2019 State Health Plan Open Enrollment. Open Enrollment Dates: Sept. 29-Oct. 31, 2018

Transcription

1 2019 State Health Plan Open Enrollment Open Enrollment Dates: Sept. 29-Oct. 31, 2018

2 Introducing the State Health Plan s New Website The new website has a new look and feel and is NOW mobile responsive! Changes to note: Name change of eenroll to ebenefits NC HealthSmart transition to Health and Wellness 3

3 Become a State Health Plan 4

4 New Explanation of Benefits (EOB) Coming Soon! These new and easier to read EOBs will be launched in August (draft version shown). Current EOB New & Improved EOB 39

5 New State Health Plan Member ID Cards for 2019 Current ID Card All members will be receiving new ID cards this year. They will be mailed in late November/early December. New & Improved ID Card 40

6 Enrollment Overview 9

7 Action Required! ALL non-medicare primary members will be moved to the 70/30 Plan effective Jan. 1, Subscribers will see this change when they log in to ebenefits in October. Subscribers MUST take action to enroll in the 80/20 Plan and reduce their premium in either the 70/30 or 80/20 Plan. Failure to take action by Oct. 31 st will result in: Remaining on the 70/30 Plan for 2019 Paying more for subscriber-only premium for failure to complete the tobacco attestation. 10

8 Plan Options The State Health Plan will continue to offer two plan options to active employees and non-medicare retirees for 2019: 80/20 Plan Members pay a 20% coinsurance for eligible in-network services. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Affordable Care Act (ACA) Preventive Services performed by an in-network provider are covered at 100% by the Plan, at no cost to the member. 70/30 Plan Services are subject to deductible and coinsurance maximum. Members pay 30% coinsurance for eligible in-network expenses. Similar to the 80/20, members pay a copay for some services (i.e., office visits, urgent care or emergency room visits). What is different on the 70/30 plan is that members also pay a copay for preventive office services. The deductible and coinsurance would apply to preventive services, like colonoscopies, performed in an outpatient setting. Members can reduce their employee premium by completing the tobacco attestation in both plans! 11

9 Tobacco Attestation Change By completing the tobacco attestation, employees can reduce employee-only premium by $60 on both the 80/20 & 70/30 plans. New attestation language and required activity: Employee must re-attest to not being a tobacco user or agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days of Open Enrollment or risk losing their credit. New hires enrolling during OE will be prompted to answer the tobacco attestation for 2018 and 2019 benefit year. While they need to answer the question twice, they can satisfy the requirement by completing either the QuitlineNC (2018) or the Minute Clinic (2019) tobacco cessation program. Subscribers enrolled through the Retirement Systems that select the 70/30 Plan do NOT need to complete the tobacco attestation. 12

10 How the CVS Minute Clinic Tobacco Cessation Program Works 1. During enrollment on the tobacco attestation screen, employee selects I AM a tobacco user, BUT I agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days after the last day of Open Enrollment or from your initial hire date. 2. Employee will then receive a letter which will include a CVS Minute Clinic Tobacco Attestation Voucher that will cover an initial visit (a $45 savings) + one follow-up (a $35 savings) visit for face-to-face tobacco cessation counseling. 3. Employee will need to bring the voucher to each session and present their State Health Plan ID card in order for the visit to be covered at 100% by the Plan (no charge to the member). 4. The initial visit is the only requirement to keep the premium credit. This will replace the QuitlineNC multi-call program enrollment requirement for the 2019 Plan benefit year. For subscribers that would like to utilize the Voucher Program after Jan. 1, 2019, they will need to call CVS Caremark at and a voucher will be mailed to them. 13

11 CVS Minute Clinic Tobacco Attestation Voucher For locations and hours visit 14

12 Tobacco Attestation Savings 80/20 Plan 70/30 Plan Total employee-only monthly premium without credit $110 $85 Attest to being tobacco-free OR agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session, if a tobacco user. TOTAL employee-only monthly premium with credit $60 $60 $50 $25 15

