CYPRESS-FAIRBANKS ISD Benefit Plan Year: September 1, 2015 August 31, 2016 BENEFITS PRESENTATION OPEN ENROLLMENT: JULY 13 AUGUST 31, 2015

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1 CYPRESS-FAIRBANKS ISD Benefit Plan Year: September 1, 2015 August 31, 2016 BENEFITS PRESENTATION OPEN ENROLLMENT: JULY 13 AUGUST 31, 2015

TRS ActiveCare Select Plan Plan Options and Benefits & Caremark Drug Plan Employee

2 Agenda TRS-ActiveCare Mandatory Enrollment and ACA The Insurance Department web page What is TRS-ActiveCare? What s new with TRS-ActiveCare? TRS ActiveCare Select Plan Plan Options and Benefits & Caremark Drug Plan Employee Premium Rates Plans Maximum Cost Comparisons Health Savings Account (HSA) CFISD s Other Optional Plans Questions 2 2

3 Why Mandatory Enrollment? TRS-ActiveCare is requiring a Mandatory Open Enrollment in order to comply with new Affordable Care Act reporting requirements. Affordable Care Act is requiring Providers and Employers to submit forms 1094-C and 1095-C to IRS and employees for the 2015 calendar year by January 31, Employers must offer health insurance to eligible employees and collect declination forms from employees that choose not to enroll in order to satisfy reporting requirements and avoid penalties. Employees failing to decline may not be allowed to enroll later should they experience a Special Enrollment Event. 3

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5 Insurance Department Website District Website: Staff / HR / Insurance Open: Your Benefits Station for Benefit Plan Summaries Plan Designs Network Provider Links Premium Rates Insurance Company Links Claim Forms Agent Contact Information 5

6 What is TRS-ActiveCare? A statewide health care benefits program for employees of school districts, charter school, regional educational service centers and other educational districts Established and signed into law in 2001 by Texas Legislature. Today over 90% of Texas school districts participate. Law authorizes minimum funding levels to help employees pay for coverage ($150 from districts; $75 from state) CFISD joined TRS-ActiveCare September 1, 2011 for the plan year. Current Law: Once a school district joins TRS-ActiveCare, they can never leave. 1,120 districts/entities participate in TRS-ActiveCare 6

WHAT S NEW WITH TRS-ACTIVE CARE Effective September 1, 2015? Mandatory Enrollment: All employees must enroll or decline (waive). Premiums increased on all plans by an average of 7%.

7 WHAT S NEW WITH TRS-ACTIVE CARE Effective September 1, 2015? Mandatory Enrollment: All employees must enroll or decline (waive). Premiums increased on all plans by an average of 7%. AC 1-HD increased premiums and OOP maximums. AC 2 increased premiums and OOP max. OOP max now includes RX deductibles, co pays, and coinsurance. TRS Board considered freezing AC 2 enrollment. AC Select increased premiums and OOP max. OOP max now includes Rx Deductibles, Co Pays, and coinsurance. TRS ActiveCare Select Plan participants that live in Harris, Fort Bend or Montgomery ( Whole Health, Memorial Hermann Accountable Care Network ) counties will be issued a Gold AETNA ID card to differentiate from the Select Open Access Network (other counties). 7

8 TRS-ActiveCare Select Plan TRS-ActiveCare Select is entering its second year. It is similar to a HMO in that it is a network-only plan. With ActiveCare Select, you are free to see any network provider without a referral. However, there is no coverage if you see a provider who is not in the plan network. The only exception is for a true medical emergency. There are two networks that make up the ActiveCare Select plan: If you live in Harris, Ft. Bend or Montgomery Counties, you will be required to use the Aetna Whole Health network and the Memorial Herman Accountable Care Network team of providers. If you live in a different county, you will use the Aetna Select (Open Access) network. (Will receive white ID cards) 8

TRS ActiveCare Select Plan Take caution when enrolling in TRS-ActiveCare Select Plan Since the Select Plan does not provide coverage for services performed

