State Employee Health Plan

Transcription

1 State Employee Health Plan Open Enrollment for Plan Year

2 HCC Decisions 2019 is an Active Enrollment Dental benefit can be elected as a standalone benefit New hire employer contribution for the HSAs/HRAs will be made on the next quarterly contribution cycle Premium Contribution changes for 2019 Employee rates will increase 3.3% Spousal rates will increase 16.7% 2

3 Contracting for 2019 Medical BCBS of Kansas and Aetna Preferred Lab Quest and Stormont Vail Health Pharmacy CVS/Caremark Dental Delta Dental Vision Surency Voluntary Benefit Plans Metropolitan Life 3

4 Benefit Changes The HCC voted to change the administration of our Health Savings Accounts and Health Reimbursement Accounts (HSAs and HRAs) to NueSynergy for NueSynergy has been administering the Flexible Spending Accounts (FSAs), and will expand to administer the HSA and HRA programs as well. 4

5 Important Note for Non State Groups The following benefits do not apply to Non State Groups: 1. Voluntary Plans- Metropolitan Life 2. Flexible Spending Accounts- NueSynergy 3. HealthyKIDS 5

6 Medical Plan Options The same 5 plan options that we ve had in 2018 will be available for 2019: Plans A, C, J, N and Q All plans cover the same benefits, the difference in each plan is your deductible, out-of-pocket maximums, and your premium deductions Review your plan options carefully! Individual medical situations change from year to year and your needs may have changed! 6

7 Selecting Your Health Plan Pick a plan design (A,C, J, N or Q) Which plan design is right for you? Premiums, Deductibles, Coinsurance & OOP Review the networks In network providers have agreed to accept the vendor's allowed charge and non network providers have not. 7

8 Network Plan A Medical & Pharmacy Medical Deductible $1,000/$2,000/$3,000 Coinsurance 20% PCP Office Visit $40 Copay Specialist Visit $60 Copay Pharmacy Coinsurance 20%/40%/65% Special Case $100/30 day Out-of-Pocket (OOP) Max Medical & Pharmacy $6,250/$12,500 Non Network Medical Deductible $1,200/$2,400/$3,600 Coinsurance 50% Out-of-Pocket (OOP) Max Medical & Pharmacy $6,250/$12,500 HSA or HRA Employer Contribution None Can EE/SP earn HQ HSA/HRA dollars? No *Note: Discount tier & non covered items or services do not count toward Deductible or OOP Max 8

9 Network Medical & Pharmacy Deductible $2,750/$5,500 Medical Coinsurance 20% Pharmacy Coinsurance Plan C Deductible, then 20%/40%/65% Out-of-Pocket (OOP) Max Medical & Pharmacy $5,500/$11,000 Non Network Medical Deductible $2,750/$5,500 Medical Coinsurance 50% Out-of-Pocket (OOP) Max Medical $5,500/$11,000 HSA or HRA Employer E /SP&Fam/E+Ch Contribution $1,000/$1,250/$1,750 Can EE/SP earn HQ Yes: $500/$1,000 HSA/HRA dollars? *Note: Discount tier & non covered items or services do not count toward Deductible or OOP Max 9

10 Network Medical & Pharmacy Plan N Non Network Medical Deductible $2,750/$5,500 Medical Coinsurance 35% Pharmacy Coinsurance Deductible, then 20%/40%/65% Out-of-Pocket (OOP) Max Medical & Pharmacy $6,650/$13,300 Deductible $2,750/$5,500 Medical Coinsurance 50% Out-of-Pocket (OOP) Max Medical $6,650/$13,300 HSA or HRA Employer E / Sp&Fam/ E+CH Contribution $500 / $625 / $875 Can EE/SP earn HQ Yes: $500/$1,000 HSA/HRA dollars? *Note: Discount tier & non covered items or services do not count toward Deductible or OOP Max 10