13 2019 Changes Individual In-Network Benefit Design 70/30 Plan (no changes) /20 Plan /20 Plan Deductible $1,080 $1,250 $1,250 Coinsurance Percentage 30% 20% 20% Preventive Coverage Cost-Sharing Applies 100% 100% Medical OOP Max Pharmacy OOP Max Medical Coinsurance Max Overall OOP Max NA $3,360 $4,388 N/A $4,350 $2,500 N/A $6,850 NA N/A N/A $4,890 PCP Copay $40 $10 (selected PCP)/$25 (non) $10 (selected PCP)/$25 (non) Chiro/Therapies $72 $52 $52 Specialist Copay $94 $45 Designated/$85 (non) $80 Inpatient Hospital $337, then Ded/Coins. $0 or $450, then Ded/Coins. $300, then Ded/Coins. Outpatient Hospital Ded/Coins. Ded/Coins. Ded/Coins. ER Copay $337, then Ded/Coins. $300, then Ded/Coins. $300, then Ded/Coins. Urgent Care $100 $70 $70 Drugs Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Tier 6 $16 $47 $74 10% up to $100 25% up to $103 25% up to $133 $5 $30 Ded/Coins. $100 $250 Ded/Coins. $5 $30 Ded/Coins. $100 $250 Ded/Coins. Preferred Diabetic Supplies* (e.g. Test Strips, Lancets, Syringes, Needles) Preferred Diabetic Supply brand is OneTouch $10 $5 $5 16 *Non-preferred Diabetic Supplies will be priced at Tier 3

14 80/20 Plan Wellness Incentive Additional Wellness Activity Reduced Copay Visit the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice. $10 copay The Blue Options Designated Provider Program will not be offered in

15 Pharmacy Benefit Reminders CVS Caremark is the Pharmacy Benefits Manager for the State Health Plan. Remember that the Plan continues to maintain a customized closed formulary, or drug list. Closed Formulary In a closed formulary, certain drugs are excluded. The formulary is updated on a quarterly basis and members should always review it to see if there have been any coverage changes to their prescribed medications. An exception process is available to providers who believe that, based on medical necessity, it is in the members best interest to remain on the excluded drug(s). Excluded drugs approved for coverage through the exceptions process will be at the tier 3 or tier 6 member copay level. 18

16 Pharmacy Benefit Reminders Individual In-Network Benefit Design 70/30 Plan 80/20 Plan Drugs Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Tier 6 $16 $47 $74 10% up to $100 25% up to $103 25% up to $133 $5 $30 Ded/Coins. $100 $250 Ded/Coins. Preferred Diabetic Supplies* (e.g. Test Strips, Lancets, Syringes, Needles). Preferred Diabetic Supply brand is OneTouch $10 $5 The Plan continues to receive feedback/complaints from employees that don t understand the impact of the 80/20 Plan s deductible/coinsurance design for Tier 3 and Tier 6 medications. Tier 3 and Tier 6 medications do not have a defined copay, but are subject to a deductible/coinsurance. This means that employees will have to pay the full cost of the medication until they meet their deductible. Once they meet their deductible, they will be responsible for the 20% coinsurance amount until they reach the out-of-pocket maximum. Medications that are subject to coinsurance in most cases will result in higher out-of-pocket costs to members. As a reminder, if an exception is approved for an excluded drug, it is only approved for coverage at the Tier 3 or Tier 6 member copay level. 19

17 Premium Rates 20

18 2019 Premium Rates (80/20 & 70/30 Plan) Monthly Premium Rates 2019 Rates * 80/20 Plan Subscriber Only $50.00 Subscriber + Child(ren) $ Subscriber + Spouse $ Subscriber + Family $ /30 Plan Subscriber Only $25.00 Subscriber + Child(ren) $ Subscriber + Spouse $ Subscriber + Family $ *Assumes completion of tobacco attestation. The employee-only premium will be $60 higher per month if the tobacco attestation is not completed. NOTE: 70/30 Plan for retiree-only coverage remains premium free. 21

