State Employee Health Plan Open Enrollment State of the Plan

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1 State Employee Health Plan Open Enrollment 2017 Micah Thompson WSU HR Kim Cinelli WSU HR State of the Plan The A&M Efficiency Report recommends changes to the health plan Plan reserves are slightly below the target level Plan expenses must be covered by Plan revenues Additional funding is needed for

2 HCC Decisions Rate & plan design changes approved to address funding needs of the plan Employer & employee contributions will increase Premiums for covering spouses will increase 2nd year of a multi year plan to adjust rates Dental rates have been adjusted Employee only will have an employee contribution 2017 Full Time Rates Based on 24 Payroll Deductions 2

3 2017 Part Time & HealthyKids Rates Based on 24 Payroll Deductions Full Time Rates Based on 24 Payroll Deductions IMPORTANT!!! These are OLD 2016 rates!!! Pg. 19 3

4 Plan A HCC Plan Changes Office visit Copays $40 (primary care)/$60 (specialist) Three (3) tiered Deductible $1,000/$2,000/$3,000 Out Of Pocket (OOP) Max $5,750/$11,500 Pharmacy Coinsurance: Tiers are now 20% (generics) 40% (preferred brand name) 65% (non-preferred brand name) Special Case Copay $100 per 30 day supply Plan C HCC Plan Changes 20% Coinsurance for medical services Pharmacy Coinsurance added Coinsurance tiers: 20% (generics) 40% (preferred brand name) 65% (non-preferred brand name) OOP Max is $5,000/$10,000 HSA/HRA Employer Contribution Reduced $500 for employee & employee/child tier Reduced $1,000 for employee/spouse & family tiers 4

5 HCC Plan Changes HealthQuest (HQ) Rewards: New wellness vendor: Cerner Corporation New weight management program: Naturally Slim by ACAP Health 40 Credits required to earn 2018 HQ Reward Employees & covered spouses now eligible to earn HQ Reward for 2018 C Plan C: Covered employees & spouses can earn up to $500 each toward employee s HSA/HRA in 2017 Selecting Your Health Plan Pick a plan design (A or C) Which plan design is right for you? Premiums, Deductibles, Coinsurance Review the provider networks Review plan claim example online: 5

6 Plan A Network Non Network Medical* Medical* Deductible $1,000/$2,000/$3,000 Deductible $1,200/$3,600 Coinsurance 20% Coinsurance 50% PCP Office Visit $40 Copay Out of Pocket (OOP) Max* Specialist Visit $60 Copay Pharmacy* Coinsurance 20%/40%/65% Special Case $100 /30 day Medical $5,750/$11,500 Combined Out of Pocket (OOP) Max* Medical & Pharmacy $5,750/$11,500 * Non covered services & discount tier drugs do not count toward Deductible, Coinsurance or OOP Max. Plan A - Three Tiered Deductible How it works: 1st Person has a $1,000 Deductible 2nd Person has a $1,000 Deductible All remaining covered members combine together toward a 3rd $1,000 Deductible Maximum Deductible on a family with 4 or more members is $3,000 (covered members will never go over $1,000 Deductible) 6

7 Pharmacy Changes Plans A & C will offer 90 day supplies on most medications Compound drugs will only be covered if purchased from a Network Pharmacy Plan A Only: Asthma and Diabetes drugs: Generics 10% to max of $20 per 30 day supply Preferred brands 20% to a max of $40 per 30 day supply Non Preferred brands 65% Coinsurance Anticipated Generic Releases 4th Quarter 2016 Seroquel Zetia 1st Quarter 2017 Minastrin 24 FE Vytorin 2rd Quarter 2017 Strattera Relpax 4th Quarter 2017 Viagra Viread 7

8 Network Medical & Pharmacy* Deductible $2,750/$5,500 Medical Coinsurance 20% Pharmacy Coinsurance* 20%/40%/65% Out of Pocket Max* Medical & Pharmacy $5,000/$10,000 Plan C Non Network Medical* Deductible $2,750/$5,500 Coinsurance 50% Out Of Pocket Max* Medical $5,000/$10,000 * Non covered services & discount tier drugs do not count toward Deductible, Coinsurance or OOP Max. Plan C - Health Savings Account Its your bank account for health care! Use your HSA to pay health care expenses of you & your tax qualified dependents You can change your HSA contribution during the year If you do not make an election during Open Enrollment your contribution will default to $25 on January 1st 8

