DoD NAF HBP Open Enrollment Overview

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1 DoD NAF HBP Open Enrollment Overview For the 2018 Open Enrollment Period, you will receive an announcement postcard mailed to your home. The postcard will direct you to for all coverage options for There will be no additional materials mailed to your home. Don t forget to sign up for enews! You ll be the first to know of upcoming events and late breaking news! Remember to register on (Aetna Navigator) to find valuable information and resources Medical and Dental Changes As a result of past plan design changes and your help in being a smart consumer to keep costs down, there will be no plan design changes for 2018, as well as no rate increases to the combined medical and dental plans. There will be a slight increase for the Stand Alone Dental plan Medical and Dental Bi Weekly Rates Tier Medical Dental Medical & Dental Stand Alone Dental The Open Enrollment Period allows eligible NAF employees to: Join the DoD NAF HBP if not already enrolled Switch plans (where applicable) Add or remove eligible dependents Add or drop dental Drop coverage altogether Elect health care and/or dependent care Flexible Spending Accounts (FSAs)* Do nothing and keep current medical/dental coverage If you are making an enrollment change, follow your employer s enrollment process and complete your change no later than December 1, 2017 * Remember: You must elect to participate in FSAs each year, and elect a new annual contribution amount Employee Only $77.33 $4.50 $81.83 $16.61 Employee + Child(ren) $ $8.68 $ $37.36 Employee + Spouse $ $10.38 $ $33.21 Employee + Family $ $13.76 $ $53.97

2 Medical All full time and part time employees (and certain flex employees) are eligible to join the DoD NAF HBP. The Aetna option offered in most US cities is the Aetna Choice POS II plan. In rural areas and overseas, it s the Aetna Traditional Choice Plan. A list of network doctors and hospitals can be found on DocFind at or through Aetna Navigator. Aetna Choice POS II Traditional Choice Indemnity (including In Network Out of Network Aetna International) Annual Deductible *Individual *Family of 2 *Family of 3 or more $500 $1,000 (2 times individual) $1,500 (3 times individual) $1,500 $3,000 (2 times individual) $4,500 (3 times individual) $500 $1,000 (2 times individual) $1,500 (3 times individual) Out of Pocket Maximum *Individual *Family of 2 *Family of 3 or more $4,000 $8,000 (2 times individual) $12,000 (3 times individual) $8,000 $16,000 (2 times individual) $24,000 (3 times individual) $4,000 $8,000 (2 times individual) $12,000 (3 times individual) Preventive Care 100%, no copay Not Covered 100%, no deductible Primary Care Physician (PCP) Visit $30 copay 60% after deductible 80% after deductible Specialist Visit $45 copay 60% after deductible 80% after deductible Walk In Clinic $30 copay 60% after deductible 80% after deductible Urgent Care Center $30 copay 60% after deductible 80% after deductible Emergency Room 90% after $350 copay (waived if admitted), no calendar year deductible 90% after separate $350 deductible (waived if admitted), no calendar year deductible Teladoc $10 Not Applicable $10 * 80% after deductible To learn more about Aetna International, go to or call Aetna International at * Teladoc is not available in all states and is not available overseas. 2

3 Key Concepts Term Copay Deductible Coinsurance Out of Pocket Maximum Definition This is the dollar amount you pay for health care expenses. For example, you pay a set dollar amount to your doctor for an office visit. So, if your copay is $30, you pay that amount when you go to your doctor. The amount you pay for covered services before your health plan begins to pay. This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum. This is a limit on costs a health plan member must pay for covered services. The limit is a yearly dollar amount. We will be including a new resource/guide on this fall that will focus on the basics of health care. This digital guide will include information on the following: Key Concepts/Terms to Know First Steps/Be Prepared How Health Care Works How to Pay for Care How to Get and Stay Healthy Ways to Save.And More 3

4 Know Where to Go When something unexpected comes up, there may not be time to make an appointment with your primary care physician (PCP). Get to know your options for care, so you can save time and money when it matters most. 4

5 Maximum Allowable Amounts The Maximum allowable amounts are standard prices for certain outpatient services. These price limits apply to facility costs for procedures that include colonoscopies and endoscopies, CT scans and MRIs, hernia surgeries, tonsillectomies, cataract surgeries and others. When you have one of these procedures, the plan pays up to the maximum allowable amount toward facility costs for the service. You pay any facility costs above the maximum allowable amount. Here s an example: Facility cost of routine colonoscopy Maximum allowable amount Member Cost Facility A $2,000 $1,500 $500 Facility B $1,500 $1,500 $0 In the example above, the member has a choice of scheduling a routine colonoscopy (which is covered at 100% of the maximum allowable amount) at Facility A or Facility B. If the member selects Facility A, they will be responsible for an out of pocket expense of $500 since that facility charges $500 more than the maximum allowable amount. However, if he selects Facility B, he can avoid an out of pocket cost and pay nothing. *To view a complete list of outpatient procedures and their maximum allowable amounts, log in at and click I want to... View Deductibles & Plan Limits. Scroll to the bottom of the page and look for the Maximum Allowable Amount box. You can also contact Member Services at for additional information. Additional information on maximum allowable and the Member Payment Estimator tools can be found on the Wellness & Resources tab on 5

