2018 OPEN ENROLLMENT OLATHE PUBLIC SCHOOLS. Welcome!

Transcription

1 2018 OPEN ENROLLMENT OLATHE PUBLIC SCHOOLS Welcome! 1

2 Introductions From Olathe Public Schools Dr. Eric Punswick Director of Classified Personnel & Services Nancy Jirik Manager of Employee Benefits Lisa Roberts Administrative Assistant to Dr. Punswick Veronica Henson Human Resources Jenevereth Myers Benefits Manager, CBIZ, Inc. Our Special Guests Valerie Seay Enrollment Supervisor Blue Cross Blue Shield Enedina Garza Enrollment Supervisor Blue Cross Blue Shield Ty Christenson Enrollment Supervisor Benefits Direct Mayling Herandez Enrollment Manager VSP 2

3 Mark your Calendars The 2018 Open Enrollment period begins Monday, November 6 th and must be completed by Tuesday, November 21 st. Benefits elected during this time period become effective January 1, 2018 and remain in place through December 31, 2018 unless you experience a life status change or event (i.e. marriage, birth, adoption, divorce, etc.)

4 Get Ready for the 2018 Benefit Plan Year All certified and classified staff members who are benefit eligible must complete the on-line enrollment process. Even if you wish to waive your right to elect benefit coverage for 2018, or if you intend to make no changes to your coverage, you must log in and complete the enrollment process. We re here to help you make informed decisions.

5 Highlights & Changes for 2018 Per IRS guidelines, deductibles for both $2600 Qualified High Deductible Plans (QHDPs) have been raised to $2700. If you elect to enroll in the $2700 QHDP BlueSelect Plus Plan you will receive a monthly $140 employer contribution to a Health Savings Account (HSA). o This means you receive an extra $1,680 to cover qualified medical expenses! The $1500 BlueSelect Plus PPO Plan no longer includes $40 per month employer contribution to a Flexible Spending Account (FSA). (However you do still have the option to contribute to a FSA.)

6 Review Benefit Choices Medical Plans o o 4 Plans 2 Provider Networks Dental Plans o 2 Plans Vision Plan o 1 Plan Supplemental Plans Health Savings Account Flexible Spending Account (FSA) Limited Purpose FSA Dependent Care FSA Life Insurance Short-Term Disability Accident Insurance Cancer Insurance

7 Medical Plans

8 Medical Plans Blue Cross Blue Shield is the Plan administrator 4 Medical Plans

9 Medical Plans 2 Provider Networks BlueSelect Plus o Lower premiums o Narrow provider options (helps BCBS control costs) o Important to use In-Network providers Preferred-Care Blue o Higher premiums o Broader provider network (more provider choices = less cost control for BCBS)

10 MyBlueKC.com 24/7 Member Access MyBlueKC.com Find a provider in your network View claims and benefits Print a temporary ID card Order a replacement card Wellness portal and other value-added programs Research Health Conditions 10

11 Hospital Locator Hospital Name HMO Blue Care Network PPO Preferred-Care Blue Network PPO BlueSelect Plus Center Point Medical Center X X NO Children s Mercy Hospitals X X X KU Medical Center X X X Lee s Summit Hospital X X NO E M P L O Y E E B E N E F I T S Liberty Hospital X X X Menorah Medical Center X X NO North Kansas City Hospital X X X Olathe Medical Center X X X Overland Park Regional X X NO Providence Medical Center X X NO Research Medical Center X X NO Shawnee Mission Medical Center X X X St. Joseph Medical Center X NO NO St. Luke s (All Locations) NO X NO St. Mary s Medical Center X NO NO Truman Medical Center (Hospital Hill and Lee s Summit) X X X

12 BlueSelect Plus Network Need to Know! BlueSelect Plus is best for members who live in the metropolitan Kansas City area. All other hospitals in Blue KC s service area considered out of network Hospitals included in the network: Children s Mercy (Hospital Hill & South) Liberty Hospital North Kansas City Hospital Olathe Medical Center Shawnee Mission Medical Center Truman Medical Center (Hospital Hill & Lakewood) University of Kansas Hospital This is a limited PPO network. Prior to choosing a health plan that uses BlueSelect Plus please confirm your provider is in this network Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 12

13 BlueSelect Plus In Network (5 Counties): Missouri Platte, Clay, Jackson Kansas Wyandotte, Johnson No network providers in the other 27 counties in our service area. Out of Network Counties: Missouri - Atchison, Holt, Nodaway, Andrew, Worth, Gentry, Harrison, Mercer, Dekalb, Daviess, Grundy, Buchanan, Clinton, Caldwell, Livingston, Ray, Carroll, Lafayette, Saline, Cass, Johnson, Pettis, Bates, Henry, Benton, Vernon, St. Clair In network benefits are available in all other areas as long as a BlueCard provider is selected