11 Network Plan Q Non Network Medical & Pharmacy Deductible $500/$1,000 Medical Coinsurance 50% Pharmacy Deductible, then Coinsurance 20%/40%/65% Medical Deductible $700/$1,400 Medical Coinsurance 60% Out-of-Pocket (OOP) Max Medical $6,650/$13,300 Out-of-Pocket (OOP) Max Medical & Pharmacy $6,650/$13,300 HSA or HRA Employer None Contribution Can EE/SP earn HQ Yes HRA only: HSA/HRA dollars? $500/$1,000 *Note: Discount tier & non covered items or services do not count toward Deductible or OOP Max 11

12 Network Medical & Pharmacy Deductible $500/$1,000 Medical Coinsurance 25% Pharmacy Coinsurance Plan J Deductible, then 20%/40%/65% Out-of-Pocket (OOP) Max Medical & Pharmacy $7,350/$14,700 Non Network Medical Deductible $1,000/$2,000 Medical Coinsurance 50% Out-of-Pocket (OOP) Max Medical $10,000/$20,000 HSA or HRA Employer None Contribution Can EE/SP earn HQ Yes HRA only: HSA/HRA dollars? $500/$1,000 *Note: Discount tier & non covered items or services do not count toward Deductible or OOP Max 12

13 Preferred Lab Benefits Available with both medical carriers Plan A 100% coverage of eligible outpatient lab services Plans C, J, N, and Q will offer discounts until the Deductible is met, then covered services paid at 100% for eligible outpatient lab services BCBSKS Members: The local BCBSKS plan of the physician that ordered the lab test will process your lab claim. If your provider is outside of the BCBSKS network, your preferred lab vendor may not be a network provider for that BCBSKS plan and the claim may be subject to non network benefits. 13

14 Quest Diagnostics Statewide preferred lab vendor List of collection sites: Your doctor can draw the sample and send to Quest Access your results quickly and easily by going to the and app patient portal Stormont Vail Health Regional preferred lab vendor: Topeka, Emporia, Manhattan, Carbondale, Wamego Labs drawn at Cotton O Neil locations may be included if by network providers Show your medical ID card to access benefit TOLL FREE TOPEKA AREA

15 Rx Savings Solutions 15

16 Telehealth All plans include Telehealth benefits Aetna is offering the Teledoc Service BCBS is offering the Amwell Service Virtual Office Visits with licensed medical providers via the internet or your smart phone Convenient access: Providers available 24/7 Lower member OOP cost than Urgent Care or ER visits 16

17 Eligibility to Contribute to an HSA You must enroll in Plan C or N Your medical coverage must be limited to only High Deductible Health Plan(s) like Plans C & N You cannot be enrolled in Medicare A or B You cannot be enrolled in TRICARE You cannot be claimed as a dependent on someone else s tax return 17

18 Health Savings Account It s your bank account for health care! Use your HSA to pay health care expenses such as deductible, coinsurance, dental expenses, etc., for you & your tax-qualified dependents You may change your HSA contribution during the year The money in your HSA belongs to you! State employees with an HSA will also be able to use a Limited Healthcare FSA to set aside additional funds pre-tax for vision and dental expenses 18

19 Employee HSA Funding Member Only Family Annual IRS Maximum Allowed HSA Contribution $3,500 $7,000 Member over age 55 additional catch up amount $1,000 $1,000 The State s HSA & HRA contributions will be made in four equal payments: First paycheck in January First paycheck in April First paycheck in July First paycheck in October Note: Non State Groups may follow a different employer contribution schedule. 19

20 Health Reimbursement Account (HRA) An HRA is an employer-funded account Same employer contribution as HSA Employee submits claims for reimbursement HRA funds are returned to the employer 60 days after the last day of employment or the end of the plan year. Make sure you submit any eligible expenses before the run-out period ends. Employees may use a Health Care FSA to set aside additional funds pre-tax to fund their health care (applicable only to State Employees) Plans J & Q You will also have an HRA for any HQ Rewards dollars that you earn Employees cannot contribute to their HRA 20

21 Selecting an HSA or HRA On Plans C & N, you can select either the HSA or HRA option* HSA Money is yours and is portable. o Plan C - you must contribute a minimum of $25 per pay period to receive the employer contribution o Plan N - employees don t have to contribute to get the employer contribution HRA No employee contributions o Account holds only employer contributions o Funds do not rollover *IRS Guidelines on eligibility still apply 21

