2015 Retiree Benefits Open Enrollment Highlights NOVEMBER 5-19, 2014

Transcription

1 2015 Retiree Benefits Open Enrollment Highlights NOVEMBER 5-19, 2014

2 Table of Contents About Open Enrollment Summary of Changes for New Prescription Drug Provider Beginning January 1, Retiree Medical Plans for Those Age 65 and Older: No Major Changes... 4 Retiree Medical Plans for Those Under Age 65: Changes and Choices for HMO, POS and PPO Plan Changes... 5 Introducing the High-Deductible Health Plan (HDHP) Plan Rates for Retirees...10 Medical Plan Rates for Retirees Under Age Retiree Dental Plan Rates...10 Supplemental Life Insurance Rates...10 Senior Medical Plan Rates for Retirees Age 65 and Over...11 Updating Your Address...12 Making Benefit Changes During the Year...12

3 About Open Enrollment 2015 Benefits Open Enrollment for 2015 runs from November 5-19, During Open Enrollment, you can make the following changes to your benefits for Any changes are effective January 1, 2015: Change, elect or drop medical coverage. Add or drop an eligible dependent. Drop dental coverage (if you drop, you will not be able to re-enroll in the future). If after reading the information in this booklet, you want to make a change to your coverage, please call Harvard Human Resources Benefits at between 9:00 AM and 5:00 PM EST Monday through Friday or benefits@harvard.edu to request the necessary forms. No action is required if you do not want to make any changes. Summary of Changes for 2015 Senior Medical Plans for Those Age 65 and Over Retiree Medical Plans for Those Under Age 65 New Prescription Drug Administrator Annual Premium Changes New Prescription Drug Administrator Annual Premium Changes Adding Deductibles and Coinsurance to HMO, POS and PPO Plans New, Lower Out-of-Pocket Maximums for HMO, POS and PPO Plans Adding High-Deductible Health Plan Option About Your Benefits for 2015 New Prescription Drug Provider Beginning January 1, 2015 For 2015, Harvard has chosen Catamaran as the new pharmacy administrator for coverage that is part of Harvard s medical plans both for the senior plans and for the under age 65 retiree plans. Catamaran is one of the largest pharmacy benefits managers in the U.S. It receives high marks for customer service and provides a number of online tools to help you manage your prescription benefits. If you are enrolled in a Harvard retiree medical plan for 2015, you will receive a new Catamaran ID card before January 1, Once you receive your new ID card, it is very important to present it when filling any prescriptions on or after January 1, You will also receive a Welcome Kit with more information. The copayment structure for prescriptions is not changing; please see the enclosed 2015 Plan Comparison Chart for copayment information. While the copayment structure is not changing, there may be routine annual changes to the tier and cost of a medication on the preferred drug list, also called a formulary. 3

4 Transition of Prescriptions: Catamaran recommends having on hand a 3-week supply of your medication(s) during the transition. You will receive communication from Catamaran in mid-november with details about prescription transitions if any of the following situations applies to you: You have a prescription that will change cost tiers in the formulary; if so, you will be provided with information about generic or preferred brand-name alternatives, if available, that you may discuss with your doctor. You have mail-order prescriptions. Generally, these will transfer automatically, but you will need to provide new shipping and payment information to Catamaran. You have a mail-order prescription that will not transfer. This may happen if there are no refills remaining on it, it is a controlled substance, the refill by date has expired, it is being held for a future fill date, or it is a compound medication. If you still need the medication, you will need to get a new prescription from your physician and submit it to Catamaran. You have a prescription that is subject to prior authorization requirements or exceeds typical quantity limits. To find out more about the list of drugs covered by the plan, visit Catamaran s Open Enrollment online portal, which can be accessed via HARVie (select Compensation & Benefits > 2015 Open Enrollment) or at hr.harvard.edu, under Total Rewards. Additional Communications for Those Enrolled in a Senior Medical Plan (for Those Age 65 or Older): In addition to the communications described above, retirees enrolled in the senior plans will receive several required notices from Catamaran and our current prescription drug provider, Express Scripts, in mid- November. You will receive a Coverage Termination notice from Express Scripts and an Enrollment/Opt-Out notice from Catamaran. These notices are required under federal guidelines because this coverage is a Group Medicare Part D plan. No action is necessary on your part. Retiree Medical Plans for Those Age 65 and Older: No Major Changes Retirees and/or their eligible spouses/domestic partners age 65 and older may choose from among three senior medical plans: Blue Cross Blue Shield (BCBS) Medex Harvard Pilgrim Health Care (HPHC) Medicare Enhance Tufts Medicare Preferred HMO For more information on each coverage option, please refer to the enclosed 2015 Plan Comparison Chart. Your monthly premium rates for senior medical plan coverage (for those who retired on or after 1/1/1996) are on page 11 of this booklet. There are no major changes to these plans for Note that prescription drug coverage for all three senior medical plans is provided through Medicare Part D coverage that is included as part of your medical plan. The cost of your prescription drug coverage is included in your monthly medical plan premium you do not pay a separate Medicare Part D premium, and do not need to enroll in a separate Medicare Part D prescription drug plan. The administrator of this benefit for 2015 will be Catamaran, as described above. 4

