Office of Group Benefits Annual Enrollment for 2013

Transcription

1 Office of Group Benefits Annual Enrollment for 2013 FOR ACTIVE EMPLOYEES & RETIREES WITHOUT MEDICARE 1 Welcome This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan option, individuals should read plan documents carefully and also consult other OGB and plan administrators publications.

2 Presentation Topics This presentation will cover: Ways to Save Eligibility Overview of Health Plans Life Insurance Flexible Benefits Changes for 2013 Plan Year OGB will no longer self-administer the PPO plan OGB will contract with Blue Cross Blue Shield of LA to administer the PPO plan OGB ill ti t t t f OGB will continue to oversee contracts for all health plans

3 Annual Enrollment Timeline Annual Enrollment begins Annual Enrollment ends Deadline for employees to submit health plan enrollment forms to HR (if changing plans) 2013 plan year begins October 1 October 31 January 1 Flexible Benefits Annual Enrollment begins Flexible Benefits Annual Enrollment ends (may end earlier for some agencies) Deadline for employees to submit Flexible Benefits forms to HR Ways to Save

4 Your Health: Our Priority 7 Ways to Save Choose the right health plan for you 1 and stay in your plan s provider network Out-of-state coverage differs by plan Consider out-of-state dependents, possible travel or job transfer Utilize providers in your plan s network to avoid balance billing All plans accessible through OGB website: 2 Get preventive (wellness) exams Prevention Early diagnosis 3 Sign up for Diabetic Sense program (PPO & HMO plans) Get free glucometer and test supplies Provided by Catamaran (formerly Catalyst Rx) through Liberty Your Health: Our Priority 7 Ways to Save 4 Request generic drugs if available Same active ingredients and big savings Preferred drug list at 5 Sign up for In Health (formerly Living Well La.) program (PPO, HMO and CDHP plans) Access to health coaches by phone Prescription drug incentive and lower co-pays for active participants 6 Use Flexible Benefits (active employees only) Pre-tax deduction saves money More take-home pay 7 Split coverage could save money for married couples Applies to state and school employees Both must be eligible for coverage

5 Prescription Cost Comparison Brand-Name Drug Prescribed for Average Cost per Prescription * Approved Generic Alternative Average Cost per Prescription * Ambien insomnia $ zolpidem $ 4.06 Plavix blood clot prevention clopidogrel Singulair asthma / allergies montelukast Flomax prostate hyperplasia tamsulosin Combivent COPD Ipratropium / albuterol Tricor cholesterol fenofibrate Ultram pain tramadol 7.57 Lamictal seizures lamotrigine Pravachol cholesterol pravastatin Prozac depression fluoxetine Topamax seizures topiramate Zocor cholesterol simvastatin Lipitor cholesterol atorvastatin Lexapro depression escitalopram * Average costs as of utilization; subject to change Source: Catamaran In Health: Blue Health Services Health Management Program (formerly Living Well Louisiana) For PPO, HMO and CDHP Administered by Blue Cross Free health management program for active plan members and retired plan members without Medicare and covered dependents diagnosed with 1 or more of these 5 ongoing health conditions: Diabetes Coronary artery disease Heart failure Asthma Chronic obstructive pulmonary disease (COPD)

6 In Health: Blue Health Services Health Management Program (formerly Living Well Louisiana) For PPO, HMO and CDHP Administered by Blue Cross Once enrolled, you have access to... Health coaches by telephone Online health information and resources Reduced co-payments for prescription drugs used to treat any of these 5 ongoing health conditions with which h you have been diagnosed d In Health: Blue Health Services Health Management Program (formerly Living Well Louisiana) For PPO, HMO and CDHP Administered by Blue Cross Active participation i requires Initial assessment and follow-up contacts Ongoing relationship with health coaches (phone contact at least once every 3 months) If you fail to maintain contact with the health coaches, or if Medicare becomes your primary health coverage, you are no longer eligible to participate in the program

