Health Employer Guide to the Concordia Health Plan. What to consider before choosing your option(s)

Transcription

1 Health 2018 Employer Guide to the Concordia Health Plan What to consider before choosing your option(s)

2 Inside This Guide The CHP in Getting Started: What You Need to Know...6 Determining Your Funding Strategy...9 Enrollment Checklist...11 Important Notes About the CHP and Health Care Reform Concordia Plan Services 2018 Employer Guide

3 Thank You for Your Service We recognize the huge commitment of time that goes into understanding your health benefit information, as well as the dedicated planning, budgeting and decision-making for which you are responsible as the benefits administrator(s) at your organization. We respect the commitment you have made to serve your workers, and we strive to support you by providing total health solutions and excellent customer service. As you read through this guide, you ll notice symbols representing calls to action with important information and pointing to online resources. Look online for more information Important date or detail Questions? Call , ext. 6010, or Our Employer Resources Team can provide you with information about which option(s) may be the right fit for your organization and workers, and talk with you about ways to maximize your healthcare dollars. Concordia Plan Services 2018 Employer Guide 1

4 For more information about CHP options, go to ConcordiaPlans. org/2018chp. The CHP in 2018 It s a new enrollment season and your opportunity to look at what the Concordia Health Plan has to offer your organization in We understand the importance of flexible healthcare solutions for ministries of The Lutheran Church Missouri Synod. By working with local carriers and focusing on quality care solutions with a variety of benefit designs, last season we introduced six new coverage options Choice 3000, Health Wise 1200, Health Wise Plus 3000, Whole Health, Whole Health 1000 and Whole Health Although we all walk with a common purpose in the LCMS Community, Concordia Plan Services understands that selecting healthcare coverage for your workers is influenced by your individual ministry s budget and the financial feasibility to take care of your workers. It is our objective to offer you options that meet you where you are, understanding that the healthcare environment is not a one-size-fits-all solution. In addition to flexible solutions, we understand the importance of providing grandfathered options to provide the conscience protection for those employers who need it and to ensure their benefits remain aligned with our Lutheran faith and beliefs. We offer multiple options anywhere from HMOs, PPOs and high deductible health plans, giving your workers the comprehensive coverage that the CHP provides. 2 Concordia Plan Services 2018 Employer Guide

5 Concordia Health Plan Options Offered in Your Area Seattle area Spokane area Portland area I-25 corridor Chicago area Baltimore area Washington, DC area Northeastern area of Virginia Atlanta area Both northern and southern areas of California Phoenix Dallas/Ft. Worth Houston Austin Tampa Orlando Miami Blue Cross Blue Shield Kaiser Permanente Health Wise (LocalPlus Network) Health Wise (Open Access Plus Network) To see if your ZIP code area falls within the network area supported by either Cigna or Kaiser Permanente: Go to ConcordiaPlans.org/2018CHP Enter your Employer ID and ZIP code You will see the plan option(s) available to your organization, as well as the plan options your currently offer, including information about how the plan options work If you re eligible for one of these options, please take the time to learn how they work before making a decision. These options present a totally different approach to health care, so it s important that you don t make your decision based solely on budget. Concordia Plan Services 2018 Employer Guide 3

6 To Learn More About Your Options CPS is here to help you understand your options and find a solution that fits your organization s needs while at the same time supports the LCMS Community as a whole. If you have questions, call , ext. 6010, to speak to an Employer Resources Team representative. If you are in a ZIP code where Cigna (Health Wise) or Kaiser Permanente (Whole Health) options are available and want to learn more about the provider networks, follow the steps below. For Cigna (Health Wise) Go to cigna.com Click the Find a Doctor button Select FOR PLANS OFFERED THROUGH WORK OR SCHOOL as your directory (it s the option highlighted in orange) Follow the step-by-step process to find a doctor Keep in mind, your provider network will depend on your ZIP code: Most areas use the LocalPlus network. The LocalPlus Network gives your workers access to a local, focused network of quality and cost-effective healthcare professionals and facilities located in your area. Your workers cost of covered services will be less with doctors and hospitals in LocalPlus. The Open Access Plus Network is broader than the LocalPlus Network and is only available in areas of Florida where LocalPlus is not offered. Your workers can keep their out-of-pocket costs down when they use providers in the Open Access Plus network. Each time your workers need care, they can choose doctors and other healthcare professionals and hospitals that work best for them. For Kaiser Permanente (Whole Health) Go to kp.org Click on Doctors & Locations Follow the step-by-step process to find a doctor or a Kaiser Permanente location 4 Concordia Plan Services 2018 Employer Guide

