What s Changing 2013 and Beyond

Transcription

1 What s Changing 2013 and Beyond New Labor Contracts: NYNE Associates October 30, 2012

2 New Hire Retirement Benefits New Hires October 28, 2012 and later: Not eligible for defined benefit pension plan Eligible for enhanced 401(k) company contribution $1 for $1 company match up to 6% of eligible pay plus discretionary company contribution New Hires August 3, 2008 and later: Annual contributions toward the cost of retiree medical coverage: $480 for each full year of net credited service, up to a maximum of 30 years Reduced amount when eligible for Medicare 2

3 Dependents Eligible for Health Care Benefits Eligible Class II Dependents can continue coverage No new Class II Dependents can be added to Verizon coverage Class II Dependents who are dropped from coverage cannot be added back to coverage 3

4 Enrollment and EPO Changes EPO no longer open to new enrollments The EPO is not available to new enrollees Once another option is chosen, cannot enroll in the EPO in the future Eligible dependents may be added to coverage Individualized enrollment is no longer available beginning January 1, 2013; changes can be made during annual enrollment or consistent with a Qualified Status Change 4

5 HMOs/EPO no Longer Open to New Enrollment after Retirement For retirements January 1, 2013 and later, if enrolled in an HMO/EPO at retirement, may remain in it as long as it is offered and or until Medicare-eligible If not enrolled in an HMO/EPO at retirement, cannot enroll in an HMO/EPO as a retiree Medicare-eligible retirees may have Medicare Advantage plans available depending on where they live 5

6 Increased Copays for HMOs/EPO No more than $20 for a primary care physician office visit No more than $25 for a specialist office visit (referral may be required) No more than $75 for an emergency room visit Provisions do not apply to Medicare Advantage Plans 6

7 New Medical Plan Administrator Anthem Blue Cross Blue Shield (Anthem) will administer HCN, MEP HCP and EPO options Includes mental health and substance abuse benefits Same network (BlueCard PPO) currently used for the MEP HCP and EPO plan options Transition services available for individuals currently undergoing treatment with provider not in Anthem network May receive in-network benefits for up to three months in 2013 to allow treatment to be completed or transition to another provider If no in-network provider for a service within 40 miles of home zip code, eligible for in-network benefits for that service 7

8 Medical Plan Premium Contributions Beginning in November, active associates will contribute medical plan premium contributions $30/month for employee only $60/month for employee plus one or more dependents Beginning in 2013, contributions increase each year and vary depending on tobacco-user status and completion of a Health Assessment Tobacco Users pay $600 more per year Associates who complete a Health Assessment pay $100 less per year 8

9 2013 Medical Plan Premium Contributions HCN and MEP HCP Non-Tobacco User Credit? Yes Yes No No Completed Health Assessment? Monthly Contribution Yes No Yes No Individual $45.00 $53.33 $95.00 $ Family $90.00 $98.33 $ $ HMOs and EPO Non-Tobacco User Credit? Yes Yes No No Completed Health Assessment? Monthly Contribution (will be no greater than the amounts in this chart) Yes No Yes No Individual $67.50 $75.83 $ $ Family $ $ $ $

10 Medical Plan Options There are changes to all medical plan options and prescription drug coverage under the new labor contracts Includes: deductibles, copays, coinsurance and out-of-pocket maximums 10

11 At a Glance HCN 2013 Benefits 11 Plan Provisions In-Network* Out-of-Network** Preventive Care (Coverage, age, and frequency The plan pays 100% The plan pays 80%, no deductible provisions of the Affordable Care Act apply) Doctor s Office Visits $20 copay for PCP and $25 copay for specialist After meeting your deductible, the plan pays 70% Outpatient Lab and X-Ray $20 copay After meeting your deductible, the plan pays 70% Other Covered Services Generally, the plan pays 90% Generally, after meeting your deductible, the plan pays 70% Chiropractic Services $20 copay After meeting your deductible, the plan pays 70% Limited to $750 per calendar year per individual; limit combined in-network and out-ofnetwork Deductible None Individual: $700 Family: 2.5 times the individual deductible amount Out-of-Pocket Maximum Individual: $1,000 in-network and out-of-network combined, plus an additional $800 out of network Family: 2.5 times the individual out-of-pocket maximum amount; an individual will never need to exceed his or her own individual amount. Note: Amounts paid toward the deductible will now apply toward the out-of-pocket maximum. Emergency * The coinsurance Room is based on Network Negotiated Fee $75 (NNF) copay as negotiated (copay waived by Anthem. if admitted) **The coinsurance is based on Maximum Allowed Amount (MAA), which is 315% of the national Medicare schedule. Urgent Care $20 copay * The coinsurance is based on Network Negotiated Fee (NNF) negotiated by Anthem. **The coinsurance is based on Maximum Allowed Amount (MAA), which is 315% of the national Medicare schedule.`

