2017 R e t i r e e B e n e f i t s O v e r v i e w

Transcription

1 2017 R e t i r e e B e n e f i t s O v e r v i e w

2 About This Guide The City of Winston-Salem offers a comprehensive suite of benefits to promote health and financial wellness for you and your family. This is a summary of the benefit choices that are available to you for the 2017 Plan Year. The City s annual enrollment period for retirees is Monday, October 3, 2016 Monday, October 31, You can make a medical election change, including the addition or removal of a dependent on your medical coverage, except when court-ordered. You will need to complete a Benefits Enrollment/Change Form and provide the required documentation to Human Resources by Monday, October 31, 2016 if you add a new dependent onto your medical coverage. You can view and make your 2017 medical election using the new web enrollment site at If you do not have a computer or web access, you can complete the Benefits Enrollment/Change Form included in your information packet and return to Human Resources by Monday, October 31 at the address listed on the form; it must be postmarked no later than Monday, October 31, Making Changes During the Year Generally, you can only change your benefit elections during the annual enrollment period, unless you experience a qualifying life event (QLE) such as marriage, divorce, birth or adoption, or a change in your (or your spouse s) employment status that affects benefits eligibility. Human Resources must be notified within thirty (30) days of QLE. Refer to the Retiree Center website at for a Benefits Enrollment/Change Form. Cover image by J. Sinclair Cover image courtesy of the Winston-Salem Visitors Bureau NOTE: This overview describes the benefit plans available to you as a retiree of the City of Winston-Salem. The details of these plans are contained in the official plan documents, including some insurance contracts. This overview is not meant to contain all of the details that are included in your Member Guides or in your other retiree benefit materials. If you have questions about the plans, or if there is a conflict between the information in this overview and the formal language of the plan, the formal wording in the plan documents will govern. The benefits highlighted and described in this overview may be changed at any time and do not represent a contractual obligation either implied or expressed on the part of the City of Winston-Salem. 1

3 Highlights & Changes for 2017 Blue Cross Blue Shield of North Carolina (BCBSNC) will continue to administer the City s medical benefits. Medical premiums for 2017 will increase; however, retirees who enroll and complete requirements for the wellness program will have an opportunity to save $50 per month on medical premiums and reduce monthly out-of-pocket expenses through a value based pharmacy benefit. This pharmacy benefit allows you and your dependents who are covered by the City s medical insurance plan to receive certain maintenance medications at a $0 copay. This is a special BCBSNC program for the City s wellness program participants and is available regardless of which pharmacy you use for your prescription medications. This benefit is available through your retail pharmacy and through mailorder. Please review the Value Based Drug List on the Retiree Center or contact BCBSNC for more information. Effective January 1, 2017, Aetna will administer the City s Medicare Advantage Plan. More information will be provided to participants who are currently enrolled in the United Healthcare plan and to those who will soon become eligible for Medicare. Case Management and Condition Care Management are being added to the wellness program. You must participate in the Case Management and/or Condition Care programs if contacted by BCBSNC representative to continue to receive your $50 per month wellness premium discount and value based pharmacy benefit. COBRA dental rates will increase. Our dental reimbursement plan will be administered by Ameritas. This change will allow retirees on the COBRA dental reimbursement plan to have access to providers within the Ameritas network who will be able to file claims directly with Ameritas. You can use the dentist of your choice; however, you will save money by going to an in-network dental provider. Prescription copays for retail and mail-order remain unchanged. Prime Therapeutics (Prime), the pharmacy manager for BCBSNC, will continue to provide prescription coverage. Your BCBSNC member ID card will be used for medical and pharmacy benefits. Participants who complete all wellness criteria will receive a $50 monthly premium discount and be eligible to participate in the value based pharmacy benefit. Effective January 1, 2017, all requirements to receive the $50 wellness discount for 2018, must be met between January 1, 2017 and September 30, Anyone who does not meet all requirements will not receive the wellness discount for the 2018 Plan Year. As a reminder, retirees will be allowed to enroll in either the Basic PPO or Basic Plus PPO regardless of their tobaccouse status. However, retirees signing up for the $50 Wellness Premium Discount must complete biometric screening scheduled for January Retirees who test positive for tobacco-use must complete a City approved tobacco cessation program between January 1, 2017 and September 30, 2017 to continue eligibility for the $50 Wellness Premium Discount. The Health Risk Assessment (HRA) will be available during the entire month of March 2017 and must be completed by March 31,