7 The PATH Ahead: Pursue and Achieve Total Health We all need to be accountable for our health. This means we must: Work toward a healthy lifestyle by making smart health choices Know our health risks and manage those risks Take a consumer approach to health care Consider new plan options that support total health As an employer, you play a key role in helping to ensure workers get on the right health path and stay on that path. The resources and incentives workers have available to become more responsible consumers for their health care will vary, depending on which plan option you choose. Your election can help them pursue and achieve total health. Why Pursuing and Achieving Total Health Is So Important The healthier LCMS workers are, the better they can serve and the stronger the LCMS Community becomes. It s all about being accountable for our Community s health so we can be good stewards today and in the future. Ultimately, our ability to live out the LCMS mission depends on our actions today. Encouraging a culture of well-being is essential to each LCMS worker s ability to continue to serve in ministry. From coordinating wellness information and activities to promoting wellness tools and resources (including the Vitality platform), Wellness Champions play a crucial role in engaging our Community to lead healthier lifestyles so that we can better serve. That s why it s so important that we identify the right Wellness Champions the ones who have the time and the passion to truly lead this charge. To name or update the Wellness Champion for your organization, visit ConcordiaPlans. org/champs. Why? In addition to affecting workers health (in a positive way) and increasing their ability to serve, total health management helps reduce the overall cost of the CHP without sacrificing quality. This is important because it will allow us to continue to serve members with chronic and catastrophic illness, the disabled, retirees and surviving spouses. This is a critical component of our mission and it s the right thing to do. Concordia Plan Services 2018 Employer Guide 5

8 Getting Started: What You Need to Know Which Group Am I In? The contraceptive mandate under the Affordable Care Act positions CHP employers into two categories exempt and non-exempt. See below to learn about the categories and what they mean in terms of the ACA. Group 1 (Exempt) Group 2 (Non-Exempt) Churches, conventions or associations of churches, and integrated auxiliaries Universities, some schools, Recognized Service Organizations (RSOs) and all others not meeting the ACA definition of religious employer The contraceptive mandate provides coverage for certain women s preventive care services that are not aligned with our Lutheran beliefs. Conscience protection applies to Group 1. Conscience protection does not apply to Group 2, unless they remain in a grandfathered health plan option or file an accommodation. You can find information about the accommodation at ConcordiaPlans. org/exempt. Contact the Employer Resources Team to discuss CHP options and/or if you have questions about the accommodation. If you have questions about the group to which you belong, please see The ACA Contraceptive Mandate: Is Your Organization Exempt? flow chart at ConcordiaPlans.org/Exempt. As an employer, it is your responsibility to determine if your organization is exempt or non-exempt. CPS cannot make this determination for you. 6 Concordia Plan Services 2018 Employer Guide

