I S S U E N O. 1 O C T 23 N O V 9, 2 0 1 7 Open Enrollment EMPLOYEES - PLAN YEAR 2018 COUNTY OF FRESNO
CONTENTS 02 IMPORTANT REMINDERS 04 BIWEEKLY PREMIUMS & PRESCRIPTION 05 MEDICAL COVERAGE 07 DENTAL COVERAGE 07 VISION COVERAGE 09 FLEXIBLE SPENDING ACCOUNTS (FSA) 10 FREQUENTLY ASKED QUESTIONS Open Enrollment OCTOBER 23 - NOVEMBER 9 This is the one time during the year that you may make changes to your health insurance plan, enroll, opt out, remove dependents without a qualifying event, and enroll in the health and/or dependent care flexible spending account for the 2018 plan year. Questions? Please contact Employee Benefits by phone at (559) 600-1810 or email to HRBenefits@co.fresno.ca.us. Additionally, you can visit our Open Enrollment website at www.co.fresno.ca.us/openenrollment. The site includes rates, forms, detailed summaries, and much more!
Important Dates Important Reminders 2018 OPT OUTS All employees who wish to opt out during the 2018 plan year (including those that are currently opted out), must submit a completed 2018 Opt Out Form and provide current, written proof of other employersponsored group health coverage. Proof submitted must include the employee s name and is subject to approval of Employee Benefits staff. ELIGIBLE DEPENDENTS Below is a list of eligible dependents and the supporting documents required to enroll them onto your health insurance plans. Dependent children are eligible until they reach 26 years of age. ELIGIBLE DEPENDENTS REQUIRED DOCUMENT(S) HOW TO ENROLL/MAKE CHANGES Option 1: Login to PeopleSoft on a County computer and use the Self Service feature. Tutorials are available online at www.co.fresno.ca.us/openenrollment. Option 2: Complete the applicable form(s) and submit to Employee Benefits, along with required supporting documentation. Ways to submit are located on the back cover. CHANGES AFTER OPEN ENROLLMENT Once Open Enrollment closes, plan changes will only be permitted if you experience a qualifying event, as defined by the IRS and detailed in our cafeteria plan document. For more information on qualifying events, please contact Employee Benefits. Spouse Domestic Partner Child Adopted Child Step Child Certified Marriage Certificate Declaration of Domestic Partnership filed with the California Secretary of State Certified Birth Certificate Adoption Order or the Certified Birth Certificate Certified Birth Certificate and a Certified Marriage Certificate/Declaration of Domestic Partnership showing your spouse/registered domestic partner as the child s parent Child of Legal Guardianship Letters of Guardianship filed with the courts Please note: the required documents listed above must be submitted each time a dependent is added to your health insurance, regardless if the dependent has been covered under your plan previously. 2
What s New? There are a few significant changes beginning plan year 2018. HEALTH PLAN CHANGES The County will be offering a new health plan through Anthem Blue Cross: an Exclusive Provider Organization (EPO) plan, which will replace the current Anthem Blue Cross Health Maintenance Organization (HMO) plan. Employees currently enrolled in the Anthem HMO plan will automatically be switched to the Anthem EPO plan effective December 18, 2017, unless an Open Enrollment change is made to enroll into a different plan. The benefits of changing from the Anthem HMO to the Anthem EPO is that employees will have access to an expanded physician network, will no longer be required to select a Primary Care Physician (PCP), and will be able to self-refer for care. During the month of December 2017, you will receive your new I.D. card in the mail. Please refer to page 10 for Frequently Asked Questions regarding this new plan. PRESCRIPTION CHANGES Beginning plan year 2018, EmpiRx Health will be facilitating the prescription benefit for Anthem EPO and PPO members. This prescription benefit will replace the current prescription benefit managed by Envolve Pharmacy Solutions. During the month of December 2017, you will receive your new EmpiRx Health packet containing your new I.D. card, plan brochure and mail order materials. Your mail order pharmacy for maintenance prescription orders is changing to Benecard Central Fill. Valid prescriptions with remaining refills will be transferred over to the new mail order pharmacy to allow refills to be filled without disruption. Visit www.empirxhealth.com to access tools to find online benefit information. For Frequently Asked Questions, turn to page 10. FLEXIBLE SPENDING ACCOUNTS (FSA) CHANGES We are pleased to announce that effective January 1, 2018, Navia Benefit Solutions (Navia) will assume administration of the flexible spending and commuter benefit accounts from ASIFlex. Please see page 9 for details. 3
