Open Enrollment 7/1/2015
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1 SCHOOLCARE HEALTH BENEFIT PLANS of the New Hampshire School Health Care Coalition Open Enrollment 7/1/2015 Jana Dalton Group Relations Specialist Jeff Kantorowski Coordinator of Benefit Programs Joanne Trainor Group Relations Specialist x x x308 In partnership with NEA-New Hampshire
2 PLAN NAME CHANGES FORMER NAME NEW NAME JULY 1, 2015 HMO Open Access POS Open Access Open Access + CDHP SCHOOLCARE Green Open Access SCHOOLCARE Blue Open Access SCHOOLCARE Red Open Access SCHOOLCARE Yellow Open Access Important: NO changes will be made to benefits, network, coverage or pharmacy programs New ID Cards will be issued for July 1, 2015 In partnership with NEA-New Hampshire 2
3 Consumer Directed Health Plans: YELLOW PLAN HIGHLIGHTS Same coverage as all the other SCHOOLCARE plans Health insurance policy with deductible and Choice Fund Preventive care and certain generic drugs are no cost All covered medical services and prescription drugs apply to deductible (except no-cost preventive care and certain generic drugs) Coinsurance begins after deductible has been met Choice Fund covers the first portion of the services that apply to the deductible In partnership with NEA-New Hampshire 3
4 CHOICE FUND Completing a confidential, online Health Assessment at is required annually by subscriber to activate the Choice Fund Provided by SCHOOLCARE to cover the first portion of the services that apply to the deductible $1,000 Single $2,000 Two-Person/Family Any remaining fund balance is rolled over to the next plan year (may accumulate up to the Out of Pocket Maximum) In partnership with NEA-New Hampshire 4
5 SCHOOLCARE Yellow Open Access (Formerly CDHP) Choice Fund Benefits In Network Benefits Only (Cigna s National Open Access Network) Preventive Care and Certain Preventive Generic Rx Choice Fund *Subscriber must take the Health Assessment at mycigna.com to activate Deductible $0 (no cost) $1,000 / $2,000 $1,250 / person; $2,500 / 2-person, family Coinsurance 20% Out of Pocket Maximum (Medical and Prescription Drugs) NET COST AFTER CHOICE FUND (if activated)* Deductible Out-of-Pocket Costs Physician / Specialty Office Visits Emergency Room / Urgent Care Lab & X-ray Advanced Radiology (MRI, PET, CAT) Hospitalization Physical /Speech /Occupational Therapy (60 combined visit limit) Chiropractic (20 visit limit) Acupuncture (12 visit limit) Durable Medical Equipment (DME) / External Prosthetic Appliances (EPA) $2,000 / person; $4,000 / 2-person, family YOU PAY Individual: $ 250; Family: $ 500 Individual: $1,000; Family: $2,000 Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max Deductible, then 20% up to max
6 SCHOOLCARE Yellow Open Access Individual deductible & coinsurance to out of pocket max 20% of medical claims, 10% of prescription claims until you reach a total of $2,000 $3,750 in claims) 20% Medical 10% Rx Coinsurance ($750) YOU = $1,000 Total = $2,000 $1,250 Deductible (Medical and Rx) $250 YOU $1,000 Choice Fund Pays first (if activated)* * Subscriber must take the online Health Assessment to activate the Choice Fund In partnership with NEA-New Hampshire 6
7 SCHOOLCARE Yellow Open Access Family deductible & coinsurance to out of pocket max 20% of medical claims, 10% of prescription claims until you reach a total of $4,000 $3,750 in claims) 20% Medical 10% Rx Coinsurance ($1,500) YOU = $2,000 Total = $4,000 $2,500 Deductible (Medical and Rx) $500 YOU $2,000 Choice Fund Pays first (if activated)* * Subscriber must take the online Health Assessment to activate the Choice Fund In partnership with NEA-New Hampshire 7
8 CDHP PRESCRIPTION (Rx) PLAN Drug 30 Day Retail 90 Day Mail Delivery Generic, Preferred Brand, Non-Preferred Brand Deductible, then 10% (up to $75 per Rx) up to OOP Max Deductible, then 10% (up to $75 per Rx) up to OOP Max Certain Generic Preventive Drugs $0.00 $0.00 Mail order for maintenance through Cigna Home Delivery Program / In partnership with NEA-New Hampshire 8