9 Minimum Participation Requirements Employers must meet the following minimum participation requirements to offer the CHP: Another health plan cannot be offered alongside the CHP At least 75 percent of those eligible to enroll in the CHP must be either enrolled in the CHP or be an eligible opt-out (as defined below) If you have three workers, you can have one ineligible opt-out, as long as two workers are enrolled in the CHP Eligible Opt-Outs Eligible opt-outs are workers who are not enrolled in the CHP because they already have health coverage under: A spouse s or parent s group health plan (coverage by virtue of employment, including military service) A former employer s group health plan A current non-lcms employer s group health plan The military as a retiree A Medicare supplement plan A government medical assistance program for low-income persons (e.g., Medicaid) A foreign country health plan A group health plan of an employer located in the state of Hawaii A worker also is considered an eligible opt-out if he/she does not meet the minimum hours worked requirement (more than 20, more than 25, more than 30 or 30 or more hours per week, as selected by the employer) to be eligible for the CHP. Health Care Reform requires that you provide: Summary of Benefits and Coverage (SBC) applicable to the employer s CHP option(s) to any newly hired workers who are eligible to enroll in the CHP. A Marketplace Notification within 14 days of the worker s start date. This notification informs workers about the Health Insurance Marketplace in their state. If you re an Applicable Large Employer under the ACA, certain tax-reporting to demonstrate compliance with affordability, minimum value and minimum essential coverage requirements. For detailed information about distributing these documents, visit ConcordiaPlans.org/Reform. Concordia Plan Services 2018 Employer Guide 7

10 How Many Options Can I Offer? 1 All employers, regardless of size, may participate in Employer Choice. That means you, as an employer, choose only one coverage option for your workers from all of the options available to you. To qualify for Worker Choice, employers must have: 2 Eligible employers may participate in Worker Choice. With this option, you choose to offer workers two options from the combinations available to you. Each worker then chooses which option is best suited to cover his/her healthcare needs for the calendar year. A minimum of 15 workers enrolled in the Concordia Retirement Plan. At least 75 percent of eligible workers enrolled in the CHP (no fewer than 10 workers). No dual health plan coverage with another carrier offered to workers. Questions? Call CPS at NOTES: Keep in mind that Worker Choice employers will be responsible for extra administrative duties, which include designating a contact person and facilitating worker elections to ensure worker election information is submitted to CPS by the deadline. The option(s) you and/or your workers select will apply for a plan year, which is usually a calendar year. During the annual election period, you have the opportunity to select a different coverage option(s) from all the options available for your specific group for the upcoming plan year. Understanding How Worker Choice Works How many options should we offer? Which options should we select? Here are the options we will offer in 2018 Step 1 Employer chooses to offer: 1 Option 2 Options Step 2 Employer selects options: Select 1000 Choice 3000 Step 3 Employer shares decisions with workers, and workers will have the opportunity to make their election online at mycps.org during the Annual Open Enrollment period. 8 Concordia Plan Services 2018 Employer Guide

11 Determining Your Funding Strategy You, as the employer, have a great deal of flexibility and many options to consider as far as who pays what for healthcare expenses. Keep the following funding strategies in mind when considering your healthcare elections for the coming year. Choice of Health Plan Option If you qualify to offer Worker Choice (see page 8), consider making two options available to your workers. If you provide an incentive for workers to enroll in a high deductible health plan, such as a monthly contribution to their health savings accounts, your workers may be more inclined to take advantage of an option with a lower contribution rate. Looking for Ways to Save on Your Healthcare Costs? The CPS Employer Resources Team can help. Call , ext Visit ConcordiaPlans. org/consult. Choice of Employer/Worker Funding You are required to pay at least 50 percent of the individual worker cost of the health plan but can determine the additional amount paid toward the cost of worker and dependent coverage. If you are paying 100 percent of the cost for dependents in the CHP, there is no incentive for a worker s spouse to use alternative health coverage that may be available. You may want to offer a monthly stipend for a worker s dependent to use the other available health plan. If you have workers share in the cost of CHP coverage, use workers pre-tax dollars. If you adopt a Premium Only Cafeteria Plan (document available at ConcordiaPlans.org), you can permit workers to deduct their portion of healthcare contributions pre-tax from their paychecks. Engage Workers to Be Well So They Can Serve Well Naming a Wellness Champion for your ministry is a great way to help engage workers to lead healthier lifestyles. Wellness Champions help workers take advantage of all the great wellness resources available through CPS, which can have a great impact toward controlling healthcare costs for all. Visit ConcordiaPlans.org/ Champs to learn more! Concordia Plan Services 2018 Employer Guide 9