7 Eligibility Eligibility Same for All Plans Full-Time Employees and Dependents Legal spouse Louisiana does not recognize same-sex marriages, regardless of other states laws Children up to age 26 regardless of child s student, marital or tax status No one can be enrolled simultaneously l as both an employee and a dependent in OGB health plans or life insurance No dependent can be covered by more than one employee

8 Eligibility Children Natural child of employee or legal spouse Legally adopted d child Child placed in employee s home for adoption Child in your home under employee s legal guardianship or custody Grandchild whose parent is a covered dependent or for whom employee has legal guardianship or custody Dependent verification required Dependent Verification Plan member must provide proof of the legal relationship of each dependent within 30 days of date of application for coverage Proof: Official documents Marriage certificate Birth letter (will suffice for first 6 months only) Birth certificate (required within 6 months) Other court records or legal documents

9 Over-Age Dependents A covered child under age 26 who is or becomes incapable of self-sustaining sustaining employment is eligible to continue coverage as an overage dependent OGB must receive required medical records before dependent reaches age 26 Definition of incapacity broadened now includes both mental and physical incapacity Pre-Existing Condition Limitation New Hires and Late Applicants PEC limitation does not apply to anyone under age 19 Must complete enrollment form (GB-01) within 30 days for new dependent otherwise, pre-existing condition (PEC) limitation applies Condition is pre-existing if diagnosed or treated within 6 months before e enrollment e date... no benefits e are payable for that condition in first 12 months of coverage May be exempt if continuously covered without 63-day break in coverage prior to enrollment date

10 Retirement Coverage must be in effect immediately prior to retirement date Participation schedule applies to... Employees enrolled in an OGB health plan on or after January 1, 2002 Dependents enrolled in an OGB health plan on or after July 1, 2002 Prior OGB health plan coverage as a spouse qualifies in computing years of participation Retiree Participation Schedule Years of OGB Health Plan Participation Before Retirement % of Premium Paid by State Less than 10 years 19% 10 years or more, but less than 15 years 38% 15 years or more, but less than 20 years 56% 20 years or more 75% Schedule not affected when you change OGB health plans Your participation percentage is set at retirement

11 Medicare and Your OGB Coverage If you reached age 65 on or after July 1, 2005, AND are retired AND are eligible for Medicare Part A premium-free, then You MUST enroll in Medicare Part B to receive OGB health plan benefits for medical expenses covered by Medicare Part B You must submit Social Security verification to OGB: If eligible submit copy of Medicare card If not eligible submit letter from Social Security This also applies to your covered spouse Overview of Health Plans

12 OGB Standard Health Plans for 2013 PPO Nationwide Administered by Blue Cross and Blue Shield of La. HMO Nationwide Administered by Blue Cross and Blue Shield of La. CDHP-HSA * Nationwide Administered by Blue Cross and Blue Shield of La. Medical Home HMO Regions 5, 6, 7, 8 & 9 Must choose a primary care physician Fully insured by Vantage Health Plan * CDHP HSA is not available to retirees Other plans are available to all employees and retirees Consumer Driven Health Plan with Health Savings Account Option (CDHP-HSA) Administered by Blue Cross and Blue Shield of La. Lower premiums higher deductible If you choose to open a Health Savings Account You can contribute to your HSA through payroll deduction State contributes up to $775 per year to your HSA $200 at start of plan year Up to $575 per year in additional matching contributions Money in your HSA grows tax-free and rolls over each year You use the money in your HSA account to pay eligible health care expenses More details on HSA in Flexible Benefits section of this presentation