12 At a Glance MEP HCP 2013 Benefits Plan Provisions In-Network* Out-of-Network** Preventive Care (Coverage, age, and frequency provisions of the Affordable Care Act apply) The plan pays 100% Doctor s Office Visits $20 copay for PCP and specialist, no deductible After meeting your deductible, the plan pays 70% Outpatient Lab and X-Ray $20 copay, no deductible After meeting your deductible, the plan pays 70% Other Covered Services After meeting your deductible, the plan pays 80% or 90% depending upon the service Generally, after meeting your deductible, the plan pays 70% Chiropractic Services After meeting your deductible, the plan pays 80% $20 copay plus difference between $92 flat fee and cost of service Deductible Carryover Deductible Limited to 60 visits per calendar year (not to exceed 1 visit per day); limit combined in-network and out-of-network Individual: $400 combined in-network and out-of-network, plus an additional $250 out-of network Family: 2.5 times the individual deductible amount Expenses applied during October, November and December also apply to the next year s deductible. Out-of-Pocket Maximum Emergency Room Urgent Care Individual: $1,050 in-network and out-of-network combined, plus an additional $950 out of network Family: 2.5 times the individual out-of-pocket maximum amount; an individual will never need to exceed his or her own individual amount. Note: Amounts paid toward the deductible will now apply toward the out-of-pocket maximum $75 copay (copay waived if admitted) $20 copay 12 * The coinsurance is based on Network Negotiated Fee (NNF) negotiated by Anthem. **The coinsurance is based on Maximum Allowed Amount (MAA), which is 315% of the national Medicare schedule.

13 At a Glance 2013 EPO Benefits Plan Provisions In-Network Only Preventive Care The plan pays 100% Doctor s Office Visits $20 copay for PCP and $25 copay for specialist Outpatient Lab and X-Ray The plan pays 100% Hospital Admissions $150 copay per admission Other Covered Services Generally, the plan pays 100% Deductible Out-of-Pocket Maximum Emergency Room Urgent Care None None $75 copay (copay waived if admitted) $25 copay 13

14 At a Glance 2013 Prescription Drug Coverage: Associates & Pre-Medicare Retirees Prescription and Drug Type In-Network Pharmacy Out-of-Network Pharmacy Retail (30-day Supply) You Pay (original prescription and each refill) You Pay (original prescription and each refill) Annual Deductible None $50 combined for generic and brand drugs Generic Drugs Brand Drugs (Single-Source and Multi-Source Brand Drugs) Maintenance Drugs (after three fills at a retail pharmacy) Mail Order Pharmacy (90-day supply**) Generic Drugs Lower of $8 copay or discounted network price 30% of discounted network price, up to $25 maximum copay per prescription.* 50% of discounted network price, maximum copay does not apply You Pay (original prescription and each refill) Lower of $16 copay or discounted network price After deductible, 30% of discounted network price plus 100% of the difference between the retail cost and the discounted network price After deductible, 40% of discounted network price plus 100% of the difference between the retail cost and the discounted network price.* 50% of discounted network price plus 100% of the difference between the retail cost and the discounted network price. You Pay (original prescription and each refill) N/A 14 Brand Drugs (Single-Source and Multi-Source Brand Drugs) 30% of discounted network price, up to $50 maximum copay per prescription.* ** If you choose a brand-name medication when a generic equivalent is available, you will pay the generic copay/coinsurance plus 100% of the difference in cost between the brand-name and generic. This additional cost will apply unless your doctor certifies that you are medically unable to take the generic medication and the exception is approved by Express Scripts. Maximum copays will not apply. **For MEP HCP (NYNE) enrollees, there is an annual out-of-pocket maximum of $600 per person for mail order pharmacy. The additional cost when you choose a brand-name medication when a generic equivalent is available does not count against the out-of-pocket maximum. N/A