12 Choice of Hours and Probationary Period For the CHP, you can designate more than 20, more than 25, more than 30 or 30 or more hours per week and more than five consecutive months as the definition of full time.* For all the Concordia Plans, you also may adopt a probationary period to delay enrollment of a newly employed lay worker for up to 60 days. (Probationary periods do not apply to rostered workers.)* *You must apply definitions of hours and probationary period equally for all workers in the specified class of employees. Universities and other Non-Qualified Church-Controlled Organizations that are enrolled in the Concordia Retirement Savings Plan cannot use a probationary period to delay enrollment in the Plans. Personal Spending Accounts Flexible spending accounts, health savings accounts and health reimbursement arrangements offer great tax-advantages to workers and ease the transition to higher deductible/higher out-of-pocket cost plans while still being easy on the employer s benefits budget. To learn more about these accounts, visit ConcordiaPlans.org/PSA or call your Employer Resources Team representative at , ext Concordia Plan Services 2018 Employer Guide

13 Enrollment Checklist What You Need to Do to Make Your 2018 Elections 1. Find out which options are available to you. 2. Decide if you want to offer personal spending accounts. 3. Indicate your CHP and personal spending account elections on your Election Form Make sure your Election Form is completed accurately and signed by an authorized representative. Send your Election Form to CPS via: Fax to , Scan and to or Mail in the envelope provided. Questions? Have a question or need help completing your Election Form? Call CPS at IMPORTANT! Whether you are offering only one CHP option or more than one CHP option, we strongly encourage all employers to make an active election decision for This means even if you are staying with the same plan option(s) that you had in 2017, you should still complete the Election Form and submit it to CPS. Help facilitate Annual Open Enrollment with your workers to ensure any requested changes to their coverage are received by the worker election deadline. Concordia Plan Services 2018 Employer Guide 11

14 Important Notes About the CHP and Health Care Reform The CHP will continue to be available to LCMS ministries and their full-time employees in 2018, providing a variety of health plan options which offer a wide array of coverage levels. CPS is a resource for you. For information related to health care reform, visit ConcordiaPlans.org/Reform. You also can contact us at The CHP is a grandfathered health plan under health care reform. As such, we have been able to maintain benefit options that are aligned with our Lutheran faith and beliefs for employers and workers who would not otherwise have these protections. NOTE: The following are the CHP options that are considered grandfathered options: Option A, Option B, Option C, Option D, Option E and Option HDHP. All other CHP options are NOT grandfathered options. The CHP intends to comply with all health care reform requirements applicable to grandfathered health plans, as well as to all other CHP options. Coverage for essential health benefits will be included, as will additional benefits, keeping the CHP a comprehensive benefits package designed to care for workers and their families. All options under the CHP meet the minimum value requirement regarding the percentage of costs associated with care that must be reimbursed by the Plan. Our Employer Resources Team also can work with employers to review their funding strategies. CPS or its benefits administrators will provide proof of Minimum Essential Coverage (Form 1095-B) as outlined under the Individual Mandate of the Affordable Care Act to all workers enrolled in the CHP and to the IRS. 12 Concordia Plan Services 2018 Employer Guide

15 Grandfathered Status The CHP believes it is a grandfathered health plan excluding all non-grandfathered options under the Patient Protection and Affordable Care Act (the Affordable Care Act, or ACA). As permitted by the ACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that the CHP may not include certain consumer protections of the ACA that apply to other plans (for example, the requirement to provide an internal and external appeal review process). However, grandfathered health plans must comply with certain other consumer protections in the ACA (for example, the elimination of lifetime limits on benefits). Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to CPS at You also may contact the U.S. Department of Health and Human Services at healthcare.gov. Concordia Plan Services 2018 Employer Guide 13

16 The Lutheran Church Missouri Synod 1333 South Kirkwood Road St. Louis, MO ConcordiaPlans.org