Frequently Asked Questions Open Enrollment 2018 Active Employees 1) Are there any changes for the 2018 plan year? The County is replacing the Anthem HMO with the Anthem EPO (Exclusive Provider Organization). There is a new prescription benefits manager, EmpiRx Health replacing Envolve Pharmacy Solutions. The Flexible Spending Account has a new administrator, Navia Benefit Solutions. 2) What is an EPO? What are the difference between the HMO and EPO plans? EPO is short for Exclusive Provider Organization. EPOs are similar to HMOs, in that you must stay within your network (emergency care is an exception); however, with an EPO you do not need to select a Primary Care Physician (PCP) nor receive a referral to see a specialist. The Anthem Blue Cross EPO plan design is identical to the Anthem Blue Cross HMO. The Anthem Blue Cross EPO network is the same as the Anthem Blue Cross PPO network and includes the Anthem Blue Cross HMO providers. 3) Will I be able to keep my same doctor? Yes, if you are currently an Anthem HMO or PPO patient with an Anthem HMO or PPO provider, you would be considered an existing patient. A new patient under Anthem is a patient who currently does not have a provider/patient relationship within the Anthem network. 4) If a procedure/test has been approved under the current HMO plan but is not scheduled to occur until after the new EPO plan takes effect, will I have to have to repeat the approval process under the new plan? Anthem will work with members that have pre approved scheduled procedures/tests under their current HMO to make a smooth transition to the EPO and avoid the need for additional approvals. Members will need to contact Anthem or their Benefits Administrator as soon as possible. 5) Can I still use Live Health Online if I enroll in the Anthem EPO plan? Yes. Live Health Online is available to all Anthem members. 6) How do I find out if my doctor is part of the EPO network? Anthem maintains the provider directory. Use the following link to search providers as a guest or a member: https://www.anthem.com/health insurance/provider directory/searchcriteria Upon reaching this page you can search as a member or guest. If you logon as a guest, a screen will show up asking you some general questions: How do you get insurance? Response: Through my employer What state do you want to search in? Response: California Page 1 of 6
What type of care are you searching for? Response: Medical Select a plan/network Response: EPO Click on Continue. This will bring the guest to a webpage where the guest can select a variety of criteria including Located near and Accepting new patients. 7) Since out-of-network care is not covered under the EPO, will employees that have children out of state currently covered under the HMO guest membership need to remove their children for the 2018 plan year or will they continue to receive coverage? Anthem s PPO network is nationwide. Guest memberships will not be required since members can select from EPO providers throughout the country. The dependent children outside of California will continue to receive coverage. 8) What is the process for a current Anthem HMO or PPO member to keep the same provider under the EPO plan? Tell your provider of the change in coverage from HMO or PPO to the EPO and present your new I.D. card for their records. If your current provider informs you that he/she cannot see you do to the change to an EPO plan, please contact Employee Benefits. 9) Where can I find a list of local pharmacies that will accept EmpiRx insurance? To locate a participating network pharmacy, log onto www.empirxhealth.com or call EmpiRx Health Member Services toll free at 1 262 7435 (TDD: 1 888 907 0020). 10) Will refills on my current specialty and non-specialty prescriptions with previously approved prior authorizations carry over to EmpiRx or will my doctor need to submit new prescriptions? Yes, valid prescriptions with remaining refills will be transferred over from the former Mail Order pharmacy to the new Mail Order Pharmacy to allow you to acquire refills without disruption. EmpiRx Health has selected Benecard Central Fill to dispense mail order prescriptions. Be sure to contact the member services team at 1 877 262 7435 to order medications without delay. 11) Will 90-day supplies be available at local covered pharmacies or just available through mail order? 90 day supplies will continue to be covered at your local pharmacy in addition to the EmpiRx Health Mail Order Pharmacy, Benecard Central Fill. 12) What do I need to do if I decide not to change health or dental plans or make any dependent changes? If after reviewing the Open Enrollment material thoroughly, you decide not to enroll or make any changes, no action is required on your part. However, if you wish to opt out or enroll/re enroll in an FSA, you must submit the applicable documents by the deadline. All employees who wish to opt out for the 2018 plan year, including those who are currently opted out, must submit a completed 2018 Page 2 of 6