5 Retiree Medical Plans for Those Under Age 65: Changes and Choices for 2015 Retirees, their eligible spouses/domestic partners and/or other eligible dependents who are under age 65 may choose from among the same medical plans as active employees. As described in preview materials sent to your home in September, Harvard is making several changes to these plans for Harvard, like most employers, must respond to the national trend of rising health care costs, including some driven by health care reform. Even with changes that we have made over the past several years, health care costs continue to be a challenge. To ensure that high-quality, affordable care remains sustainable in the long term for both the University and for retirees and their family members, we are changing the way we share the cost of care for some kinds of medical services in the plans available to eligible Harvard retirees under age 65. In 2015, for the HMO, POS and PPO plans, Harvard will now include deductibles and coinsurance for certain types of non-preventive care. We are also introducing a new health care option, a high-deductible health plan (HDHP). HMO, POS and PPO Medical Plan Changes The HMO, POS and PPO plans offered by Harvard will now include deductibles and coinsurance for certain kinds of care. It s important that you understand what each means: Deductible: The amount you must pay for health care services before the health plan begins to pay. Coinsurance: Your share of the cost of health care services, after the deductible. Out-of-Pocket Maximum: The maximum amount you will be required to pay during a calendar year for covered health care, excluding premiums, after which your medical plan will pay 100% of covered health care costs. Please note: Because Harvard is instituting a global out-of-pocket maximum, virtually all eligible in-network out-of-pocket medical costs, including copayments for office visits and prescriptions, will count toward your out-of-pocket maximum. Premium costs do not apply to the maximum. Principles Behind the Changes As the University developed the changes that will take effect on January 1, 2015, we did so with the intent to preserve the health plans on which retirees and their families rely. Harvard remains committed to these guiding principles: Access to health care, and to top-rated doctors, providers and networks in Boston s quality-rich area. Choice of both proven and innovative plan designs. Affordability for all of our people. Fairness in cost-sharing between the University and its faculty, staff and retirees, and among health plan participants. Transparency so that we can all become more aware of how much health care actually costs and the cost differences between providers. 5

6 These changes do not apply to in-network preventive care, such as annual physicals, immunizations and preventive testing and screening, which continue to be covered at 100%. In addition, the deductibles and coinsurance will not apply to in-network office visits for care of sickness or injury, outpatient mental health, or prescription drugs; these will continue to have the same copayments as they do today for most retirees (see Other Changes page 7). For important plan coverage details, please refer to the enclosed 2015 Plan Comparison Chart and Services and Charges At-a-Glance on page 7 of this booklet. How does this translate into costs for the HMO, POS and PPO plans in 2015? For the HPHC and HUGHP HMO, POS and PPO plans, in-network preventive care continues to be fully covered, with no cost to you. For in-network office visits, prescriptions and emergency room visits, you will continue to pay only copayments when receiving these services. For certain non-preventive medical services, you will pay a deductible and coinsurance, up to the annual out-of-pocket maximum. These services include: Hospitalization Surgery Advanced diagnostic testing Out-of-network services (available with the POS and PPO plans) are subject to separate deductibles, coinsurance and out-of-pocket maximums; this is not new for New cost structure for non-preventive care in the HMO, POS and PPO plans Plan Feature HMO POS and PPO In-Network Out-of-Network In-Network Out-of-Network Deductible (for non-preventive and out-of-network care) $250 per person/ not to exceed $750 per family $250 per person/ not to exceed $750 per family $750 per person/ not to exceed $2,500 per family Coinsurance (for non-preventive and out-of-network care) 10% (after deductible) Not applicable to HMO plan coverage 10% (after deductible) 30% (after deductible) Out-of-Pocket Maximum (includes deductible, coinsurance, and copayments) $1,500 per person/ not to exceed $4,500 per family $1,500 per person/ not to exceed $4,500 per family $2,500 per person/ not to exceed $7,500 per family Note: In-network and out-of-network deductibles and out-of-pocket maximums accrue separately. Here s how the new cost structure works: 1st You pay for the full cost of your care for certain non-preventive medical expenses until you reach your deductible. 2nd You and Harvard, through coinsurance, each pay for a portion of these nonpreventive health care services until you reach the out-of-pocket maximum. You will not pay more for covered health care services than the out-of-pocket maximum in a calendar year. Once you reach the out-of-pocket maximum, your plan pays 100% of further eligible costs for the year. You can see examples of how these costs work by going to HARVie (harvie.harvard.edu). Select Compensation & Benefits > Open Enrollment