19 2019 Premium Rates (High Deductible Health Plan) Monthly Premium Rates 2019 Rates HDHP Subscriber Only $96.00 Subscriber + Child(ren) $ Subscriber + Spouse $ Subscriber + Family $

20 Employer Contributions The State Budget provides an increase of 4% in the monthly employer contributions: Active Employer Contribution Rate: $ Medicare Primary Employer Contribution Rate: $ Non-Permanent Full-time Employer Rate (HDHP): $ As a reminder, the current monthly employer contribution rate for active employees is $ rate sheets will be available on the Plan's website soon. The monthly employer contributions above will be effective January 1, 2019, which means they should be reflected in December's payroll deductions. 23

21 Open Enrollment Communications 26

22 Communicating Open Enrollment to Members Communications will begin in August: Direct mail Telephone Town Halls (for retirees) Webinars Remember to process terminations for members turning 65 and retiring in the next couple of months so they receive the appropriate mailers. Resources available on the Plan s website will include: Videos Decision guides Rate sheets Comparison charts Benefit Booklets Summary of coverage documents AUG 2018 SEPT 2018 OCT

23 Extended Call Center Hours The Eligibility and Enrollment Support Center will have extended hours: Monday Friday, 8:00 a.m. 10:00 p.m. Saturday 8:00 a.m. Noon. Do not to wait until the last minute! Longer hold times occur the first and last week of Open Enrollment

24 Open Enrollment ebenefits Instructions 29

25 Member Home Page at Login Click Get Started 30

26 Adding Dependents Make any needed changes to your dependents, then click Next. 31

27 Begin Enrollment Click Begin Enrollment 32

28 Reason for Change Select Open Enrollment Click Next to continue 33

29 Who do you want to cover? Click Next 34

30 Plan Selection Review options and click Select plan and Next to continue. This HR note will display. 35

31 Tobacco Attestation and Premium Credit Select Answer, then click Next Select Answer, then click Next 36

32 Medical Summary Page Click Edit to modify tobacco survey answer if you need to. Click Edit to update additional insurance if you need to. Click Save Click Edit to add a Primary Care Provider if you need to. Other options to edit Premium Credit, Additional Insurance and Primary Care Provider will follow. 37

33 Review Elections and Select Save! Click Save changes to complete enrollment process 38

34 Confirmation Page Click to view and print Confirmation Statement Confirmation statement example. 39

35 Important Points for Members Members need to SAVE their choices at the end of the enrollment process. Many members overlook this vital, final step and therefore fail to complete enrollment! All enrollment choices will be displayed for confirmation but the member isn t finished yet! Members then need to scroll down and click SAVE to record their enrollment choices. Otherwise, it will be as if they never enrolled. Printing out their confirmation statement is also recommended! The choices you pick Will NOT stick Unless you SAVE them With a CLICK! 40

36 Dependent Eligibility Verification 44

37 Dependent Eligibility Reminder Open Enrollment is the time to add/drop dependents and/or change plans Outside of OE, there must be a QLE to add/drop dependents Within 30 days of the event Dependent verification documentation is required for all dependents. Full list of required documents on the Plan s website Documents should be uploaded and stored on ebenefits Contact the State Health Plan for assistance 45

38 Thank You! This presentation is for general information purposes only. If it conflicts with federal or state law, State Health Plan policy or your benefits booklet, those sources will control. Please be advised that while we make every effort to ensure that the information we provide is up to date, it may not be updated in time to reflect a recent change in law or policy. To ensure the accuracy of, and to prevent the undue reliance on, this information, we advise that the content of this material, in its entirety, or any portion thereof, should not be reproduced or broadcast without the express written permission of the State Health Plan.