13 Member Out-of-Pocket Expenses PPO HMO CDHP-HSA Medical Home HMO Coverage In-Network Administrator i t Lifetime Maximum Nationwide Nationwide Nationwide Blue Cross & Blue Shield Blue Cross & Blue Shield Blue Cross & Blue Shield of La. of La. of La. Unlimited Regions 5, 6, 7, 8 & 9 Must choose primary care physician Vantage Health Plan Deductible $500 active $300 retiree 3-person maximum None $1,250 per employee $2,500 per employee plus 1 $3,000 per family None Out-of-Pocket Maximum $1,000 per person** $1,000 per person $3,000 per family $2,000 per person $2,000 per person $6,000 per family Hospital In-Network 10% of contracted rate* Pre-certification required $100 per day $300 maximum per admit Pre-certification required 20% of contracted rate* Pre-certification required $150 per day $450 maximum per admit Pre-certification required Doctor Visits 10% of contracted rate* No referral required Co-pay $15 primary care $25 specialist No referral required 20% of contracted rate* (primary care & specialists) Co-pay $15 primary care $45 specialist Referral required * Subject to plan year deductible and/or applicable co-insurance ** Active employees & retirees without Medicare Member Out-of-Pocket Expenses Coverage In-Network PPO HMO CDHP-HSA Medical Home HMO Referrals None required None required None required Required for all specialists except OB/GYN and 1 routine eye exam every plan year $90 co-pay (first visit only) Maternity 10% of $90 co-pay 20% of $90 co-pay Doctor Visits contracted rate * (first visit only) contracted rate * MRI or CAT Scans Sonograms Chemotherapy Radiation Therapy Routine Mammograms Routine PSAs Cardiac Rehabilitation 10% of contracted rate * 10% of contracted rate * 10% of contracted rate * 0% of contracted rate 0% of contracted rate 10% of contracted rate * Complete within 6 months $50 co-pay $25 co-pay $15 co-pay 20% of contracted rate * 20% of contracted rate * 20% of contracted rate * $150 per test ** $150 per test ** 20% of allowable amount ** $0 co-pay Member pays $0 100% covered $0 co-pay Member pays $0 100% covered $15/$25 co-pay Emergency Care $150 deductible $100 co-pay 20% of contracted rate* 20% of contracted rate* $45 co-pay per visit Up to 36 visits per plan year ** $100 co-pay * Subject to plan year deductible and/or co-insurance ** Prior authorization required

14 Member Out-of-Pocket Expenses Coverage Out-of-Network PPO HMO CDHP-HSA Medical Home HMO $1,000 deductible $1,000 deductible per person $3,000 deductible per family 30% of fee schedule* 30% of reasonable and customary charge * 30% of fee schedule * 50% co-insurance of allowable amount after deductible * All non-emergency services require prior plan approval * Plan member owes deductible, co insurance and balance of billed charges Prescription Drug Benefit (PPO & HMO) Payments Formulary Mail Order Program Prescription Drug Benefit In-Network Generic drug and brand-name drug with no FDA-approved generic available: Plan member pays 50% Maximum $50 per 31-day fill After $1,200 per person per plan year brand-name drug co-pay $15, generic drug co-pay $0 Brand-name drug with FDA-approved generic available: Plan member pays cost difference between brand-name drug dug&ge generic, e c,pus plus 50% of brand-name a drug cost Cost does not apply to $1,200 out-of-pocket maximum None Same as above PPO & HMO prescription drug benefit administered by Catamaran (formerly Catalyst Rx)

15 Prescription Drug Benefit (Consumer Driven Health Plan with HSA Option) Prescription Drug Benefit In-Network Payments Formulary Mail Order Program Per 31-day fill Generic drug - $10 co-pay Preferred brand drug - $25 co-pay Non-preferred brand-name drug - $50 co-pay Specialty drug - $50 co-pay Maintenance drugs not subject to deductible None Same as above for 90-day supply Maintenance drugs not subject to deductible CDHP prescription drug benefit administered by Express Scripts for Blue Cross Prescription Drug Benefit (Medical Home HMO) Prescription Drug Benefit In-Network Payments Per 30-day fill (Tier 1) Generic drug - $10 co-pay (Tier 2) Preferred brand-name drug - $45 co-pay (Tier 3) Non-preferred brand-name drug - $85 co-pay (Tier 4) Specialty drug - 25% co-insurance Formulary Closed with exceptions * Mail Order Program 30-day supply - 1 co-pay 60-day supply - 2 co-pays 90-day supply - 3 co-pays *Prescription drugs not on Vantage s formulary list may be available at higher out-of-pocket cost Medical Home HMO prescription benefit administered by Catamaran (formerly Catalyst Rx) for Vantage Health Plan

