Open Enrollment Presentation Plan Year 2018 Tammy Gill Assistant Director, Human Resources
Agenda Important Dates to Remember PEIA Changes for Plan Year 2018 Healthy Tomorrows iselectmd Prescription Changes for PY 2018 Rx Savings Solutions Facility Fee Limit Changes for PY 2018 Mountaineer Flexible Benefits (FBMC) Changes for Plan Year 2018 Things to Consider/Reminders
Reminder Open Enrollment is your opportunity to review all benefit elections to determine what is best for you and your family! Please take time to review all available benefit options and information provided.
Important Dates To Remember Open Enrollment period: 4/2/17 midnight on 5/15/17; changes are effective 7/1/17) Plan Year 2018 is 7/1/17 6/30/18 Healthy Tomorrows Reporting Form and Primary Care Physician designation are due 5/15/17 (PPB Plan policyholders only)
PEIA Plan Changes
Active State Employees Coinsurance Structure Changes In West Virginia Outside West Virginia with Approval from HealthSmart Outside West Virginia without Approval from HealthSmart Plan A 80/20 70/30 60/40 Plan B 70/30 65/35 50/50 Plan C High Deductible No Change No Change No Change Plan D 80/20 70/30 n/a *This includes network providers in contiguous counties of surrounding states. Members may still use those providers without prior approval, but will pay the higher coinsurance amount for services. **** Emergencies Included on the higher amount if it is not pre-certified
Active State Employees Increase deductible and out-of-pocket maximum amounts in PEIA PPB Plans A, B, and D Increase deductible by $200 single/ $400 family Increase out-of-pocket maximum by $1,000 single/$2,000 family
Prescription changes: Implement mandatory 90-day prescription fill for all maintenance medications Example 1: Generic: Drug A Your cost is $20 (2 x $10 copayment for 90 day supply) Example 2: Preferred brand: Drug B Your cost is $50 (2 x $25 copayment for 90 day supply) Example 3: Non-preferred brand: Drug C costs $500 for 90 day supply Your cost is $500 x.75 = $375 Drugs on the maintenance medication list would not be covered in anything less than a 90-day supply. Active State Employees
Comprehensive Care Partnership CCP Comprehensive Care Partnership program pairs members with primary care clinics around the state CCP members pay reduced or no copayments for specified services at their chosen CCP provider CCPs provide primary care, reminders about needed screenings, coordination with specialists, and patient management Some CCPs also provide specialist services and labs CCP Assignments Starting March 1, if a member uses a CCP provider more than any other provider, but they haven t chosen that provider as their CCP, PEIA will be automatically enrolling them as a member of the CCP, unless they opt out.
2018 PEIA Healthy Tomorrow s Plan Year 2018 (Phase 3) due by May 15, 2017 Chose a provider and meet measurement goals or have the waiver box signed by the doctor BP <140/90 Cholesterol <245 Glucose <125 Waist Circumference (report only) Men <40, Women <35 Additional $500 deductible for non-compliance. Biometrics collected between 4/2/16 5/15/17
PEIA Manage My Benefits Login page First time users click Need to Register to set up an account.
Check Status of Healthy Tomorrows Form
Plan Year 2019 Begins 7/1/18 Policyholders must submit Healthy Tomorrows form for biometrics collected between 4/2/17 5/15/18 If policyholders do not comply they will face increased monthly premiums
PEIA Partners with iselectmd Telehealth Members connect with a physician via phone or video chat when they have a non-emergent medical condition that needs treatment A physician will call back generally within 30 minutes iselectmd physicians treat many non-emergent conditions, including: Sinus Infections Bronchitis Cold & Flu Ear Infections Urinary Tract Infections Gastroenteritis Sore Throat Pink Eye and much more iselectmd physicians can prescribe certain medicines, as needed
iselectmd for PPB Members Services For consultation with a state licensed/board Certified Physician call 1-877-775-3006; $40 co-pay WV Code is: WV1144 Available anytime and anywhere 24/7 Encourages everyone to have a PCP and does not replace an existing PCP. Requires a Medical History Disclosure to be completed prior to the first consultation. This may be completed online at www.iselectmd.com or by calling customer care at 1-877-775-3006 x3.
Rx Savings Solutions New service is available April 1, 2017 Website that members can use to save money on prescriptions Rx Savings Solutions tracks prescription prices by pharmacy, and can let members know when they can save money by choosing a different pharmacy The software analyzes data to find lower cost alternative drugs that could save the member money
Rx Savings Solutions is Easy Clear cost comparisons Basic healthcare terms Phone, email or text notifications Certified pharmacy tech support Safe Pharmacist designed and validated Clinically trustworthy HIPAA-compliant Drug interaction awareness This service is available to members in PEIA PPB Plans A, B, C and D.