9 TRS ActiveCare Select Plan Take caution when enrolling in TRS-ActiveCare Select Plan Since the Select Plan does not provide coverage for services performed out of network, unless for a true emergency, it is not recommended for employees with children away at college or living in another part of the state/country. 9

10 TRS-ActiveCare Select Plan You may want to consider this plan if: Understand which ActiveCare Select network you will be placed in based on the county you live in. Do NOT cover dependents who live outside your plan s network area. Want a lower deductible and a lower premium cost for coverage. Do NOT expect to use non-network providers. To find network providers: go to and click Find a doctor or facility. You can then search by name, specialty, procedure or condition. Be sure to choose from the network that applies to you, based on where you live as shown on the chart. 1 0

Teladoc Services Teladoc Services As a TRS-ActiveCare plan participant you and your eligible dependents have 24/7/365 access to U.S. board-certified doctors by phone.

11 Teladoc Services Teladoc Services As a TRS-ActiveCare plan participant you and your eligible dependents have 24/7/365 access to U.S. board-certified doctors by phone. Talk to a doctor anytime ( ) Teladoc can treat conditions like: Cold and flu symptoms Allergies and Bronchitis Ear infections Respiratory infections Sinus problems and can prescribe medications The consultation is covered at 100% under ActiveCare Select plan and ActiveCare 2. Under the ActiveCare 1-HD your cost is a $40 consultation fee that counts towards your deductible and out-of-pocket maximum. 11

Quest Diagnostics Quest labs are covered at 100% for ActiveCare2 and Select plans ActiveCare 1-HD members have a lower cost share due to our preferred rates with Quest Members may visit a quest lab

12 Quest Diagnostics Quest labs are covered at 100% for ActiveCare2 and Select plans ActiveCare 1-HD members have a lower cost share due to our preferred rates with Quest Members may visit a quest lab or have labs drawn in participating offices/facilities Members have the right to ask their providers to send their samples to Quest labs Pick up service may be available from your Doctor s Office (please refer to Quest Website) New locations being added every month 12

Beginning Right Maternity Program healthier pregnancy and baby Aetna s Beginning Right Maternity Program can give you the tolls and information you need for a healthy pregnancy.

13 Beginning Right Maternity Program healthier pregnancy and baby Aetna s Beginning Right Maternity Program can give you the tolls and information you need for a healthy pregnancy. You ll learn about prenatal care, labor and delivery, newborn and baby care, and more. Plus, you can get information for your baby s father or your partner. If you have health issues or risk factors that need special attention, our nurses can help you find out ways to lower your risks. All this is included free as part of your TRS-Active Care package. Preterm labor symptoms Special help for pregnancy risks Solid support to quit smoking Lower your risk for early labor Easy to sign up for the program: Call CRADLE Or log in to Aetna Navigator at Aetna Women s HealthSM online womenshealth.aetna.com Reproductive health, Menopause, Migraines, Depression, Breast and heart health 13

14 Cypress-Fairbanks Enrollment Summary CFISD May 2015 AC1- HD 4,451 = 57% AC 2 2,274 = 29% AC Select 1,129 = 14% HMOs 7 = 0% Total 7,861 Active Care 2 29% Active Care Select 14% HMO 0% Active Care 1- HD 57% Total Eligible Employees 14,304 % Insured Employees 55% AC 1-HD AC 2 AC Select HMO 14

15 Who is Eligible to Enroll? To be eligible for TRS-ActiveCare coverage, you must: Be employed by a participating district/entity and Be an active, contributing TRS member or Be expected to work 10 or more hours each week. This includes substitutes and temporary workers. Health care coverage for public school employees and their families 15

16 Employees NOT Eligible to Enroll State of Texas employees or retirees Higher education employees or retirees TRS retirees, either receiving or who have declined coverage under TRS-Care These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee. 16

Eligible Dependents Spouse (including a common law spouse and same sex

Adopted child Stepchild Foster child Child under the employee s legal

Enrollment Guide) Other child under age 26 (unmarried) in parent-child

17 Eligible Dependents Spouse (including a common law spouse and same sex marriage) Children (married or unmarried) under age 26 Natural child Adopted child Stepchild Foster child Child under the employee s legal guardianship Other eligible dependents (see page 18 in TRS-ActiveCare Enrollment Guide) Other child under age 26 (unmarried) in parent-child relationship Grandchildren (under age 26) Disabled children (of any age) 17 17

