen in January pay checks for February coverage changes Flexible spending contributions and long term disability premiums for Plan 1 and 2 employees will begin in January Health Savings Account total contributions increased: $3,450 individual/$6,900 family (includes any incentives earned and City contributions) Flexible spending max contribution increased to $2,650, $500 can still roll over

12 Open Enrollment Highlights (slide 6 of 6) MDLIVE copay will continue at $10/visit for all Medical plans except the HDHP it will be $39/visit for HDHP members. The Wellness Incentive ($300) criteria have been expanded to include dental exam for The Diabetic Disease Management Program incentive ($200) will be enhanced to covered children in Legal benefit plans will not change for Spousal coverage will remain the same for Medical (No surcharge)

13 2018 Wellness Incentive - $300 Covered employees and retirees obtain an annual physical and Obtain an annual eye exam and Obtain a routine dental cleaning/preventive exam The annual wellness incentive is loaded onto a WageWorks Card which can be used for medical, dental and vision expenses as well as some OTC health related products (see the FSA store on the WageWorks website) If you have a medical flex spending account the incentive will be loaded to the same account. If the member has an HSA account the incentive will be deposited to the HSA account

14 Diabetic Disease Management Program Diabetes Management Program The Optima Health Diabetes Management Program provides participants with information to help keep diabetes under the best possible control. Employees/retirees, enrolled spouses and children are eligible! Earn up to $200 - It s EASY! Go to the doctor regularly. Complete all annual preventive health screenings including your annual physical, feet and eye exams. Complete all requirements of Optima s Disease Management Program to include completing lab work (e.g. A1c, microalbumin and cholesterol). Develop a diabetic disease management program, nutrition and activity plans. Talk to a Health Coach at Optima Health every three months. If you are interested in learning more about the program, contact Optima s member services department at This slide provides a summary of the program highlights and does not include all of the details of the program.

15 Dependent Eligibility Audit (slide 1 of 2) The City intends to conduct a dependent eligibility audit in Employees will be required to provide proof of dependent eligibility (e.g. birth certificate, marriage certificate) for anyone they cover on the City s health insurance. Eligible dependents include current spouses and children under the age of 26 unless they are disabled.

16 Dependent Eligibility Audit (slide 2 of 2) Employees will have one more opportunity to dis-enroll ineligible dependents during open enrollment with no questions asked. Dependents who are not eligible include: Grandchildren* Nieces* Nephews* Former spouses * unless the employee has legal custody of the child and provides documentation

17 Medical Rates Employee Monthly Contributions 2017 HDHP HMO POS PPO Employee Only $18.00 $45.04 $66.80 $ Employee & Spouse $66.32 $ $ $ HDHP HMO POS PPO Employee Only $19.20 $48.08 $71.24 $ Employee & Spouse $70.80 $ $ $ Employee & Child $41.28 $ $ $ Employee & Child $44.04 $ $ $ Employee & Children $63.48 $ $ $ Employee & Children $67.72 $ $ $ Family $ $ $ $ Family $ $ $ $

18 What is a High Deductible Health Plan (HDHP)? A HDHP is a plan with a deductible which is higher than traditional plans and is higher than the deductibles on the City s current HMO, POS and PPO plans. A deductible is the amount the subscriber must pay prior to the plan paying. HDHP s have lower monthly premiums than traditional plans and are offered with a special savings account called a Health Savings Account. A Health Savings Account or HSA is defined on the next slide.

19 What is a Health Savings Account (HSA)? A HSA is a pretax savings account which can be used with a High Deductible Health Plan to pay tax-free for qualified medical expenses. In addition, HSA deposits earn tax-free interest and carry over from year to year, even if you change jobs or retire. HSA eligibility To make tax-free* deposits to an HSA, the IRS requires that: You are covered by an HSA-qualified health plan You have no other health coverage (such as traditional health plan, Medicare, military health benefits such as Tricare, or Medical Flexible Spending Account). You are not claimed as a dependent on another individual's tax return You have not received Veterans Administration (VA) benefits within the past three months, except for preventive care. If you are a veteran with a disability rating from the VA, this exclusion does not apply. *Note regarding tax-free statements: HSAs are never taxed at a federal income tax level when used appropriately for qualified medical expenses. Also, most states recognize HSA funds as tax-free with very few exceptions. Please consult a tax advisor regarding your state's specific rules.

Example 1: I am enrolling in family coverage. I have high cholesterol and take generic Lipitor for my condition. Due to my condition, I see a PCP four times/year and a Specialist three times/year.