Rx Savings Solutions Access Rx Savings Solutions by logging into your HealthSmart account at myhealth.healthsmart.com. Select Rx Savings Solutions from the menu. Need help with a prescription or the website? The Rx Savings Solutions' Member Services department is available to answer questions M - F, 7am to 8pm CST. Email: info@rxsavingssolutions.com Phone: 1-800-268-4476
Medical Benefit Changes Active State Employees Increased the number of outpatient procedures subject to Facility Fee Limits. If the member chooses an out-of-state facility that charges more than the PEIA facility fee limit, the member will be responsible for the difference between PEIA s payment and the facility s charge. This will include bordering counties.
Outpatient Procedures Subject to Maximum Facility Fees See complete list in PEIA Shopper s Guide
The Health Plan PPO Plan C will ONLY cover generic drugs at a $10 co-pay
PEIA Reminders Changes only enrollment Submit changes online at www.peia.wv.gov, click on Manage My Benefits or call PEIA to request a Transfer Form at 1-877-676-5573 Check your tobacco status update online or over the phone
Mountaineer Flexible Benefits (FBMC)
Mountaineer Flexible Benefits Open Enrollment Dates: April 2, 2017 May 15, 2017 Changes Only Enrollment Enroll online via Premier Enroll at MyFBMC.com or via FBMC paper enrollment form Benefit effective date July 1, 2017
Mountaineer Flexible Benefits Dental Vision Short-Term Disability Long-Term Disability Hearing Plan Legal Plan Flexible Spending Accounts (Health Care & Dependent Care) ** DCFSA: Coverage extends to age 13, unless disabled Health Savings Account (HSA) (Must be enrolled in PEIA Plan C) Limited Health Care FSA (Must be enrolled in HSA)
What s New for Plan Year 2018 If you do not make changes, your benefits will roll over and your premiums will be adjusted to reflect any new rates. The dental rates for the Routine and Assistance Plans are slightly increasing. The Basic and Enhanced Plans are remaining the same. The Hearing Plan rates are slightly increasing and the benefit allowance is now $500 per ear per device. The Health Care FSA, Dependent Care FSA, Health Savings Account and Limited Health Care FSA are now administered by PayFlex.
What s New for Plan Year 2018 The Health Care FSA & Limited Health Care FSA minimum annual contribution is now $150 and the maximum annual contribution increased to $2,600. Mountaineer Flexible Benefits will maintain the grace and run-out period. Individual HSA contribution limit is $3,400 per year. The HSA custodian fee will decrease to $2.50. Employees should exhaust their FSA balance with WageWorks by the end of the grace period (September 15, 2017).
Enrollment Form Open Enrollment New Hire Transfer Change in Status
MyFBMC.com Registration Employees that have not previously enrolled on Premier Enroll will need to register as a new user Employees should use their SSN for the first registration An email will be sent to participants to validate registration
Online Enrollment Confirmation Statement
Things to Consider/ Reminders
Long Term Disability Things to Consider Premiums are based on age and salary of employee. Premiums increase every 5 years (as age and salary increase). LTD insurance is not a lifetime benefit. Benefits end as of age 70. Do you know how much you are paying each month?
TIAA - Things to Consider If you haven t looked at your retirement investments in the last 5-10 years, please take the time to do so! Life Cycle Funds became available approximately 7 years ago. This product uses targeted retirement dates to direct investments in a diversified portfolio. Changes can be completed online or by calling TIAA at 800-842-2273.
Reminder Beneficiary Designations Please remember to keep your beneficiary designation(s) current! Life events may affect how you want your benefits paid. If you can t remember, it is always best to complete a new form/go online, as information is likely outdated.
Reminder Beneficiary Designations Designations should be made for Basic and Optional Life Insurance. Primary Beneficiary(ies) The person or persons named will receive the proceeds. Contingent (Secondary) Beneficiary(ies) At the time of your death, if the primary beneficiary(ies) is no longer living, the benefit is paid to this person or persons.
Reminder Beneficiary Designations Default Beneficiary(ies) If a beneficiary is not named, proceeds will be paid in the following order: to a spouse, if living, if not; to child(ren), if living, if not; to parent(s), if living, if not; to siblings, if living, if not; to your estate
Beneficiary Changes Two options for updating beneficiary information with PEIA: Go to www.peia.wv.gov and select Manage My Benefits Complete Basic and/or Optional Life Beneficiary Change paper form Remember to update beneficiaries with your retirement vendor (TIAA or Empower)
Questions?