18 Special Eligibility Situations If an employee and spouse both work for a participating district/entity: A spouse may be covered as an employee or as a dependent of an employee Only one parent can cover dependent children A child (under age 26) employed by a district/entity and a contributing TRS member cannot be covered as a dependent The child must be covered as an employee If the child is not a contributing TRS member, the child may be covered as a dependent 18

19 CFISD EMPLOYEE MONTHLY PREMIUMS ALL TRS HEALTH PLANS AND HMOs Full Time Employee Premium Rates 19 Coverage Category Plans AC 1-HD AC Select AC 2 Emp Cost Emp Cost Emp Cost FirstCare HMO Emp Cost Scott & White HMO Emp Cost Employee Only $116 $242 $376 $ $ Employee + Spouse $478 $673 $1017 $ $ Employee + Child(ren) $326 $462 $682 $ $ Employee + Family $751 $844 $1027 $ $

20 COINSURANCE & COPAYMENTS? WHAT IS A DEDUCTIBLE? It is the fixed dollar amount(i.e. Plan 1-HD- Emp Only: $2,500) of the eligible expenses you are required to pay before your insurance either reimburses you or pays your medical provider directly for a covered service. WHAT IS COINSURANCE? Coinsurance is your share of the costs (i.e. 20% ) of a covered health care service usually a percentage of an eligible expense due AFTER you have met your annual deductible. WHAT IS A COPAYMENT? A copayment is a fixed dollar amount (i.e. $30.00 Copay for an office visit) that you are required to pay for a covered service at the time you receive care. Can also be charged in addition to the deductible and coinsurance 20

21 Plan Overview (Network Level of Benefits) Services Deductible (Employee Only / Employee / Family) Out-of-Pocket Maximum (individual / family; (includes medical & pharmacy deductibles, co-pays and co-insurance. Coinsurance (Plan pays / participant pays after deductible) Office Visit Copay ActiveCare 1-HD ActiveCare Select (no out of network coverage) ActiveCare 2 $2,500 / $5,000 $1,200 / $3,600 $1,000 / $3,000 $6,450 / $12,900 $6,600 / $13,200 $6,600 / $13,200 80% / 20% 80% / 20% 80% / 20% 20% coinsurance after deductible $30 for primary $60 for specialist $30 for primary $50 for specialist Preventive Care Plan pays 100% when using network providers Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians. All other physicians are specialists. 21

22 Plan Overview (Network Level of Benefits) Services ActiveCare 1-HD ActiveCare Select ActiveCare 2 High-tech Radiology (CT scan, MRI, nuclear medicine) 20% after deductible $100 copay per service, plus 20% after deductible $100 copay per service, plus 20% after deductible Inpatient Hospital 20% after deductible $150 copay per day, plus 20% after deductible ($750 max copay per admission) $150 copay per day, plus 20% after deductible ($750 max copay per admission, $2,250 max co-pay per plan year) Emergency Room 20% after deductible $150 copay, plus 20% after deductible (copay waived if admitted) Outpatient Surgery 20% after deductible $150 copay per visit, plus 20% after deductible $150 copay, plus 20% after deductible (copay waived if admitted) $150 copay per visit, plus 20% after 22 deductible 22

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25 PLAN COMPARISONS_MAX ANNUAL EXPENSES SUMMARY 25

26 CAREMARK Prescription Drug Benefits Network Level: Plan participant pays Features ActiveCare1-HD Select ActiveCare 2 Drug Deductible (per person, per plan year) Subject to plan year deductible Retail Short-Term (up to 31-day supply) Generic/Preferred Brand/Non-Preferred Brand 20% Retail Maintenance (after FIRST FILL, up to 31- day supply) Generic/Preferred Brand/Non-Preferred Brand Mail Order and Retail- Plus (up to 90-day supply) Generic/Preferred Brand/Non-Preferred Brand coinsurance after deductible $0 GENERIC $200 BRAND PER PERSON $20 $40*** 50% coinsurance $25 $50*** 50% coinsurance $ 45 $105*** 50% coinsurance $0 GENERIC $200 BRAND PER PERSON $20 $40*** $65*** $25 $50*** $80*** $45 $105*** $180*** *** If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug 26