7 Services and Charges At-a-Glance This chart summarizes the kinds of care that are provided by the HMO, POS and PPO plans (in-network) without charge, those that are subject only to a copayment, and those that are subject to an annual deductible and coinsurance up to annual out-of-pocket maximums. After reaching the in-network out-of-pocket maximum all eligible costs are fully (100%) covered. TYPE OF CARE Routine examinations for preventive care, including immunizations and routine vision exams Office visits for non-preventive care of sickness and injury, authorized office visits for consultations/evaluations with specialists No Charge Copayment Only Annual deductible, then 10% coinsurance Up to annual out-of-pocket maximum Rehabilitation, speech, occupational, chiropractic and physical therapy Prescriptions Outpatient mental health services including group and individual therapy, detoxification Emergency room care (copayment is waived if admitted directly to the hospital) Inpatient hospitalization (e.g., acute care, maternity, rehabilitation, mental health) Intermediate mental health care services (e.g., acute residential treatment including detoxification, intensive outpatient programs, partial hospitalization, and day treatment) Hospice, skilled nursing, home health care Non-preventive laboratory and radiology services (includes advanced radiology such as CT and PET scans) Surgery inpatient and outpatient (including colonoscopy, endoscopy and sigmoidoscopy) This is a summary of services and charges and not a complete listing of plan coverage, provisions or limitations. Other Changes There are several other changes to the HMO, POS and PPO plans that are effective as of January 1, 2015: The coinsurance for out-of-network care in the POS and PPO plans is changing from 20% to 30%. The emergency room copayment is increasing from $75 to $100. In addition to the changes described above, a small number of retirees who were in the HUCTW and Local 26 bargaining units and retired on or after July 5, 2011 will also see a small increase in copayments for office visits and prescriptions as well as an increase in the emergency room copayment. Please see the enclosed 2015 Plan Comparison Chart for details. 7

8 HMO, POS and PPO family deductibles and out-of-pocket maximums for two-person and three+ person families If you cover yourself and one dependent under family coverage, your in-network deductible will be $250 per person, and no more than $500 for your family. Coinsurance begins for each family member when the applicable individual deductible is met for that person. Your in-network out-of-pocket maximum will be $1,500 per person, up to a total family maximum of $3,000. If you cover yourself and two or more dependents, your in-network deductible will be $250 per person, with a $750 total family maximum. Coinsurance begins for each family member when the applicable individual deductible is met for that person. Your in-network out-of-pocket maximum will be $1,500 per person, up to a total family maximum of $4,500. Even if you cover more than three people, you will not pay more for eligible in-network services than your $4,500 family out-of-pocket maximum. Coinsurance begins when the applicable individual deductible is met. Deductibles, coinsurance and copayments count toward the out-of-pocket maximum. Introducing the High-Deductible Health Plan (HDHP) The High-Deductible Health Plan (HDHP), a new option for 2015, is a lower-premium, high-deductible health insurance plan, which means you pay less for premiums and more out-of-pocket at the point of care for services that are not considered preventive. The HDHP will be offered through Harvard Pilgrim Health Care and HUGHP Blue Cross Blue Shield of MA, so you will continue to have access to the same network of providers that are currently part of Harvard s health plans. HUGHP HDHP members will have access to an expanded network of Blue Cross Blue Shield of MA providers that includes Harvard University Health Services (HUHS). HDHP Summary Plan Feature In-Network Out-of-Network Preventive Care Covered at 100% After deductible, 35% coinsurance Deductible (applies to all non-preventive expenses) $1,500 for individual coverage/$3,000 for family coverage Amounts paid for both in-network and out-of-network care can be combined to satisfy the deductible. If you are enrolled in family coverage, the full family deductible must be met before coinsurance begins for any family member. Coinsurance (after deductible is met) 15% coinsurance 35% coinsurance Out-of-Pocket Maximum (after this is met, the plan [Harvard] pays 100% of costs) $3,000 individual coverage $6,000 family coverage* For family coverage, the full family out-of-pocket max must be met. $6,000 individual coverage $12,000 family coverage* For family coverage, the full family out-of-pocket max must be met. Emergency Room After deductible, 15% coinsurance All other covered non-preventive care such as: PCP/Specialist Office Visits; Hospital Admission; Outpatient Surgery; Lab/X-Rays After deductible, 15% coinsurance After deductible, 35% coinsurance Prescription (Retail 30-day/Mail Order 90-day) Generic Preferred Brand Non-Preferred Brand $7 retail/$14 mail order, after deductible $20 retail/$50 mail order, after deductible $45 retail/$110 mail order, after deductible 8 * There are separate out-of-pocket maximums for in-nework care and out-of-network care. They accrue separately. For example, if you meet the in-network out-of-pocket maximum, the plan will pay 100% of covered in-network services for the rest of the year but you would still have to pay your share of cost for any out-of-network care you receive until you meet the out-of-network maximum.