22 Flexible Spending Accounts (Not applicable to Non State Groups) Health Care FSA with this account, you are able to pay for eligible medical, dental, prescription and vision expenses not covered by insurance. Dependent Care FSA For child care expenses for children under 13 or dependent care expenses for an adult unable to care for themselves. Limited Purpose FSA For those with a Health Savings Account, the Limited Purpose FSA can preserve your HSA dollars when paying for Dental and Vision expenses 22

23 Flexible Spending Accounts (Not applicable to Non State Groups) Plans A, J & Q: Healthcare FSA Maximum Contribution $2,650 Plans C & N with an HSA: Limited Healthcare FSA Maximum Contribution $2,650 Plans C & N with an HRA: Healthcare FSA Maximum Contribution $2,650 With Healthcare FSAs, you may roll up to $500 of unspent funds into the next plan year Dependent Care FSA Maximum Family contribution of $5,000 23

24 Basic Enhanced Dental Plan pays for 2 exams & cleanings per year Benefit PPO Premier Non Network Preventive Services Covered in full Covered in full Allowed amount covered in full Basic Restorative 50% 50% 50% Major Restorative 60% 70% 70% Benefit PPO Premier Non Network Preventive Services Covered in full Covered in full Allowed amount covered in full Basic Restorative 20% 40% 40% Major Restorative 50% 50% 50% 24

25 Basic Plan Vision Benefits Enhanced Plan - Covers everything in the Basic Plan PLUS Office Visit Copay $50 Materials Copay $25 Frame Allowance $150 High Index Allowance Up to $116 Frame Allowance $100 Polycarbonate lenses Covered in Full Lenses: single vision, standard bifocal, trifocal or lenticular 100% Progressive lenses Allowance Up to $165 Contact lenses Allowance $150 Scratch & UV coating Covered in full Contact Fitting Fee Copay $35 25

26 PY 2019 HealthQuest (HQ) Rewards HQ Rewards Premium Incentive Discount for PY 2019 is available to employees & covered spouses who earn 40 credits during Discount earned by coverage tier: EE & EE/Children Tiers: EE can earn the full $480 of the premium incentive EE/Spouse & EE/Family Tiers: EE & spouse can each earn $240 of premium incentive discount 26

27 Voluntary Plans (Not applicable to Non State Groups) Voluntary Plans available from Metropolitan Life: Accidental Insurance Hospital Indemnity Insurance Critical Illness Insurance These Voluntary plans pay you cash to help offset unexpected expenses due to an accident or illness 27

28 What Do I Need to Do? Active Enrollment required for 2019 During the month of October, you will need to log in to the Membership Administration Portal (MAP) and complete the election process for 2019 EEs need to Save and Submit elections Print the Pending Elections Statement 28

29 What Happens If I Don't Enroll? Open Enrollment is your opportunity to elect your benefits for 2019 If you are currently covered and do not complete the OE election process: o MAP will default you to Plan N with your current medical carrier and an HRA for the employer contributions o You will not be allowed to change your plan election until the next open enrollment in October 2019 o Members that have waived coverage will remain waived. 29

30 Open Enrollment Oct. 1 31, 2018 All Employees covered under the medical insurance will need to re-enroll for 2019 MAP - or for employees with ESU, KSU, KU, KUMC and PSU Enroll for health Insurance Apply for HealthyKIDS (State employees only) Elect an FSA (State employees only) Select HSA employee contributions Enroll in voluntary benefit plans (State employees only) Don t wait until the last minute to enroll! Enroll early! 30

31 Identification Cards Caremark is sending new cards to all members Aetna, BCBSKS, Delta, Surency and Quest are only sending cards to new members or members who make changes in coverage NueSynergy is sending debit cards to new FSA account holders and to all HSA/HRA participants 31

32 OE 2019 Resources SEHP Website: Benefit & Coverage Questions: Aetna: BCBSKS: Caremark: Delta Dental: NueSynergy: Quest: Stormont Vail Health: Surency: Metropolitan Life: Eligibility & Enrollment Portal HRA & HSA Health Plan 32

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34 Rates Based on 24 Payroll Deductions 34

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