4 Blue Cross Blue Shield of NC PPO Plans You can choose from the following Provider Preferred Organization (PPO) plans: Basic PPO and Basic Plus PPO. Coverage Annual Deductible In-Network Basic PPO Out-of- Network Basic Plus PPO In- Network Out-of- Network Individual $1,000 $2,000 $500 $1,000 Family $2,000 $4,000 $1,000 $2,000 Out-of-Pocket Maximum (including copay and deductible) Individual $4,000 $8,000 $2,000 $4,000 Family $8,000 $16,000 $4,000 $8,000 Physician s Office Visits Primary $20 copay 60%* $20 copay 70%* Specialist $40 copay 60%* $30 copay 70%* Routine Physical $0 60%* $0 70%* Hospital Care Inpatient 80%* 60%* 90%* 70%* Outpatient 80%* 60%* 90%* 70%* Emergency Treatment Emergency Room $150 copay $150 copay $100 copay $100 copay Urgent Care $40 copay $45 copay $30 copay $35 copay Mental Health Office Visit $40 copay 60%* $30 copay 70%* Inpatient 80%* 60%* 90%* 70%* Substance Abuse Office Visit $40 copay 60%* $30 copay 70%* Inpatient 80%* 60%* 90%* 70%* Other Services Vision (basic routine) $0 60%* $0 copay 70%* Chiropractic Medical Benefits Summary $40 copay; 30 visits per year 60%* $30 copay; 30 visits per year 70%* 2017 Medical Premium Rates Basic Plan Premium Comparison Basic PPO Coverage Tier Retiree Monthly Premium Premium Premium w/ $50 Wellness Discount * Retiree Only $263 $213 Retiree/Child $599 $549 Retiree/Spouse $748 $698 Retiree/Children $1,097 $1,047 Retiree/Family $1,271 $1,221 Spouse Only $ Spouse/Child $ Spouse/Children $1, Basic Plus Plan Premium Comparison Basic Plus PPO Coverage Tier Retiree Monthly Premium Premium Premium w/ $50 Wellness Discount* Retiree Only $383 $333 Retiree/Child $904 $854 Retiree/Spouse $1,051 $1,001 Retiree/Children $1,491 $1,441 Retiree/Family $1,755 $1,705 Spouse Only $ Spouse/Child $1, Spouse/Children $1, * This premium applies to retirees who are participating in the City's Wellness Program. *After deductible For a complete list of covered services, refer to the Blue Member Guide on the Retiree Center website Please note that coinsurance/copayments apply toward your out-of-pocket maximum. 3

5 Prescription Drug Program Non-specialty prescriptions can be filled at a participating retail pharmacy (such as Walmart, CVS, Walgreens, and many others). Simply present your BCBSNC member ID card at the time you get your prescription filled; or you may have to pay a higher amount than the contracted cost. If you submit a manual claim you will only be reimbursed up to the contracted cost of a prescription. For added savings, you can use the mail-order prescription program that is administered by Prim and receive a 90-day supply of maintenance medications (i.e. blood pressure, birth control, allergy, etc.) for the same cost as a 60-day supply. This discount is for mailorder prescriptions only and does not apply to prescriptions filled at a retail pharmacy. Step Therapy allows prescriptions to be filled with an effective but more affordable medication. A more costly medication can be authorized if the alternative medication is not effective in treating the condition. Prior authorization may be required. If you have pharmacy or prescription questions, contact BCBSNC Customer Service at For questions regarding your mail-order prescriptions, please contact Prim Member Services at All specialty medications are distributed by Prime Specialty Pharmacy (PSP). To begin service or to get additional information, call PSP at Value Based Pharmacy Benefit In addition to the $50 a month Wellness Premium Discount, retirees who complete the wellness requirements will also be able to participate in the value based pharmacy benefit. This new benefit allows you and your dependents who are covered by the City s medical insurance to receive certain maintenance medications at a $0 copay. Please review the Value Based Drug List or contact BCBSSNC Customer Service at if you have any questions. Prescription Plan Benefits Summary Tier Basic PPO Basic Plus PPO Retail (30 day supply) Tier 1 - Generics $10 copay $10 copay Tier 2 Preferred Brand Tier 3 - Non Preferred Brand 20% coinsurance* $40 min. - $70 max 20% coinsurance* $55 min. - $105 max Mail-Order ( 90 day supply) 10% coinsurance* $30 min. - $60 max 10% coinsurance* $50 min. - $100 max Tier 1 - Generics $20 copay $20 copay Tier 2 Preferred Brand Tier 3 - Non Preferred Brand $60 copay $50 copay $100 copay $90 copay * Prescription coinsurance/copayments apply toward the out-of-pocket maximum under the medical plans Example of Prescription Plan for 2017 with Coinsurance and Minimum & Maximum Prescribed Drug (Retail Pharmacy) Drug Cost Drug Cost Basic PPO(20%)/ Basic Plus PPO (10%) w/ Min. & Max. Pradaxa Formulary/Preferred $190 20% = $38/ 10% = $19 (Coinsurance amounts less than min.) Actual Member Cost = $40/$30 Humira Specialty/Non-Preferred Brand $3, % = $ / 10% = $ (Coinsurance amounts greater than max.) Actual Member Cost = $105/$100 Medicare Advantage PPO Plan Retirees and their spouses who become eligible for Medicare Part A & Part B due to age or disability, as defined under the Social Security Act, can enroll in the City s Medicare Advantage PPO Plan. Effective January 1, 2017, Aetna will administer the City s Medicare Advantage Plan. More information will be sent to eligible participants about this change. The City will provide up to $200 towards the monthly premium for City retirees. The medical plan includes medical coverage for in-network and out-of-network provider services and prescription coverage (Part D). 4