9 Health Savings Account (HSA)-Eligible Plan With the HDHP, eligible out-of-pocket expenses may be covered with a Health Savings Account, or HSA. An HSA can be used to pay eligible expenses now or as a vehicle to save for future expenses. If you meet federal eligibility requirements and are enrolled in the HDHP, you may open an HSA or you may use your own existing HSA. What You May Want to Consider Like any health plan, there are things you should consider prior to enrolling in the HDHP. Here are some things to understand as you review the HDHP compared to Harvard s other options: Lower Premium: You pay less each month for coverage. Preventive Care: In-network preventive care is covered at 100%. Out-of-Pocket Costs: These costs are higher in the HDHP than in the other plan options. For all non-preventive services, you pay the full cost (100%) of expenses until you meet your deductible. You are then responsible for a portion of the cost of care (coinsurance) until you reach the outof-pocket maximum. Deductible: If you re enrolled in family coverage, you must meet the entire family deductible before the plan pays there is no per person deductible like there is in the HMO, POS and PPO plans. Out-of-Pocket Maximum: If you re enrolled in family coverage, you must meet the entire family out-of-pocket maximum before the plan begins paying at 100% there is no per person maximum like there is in the HMO, POS and PPO plans. Pharmacy Benefits Prescription drug coverage is included with all HPHC and HUGHP medical plans (HMO, POS, PPO and HDHP). Prescription drug coverage has three copayment tiers, with generic medications having the lowest copayments. You can save even more on medications you take regularly, sometimes called maintenance medications, by using mail order. Prescription drugs are not subject to a deductible under the HMO, POS and PPO plans just copayments. Under the new HDHP plan, you must meet the plan deductible before the plan covers prescription drug costs; once you meet the deductible, the same copayment structure applies. See the enclosed 2015 Plan Comparison Chart for details. Resources and Information There is a lot for you to consider so you can make a well-informed decision for you and for your family. Take the time to review the HMO, POS, PPO and HDHP plans in the enclosed 2015 Plan Comparison Chart. You re also invited to attend an Online or On-Campus Information Session. Sessions will be held October 27 to November 14, 2014; for the schedule, please visit HARVie (harvie.harvard.edu) and select Compensation & Benefits > Open Enrollment 2015 or go to hr.harvard.edu/benefits. Please note that these sessions will only cover the Under Age 65 plans and the changes to those plans. 9

10 2015 PLAN RATES FOR RETIREES Medical Plan Rates for Retirees Under Age 65 (monthly) INDIVIDUAL COVERAGE (per month) Your rate is based on your salary tier on the date you retired. Salary Tier 1 Salary Tier 2 Salary Tier 3 HUGHP HMO $79 $120 $153 HUGHP POS $108 $149 $182 HUGHP HDHP $39 $80 $113 Harvard Pilgrim HMO $91 $132 $165 Harvard Pilgrim POS $120 $161 $194 Harvard Pilgrim PPO* $120 $161 $194 Harvard Pilgrim HDHP $50 $91 $124 FAMILY COVERAGE (per month) HUGHP HMO $213 $323 $412 HUGHP POS $289 $399 $488 HUGHP HDHP $106 $216 $305 Harvard Pilgrim HMO $250 $360 $449 Harvard Pilgrim POS $329 $439 $528 Harvard Pilgrim PPO* $329 $439 $528 Harvard Pilgrim HDHP $136 $246 $335 * Only available for retirees living outside of Massachusetts. Retiree Dental Plan Rates (monthly) For all retirees enrolled in this coverage Supplemental Life Insurance Rates For all retirees enrolled in this coverage Individual Family Delta Dental $51.25 $ HURA Dental $52.77 $ PLEASE NOTE: The HURA dental plan has been closed to new enrollees since before Age Monthly Cost per $1,000 of Insurance $ $ $ $ PLEASE NOTE: Total amount of life insurance coverage reduces by 35% on the July 1st following your 66th birthday, except retired hourly employees whose total amount of life insurance coverage reduces by 35% on the July 1st following your 65th birthday. Your group coverage with Harvard ends on the July 1st following your 70th birthday. You will be offered the option to continue your coverage with an individual plan at the time of reduction and/or termination.