Biweekly Premiums As of the date of publication, negotiations were not completed for the County contribution toward biweekly health insurance premiums. Therefore, the following 2017 contribution rates are included on this chart for comparison purposes only 1 : Employee Only: $283 Plus Spouse: $378 Plus Child(ren): $378 Plus Family: $383 Upon completion of negotiations and Board approval, the 2018 rates, including County contribution, will be made available. If you have any questions regarding the status of negotiations, please contact your bargaining unit representative. The premiums listed below are paid by the employee via payroll deduction on a biweekly basis. How to use this chart: First, choose your medical/mental health plan. Next, choose your dental plan from the corresponding plan column of your choice. Last, choose the corresponding level of coverage that best meets your needs (employee only, plus spouse, children, or family) to determine your biweekly premium. PLAN 1 PLAN 2 PLAN 3 Medical/Mental Health Kaiser Permanente HMO Anthem Blue Cross EPO Anthem Blue Cross PPO $250 Prescription Kaiser Permanente EmpiRx EmpiRx Vision Kaiser Permanente Vision Service Plan (VSP) Vision Service Plan (VSP) Dental Plans Delta Dental DPPO DeltaCare or USA DHMO Delta Dental DPPO DeltaCare or USA DHMO Delta Dental DPPO DeltaCare or USA DHMO EMPLOYEE COST EMPLOYEE COST EMPLOYEE COST Employee Only $99.60 $88.57 $115.00 $103.97 $269.25 $258.22 Employee + Spouse $292.48 $276.36 $319.32 $303.20 $763.93 $747.81 Employee + Child(ren) $214.87 $203.66 $238.56 $227.35 $656.50 $645.29 Employee + Family $496.97 $479.95 $532.09 $515.07 $1,188.68 $1,171.66 PLAN 4 PLAN 5 PLAN 6 Medical/Mental Health Anthem Blue Cross PPO $1000 Anthem Blue Cross HDPPO $1500 Anthem Blue Cross HDPPO $3000 Prescription EmpiRx Anthem Blue Cross Anthem Blue Cross Vision Vision Service Plan (VSP) Vision Service Plan (VSP) Vision Service Plan (VSP) Dental Plans Delta Dental DPPO DeltaCare or USA DHMO Delta Dental DPPO DeltaCare or USA DHMO Delta Dental DPPO DeltaCare or USA DHMO EMPLOYEE COST EMPLOYEE COST EMPLOYEE COST Employee Only $135.41 $124.38 $99.35 $88.32 $35.39 $24.36 Employee + Spouse $482.99 $466.87 $407.27 $391.15 $278.45 $262.33 Employee + Child(ren) $401.97 $390.76 $333.37 $322.16 $210.94 $199.73 Employee + Family $800.55 $783.53 $695.95 $678.93 $508.73 $491.71 1 These rates do not apply to part-time employees who are eligible for health insurance. For a copy of parttime rates, please visit the Open Enrollment website at www.co.fresno.ca.us/openenrollment or call Employee Benefits at (559) 600-1810. 4
Medical & Prescription Coverage Choosing a medical plan that is right for you and your family is an important decision. The County of Fresno offers six (6) different plans to allow you to select the coverage that best meets your needs. Medical Kaiser Permanente HMO Anthem EPO (in-network only) Anthem PPO $250 (in-network) Individual Deductible $0 $0 $250 Plan Year Family Deductible $0 $0 $500 Plan Year Individual Out of Pocket Max $1,500 $1,000 $3,000 Family Out of Pocket Max $3,000 $2,000 $5,000 Preventive Care $0 $0 $0 2 Office Visit Copay $15 $15 $20 2 Emergency Room Visit $100 $100 $100 Inpatient Hospitalization $0 $0 $0 Outpatient Surgery $15 $0 $0 X-ray and Lab (simple, non-diagnostic) $0 $0 $0 Chiropractic $10 $10 $0 Mental Health Kaiser Permanente Anthem Blue Cross Anthem Blue Cross Inpatient $0 $0 $0 Outpatient $15 $15 $20 2 Pharmacy Kaiser Permanente EmpiRx EmpiRx Generic $10 $10 $10 Brand $20 $20 $20 Non-formulary N/A $35 $35 This chart is only a summary of benefits. Please see the Evidence of Coverage (EOC) for a full description of benefits. If there are any discrepancies between this summary and the EOC, the EOC will prevail. 5