14 BlueSelect Plus Network Need to Know! This is a limited PPO network. Prior to choosing a plan that uses BlueSelect Plus please confirm your provider is in the BlueSelect Plus network. To search for BlueSelect Plus providers: Go to BlueKC.com Click Find a Doctor Choose BlueSelect Plus as the Network Click Go 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 14

15 Routine Preventive Services 100% Covered on All Plans In-Network routine Preventive services and the related office visit for routine preventive services covered at 100% Annual Physicals Well women exams & mammograms Colorectal cancer exams Childhood Immunizations PSA tests Generic contraceptive drugs at 100% Services MUST be Preventive Services MUST be done in a different calendar year Breastfeeding support, supplies (pumps) and counseling at 100% 15

16 Traditional Plans

17 Blue-Care Office Visit Hospital: Inpatient or Outpatient MRI, MRA, CT and PET Scans Physician s Office, Imaging Center, Outpatient Setting Emergency Room Urgent Care (includes Minute Clinics & Take Care Centers) Out-of-Pocket Maximum HMO Plan PCP: $30 copay (IM, FP, GP, PED) Specialist: $60 copay (all others) $300 copay per day inpatient / outpatient occurrence up to $1,500 per calendar year Inpatient/Outpatient surgical copays limited to 5 copays per member per calendar year $200 copay Only one copay will apply for each provider on a specified date of service even if multiple scans are performed $200 copay (copay waived if admitted) $60 copay Individual: $3,500 / Family: $8,750 (Includes all medical and Rx copays)

18 Deductible Network: Non-network: Coinsurance Network: Non-network: Inpatient or Outpatient Services Office Visits Urgent Care: (Minute Clinics, Take-Care Centers) $1,000 PPO BlueSelect Plus 9 Metro-Area Hospitals $1,000 individual / $2,000 family $2,000 individual/ $4,000 family You pay: 10% / BlueKC pays: 90% You pay: 40% / Blue KC pays : 60% Deductible then coinsurance $40 copay (IM, GP, FP, PED) $80 copay (all others) Non-network: Ded. then coinsurance $80 copay Non-network: Ded. then 60% $1,000 PPO Preferred-Care Blue 15 Metro-Area Hospitals $1,000 individual / $2,000 family You pay: 10% / BlueKC pays: 90% You pay: 40% / Blue KC pays : 60% Deductible then Coinsurance $40 copay (IM, GP, FP, PED) $80 copay (all others) Non-network: Ded. then coinsurance $80 copay Non-network: Ded. then 60% Emergency Room $150 copay then Deductible then 90% (copay waived if admitted) Out-of-Pocket Maximum* Network Non-Network: $5,000 individual / $10,000 family $19,875 individual / $39,750 family $150 copay then Deductible then 90% (copay waived if admitted) $5,000 individual / $10,000 family $15,000 individual / $30,000 family *Out-of-Pocket Maximum includes all covered member medical services: office visit, urgent, ER and Rx copays

19 Prescription Drug Coverage (HMO and $1,000 PPO Plans) Certain drugs may require prior authorization, have quantity limitations or require step therapy (Generics First). Refer to for additional details. Up to a 34-day supply In-network Pharmacy Deductible $200 Individual / $400 Family Tier 1: $12 copay Tier 2: $60 copay Tier 3: $80 copay Up to a 102-day supply Express Scripts Mail-Order Deductible $200 Individual / $400 Family Tier 1: $24 copay Tier 2: $120 copay Tier 3: $160 copay Rx copays help satisfy the Out-of-Pocket Maximum

20 (HMO and $1,000 PPO Plans) BlueKC offers a unique Value Based Incentive Program for members with Diabetes and Coronary Artery Disease TO ENROLL, call the customer service number on your member ID card How Do I participate in the Value-Based Incentive Program? 1) You must be willing to participate in the Healthy Companion disease management program. 2) You must actively obtain screenings for your condition. 3) You must agree to online or telephonic assessment with a Healthy Companion nurse. By participating in the program you can receive waived or reduced copays for selected medications or supplies specifically related to these conditions.

