Open Enrollment Survival Kit

Transcription

1 Open Enrollment Survival Kit Carol Buckner, AIP Sherri Schwartze, AIP Agenda Contract Updates Optional Plans 2011 Medical Plans Benefits Overview Prescription Plan Eligibility Changes Lifestyle Ladder Disease Management Enrollment Information Contract Updates Renewed plan contracts Employee Assistance Program Magellan Health Services Third Party Administrator UMR Pharmacy Benefit Manager Express Scripts Awarded plan contracts Dental Delta Dental Vision Vision Service Plan (VSP)

2 No Benefit Changes Delta Dental Vision Service Plan (VSP) EAP Magellan Health Services Medical for 2011 Medical plans available PPO 300 PPO 600 High Deductible Health Plan with Health Savings Account Nationwide network through United Healthcare Choice Plus or First Health Network and non-network benefits Preventive services covered at 100% Bariatric surgery and infertility services are no longer covered PPO 300 Benefits Benefit In Network Non-network Individual Deductible $300 $600 Family Deductible $600 $1,200 Individual Out of Pocket Family Out of Pocket $1,200 $2,400 $2,400 $4,800 Lifetime No limit $3,000,000 Coinsurance 10% 30% Preventive Services 100% 30% Emergency Room/Urgent Care 10% 10%

3 PPO 600 Benefits Benefit In Network Non-network Individual Deductible $600 $1,200 Family Deductible $1,200 $2,400 Individual Out of Pocket Family Out of Pocket $1,500 $3,000 $3,000 $6,000 Lifetime No limit $3,000,000 Coinsurance 10% 30% Preventive Services 100% 30% Emergency Room/Urgent Care 10% 10% HDHP with HSA Benefit In Network Non-network Individual Deductible $1,200 $2,400 Family Deductible $2,400 $4,800 Individual Out of Pocket Family Out of Pocket $2,400 $4,800 $4,800 $9,600 Lifetime No limit $3,000,000 Coinsurance 20% 40% Preventive Services 100% 40% Emergency Room/Urgent Care 20% 20% Health Savings Account (HSA) MCHCP contribution to HSA: $700/year for individual coverage $1,400/year for subscriber plus dependents per year Subscriber may contribute to account

4 Health Savings Account IRS annual contribution limits to HSA: $3,050 for subscriber includes $700 MCHCP contribution $6,150 for subscriber plus dependents includes $1,400 MCHCP contribution Beginning in 2011 the tax for HSA distribution for non-qualified medical expenses is 20% Medicare Supplement Medicare enrolled retirees only Covered dependents must also be enrolled in Medicare Covers Medicare eligible benefits Express Scripts, Inc. (ESI) Retail (up to a 30 day supply) Generic Formulary -$8 Brand Formulary -$35 Non-Formulary Brand Not Covered *If you purchase a brand name drug when there is an FDA-approved generic drug, you pay the generic copayment ($8) plus the difference in the cost of the drugs.

5 Express Scripts, Inc. (ESI) Mail Order (90-day supply) Generic Formulary - $20 Brand Formulary - $87.50 Non-Formulary Brand Not Covered Eligibility Changes Dependent children eligible for coverage until age 26 Hospital certificates are no longer acceptable proof of eligibility for newborns New employees will be auto enrolled in a plan Eligibility Changes Retirees may continue dental and/or vision without medical Active employees may only cancel dental and/or vision coverage during the year if: Terminating employment Terminating COBRA coverage Retiring Death Leave of Absence

6 StayWell Health Management Online Health Assessment required for enrollment in the program Members must earn 100 points per quarter to continue the incentive premium Members and spouses have separate participation, tracking and incentive amounts Phone, mail and online access available Earn money off of your monthly premium $25 (employee or spouse) $50 (employee and spouse) StayWell Health Management Disease Management Through UMR Diseases managed: Coronary Artery Disease (CAD) Diabetes (includes children) Asthma (includes children) Depression Congestive Heart Failure Chronic Obstructive Pulmonary Disease (COPD) Hypertension (High Blood Pressure)

7 Enrollment Information Open Enrollment -October 1 October 31 Web site Log in to mymchcp Enroll for 2011 coverage Take Health Assessment Fax OE worksheet Mail OE worksheet (must be postmarked by Oct. 31) Phone enrollment not available Enrollment Information MCHCP Web site Member Handbook 2011 Enrollment Guide mymchcp Provider Directories UMR Coverage Advisor Premiums MCHCP Customer Service UMR Customer Service