16 Mental Health & Substance Abuse Treatment Benefit PPO Magellan HMO Magellan CDHP-HSA Magellan Medical Home HMO Vantage Health Plan Inpatient Member pays 10% of contracted rate 1, 2 Member pays $100 co-pay 2 $300 maximum per admission Member pays 20% of contracted rate 1, 2 Member pays $150 co-pay 2 $450 maximum per admission Outpatient ti t Member pays 10% of contracted rate 1 Member pays $15 co-pay per office visit Member pays 20% of contracted rate 1 Member pays $45 co-pay per visit 2 1 Subject to plan year deductible and/or co-insurance 2 Pre-authorization required Key Points Can change health plans during Annual Enrollment Compare costs, benefits, restrictions and network providers when choosing a plan Active employees and retirees who stay in the same health plan do not need to fill out a form Active employees who want to change plans must notify agency HR office All PPO, HMO and CDHP members will receive new ID cards from Blue Cross for 2013

17 Retiree Plan Changes Retirees who want to change plans should Fill out an OGB enrollment form or write a letter to OGB and include: Your health plan choice Your name and address Your date of birth Your daytime phone number Sign your form or letter and mail it to... OGB Eligibility Division P.O. Box Baton Rouge, LA or visit any OGB Agency Services office Life Insurance

18 Life Insurance Group term life insurance policy State pays half of premium for employees and retirees Employee or retiree pays full premium for dependent life insurance 25% reduction in coverage and appropriate reduction in premium on July 1 after plan member reaches age 65 and age 70 Life Insurance Now administered by Prudential Life Insurance Contract ends December 31, 2012 Contracting process underway; may be administered by a different company effective January 1, 2013 Premiums may change Visit OGB website ( for information and forms

19 Life Insurance Basic Plan Option I Option II Employee $5,000 $5,000 Spouse $1,000 $2,000 Each Child $ 500 $1,000 Employee Schedule in Premiums Helpful Information Book Life Insurance Basic Plus Supplemental Plan Option I Option II Employee Schedule to maximum of $50,000 (amount based on employee s annual salary) Same Same Spouse $2,000 $4,000 Each Child $1,000 $2,000 Employee Premiums Schedule in Helpful Information Book

20 Life Insurance Accidental death and dismemberment (AD&D) benefits available to all active and retired employees covered under Basic or Basic Plus plan Retirees over age 70 not eligible for AD&D All inquiries and changes in life insurance must be made through your agency HR office Flexible Benefits

21 Why Enroll? Man, I need a raise! How can Ii increase my income? Oh yeah!... The Flexible Benefits Plan!! Flexible Benefits 5 Options Premium Conversion Set aside eligible payroll deductions for health care premiums General-Purpose (Health Care) FSA Set aside money from paycheck for eligible out-of-pocket health care expenses Limited-Purpose (Dental & Vision) FSA Set aside money from paycheck for eligible out-of-pocket dental and vision expenses only Dependent Care FSA Set aside money from paycheck for dependent care expenses while you work Health Savings Account for CDHP members Set aside money from paycheck for out-of-pocket health care expenses; state makes initial taxfree contribution of $200 and matches up to an additional $575 in contributions by you Flexible Benefits Plan Year January 1, 2013 through December 31, 2013