6 Wellness Program Retirees enrolled in a City medical plan are eligible to participate in the City s Wellness Program. Participants receive a $50/month Wellness Premium Discount and a $0 copayment on certain maintenance medications (value based pharmacy benefit). Effective January 1, 2017, all requirements to receive the wellness discount and value based pharmacy benefit for 2018 must be met between January 1, 2017 and September 30, Anyone who does not meet all requirements will not receive the wellness discount for the 2018 Plan Year. All program requirements must be met and are as follows: Biometric Screening, Tobacco-Use Status Participate in a 2017 biometric screening including nicotine testing to verify tobacco-use status. Retirees who test positive for tobacco-use will have an opportunity to participate in the Wellness Premium Discount by completing the tobacco cessation programs offered through the City. FDA-approved tobacco cessation medications, including prescription drugs and Over-The-Counter (OTC) medications (such as nicotine replacement therapy) are covered by Prime at 100%. Health Risk Assessment (HRA) Complete the HRA in March The HRA can be accessed through the BCBSNC website at and must be completed by March 31, New hires and employees certified for benefits must complete the HRA within 90 days of the effective date of medical coverage. Annual Preventive Care Visit or Physical Complete your annual preventive care visit or physical between January 1, 2017 and September 30, If you are newly hired/certified for benefits or experience a QLE, you are encouraged but not required to have a physical or preventive care doctor visit until the 2017 Plan Year. Wellness Education Classes/Seminars Complete one wellness education class or seminar between January 1, September 30, Go to the Employee Center website or contact the wellness coordinator at for program information. Case Management and Condition Care Management (Only required if contacted by BCBSNC) Both the Case Management and Condition Care Programs offer a team of dedicated health care professionals nurses, social workers, dietitians and others who provide personal, one-on-one assistance. The goal of these programs is to help remove any barriers that may get in the way of members better managing their health. Case Managers and Condition Care coaches work to: Make sure members understand their condition, treatment options and doctor s treatment plan Offer methods to improve day-to-day management of the condition or disease Provide resources to help members make well-informed decisions about health care Work with doctors and other health care professionals to assist in coordinating members needs Help members connect to community resources that offer additional support If you are identified by BCBSNC as a member who could benefit from this service, you will receive a call at the telephone number you provided when you enrolled in the medical plan. If you cannot be reached at that telephone number after several attempts, you will receive a letter from BCBSNC stating that an attempt was made to call you to invite you into the program. The letter will provide a phone number for you to return the call to engage in the program. As part of the City of Winston-Salem s Wellness Program, if you are contacted by a BCBSNC Condition Care Coach or a Case Manager, either by telephone or by letter, you must participate in the program in order to continue to receive your $50 wellness discount and the value based drug benefit. It is not required that spouses and dependent children participate in order to continue to receive the $50 wellness discount although they are welcome to participate if contacted. 5