21 Deductible Network: Non-network: Coinsurance Network: Non-network: Inpatient or Outpatient Services Office Visits Urgent Care: (Minute Clinics, Take-Care Centers) $1,500 PPO BlueSelect Plus 9 Metro-Area Hospitals $1,500 individual / $3,000 family $3,000 individual/ $6,000 family You pay: 0% / BlueKC pays: 100% You pay: 30% / BlueKC pays : 70% Deductible then coinsurance Non-network: same Deductible then coinsurance Non-network: same Deductible then 100% Non-Network: Deductible then 30% Emergency Room Deductible then 100% Non-network: Deductible then 30% Out-of-Pocket Maximum* Network: Non-Network: $1,500 individual / $3,000 family $7,500 individual / $15,000 family $1,500 PPO Preferred-Care Blue 15 Metro-Area Hospitals $1,500 individual / $3,000 family Non-network: same You pay: 0% / BlueKC pays: 100% You pay: 20% / BlueKC pays : 80% Deductible then coinsurance Non-network: same Deductible then coinsurance Non-network: same Deductible then 100% Non-Network: Deductible then 20% Deductible then 100% Non-network: Deductible then 20% $1,500 individual / $3,000 family $3,000 individual / $6,000 family *Out-of-Pocket Maximum includes all covered member medical services.

22 Claim Flow Example Full cost of a doctor visit is $140 BlueKC has negotiated a fee of $65 using Preferred-Care Blue Doctors. You pay nothing at the visit* Your doctor sends a bill for $140 to your home, but you don t pay it. You receive the Explanation of Benefits (EOB) from BCBSKC indicating that you owe $65. You pay your doctor $65 (this amount goes towards your deductible). *At your physician s discretion

23 Qualified High Deductible Health Plan + Health Savings Account

24 Deductible Network: Non-network: Coinsurance Network: Non-network: Inpatient or Outpatient Services Office Visits Urgent Care: (Minute Clinics, Take-Care Centers) $2,700 QHDP BlueSelect Plus 9 Metro-Area Hospitals $2,700 individual / $5,400 family $5,400 individual/ $10,800 family You pay: 0% / BlueKC pays: 100% You pay: 30% / Blue KC pays : 70% Deductible then coinsurance Non-network: same Deductible then coinsurance Non-network: same Deductible then coinsurance Non-network: same Emergency Room Deductible then 100% Non-network: same Out-of-Pocket Maximum Network Non-Network: : $2,700 individual / $5,400 family $13,500 individual / $27,000 family $2,700 QHDP Preferred-Care Blue 15 Metro-Area Hospitals $2,700 individual / $5,400 family $5,400 individual/ $10,800 family You pay: 0% / BlueKC pays: 100% You pay: 20% / Blue KC pays : 80% Deductible then coinsurance Non-network: same Deductible then coinsurance Non-network: same Deductible then coinsurance Non-network: same Deductible then 100% Non-network: same $2,700 individual / $5,400 family $5,400 individual / $10,800 family *Out-of-Pocket Maximum includes all covered member medical services:.

25 Claim Flow Example Doctor/Hospital bills Blue KC Blue KC manages the claim Explanation of Benefits sent to you Discounted amount of medical service helps satisfy deductible Provider bills you Settle payment with provider 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 25

26 Prescription Drug Claim Flow Example Doctor writes prescription Show ID card at time of transaction Receive Blue KC discounts by using network pharmacies Prescriptions are priced immediately You pay the discounted amount of the prescription drug at the time of purchase. Discounted amount of prescription drugs is automatically applied to the deductible. After the deductible is satisfied prescriptions are covered at 100% 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 26

27 Understanding the HSA Concept Health Insurance Plan Qualified High Deductible Health Plan Bank Account Individually owned Tax advantaged Used to pay for eligible medical, dental and vision out-of-pocket expenses HSA administered by UMB 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 27

28 What is a HSA? A Health Savings Account (HSA) can help you manage your expenses today and in the future. It s yours to: Own. The HSA is always yours, even if you change jobs, re-enroll in one of the Traditional plans, become unemployed or retire. Grow. Your unused balance rolls over from year to year. No use it or lose it. Save. HSA s provide tax-free contributions and tax-free withdrawals and tax-free earnings from investment options. Choose. Use for current expenses, save for the future or explore investment options Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 28

29 Health Savings Accounts (HSAs) Maximize Your Tax Savings Three Ways to Maximize Your Tax Savings Contributions to an HSA are tax-free (they can be made through payroll deduction on a pretax basis when you open an account with UMB). As long as the funds are used to pay for qualified medical expenses, they are spent tax-free. The money in this account (including interest and investment earnings) grows tax-free Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 29