9 Eligibility for HSA To qualify for an HSA: You must enroll in Plan C Your medical coverage must be limited to only High Deductible Health Plan(s) like Plan C. You cannot be enrolled in Medicare or TRICARE You cannot be claimed as a dependent on someone else s tax return Employer HSA & HRA Funding Employer Contribution Annual Amount* Employee Bi Weekly Contributions*** Employer Contribution PLUS maximum HSA/HRA deposit Employee Bi Weekly Contributions after maximum Employer HSA/HRA deposit*** Total IRS Maximum Employee & Employer Amounts*** Full Time Employee** Employee Only Employee / Spouse OR Family Employee / Child(ren) $1,000 ($250 per quarter) $1,250 ($ per quarter) $1,750 ($ per quarter) $25 $ ($600 $2,400 total) $25 $ ($600 $5,500 total) $25 $ ($600 $5,000 total) $1,500 (up to $500 extra) $2,250 (up to $1,000 extra) $2,250 (up to $500 extra) $25 $79.17 ($600 $1,900 total) $25 $ ($600 $4,500 total) $25 $ ($600 $4,500 total) *The State s HSA & HRA contributions will be made in four payments on the 1st pay period of January, April, July & October. $3,400 $6,750 $6,750 ** HSA Contributions are based on full time employees with 24 pay period deductions. See Open Enrollment book for part time information. *** Members over age 55 can contribute an additional $1,000 Catch up amount 9

10 Health Reimbursement Account (HRA) For employees not eligible for an HSA The HRA is an employer funded account Same employer contribution as HSA Employee does NOT contribute to the Account Employee submits claims for reimbursement HRA funds are use it or lose it Employees may use a Health Care FSA to set aside additional funds pre-tax to fund their health care Preferred Lab: Stormont Vail Plan A - 100% coverage for eligible outpatient lab services Plan C - Discounts on eligible outpatient lab services until Deductible met, then paid at 100% Labs drawn at other Cotton-O Neil locations may be included if by network providers Show your medical ID Card to access benefit BCBS Members: The local BCBS plan of the physician that ordered the lab test will process the lab claim. If your provider is outside of BCBS of Kansas area, Stormont-Vail may not be a network provider and the claim may be subject to non network benefits. 10

11 Preferred Lab: Quest Diagnostics Plan A - 100% coverage for eligible outpatient lab services Plan C - Discounts on eligible outpatient lab services until Deductible met, then paid at 100% List of collection sites: Your doctor can draw the sample and send to Quest BCBS Members: The local BCBS plan of the physician that ordered the lab test will process your lab claim. If your provider is outside of BCBS of Kansas area, Quest may not be a network provider for that BCBS plan and the claim may be subject to non network benefits. Dental Changes Employee only dental will now have a contribution You and your dependents must have medical coverage to buy dental Changes to dental eligibility: You may opt out of purchasing dental You may elect a different coverage tier for dental than medical 11

12 Enhanced Dental Plan pays for 2 exams & cleanings per year Basic 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% Basic Plan Eye Exams Vision Benefits Enhanced Plan Covers everything in the Basic Plan PLUS Frame Allowance $150 Copay without $50 medical coverage WITH medical Covered in Full coverage Materials Copay $25 Frame Allowance $100 Lenses: single vision, standard Covered in Full bifocal, trifocal or lenticular Contact lenses Allowance* $150 Contact Fitting Fee Copay $35 High Index Allowance Up to $116 Polycarbonate lenses Progressive lenses Allowance Scratch & UV coating Covered in Full Up to $165 Covered in full *You must use the entire contact lenses allowance at one time. 12

13 Voluntary Plans New plans available from Colonial Life: Accidental Insurance Hospital Indemnity Insurance Cancer Insurance Critical Illness Insurance Flexible Spending Accounts FSA ($500 rollover) o Healthcare FSA - Limited to $2,550 o Plan C Limited FSA - $2,550 limit Dependent Care FSA o $5,000 limit (use it or lose it) o Mobile App 13

14 HealthQuest (HQ) New Naturally Slim program by ACAP Health Interactive web based program that promotes healthy eating & weight management New wellness vendor Cerner New HQ website and programs Aligning HQ year to calendar year New programs start in January 2017 PY 2018 HealthQuest (HQ) Rewards HQ Rewards Premium Incentive Discount for PY 2018 is available to employees & covered spouses that earn 40 credits each. 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 The Premium Incentive Discount is earned in PY 2017 and received in PY

15 HQ Rewards: Plan C only Employees & covered spouse can each earn up to $500 HSA\HRA dollars by completing HQ activities HSA/HRA funds earned will be paid during 2017 More information coming soon! The new HQ programs start January 1, 2017 Castlight Health Dental services information coming to Castlight in 2017! 15

16 Rx Savings Solutions Identification Cards BCBS, Caremark, Delta and Surency are sending new cards to all members Aetna is sending all Plan A members new cards and members who make changes. Quest is only sending cards to new members or members who make changes in coverage NueSynergy is sending all FSA accounts a debit card Optum Bank will send out HSA and HRA cards to new members and those with expiring cards. 16

17 Open Enrollment Oct. 1 31, 2016 Enroll online: HealthyKIDS available enroll online at: Questions Link to Open Enrollment book: HRA, HSA, Eligibility, & Enrollment Portal Questions: SEHPMembership@kdheks.gov Benefit & Plan Questions: Benefits@kdheks.gov WSU Open Enrollment Webpage 17

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