6 Pharmacy Plan Your copay/coinsurance summary Any network retail pharmacy Up to a 30 day supply Maintenance Choice: Aetna Rx Home Delivery or CVS pharmacy Up to a 90 day supply Tier 1: Generic Drugs $10 copay $20 copay Tier 2: Preferred Brand Drugs $35 copay $70 copay Tier 3: Non Preferred Brand Drugs 35% with $60 minimum/ $125 maximum Tier 4: Specialty Medications 40% with $60 minimum/ $125 maximum 35% with $120 minimum/ $250 maximum Not Applicable Fill Limit for Maintenance Medications Coverage for 2 30 day fills only Not Applicable Members that use maintenance medications can fill a 90 day supply of maintenance medications at a CVS pharmacy or at Aetna Rx Home Delivery mail order pharmacy. The member will pay the same out of pocket costs either way. For the maintenance medications, members can fill a 30 day supply of these drugs at a retail pharmacy up to two times. If they choose a 30 day supply for the next fill, they will pay the full cost of the drug. Maintenance Drugs are drugs that you take on a regular basis that treat conditions like arthritis, asthma, diabetes or high cholesterol. The Maintenance Drug list is posted on Additional information on Maintenance Choice and the Member tools (Price a Drug) can be found on the Wellness & Resources tab on 6

7 Dental Options for 2018 Plan Passive PPO Dental Stand Alone Dental Eligibility For members enrolled in a DoD NAF HBP medical plan For members who are not enrolled in a DoD NAF HBP medical plan Annual Deductible Individual/Family $100/$200/$300 $100/$200/$300 Annual Maximum $2,500 $2,000 Preventive Care (Cleanings) 100% 100% Basic Care Restorative/Major Care Orthodontia Coverage Oral Surgery (dental in nature) TMJ Coverage 80% (fillings, root canal, extractions) 50% (inlays, crowns, bridgework) 50%, no deductible; $2,000 Lifetime maximum, includes TMJ appliances 100% of first $1,000, then 80% thereafter 50%, no deductible, $750 lifetime maximum 80% (fillings, extractions) 50% (root canal, inlays, crowns, bridgework) 50%, no deductible; $1,500 Lifetime maximum*, excludes TMJ appliances Not Covered Not Covered When you visit a dentist in our dental PPO network there are no claim forms and no balance billing. You also take advantage of rates Aetna has negotiated with the dental providers. When you see any other licensed dentist you may have to file claim forms and may be subject to balance billing above recognized charges. As a result, your out of pocket expenses may be higher. * 12 month waiting period for members enrolling on or after 1/1/

8 Health Incentive Credit (HIC) Health Assessment Required before you can earn HICs Employees and their covered spouse must complete the Health Assessment in order for any of the Health Incentive Credits (HICs) earned to be deposited. No activities will have credits deposited until the assessment is completed. The screening results from the biometric screenings will need to be manually entered by the member into the Health Assessment. To take the assessment, log in to > Stay Healthy > Complete a Health Assessment. Activity Health Incentive Credit Amount Employees and Covered Spouses Complete biometric screening between January 1 and November 30, 2018 Disease Management (DM) goal complete 3 calls with a DM nurse Complete online Journey (average time 32 days) $150 each $100 each $50 each up to 4journeys Dependent Children Under Age 18 Have a preventive care exam $50 for each child per year For all activities, you can earn up to the calendar year maximum of $250 for employee only or $600 for employees who cover dependents. These credits will be placed in an account and applied towards the first family member s claim where the deductible and/or coinsurance would be applied. Employees can earn a maximum of $250 per year per person, up to $600 per family per year. Applied to the medical deductible and/or coinsurance as claims are processed. The Credit cannot be applied to copayments such as PCP, Specialist, Emergency Room, Urgent Care copays, Hospital confinement fees, or pharmacy copays. The credit will roll over every year until used, up to 3 years. Credits are displayed on Explanation of Benefits and in Aetna Navigator 8

9 Flexible Spending Accounts Overview Health Care Spending Account Basics Employees can set aside up to $2,600 in pre tax dollars each year in a Health Care FSA to reimburse eligible medical, dental and vision expenses that aren t covered by their medical plan (including copays, coinsurance, deductibles and eligible over the counter items). FSA dollars are no longer completely use it or lose it funds. Employees can rollover up to $500 of their account balance into the next plan year. This means that if employees have any unused funds at the end of the plan year, up to $500 will rollover. Any amount unused over $500 will be forfeited.* Please refer to FSA section of website, for additional detail. With FSA Without FSA Annual income $25,000 $25,000 Estimated pretax contributions ($2,000) $0 Taxable Income: $23,000 $25,000 Estimated Federal Withholding: $1,805 $2,105 Estimated FICA $1,760 $1,913 Health Care expenses $0 $2,000 Net after tax income $19,435 $18,982 Savings with the FSA $453 Filing Status: Single tax filer, tax bracket of 15%, out of pocket health care expenses of $2,000. These projections are only estimates and should not be assumed to be tax advice. Dependent Care Spending Account Basics The IRS limits the amount employees can put into a Dependent Care FSA up to $5,000 per year, if married and filing a joint return, or if a single parent, or $2,500 per year, if married and filing separately Dependent Care FSA dollars are use it or lose it funds. Account balances are not carried over from year to year. This means that if an employee has any unused funds at the end of the plan year, those funds will be forfeited. There is no debit card for the Dependent Care FSA * The Air Force FSA plan does not allow the rollover of FSA balances. Please refer to for additional detail. 9

10 Next Steps Step 1 Step 2 Step 3 Step 4 Step 5 Review Your Current Elections Visit Gather Your Documentation Sign Up for Your FSA Return Signed Forms & Documents by December 1, 2017 Visit to find specific enrollment procedures for your NAF employer or contact your HR Representative 10