Opt Out Form and provide current, written proof of the other employer sponsored group health insurance coverage, which must include the employee s name. All opt out forms and supporting documents must be received by Employee Benefits no later than 5:00pm on Friday, December 1, 2017. 13) What do I need to do if I decide to change health and/or dental plans? If you wish to change plans for any reason, you must complete an Open Enrollment 2018 Employee Health Insurance Application or login to PeopleSoft to make your changes during Open Enrollment. 14) What do I need to do if I want to enroll in a healthcare and/or dependent care Flexible Spending Account (FSA)? Enrollment in the healthcare and/or dependent care FSA must be completed every year during Open Enrollment for the upcoming plan year. You can either submit a Flexible Spending Accounts 2018 Plan Year Health & Dependent Care Election Agreement to Employee Benefits or login to PeopleSoft to enroll. 15) Who is the vendor for the Flexible Spending Accounts? Navia Benefit Solutions is our new claims administrator for the health care and dependent care flexible spending account, as well as for the transit/van pooling and parking accounts. Website: naviabenefits.com Phone: (800) 669 3539 16) Where do I submit my Flexible Spending Account claims? Manual claims may be mailed or faxed to Navia Benefit Solutions as shown above. Claims can also be filed online at naviabenefits.com or through the Navia Mobile App. 17) When will I receive my Flexible Spending Account cards? Enrollees should receive their cards on or around January 1, 2018. Cards are provided in sets of two and arrive in a plain white envelope. 18) Do I need to keep my receipts if I use my Flexible Spending Account Card? Yes! The card process is not paperless and the IRS has very strict rules that require you to provide documentation of card transactions. Keep all itemized receipts and insurance carrier Explanation of Benefit forms! Why Because all transactions must be substantiated. Some are substantiated electronically; but many require you to provide supporting documentation. Why? Two reasons 1) The IRS requires it. 2) The card company reports only the transaction date, merchant name, and dollar amount. The IRS also requires that you provide a description of the service and actual date of the service, regardless of the card transaction date. There are some limited situations in which documentation may not be required: Copayments A transaction for a flat dollar copayment that matches the County plan you are enrolled in can be automatically accepted without the need for backup documentation. Page 3 of 6
Over the Counter Health Care Products A transaction at a retail merchant, such as Walgreens, Walmart, Target, or www.fsastore.com, who identifies and inventories eligible health care products, such as Band Aids, sunscreen, or contact lens solution, can be automatically accepted without the need for backup documentation. Identified Recurring Expenses A recurring expense, such as a monthly orthodontia or chiropractor payment, made each month for the exact same dollar amount to the same provider may be identified as a recurring expense that does not require additional documentation. For example, if you have a monthly chiropractor visit for $45.50 that does not match your County plan copay, you will be prompted for documentation the first time. You need to substantiate the expense and include a note stating this will be a recurring expense. Future transactions at this same provider for the same amount will not require documentation. All other card transactions require backup documentation. This includes medical offices, hospitals, lab, x ray, physician services, etc., as well as dental, vision and hearing expenses. This also includes copayments made under a spouse s benefit plan. 19) If I am making Open Enrollment changes online, do I need to still turn in supporting documents? Yes. Any supporting documents such as certified birth certificates or certified marriage certificates are still required. If supporting documents are not submitted by 5:00pm on November 09, 2017, the change will not be processed. Employee Benefits recommends emailing, faxing, or dropping off supporting documents, as they may get lost in the mail. 20) If I am adding dependent(s) who have been covered under my plan previously, do I still need to turn in supporting documents? Yes. Any supporting documents such as certified birth certificates or certified marriage certificates are still required, even if your dependent has been covered under your plan and you ve submitted the documents previously. 