9 Example $1000 Choice Fund, $250 You, then 20% medical, 10% Rx up to $2000. $125 Office visit for illness: $125 deducted from Choice Fund $250 Rx at pharmacy: $250 deducted from Choice Fund $750 X-Rays /tests: $625 deducted from Choice Fund You pay $125 $125 Office visit for illness: You pay $125 (Deductible of $1250 met, now you pay 20% medical, 10% Rx) $125 Office visit for illness: (20%) You pay $25 $300 Rx at pharmacy: (10%) You pay $30 $350 Specialist office visit: (20%) You pay $70 $1,200 Rx at pharmacy: (10%, cap of $75) You pay $75 $10,000 surgery (20% to out of pocket max) You pay $550 (Out of pocket max met: $1,000 Fund /$1,000 You) C A N U S E F L E X C A R D $300 Rx at pharmacy: You pay $0 $350 Specialist office visit: You pay $0 In partnership with NEA-New Hampshire 9
10 HEALTH ASSESSMENT for CHOICE FUND Located at 65 questions takes about 15 minutes to complete Biometric values NOT required Subscriber (Employee) must complete annually between June 1 and July 31 to activate YOUR Choice Fund Upon completing the Health Assessment, it may take up to 3 business days for the Choice Fund dollars to be loaded on mycigna.com In partnership with NEA-New Hampshire 10
11 MYCIGNA.COM TOOLS Answers and costs without the long walk Separate search paths for doctors, facilities, and procedures Calculates cost based on customer s coverage and deductible status Shows likely costs for common procedures with wide cost ranges In partnership with NEA-New Hampshire 11
12 REVIEW YOU can earn rewards every plan year! Subscribers = $800 Subscribers & Covered Spouses = $1,200 Plan year runs July 1 st through June 30 th Three (3) pillars of wellness Understand YOU: Build awareness of your own personal health and wellness Take Action: Educate yourself on your own personal health and wellbeing Stay Active: Make physical activity part of your lifestyle In partnership with NEA-New Hampshire 12
13 WRAP-UP JUNE 30, 2015 All current Good For You! wellness programs will end as of 6/30/15 Keeping Fit cycles that are partially completed will be given pro-rated incentives Health Education Certificates will be available until 8/31/15 for any remaining pre-approved requests ending on 6/30/15 Payouts for all remaining points will be received by 9/30/15 As of July 1, 2015 you will need to register for a new account In partnership with NEA-New Hampshire 13
14 ENHANCEMENTS FOR JULY 1, 2015 New Partnership with VIVERAE All programs on one website - Longer customer service hours Programs that are more unique to YOU Nutritional Programs Challenges Community Ability to access all wellness programs via your smartphone or tablet Quarterly incentives ~ PayPal Wireless Activity Tracker Integration!! In partnership with NEA-New Hampshire 14
15 QUARTERLY INCENTIVES BEGINNING JULY 1, 2015 Subscriber up to $800 Covered Spouse up to $400 Quarter 1 July 1 to Sept 30 UNDERSTAND YOU *Health Assessment & Biometric Data Quarter 2 Oct 1 to Dec 31 TAKE ACTION *Health Coaching Quarter 3 Jan 1 to Mar 31 TAKE ACTION *Preventive Care Compliance Quarters 1 through 4 July 1 to June 30 STAY ACTIVE Quarterly Program Activities Questionnaires, Employer Challenges, Targeted Programs, Peer Challenges, Online Course, Webinars, Healthy Events & Dependent Activities (self-reported) *Health Assessment and Biometrics are required to be completed before Health Coaching becomes available. Each quarter as a new wellness component becomes available, it will remain accessible throughout the plan year for completion. In partnership with NEA-New Hampshire 15
16 EMPLOYEE ASSISTANCE PROGRAM (EAP) Available 24/7 to all employees and everyone living in employee s household Call Employer ID: SCHOOLCARE Legal, financial, tax services, elder care, and much more 3 face-to-face visits with specialist at $0 In partnership with NEA-New Hampshire 16
17 FRAUD PROTECTION COVERAGE Identity Fraud Expense Reimbursement Coverage limit $10,000 Available to subscriber, spouse/partner, children under the age of 25 and parents residing in your household To report claim: In partnership with NEA-New Hampshire 17
18 NEXT STEPS Consider any changes such as plan or covered dependents by May 31 st! Complete the SCHOOLCARE Enrollment/Change Form and return it to your employer Consider enrolling in your employer sponsored Flexible Spending Account (FSA), if available Complete YOUR health assessment at between June 1 and July 31 to active your Choice Fund New ID cards for all participants will be mailed by June 22 nd In partnership with NEA-New Hampshire 18
19 Thank you Questions? In partnership with NEA-New Hampshire 19
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