22 Premium Conversion Participation reduces your state and federal income taxes Participation provides more take-home pay Participation in Premium Conversion is free (for you and for your agency) Participation is easy enroll once, then continue from year to year unless you drop out during Annual Enrollment Premium Conversion Increases Your Spendable Income Premium Conversion Option Category Participant Non-Participant Monthly Taxable Salary $2,000 $2,000 Pre-Tax Premium - $420 - $0 (Employee + Spouse) Taxable Income $1,580 $2,000 Federal Taxes (20%) - $316 - $400 After-Tax Premium - $0 - $420 SPENDABLE INCOME $1,264 $1,180 $84 Monthly Savings x 12 = $1,008 Yearly Savings

23 Flexible Spending Arrangements You can participate in any Flexible Spending Arrangement (FSA) even if you are... Not enrolled in the Premium Conversion option Not enrolled in an OGB health plan New! Maximum Contribution Amount for GPFSA and LPFSA Short Effective Plan Year January 1, 2013 July 1, the 2011 maximum December m FSA plan 31, 2011 year contribution amount is $2,500 Regular Plan Year January for the 1, 2012 General-Purpose December 31, FSA2011 and the Limited-Purpose FSA Minimum FSA plan year contribution amount $600 FSA administrative fee $36

24 General-Purpose FSA Increases Your Spendable Income Category Participant Non-Participant Monthly Taxable Salary $2, $2, Monthly Deduction - $ $0.00 General-Purpose FSA Monthly Administrative Fee - $ $0.00 General-Purpose FSA Monthly Taxable Income $1, $2, Taxes (20%) $ $ After-Tax (Out-of-Pocket) Health Care Expenses - $ $ SPENDABLE INCOME $1, $1, $27.60 Monthly Savings x 12 = $ Plan Year Savings Limited-Purpose FSA Only for dental and vision medical expenses Can be used in conjunction with a Health Savings Account; but Cannot be used with a General-Purpose (Health Care) Flexible Spending Arrangement (GPFSA)

25 FSA Dependent Coverage Rule You can be reimbursed for eligible out-of-pocket of medical expenses for your dependent children up to age 27 through your General-Purpose FSA or Limited-Purpose FSA Eligibility and Enrollment Rules General-Purpose FSA and Limited-Purpose FSA You must be an active full-time employee (as defined by your employer) in a participating payroll system You must be continuously employed as an active fulltime employee for at least 12 consecutive months from January 1, 2012, through December 31, 2012 You can enroll during Annual Enrollment or after you experience an IRS-approved qualifying event You must re-enroll each year to continue participation

26 Dependent Care FSA For eligible dependent care expenses while working Can reduce DCFSA claims submitted by signing up for DCFSA Recurring Expense Service Reimbursement is limited to amount in account You must re-enroll each year to continue participation You must file an IRS Form 2441 Dependent Care FSA Plan Year Maximum Contribution Amounts Parental/Tax Status Single Parent or Married Filing Separately Single Head of Household Maximum Amount $2,500 $5,000 Allowable Dependents Child age 12 or younger Older dependent incapable of self-care Child age 12 or younger Older dependent incapable of self-care Child age 12 or younger Married Filing Jointly $5,000 Older dependent incapable of self-care Spouse incapable of self-care Note: DCFSA is good for employees who earn $25,000 or above

27 FSA mysource Card Use card to pay providers who accept MasterCard for eligible GPFSA, LPFSA and DCFSA expenses Full amount of General-Purpose FSA and Limited-Purpose FSA funds available immediately Dependent Care FSA funds available upon deposit Fax receipts within 2 weeks upon request Doctor s prescriptions and receipts are needed for reimbursement of FSA-eligible over-the-counter drugs and medicines DataPath Administrative Services Phone (toll-free): info@idpas.com Fax: Website:

28 Grace Period and Run-Out Period Grace Period January 1 March 15 You can incur eligible expenses during this period to be paid with money remaining in FSA account for immediately preceding plan year that ended December 31 Run-Out Period March 16 April 29 All claims for reimbursement must be received by April 29 Health Savings Account (HSA) You must participate in the Consumer Driven health plan (CDHP) to participate in a Health Savings Account (HSA) You cannot participate in an HSA if you have: General-Purpose (Health Care) FSA or spouse has General-Purpose (Health Care) FSA Medical coverage under a non-hdhp TRICARE or TRICARE for Life Used any VA benefits within previous 3 months Medicare Part A or Part B