27 Specialty Medications Benefits Specialty medications: Used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis Features ActiveCare1-HD Select ActiveCare 2 Specialty Medications (retail or mail) 20% after deductible 20% coinsurance per fill $200 per fill (up to 31 day supply) $450 per fill ( day supply) Retail-Plus Pharmacy Network Retail pharmacies that choose to participate in the Retail-Plus network are able to dispense a 60-day to 90 day supply of medication. You may visit or contact TRS-ActiveCare Customer Service at for more information on which pharmacies have chosen to participate in the Retail-Plus network. Examples of participating retail pharmacies: HEB, CVS, Wal-Mart, Kroger, & Target 27

Caremark Prescription Drug Resources Caremark Website www.caremark.

28 Caremark Prescription Drug Resources Caremark Website Website Features Include: See Plan Option Details Check Cost of Drugs per plan Learn about My Meds Keep Me Informed / Frequently Asked Questions Request a Temporary ID Locate a participating pharmacy Download mail order forms 28

29 HMOs - Limited by County of Residence Scott & White Service Areas Austin Madison Bastrop Travis Blanco Walker Burleson Waller Caldwell Washington Grimes Williamson Hays Lee Leon FirstCare Service Areas Bell Lampasas Bosque Limestone Brazos Llano Burnet McLennan Coryell Milam Falls Robertson Hamilton San Saba Hill 29

30 How to Enroll All eligible employees must either enroll in TRS-ActiveCare or decline (waive). Enroll through benefitsconnect online enrollment system during the Open Enrollment Period of: July 13 August 31, Mid-Year Plan Changes are made by submitting change forms and required documentation of your qualifying event NO LATER THAN 30 DAYS after the event date. Instructions and forms are on the Insurance Department web page under Mid-Year Plan Changes You should choose your plan carefully You may not change plans during a plan year unless you experience a qualified change of status that result in a Special Enrollment Event. 30

31 NEW CY-FAIR EMPLOYEES Enroll through benefitsconnect online enrollment system during your first 31 days of employment. Example: Date of Hire: Friday, 8/14/2015 Enrollment Eligibility Ends: Sunday, 9/13/2015 Example: Date of Hire: Monday, Jan 4, 2016 Enrollment Eligibility Ends: Wed. Feb 3, 2016 Access through the District s Insurance Department web page at Staff / HR / Insurance / benefitsconnect 31

32 Mid-Year Plan Changes Enrollees may make plan changes during the plan year due to a Special Enrollment Event Individuals who voluntarily drop coverage because of a Special Enrollment Event during the plan year may re-enroll during the plan year due to experiencing another Special Enrollment Event Changes must be made within 30 days after the event date (special rules apply to newborns) An application must be submitted for any change Special enrollment event/family status change: Marriage, divorce (resulting in a loss of coverage), birth, adoption or placement for adoption, or if an individual with other health insurance coverage involuntarily loses that coverage Common law marriage: Not considered a special enrollment event unless there is a Declaration of Common Law Marriage filed with an authorized government agency 32

33 Application to Split Premium Married couples working for different participating entities may split funds Optional Requires an Application to Split Premium Form be completed by both employees and both employers Form is available on the insurance website 33 33

34 ID Cards Will Be Mailed to Your Home TRS-ActiveCare 1-HD, Select and AC 2 Cards will only be mailed to new enrollees and those making making changes only. Separate cards for medical and prescription drugs will be mailed to you. Aetna Member ID cards are family ID cards with up to up to 5 family members on 1 card. AC Select Aetna Whole Health ID cards will be gold Caremark Prescription Drug ID cards For additional or temporary cards call customer service at HMO Plans All new HMO participants will receive new cards Each individual covered under the plan will receive a card 34

Downloadable forms (enrollment application, split premium, claim form, etc.