21) How is an Anthem Blue Cross High Deductible PPO (HDPPO) different from an Anthem Blue Cross PPO plan? Subscribers of the HDPPO plan must meet a higher deductible for the calendar year. A deductible is the amount that must be paid, by the subscriber, before the plan will pay any claims. The HDPPO plans are also Health Savings Account (HSA) qualified. Subscribers of the PPO plan must meet a lower deductible and most services still require certain copays. The PPO plans are not HSA compatible; however, employees may still enroll in an FSA. 22) The Anthem Blue Cross HDPPO Plan is Health Savings Account (HSA) qualified. What is an HSA? Health Savings Accounts (HSAs) allow you to make tax deductible deposits and withdraw the funds to pay for qualified medical expenses tax free. If you enroll in an Anthem Blue Cross HDPPO Plan and have no other first dollar medical coverage, (e.g. low or no deductible medical coverage) you may be eligible to open an HSA account through your financial institution. 23) Can I go to any Bank or Financial Institution to open an HSA account? Page 4 of 6
No. Only a bank or financial institution that has taken the appropriate steps can provide HSA qualified accounts. Check with your local financial institution or attend the Health Fest for more information. 24) How do I enroll in the Anthem Blue Cross High Deductible PPO (HDPPO) plan? Complete an Open Enrollment 2018 Employee Health Insurance Application and the applicable Anthem Blue Cross HDPPO Supplemental Form. The forms must be received by Employee Benefits by 5:00pm on Thursday, November 09, 2017. 25) What information do I need to properly enroll eligible dependents? Please see a list of eligible dependents and the document(s) required to add them below. Eligible Dependents Spouse* Registered Domestic Partner Child Stepchild Adopted Child Child of Legal Guardianship Required Document(s) A copy of the Certified Marriage Certificate A copy of the Declaration of Partnership filed with the California Secretary of State A copy of the Certified Birth Certificate A copy of the Certified Birth Certificate and a copy of either the Certified Marriage Certificate or Declaration of Partnership filed with the California Secretary of State showing your spouse or registered domestic partner as the child s parent A copy of the Adoption Order or the Certified Birth Certificate A copy of the Letters of Guardianship filed with the courts *The term spouse includes same sex spouses, pursuant to IRS Revenue Ruling 2013 17. 26) My child is over 18. Do they need to be a full-time student to be covered under my plan? No. Eligible children may be enrolled on your County health insurance plan up to the age of 26. 27) When do the changes I make during Open Enrollment take effect? Any changes made during Open Enrollment are effective on December 18, 2017. Healthcare and/or dependent care FSA enrollments for the 2018 plan year will take effect on January 1, 2018. 28) When will I see the biweekly deductions for health insurance premiums and/or the flexible spending account(s) come out of my payroll check? If applicable, you will see the deductions on your January 12, 2018 paycheck. 29) Can I change to another health or dental plan after the Open Enrollment period ends? Page 5 of 6
No. If forms are not received by Employee Benefits by 5:00 pm on Thursday, November 09, 2017, you will not be able to make plan changes until the next Open Enrollment period, unless you experience a qualifying event. For more information on qualifying events, contact Employee Benefits. 30) Can I add or delete dependents after the Open Enrollment period ends? No, unless you experience a qualifying event (e.g. marriage, birth or adoption of a child, loss of other health insurance). Documentation of the qualifying event must be provided to Employee Benefits within thirty (30) days of the qualifying event date. 31) I am currently opted out of the County s insurance. Do I need to turn anything in? Yes. Every year you will need to complete a new Opt Out Form and submit current, written proof of other employer sponsored group health coverage. You have until December 1, 2017 to complete the 2018 Opt Out Form and turn in your supporting documents. If you do not complete the form and turn in the documents, you will be automatically enrolled in the Anthem Blue Cross EPO and DeltaCare USA DHMO plans with employee only coverage. If you have further questions, please contact Employee Benefits at (559) 600-1810. Page 6 of 6