20 Example 1: I am enrolling in family coverage. I have high cholesterol and take generic Lipitor for my condition. Due to my condition, I see a PCP four times/year and a Specialist three times/year. My wife does not take any prescriptions. We have two children & both are relatively healthy. I only anticipate my wife and children seeing their PCP for preventive care which is covered at 100%. Plan Options HDHP PPO HMO POS PPO Annual Deductible $2,600/$5,200 $600/$1,200 $500/$1,000 $750/$1,500 Physician copay/coinsurance* $316 $100 $100 $100 Specialist copay/coinsurance** $552 $210 $150 $210 Prescription copays/expenses*** $ $120 $120 $120 Annual Employee Premium Family $ 2, $ 5, $ 8, $ 12, Total out-of-pocket $3, (wellness) - 1, (HSA) $2, $5, (wellness) $5, $8, (wellness) $8, $13, (wellness) $12, *$25 x 4 = $100; $79 (Optima Treatment Cost Calculator) x 4 = $316 **$50 X 3 = $150; $70 x 3 = $210; $184 (Optima Treatment Cost Calculator) x 3 = $552 ***$10 x 12 = $120; generic Lipitor amount Optima will pay $47.35 x 12 = $568.20

21 Example 2: I am covering myself and my twenty year old son who is residing in Florida. We are both healthy, are not currently taking any prescription medications, and generally only see a doctor once a year for an annual check up. I want to make sure my son has comprehensive coverage just in case. Plan Options HDHP PPO HMO POS PPO Annual Deductible $2,700/$5,400 $600/$1,200 $500/$1,000 $750/$1,500 Out of Network coverage YES YES (out of area dependents only) YES YES Annual Employee Premium Employee & Child $ less + $1, (HSA) Rolls over $1, $2, $ **Employee can complete the Out of Area Dependent form located on and submit form to payroll clerk for dependent to obtain coverage FORM MUST BE SUBMITTED ANNUALLY

22 Example 3: I am enrolling in employee & children coverage. I have diabetes and take Januvia to treat my condition. Due to my condition, I see a PCP four times/year. I have three children who are relatively healthy. I only anticipate my children seeing their PCP for preventive care which is covered at 100% or perhaps one other time in the year for each child, for a minor illnesses (e.g. ear infection, sore throat). Plan Options HDHP PPO HMO POS PPO Annual Deductible $2,700/$5,400 $600/$1,200 $500/$1,000 $750/$1,500 Physician copay/coinsurance for treatment of moderate condition* Physician copay/coinsurance for treatment of minor condition** $316 $100 $100 $100 $156 $75 $75 $75 Prescription copays/expenses*** $4,776 $360 $360 $360 Annual Premium Employee & Children Total out-of-pocket $4,468.64**** -1, (HSA) (wellness) (Diabetes DM) $3, $ $2, $3, $6, $2, (wellness) (Diabetes DM) $2, $4, (wellness) (Diabetes DM) $3, $7, (wellness) (Diabetes DM) $6, *$25 x 4 = $100; $79 (Optima Treatment Cost Calculator) x 4 = $316 **$25 X 3 = $75; $52 (Optima Treatment Cost Calculator) x 3 = $156 ***$30 x 12 = $360 ; Januvia (amount Optima will pay) $398 x 12 = $4,776

23 Example 4: Family Catastrophic Event Family of four in severe auto accident with multiple injuries and hospitalization for each family member. Plan Options HDHP PPO HMO POS PPO Annual Deductible $2,600/$5,200 $600/$1,200 $500/$1,000 $750/$1,500 Inpatient Hospitalization/Out of Pocket Maximum Annual Employee Premium Family $7,000 $8,000 $8,000 $8,000 $2, $5, $ $12, Total out-of-pocket $9, (wellness) - 1, (HSA) $7, $13, (wellness) $12, $16, (wellness) $15, $20, (wellness) $20,554.40

24 Optima s Treatment Cost Calculator To Access: Log into your Optima Account from Select Treatment Cost Calculator under My Optima Search for the condition for which you would like pricing Page 24 *Proprietary* 24

conditions. MDLIVE doctors can diagnose symptoms, prescribe medication, and send prescriptions to the employee s pharmacy of choice, as appropriate.