35 This image cannot currently be displayed. TRS-ACTIVECARE Enrollment Support Enrollment guide (English and Spanish) Downloadable forms (enrollment application, split premium, claim form, etc.) Provider locator Frequently asked questions Your Benefits Station

What if I Have Questions on TRS-ActiveCare

36 What if I Have Questions on TRS-ActiveCare medical or prescription drug plans? Aetna and Caremark Personalized Service Call TRS-ActiveCare Aetna / Caremark customer support for: Claim questions/status Network provider information Membership and eligibility Medical coverage questions Inquiries (telephone and ) ID card requests Transition of care information Help with online tools! May also utilize the Concierge Line to assist with service. (713) 222- CARE (2273) Customer Service

37 Other Benefit Plans District-Paid Basic Life Insurance & AD&D - $30,000 Optional Life Insurance up to $250,000. (Guaranteed Issue up to $250,000 for new hires) Optional Life Insurance up to $125,000 for spouse (Guaranteed issue up to $50,000 for new hires.) Existing employees must pass eligibility Optional Life Insurance up to $10,000 for each of your children (Guaranteed issue with a minimum of $10,000 coverage for employee.) Disability: Assurant Employee Benefits Guaranteed Issue with waiting periods Dental Plans: Assurant Indemnity Dental Insurance Plan- PPO (Insurance) Heritage DHMO (an HMO Type) Dental Plan - HMO (Insurance) MSofA Dent-All Discount Plan (Discount plan) QCD of America Discount Plan (Discount Plan) Guardian VSP Vision Insurance Plan Humana Cancer & Specified Disease Plan (requires Application Form) Long Term Care Insurance through Genworth Life available through TRS 37

38 Health Savings Account (HSA) What is an HSA? (See IRS Publication 969) Special account owned by an individual and used to pay out-of-pocket expenses (such as deductibles) or to grow as savings for future qualifying expenses Funded by the employee Pre-tax payroll deduction, maximum contribution per year of $3,350 for individual or $6,650 per family; 55 years of age and over = $1,000 additional catch-up per year. Portable, meaning the HSA funds always belong to the individual Who is eligible? Per IRS rules, any adult can contribute to an HSA if he/she: Has coverage under an HSA-qualified high deductible health plan (TRS-ActiveCare 1-HD, all coverage categories) Has no other first-dollar medical coverage Is NOT enrolled in Medicare; must be < 65 years old Cannot be claimed as a dependent on someone else s income tax return Who administers the HSA? JP Morgan Chase & Co. Maintenance fee of $2.50 per month paid by employee Employee receives two debit cards and views statement online 38

39 Tax-Deferred Retirement Investment Plans Tax Defer Savings for Your Retirement 403(b) Plan: Administered by JEM Resources Partners Refer to TRS approved list on TRS website Start an Account any time of year 457 Plan: Administered by JEM Resources Partners Easier to open than a 403(B) account just fill out the forms 15 Investment Choices Start an Account any time of year (minimum $5.00 per paycheck) Find Information on the HR Department web page / Staff / HR / Retirement 39

40 Long Term Care Insurance through TRS Plan Offered Through Teachers Retirement System of TX (TRS) Underwritten by Gemworth Life Insurance Company Apply for Yourself, Spouse, Family Member at Any Time of Year CHECK LIST Would an extra bill of $30,000 to $80,000 a year during your retirement be a problem for you? Do you have a spouse? Daughters? Sons? What are your expectations for your care; and what are your family members expectations for providing you with the care you may need? What are your retirement income/expenses expected to be? What are your assets and will they be available to use to pay for your care? See the Insurance Department web page for more information. 40

41 Questions Thank you for coming. 41

CYPRESS-FAIRBANKS ISD BENEFITS PRESENTATION OPEN ENROLLMENT: JULY 18 AUGUST 19, 2016

CYPRESS-FAIRBANKS ISD BENEFITS PRESENTATION OPEN ENROLLMENT: JULY 18 AUGUST 19, 2016 Agenda Introducing New Online Benefits Administrator - TCG The Insurance Department web page What s new in 2016-2017?