15 At a Glance 2013 Prescription Drug Coverage: Medicare Retirees Prescription and Drug Type In-Network Pharmacy Out-of-Network Pharmacy Retail (30-day Supply) You Pay (original prescription and each refill) You Pay (original prescription and each refill) Annual Deductible None $50 combined for generic and brand drugs Generic Drugs Lower of $8 copay or discounted network price After deductible, 30% of discounted network price plus 100% of the difference between the retail cost and the discounted network price Brand Drugs (Single-Source and Multi-Source Brand Drugs) Maintenance Drugs (after three fills at a retail pharmacy) Mail Order Pharmacy (90-day supply) Single-Source - 30% of discounted network price, up to $25 maximum copay per prescription. Multi-Source 40% of discounted network price, up to $30 maximum copay per prescription 50% of discounted network price, maximum copay does not apply You Pay (original prescription and each refill) Generic Drugs Lower of $16 copay or discounted network price N/A Brand Drugs (Single-Source and Multi-Source Brand Drugs) Single-Source - 30% of discounted network price, up to $50 maximum copay per prescription. Multi-Source 40% of the discounted network price, up to $60 maximum copay per prescription Note: For MEP HCP (NYNE) enrollees, there is an annual out-of-pocket maximum of $600 per person for mail order pharmacy. Single-Source - After deductible, 40% of discounted network price plus 100% of the difference between the retail cost and the discounted network price. Multi-Source After deductible, 50% of discounted network price plus 100% of the difference between the retail cost and the discounted network price 50% of discounted network price plus 100% of the difference between the retail cost and the discounted network price You Pay (original prescription and each refill) N/A 15

16 New! Health Reimbursement Account (HRA) Health Reimbursement Account (HRA) available beginning January 1, 2013: Full-Time Employees Part-Time Employees working 17 hours or more per week At least three months of net credited service Eligible for medical coverage; do not need to be enrolled One-time credit of $850 (Full-Time Employees) or $425 (Part-Time Employees) HRA can be used for eligible medical expenses such as copays, deductibles, and prescriptions, but not contributions for medical coverage. If enrolled for a Health Care Spending Account (HCSA), HCSA balance must be exhausted each year prior to claims being reimbursed from the HRA 16

17 Retiree Medical Contributions Retire Before January 1, 2013 (Net credited service date before August 3, 2008) No premium contributions during 2013, 2014, and 2015 for HCN or MEP HCP options Monthly premium contributions apply for the EPO or an HMO option EPO and HMOs EPO and HMO 2013 contributions no greater than the following rates* Retiree Only $67.50 Retiree + 1 $ Retiree + Family $ * Medicare-eligible retirees will pay no more than half this amount. 17

18 Retiree Medical Contributions Retire January 1, 2013 or later (Net credited service date before August 3, 2008) Monthly premium contributions apply for all medical plan options HCN and MEP HCP Pre-Medicare Retiree 2013 Monthly Contribution Medicare-Eligible Retiree 2013 Monthly Contribution Retiree Only $35.00 $17.50 Retiree + 1 $60.00 $30.00 Retiree + Family $60.00 $30.00 EPO and HMOs EPO and HMO 2013 contributions no greater than the following rates* Retiree Only $67.50 Retiree + 1 $ Retiree + Family $ * Medicare-eligible retirees will pay no more than half this amount. 18

19 Retiree Medical Caps Prior labor contracts specify limits on amount company will contribute towards retiree medical coverage -- referred to as retiree medical caps New labor contracts ensure retirees enrolled in the MEP HCP or HCN medical options will not have to pay amounts above retiree medical caps during term of new labor contracts, even though cost of plan options is projected to exceed the retiree medical caps New labor contracts also increase the amount of the retiree medical caps that will apply beginning in

20 Additional Changes under the Patient Protection and Affordable Care Act $2,500 Contribution Limit to Health Care Spending Account Medical Plan Options No Longer Grandfathered Dependent Child to age 26 eligible even if he or she is eligible for other employer-sponsored coverage Certain preventive care goods and services, including women s preventive care covered with no cost sharing in-network Additional Independent Review for claim denials involving medical judgment or rescission of coverage New consumer protections if plan requires a primary care physician (PCP) be designated 20