29 Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) Option Consumer Driven health plan (CDHP) premiums Must be paid through an IRS SSection 125 cafeteria plan (i.e. OGB s Premium Conversion option) Health Savings Account (HSA) eligibility rules Current General-Purpose FSA participants must have a $0 balance in FSA account On or before December 31 to be HSA-eligible on January 1; or On or before March 15 to be HSA-eligible on April 1 Health Savings Account (HSA) The state makes an initial $200 deposit to your HSA The state t matches your additional HSA contributions ti made through payroll deduction dollar-for-dollar, up to $575 (your HSA is an IRS Section 125 cafeteria plan) Reimbursement is limited to your current account balance Your annual contribution limits are $3,250 (individual coverage) $6,450 (family coverage) You can contribute $1,000 more per year if you are age 55 or older

30 Health Savings Account (HSA) The IRS use or lose rule does not apply Funds can roll over from one plan year to the next Money in your HSA grows tax-free If you change health plans or jobs, or you retire, the money in your HSA is yours to keep From age 65 on, you can use your HSA dollars for any health care or non-health care expense -- with no penalty Health Savings Account (HSA) Use your HSA to pay eligible health care expenses: Office visits (including deductibles and co-insurance) Chiropractic services Prescription drugs Over-the-counter medications with a prescription Dental expenses Eye glasses, contact lenses and solutions Eye surgery (including LASIK) Lab fees COBRA, Medicare and qualified long-term care premiums

31 Life Changes Qualifying Event Matrix Use the matrix in the Flexible Benefits Plan Summary as your guide to determine allowable mid-year changes based on applicable qualifying events Event Description Premium Conversion Health FSA Dependent Care FSA Required Documentation Flex Change Form Event A. Change in Participating Employee's Legal Marital Status. 1. Marriage. Employee may enroll or increase election for newly eligible spouse and dependent children. Also employee may revoke or decrease employee's or dependent coverage only when such coverage becomes effective or is increased under the spouse's plan. Employee may enroll or increase election for newly eligible spouse and dependent children. Also, employee may revoke or decrease employee's or dependent coverage only when such coverage becomes effective or is increased under the spouse's plan. Employee may enroll or increase to accommodate newly eligible dependents or decrease or cease coverage if new spouse is not employed or makes a DCAP coverage election under spouse's plan. To increase coverage: (1) Flex change form; (2) marriage certificate; (3) dependent birth certificate. To revoke or decrease coverage: (1) Flex change form; (2) marriage certificate; (3) documentation of coverage under spouse's plan Marriage Flexible Benefits Summary No fee for Premium Conversion or Health Savings Account Administrative fee ($36 per account, per plan year) applies to General-Purpose FSA, Limited-Purpose FSA and Dependent Care FSA accounts Use or lose rule applies to all FSAs Your contribution amount is locked in for the plan year unless you experience an IRS-approved qualifying event

32 Flexible Benefits Annual Enrollment Period for 2013 October 1, 2012 through October 31, 2012 May vary by agency check with your agency s HR office Sources of Information The OGB website has links to each health plan s current provider directory Go G to OGB s home page Click on the Annual Enrollment for 2013 box (through December 31, 2012) or the Health Plans link in the Quick Links list (after January 1, 2013) Look under OGB Standard Health Plans for links to a searchable list of network providers (and other information) for each OGB health plan OGB Customer Service Blue Cross and Blue Shield of La. (PPO, HMO & CDHP) Vantage Health Plan (Medical Home HMO) Catamaran (formerly Catalyst Rx) In Health Program (formerly Living Well Louisiana) Diabetic Sense Program (PPO & HMO) DataPath Administrative Services (Flexible Benefits)

33 Questions?