25 MDLIVE Save Time and Money MDLIVE, provides access to a doctor from your home, office, or on the go. Employees and their covered family members can visit with Board Certified doctors by phone or secure video to help treat many nonemergency medical conditions. MDLIVE doctors can diagnose symptoms, prescribe medication, and send prescriptions to the employee s pharmacy of choice, as appropriate. Save time and money. HMO, POS and PPO plan participants pay only a $10/copay and participants in the HDHP pay only $39. To register, go online to to create an account or call

26 Flexible Spending Medical Care Must actively re-enroll every year by entering new per pay period amount Full-Time Employees NOT enrolled in the HDHP with HSA Can contribute up to $2,650 per year The City allows for $500 carryover from calendar year to calendar year Funds are available on a personal debit VISA card the first day of the plan year Listing of eligible expenses is available at WageWorks EZ Receipts mobile app has new functionality User friendly claims submissions and Services to pay providers on the go - for more information, visit NOTE: If an employee enrolls in the HDHP and HSA, they cannot have any funds remaining in their FSA from 2017.

27 Flexible Spending Dependent Care Full/Part Time Employees Can contribute up to $5,000 per year Allows you to use pretax dollars to pay for eligible expenses* Reimbursed for expenses that fall within your current account balance May be used for qualified dependents under the age of 13 or other dependents as determined by the IRS *Eligible expenses include: daycare for children, after school care for children, daycare required for seniors/adults. See WageWorks.com for a complete list of eligible expenses. **Refer to IRS Publication 503 for dependent qualifications.

28 Legal Resources Legal Resources provides an affordable way for you and your family to have legal representation whenever you need it. Pay no attorney fees for the most common legal services Work directly with a local law firm Annual cost is less than one hour of an attorney s time Only $17.00 per month for you and all eligible dependents Ask the attorney s office if they charge any fees

Legal Resources provides coverage for all your everyday legal needs Members pay $0 for attorney fee s for fully covered legal services Most often needed legal services are covered at 100% $17.

29 Legal Resources provides coverage for all your everyday legal needs Members pay $0 for attorney fee s for fully covered legal services Most often needed legal services are covered at 100% $17.00 per month covers employee, spouse and dependents up to age 26 Parents* of members receive legal services at a 25% discount Annual cost of the plan is less than one hour of an attorney s time *consult coverage information for details

31 Long Term Disability (LTD) Long Term Disability provides a monthly monetary benefit if you are unable to work because of a qualifying disability. Employees in the Hybrid Plan are automatically covered on a LTD benefit administered by the Reed Group and paid for by the City. Employees in VRS Plans 1 or 2 are covered in a Basic Benefit paid for by the City administered by The Standard. Employees in VRS Plans 1 or 2 were offered the opportunity to purchase an enhanced LTD benefit with guaranteed issue in July of Employees in VRS Plans 1 or 2 can request coverage in the enhanced LTD benefit during open enrollment. Medical underwriting is required and thus approval is not guaranteed. Basic Benefit Waiting Period 180 days 90 days Income Replacement Percentage 40% 60% Maximum Benefit Period 2 years Enhanced Benefit Normal Social Security Retirement Age

32 Online Enrollment Employees will enroll through Employee Self Service (ESS), Employees in the Active Directory will use their computer user name and password to access ESS. If you need your password reset, please contact the City s Help Desk at , or helpdesk@cityofchesapeake.net. Employees not in the Active Directory (e.g. Libraries, CIBH) will use their employee number and last four of their SSN (or password they set-up) to access ESS. Only employees in these departments can use the reset password feature in ESS. Visit the City of Chesapeake s dedicated benefits website, for detailed information about benefits offered. Please note this is a summary of benefits and a full description of your benefits is provided at

33 Open Enrollment - Elections Medical, Dental, Legal, Vision & LTD If no changes are made, employees and pre-medicare eligible retirees will maintain enrollment in their current plan/tier. No action is required by the employee/retiree. Flexible Spending Re-enrollment is required annually. Employees may rollover up to $500 of unused medical flexible spending balances. You must re-enroll for calendar year 2018 in order for unused calendar year 2017 funds to rollover. Unused funds from the prior year will be available after April 1 st of the new year.

34 Questions? Frequently asked questions and corresponding answers will be posted on the open enrollment website, Employees may also contact Human Resources directly at or

Odessa School District

Odessa School District 2016 Employee Benefits Effective July 1, 2016 DELTA DENTAL OF MISSOURI PPO BASE Premier or Non-Network PPO BUY-UP Premier or Non-Network Deductible Individual $50 $50 Family $150