7 Dental Reimbursement Plan (COBRA Participants Only) The dental plan below is only offered to retirees and dependents (including retiree spouses) who have elected to continue their dental coverage under COBRA at retirement or due to a qualifying life event. The City s dental plan covers a full range of services and all dental claims are handled by Ameritas. You can use the dentist of your choice, however you will save by going to an in-network dental provider. Orthodontia is only available for covered dependents under the age of 19 with a lifetime maximum benefit of $1,500. Amount of Expense Dental Benefits Summary Employe r Share Level of Coverage Retiree Share First $ % 0% $300 Next $50 0% $50 deductible $0 Next $250 80% 20% $200 Next $1,600 50% 50% $800 Dental Cobra Premiums COBRA Monthly Premium Retiree Only $26.52 Retiree/Family $79.56 Paid Benefit $1,300 annual maximum benefit per covered member PPO Dental Network Ameritas Participating Provider Organization [PPO] gives you access to a nationwide network of credentialed providers. You have the option of receiving care from any provider you choose; however, your out-of-pocket costs will almost always be lower if you choose a provider from the Ameritas PPO dental network. Ameritas PPO network dentists agree to charge only a specific amount per procedure; they provide the same excellent service at a reduced fee, resulting in savings for you. Finding A Dentist Visit Ameritas at click on Find A Provider and follow the brief step-by-step instructions to locate convenient PPO providers. You ll see the provider s name, address, and phone number, whether it s a general or specialty practice, and if the provider is currently accepting new patients. You can even request a map and driving directions to the provider s office. Clicking on the profile button brings up office hours and the university the provider attended, if available. Ameritas also has a "find a provider" smart phone app. This will allow an employee to search for providers in their given area from their mobile phones and it is free to download. Just search "Ameritas Find a Provider" in the App Store. For more information you can contact a customer relations associate by calling a.m. to midnight, Monday-Thursday, and 7 a.m. to 6:30 p.m. on Friday. 6

8 In-Network Example Dental Plan Examples Your Dentist Billed In-Network Allowed Amount Amount Reimbursed Employee Pays Plan Description Routine Check-Up #1 $206 $128 $128 $0 100% of first $300 Routine Check-Up #2 $206 $128 $128 $0 100% of first $300 $44 $0 100% of first $300 $0 $50 0% of next $50 Crown (D2752) $1,055 $746 $200 $50 80% of next $250 $ $ % of remaining charges TOTAL $ $ Out-of-Network Example Your Dentist Billed Out-of-Network Allowed Amount Amount Reimbursed Employee Pays Plan Description Routine Check-Up #1 $206 $206 $206 $0 100% of first $300 $94 100% of first $300 Routine Check-Up #2 $206 $206 $0 $50 0% of next $50 $49.60 $ % of next $250 $ $ % of next $250 Crown (D2752) $1,055 $1,055 $ $ % of remaining charges TOTAL $ $

9 Notification of Change Address Change If you have an address change, please keep us informed of the change. We would like to make sure you are aware of any changes to your benefits and invite you to upcoming events. Address changes can be sent to City of Winston- Salem Human Resources Department, PO Box 2511, Winston-Salem, NC You will also need to report address changes to the NC State Retirement System at NC-SECURE ( ). $2,000 Life Insurance Benefit To ensure we honor your intentions, please make sure you update your beneficiary information. You can access a copy of the Beneficiary Change Form online at the Retiree Center or call Human Resources at Medicare Advantage PPO Plan If you are enrolled in one of the City s PPO medical plans and become eligible or enroll in Medicare Part A & Part B due to age or disability as defined under the Social Security Act, please contact Human Resources at to discuss your medical coverage plan option. Retiree Center Website The City Retiree Center is an easy way for you to get benefits information and forms. The website is a great source to get information of upcoming events, education classes, health screenings and clinics, and other health related programs that are available to retirees and their dependents. Retiree Center Website: Important Contacts Plan Provider Contact Number Website Medical Insurance BCBSNC bcbsnc.com PPO Prescription Drug Plan Prime Therapeutics Prim Prime Specialty bcbsnc.com myprim .com Medicare Advantage PPO Plan Aetna aetna.com Flexible Spending/Medicare Premium Reimbursement Savers Administrative Services, Inc. (Savers Admin) saversadmin.com/fsalogin Dental Ameritas Basic and Supplemental Life Insurance North Carolina Mutual/Securian EOI : Claims: lifebenefits.com Universal Life Insurance Unum Colonial unumprovident.com coloniallife.com Midlife N/A Reassure N/A Pension Plan NC Retirement System NC-SECURE nctreasurer.com 457 Deferred Compensation Plan & Roth IRA ICMA-RC icmarc.com Nationwide nrsretire.com 401(k) Plan & Roth 401(k) Plan Prudential ncplans.prudential.com NC 529 Plan College Foundation of NC CFNC cfnc.org/nc (a) ICMA-RC icmarc.org 8

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