30 Eligibility to Open an HSA You must be covered by the Qualified High Deductible Health Plan (QHDHP); You cannot have any other coverage such as: A plan that is not an HSA-qualified HDHP Spouse s plan that is not a QHDHP (Traditional HMO or PPO) Medicare or Medicaid Tricare Coverage (military health care) Health Flexible Spending Account (not to include Flexible Spending Account for Dependent Day Care or Limited FSA) Health Reimbursement Arrangement (HRA) You cannot be claimed as a Dependent on someone else s tax return. It is the accountholders responsibility to maintain compliance under these regulations 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 30

31 Eligibility to Open an HSA You ARE ELIGIBLE to elect an HSA if: You elect to enroll in a QHDP effective 1/1/18. Your Spouse is also enrolled in a QHDP effective 1/1/18. No one else will claim you as a Dependent on your 2017 tax return. You are NOT ELIGIBLE to elect an HSA if: Your Spouse is enrolled in a Traditional PPO or HMO Plan. (Your Spouse must also be enrolled in an QHDP effective 1/1/18!) You are claimed as a Dependent on someone else s tax return. You are enrolled in Medicare, Medicaid or Tricare. You have a balance or are contributing to a Medical Flexible Spending Account. (Electing a Limited Purpose FSA and/or a Dependent Care FSA are okay!) You receive a Health Reimbursement Arrangement (HRA) from another source. Per the IRS, it is your responsibility as the account holder to maintain compliance under these regulations Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 31

32 How Much Can I Contribute in 2018? IRS limits the annual maximum HSA contribution $3,450 individual $6,900 family Catch-up contributions of $1,000 available for employees and spouses 55 and older Maximum HSA amount includes contributions from all sources 2016 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 32

33 Qualified Expenses Use the HSA funds to pay for IRS eligible expenses permitted under Federal Tax law including: Medical out-of-pocket expenses Dental treatments Hearing aids including batteries Prescription drugs Eye exams, eyeglasses, and contact lenses Chiropractic Care and Acupuncture Premiums for qualified long term care insurance and COBRA Medicare premiums Health plan coverage while receiving Federal or State unemployment benefits Review IRS Publication 502 for a complete list of eligible expenses. Pay for expenses for yourself and your spouse or tax dependents (even if they are not covered by your health plan) Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. 33

34 Flexible Spending Account (FSA) The Flexible Spending Account (FSA) is a plan that can help you pay for out-of-pocket medical, dental & vision expenses Payroll deductions are pre-tax under IRS Section 125 Contribution maximums for 2018 o $2,650 Individual o If both spouses elect an FSA through their respective employers, they can each elect the maximum, for a total of $5,300 per household The amount you elect is front-loaded to your FSA account in January. Careful planning is important due to the Use it or Lose Rule. Any funds still left in the account on March 15 th, 2019 will be forfeited. Complimentary debit card available Administered by American Fidelity Assurance

35 Limited Purpose Flexible Spending Account (FSA) Only eligible to elect a Limited Purpose FSA when enrolled in a QHDP and HSA. Can only be used to pay for Dental & Vision expenses. Take extra care to plan. Otherwise functions as a regular FSA o Payroll deductions are pre-tax under IRS Section 125 o Contribution maximums for 2018 o o o o $2,650 Individual If both spouses elect an FSA through their respective employers, they can each elect the maximum, for a total of $5,300 per household The amount you elect is front-loaded to your FSA account in January. Careful planning is important due to the Use it or Lose Rule. Any funds still left in the account on March 15 th, 2019 will be forfeited. Complimentary debit card available Administered by American Fidelity Assurance

36 Dependent Care Flexible Spending Acct. If you have one or more child(ren) under age 13, the Dependent Care FSA offers a great way to help pay for nursery and daycare expenses so you re able to work. If you elect to participate in this plan your pre-tax contributions to this account may also be used to pay for custodial or elder care expenses for your spouse or relative. o o Must live with you at least 8 hrs./day Physically or mentally incapable of self-care Eligible Dependent Care expenses include, daycare, nursery school, baby sitting, nanny care, summer camp, preschool, before & after school care. In 2018, employees are eligible to contribute up to $5,000 (or $2,500 if married & filing separate tax returns). There are three important factors make this plan different from the Medical FSA plans o o o The Dependent Care FSA cannot be used to pay for medical expenses. Only care-related expenses that grant an employee the opportunity to work, look for work or go to school. If you elect to participate, your pre-tax payroll deductions will be applied evenly throughout the plan year. As funds are deducted and deposited into your Dependent Care FSA, you re able to use the available balance to pay eligible expenses. Unlike the regular Flexible Savings Plans, mentioned on the Dependent Care FSA is not pre-fund Use It or Lose It Rule does apply, any funds left in the Dependent Care FSA after the plan year s grace period is over, will be forfeited. You are encouraged to contact American Fidelity or a Tax Advisor for information and recommendations.