11 Senior Medical Plan Rates for Retirees Age 65 or Over (monthly) (for those retiring on or after 1/1/1996*) BCBS Medex HPHC Medicare Enhance Tufts Medicare Preferred HMO Total Rate $361 $296 $319 Years of Service Contribution Harvard Retiree Retiree Share Contribution Retiree Contribution Harvard Retiree Share Harvard Retiree 20+ $289 $72 20% $289 $7 2% $289 $30 9% Retiree Share 19 $278 $83 23% $278 $18 6% $278 $41 13% 18 $267 $94 26% $267 $29 10% $267 $52 16% 17 $256 $105 29% $256 $40 13% $256 $63 20% 16 $245 $116 32% $245 $51 17% $245 $74 23% 15 $235 $126 35% $235 $61 20% $235 $84 26% 14 $224 $137 38% $224 $72 24% $224 $95 30% 13 $213 $148 41% $213 $83 28% $213 $106 33% 12 $202 $159 44% $202 $94 32% $202 $117 37% 11 $191 $170 47% $191 $105 35% $191 $128 40% 10 $181 $180 50% $181 $115 39% $181 $138 43% How to read the chart above: Along the top of the chart are the three Senior Medical Plan options and below is the total monthly rate for each plan. Down the left side, find your years of pensionable service, then follow this across to the option of your choice to see the monthly amount Harvard will contribute for each individual plan, what your monthly cost will be, and what percent your cost is of the total monthly rate. Costs are rounded to the nearest dollar; retiree contribution reflects actual retiree cost for Cost of Senior Medical Plan Coverage If you retired on or after January 1, 1996, the University contributes a percentage of the Harvard group BCBS Medex rate, and applies that dollar amount toward the individual cost of the senior medical plan option you choose, as shown above. Harvard s subsidy currently ranges from 50% to 80%, depending on your years of pensionable service. The per person cost of medical coverage for you and your eligible spouse/domestic partner under the three senior medical plan options listed above is based on the date you retired from Harvard and your years of pensionable service. Each year Harvard recalculates the University subsidy amount. As a current retiree, with 10 years of pensionable service, the subsidy is 50% of the total cost of the BCBS Medex plan. Harvard s contribution increases by 3% of the total Medex rate for every year of pensionable service between 10 and 20 years. At 20 years of pensionable service, the subsidy reaches the 80% maximum. If you select one of the other senior medical plan options, the amount of the BCBS Medex subsidy is applied toward the cost of that option. * If you retired before January 1, 1996, Harvard pays 100% of the cost of monthly premiums. 11

12 Making Benefit Changes DURING THE YEAR Updating Your Address You can update your address by going to PeopleSoft via HARVie (harvie.harvard.edu); select the link to PeopleSoft at the top of any page and log in using your Harvard ID number as your user name and your Harvard PIN as your password. If you are enrolled in Tufts Medicare Preferred HMO, your new address must be in Tufts service area (call Tufts to confirm the service area: ). If you are enrolled in Harvard Pilgrim Health Care Medicare Enhance, you must have an address within the United States. If you are enrolled in BCBS Medex, you are not required to have an address in a specific service area. If you need to make an address change, and do not have HARVie access, please contact Benefits at to request an address change form. You may be able to make certain benefit changes during the year (outside of Open Enrollment) if you experience certain qualified life events. If you have a life event, you have 30 days from the date of the event to make a benefit change, per Internal Revenue Service (IRS) guidelines. For a list of qualified life events that allow you to make certain benefit election changes, go to HARVie (harvie. harvard.edu/life_changes). If you have a qualified life event and wish to make a permitted benefit election change, please call Benefits as soon as possible at in order to make any changes within the 30-day window. C-RETIREE OPEN-ENROLLMENT-HIGHLIGHTS-2015 This brochure has been designed to acquaint you with the features of the 2015 benefit plans and every attempt has been made to summarize these programs accurately. The actual provisions of each plan will govern if there is any inconsistency between this brochure and Harvard s formal plans and contracts. 12