37 Dental Plan Delta Dental of Kansas offers 2 plans, Basic Plan and the Basic+Orthodontia Plan Both plans cover: o Most all diagnostic & preventive services at 100% (i.e. exams, x-rays, cleanings, etc.) o Basic services at 90% (i.e. standard fillings, root canal, oral surgery, etc.) o Major restorative at 50% (i.e. bridges, crowns, etc.) o Maximum annual benefit for all covered services is $1,000 per member The Orthodontia Plan is designed exclusively for dependent children under age 19 This plan covers orthodontia appliances and treatment at 50% $1000 per beneficiary per lifetime Although you and your family are welcome to use In-Network or Out-of-Network providers there are several cost and convenience advantages to staying In-Network The overall cost will be significantly less In-Network providers manage claims on your behalf Go to to locate a dentist from the Delta Dental Premier network

38 Vision Plan Insured through VSP Benefits include $10 copay for exam every 12 months $25 copay for materials Up to $130 frame allowance once every 24 months OR Up to $130 contact & contact fitting fee allowance every 12 months Various lens allowances (depends on type of lens) once every 12 months You are welcome to use In-Network or Out-of-Network providers, however there are several cost and convenience advantages to staying In-Network The overall cost will be significantly less In-Network providers manage claims on your behalf Go to to find an Eyecare provider near you

39 Life Insurance Plans Basic Life Insurance is provided to benefit eligible employees who are actively at work o o This is a Group Term Life plan with coverage equal to 1.5 X s your annual salary The District pays the cost of this coverage (to KPERS directly). Voluntary Life Insurance plans are administered and insured through the Lincoln Financial Group. o Premium rates are figured by age. During the 2018 Open Enrollment period, Lincoln Financial is offering employees the opportunity to ELECT VOLUNTARY LIFE COVERAGE FOR THE FIRST TIME or INCREASE YOUR CURRENT COVERAGE AMOUNTS you already have: o o VOLUNTARY EMPLOYEE LIFE: As an eligible employee under age of 70, you may elect new coverage or increase your existing coverage at guaranteed issue level by either $10,000 or $20,000 without EOI. Any elections over $20,000 would require completion of a medical questionnaire (EOI). Cannot exceed the overall maximum of $300,000 or 7 X s annual salary. VOLUNTARY SPOUSE LIFE: You may elect new coverage or increase your existing Spouse coverage by $10,000 without EOI. Any elections over $10,000 would require completion of a medical questionnaire (EOI). Cannot exceed the overall maximum $150,000 or 3.5 X s annual salary. Additional underwriting limitations may apply, please contact Lincoln Financial for details.

40 Disability Plans KPERS offers Long-Term Disability coverage at no cost o Coverage starts after 180 day waiting period Short-Term Disability insured through American Fidelity o Guaranteed issue as a new hire o Employee chooses elimination period 8, 15, 31 days o Provides employees compensation of 66% - 70% o Coverage can last for a maximum of 6 months o Premium figured by your annual income o District sick leave can be used in addition to Short-Term Disability

41 Accident Insurance Insured and administered through American Fidelity Provides cash benefit in the event of a covered accident o Payment made to policy holder o Benefits can be used for medical related expenses o Three levels of coverage Basic, Enhanced or Enhanced Plus o Individual and family coverage options

42 Cancer Insurance Insured through American Fidelity Provides cash benefit in the event of a Cancer diagnosis o Payment to the policy holder for screening, treatment, and related cost of care o Benefit is paid regardless of medical coverage o Monetary Preventative Care incentive o Two plans Basic Enhanced

43 Key Points Benefit elections you make during this Open Enrollment period remain in effect until December 31, 2018, unless you experience a qualifying life event Review BCBS s Medical Plans BlueSelect Plus o Lower premiums o Narrow provider options (helps BCBS control costs) o Important to use In-Network providers Preferred-Care Blue o Higher premiums o Broader provider network (more provider choices = less cost control for BCBS) o Not as important to remain In-Network (but still important!) Are you a New Hire? If you were hired on or before September 1st, you must go through the enrollment process twice. o Enroll now for the remainder of the 2017 benefit plan year. o Enroll again during this Open Enrollment period for benefits effective January 1, Have you completed the Wellness incentive requirements? Health Screening Completed the Health Risk Assessment? (HRA)

44 Resources to Help You The District provides resources to help you make informed decisions o Website links on the Olathe website Log on through The O-Zone Click on Human Resources Select Benefits Information Go to the Benefits tab to access the plan you re looking for.