Medical Anthem PPO $1,000 (in-network) Anthem HDPPO $1,500 (in-network) Anthem HDPPO $3,000 (in-network) Individual Deductible $1,000 Plan Year $1,500 Calendar Year $3,000 Calendar Year Family Deductible $2,000 Plan Year $3,000 Calendar Year 1 $6,000 Calendar Year Individual Out of Pocket Max $4,000 $3,000 $3,000 Family Out of Pocket Max $8,000 $5,000 $6,000 Preventive Care $0 2 $0 2 $0 2 Office Visit Copay $45 2 20% After Deductible $0 After Deductible Emergency Room Visit $100 + 20% 20% After Deductible $0 After Deductible Inpatient Hospitalization $1,000/year 3 + 20% 20% After Deductible $0 After Deductible Outpatient Surgery $250/surgery + 20% 20% After Deductible $0 After Deductible X-ray and Lab (simple, non-diagnostic) $0 20% After Deductible $0 After Deductible Chiropractic $25 2 20% After Deductible $0 After Deductible Mental Health Anthem Blue Cross Anthem Blue Cross Anthem Blue Cross Inpatient $1000/year 3 + 20% 20% After Deductible $0 After Deductible Outpatient $45 2 20% After Deductible $0 After Deductible Pharmacy EmpiRx Anthem Blue Cross Anthem Blue Cross Generic $10 20% After Deductible $0 After Deductible Brand $20 20% After Deductible $0 After Deductible Non-formulary $35 20% After Deductible $0 After Deductible 1 One member responsible for up to $2,700 of the family deductible before plan starts contributing for that member. Second member responsible for remaining $300 before plan starts contributing. 2 Deductible Waived. 3 Does not apply towards the deductible; applies to the out-of-pocket maximum. 6
Dental/Orthodontic Coverage Good oral hygiene is important to your overall health. The County of Fresno offers two (2) choices in dental plans: Delta Dental DPPO, which is a fee-for-service plan with the best discounts provided within the Delta Dental DPPO network; and DeltaCare USA DHMO which has set copays for services when provided by your primary care dentist. Dental Delta Dental DPPO DeltaCare USA DHMO Annual Deductible $50 Per Person / $150 Per Family No Deductible Maximum Benefits $2,500 Per Person Per Year No Annual Maximum Preventive Services 0% PPO Provider / 10% Non-PPO Provider $0 Most Services Basic Services Major Services (Includes Periodontic, Endodontic, and Oral Surgery) Orthodontia Child Adult Vision Coverage 10% PPO Provider / 10% Non-PPO Provider 50% $1,660 Copay $1,880 Copay Once per lifetime Max 24 months of treatment Vision In-Network Out-of-Network $0 Most Services Copay may be required for upgraded materials/services $0 Most Services Copay may be required for upgraded materials/services $1,700 Copay $1,900 Copay Pre and post-treatment services have additional copayments Eye exams support eye and overall health. It is important to have an exam once a year to ensure that your eyes are healthy. If you are in an Anthem health plan, your vision insurance is through Vision Service Plan (VSP). Exam Copay / Frequency $10 / Every 12 Months Up to $45 / Every 12 Months Contact Allowance / Frequency $150 / Every 12 Months Up to $105 / Every 12 Months Frame Allowance / Frequency $150 / Every 24 Months Up to $70 / Every 24 Months Lenses Copay / Frequency Single Vision Lined Bifocal Lined Trifocal Standard Progressive $0 / Every 12 Months $0 / Every 12 Months $0 / Every 12 Months $55 / Every 12 Months Up to $30 / Every 12 Months Up to $50 / Every 12 Months Up to $65 / Every 12 Months Up to $50 / Every 12 Months Kaiser Permanente members have vision coverage through Kaiser directly. Members must access services at a Kaiser facility, unless otherwise approved by Kaiser. Kaiser In-Network Out-of-Network Exam Copay No Charge Not Covered 7 Glasses/Materials $175 allowance limited to Not Covered
Employee s Guide to Health Plans DEFINITION Health Maintenance Organization (HMO) Exclusive Provider Organization (EPO) Preferred Provider Organization (PPO) High Deductible Health Plan (HDHP) Deductible Out-of-Pocket Maximum (OOPM) Covers services performed solely by providers in a network. This tends to be a low cost system, but is more restrictive than other plans. A primary care physician (PCP) coordinates all medical care and must make referrals to specialty providers. Services by out-of-network providers are not typically covered under the plan. EPO plans combine the flexibility of PPO plans with the cost savings of HMO plans. You won't need to choose a primary care physician, and you don't need referrals to see a specialist. Out-of-network providers are not covered. Has a network of providers, but also allows use of medical providers outside of the plan s network (typically with higher employee cost). It is more flexible than an HMO, but also more expensive generally. You can go to any health care professional you choose inside your network without a PCP referral. Has a higher deductible than a traditional health insurance plan with typically lower premiums. It is often paired with a tax-advantaged account, such as a Health Savings Account (HSA), to pay for medical expenses. A set dollar amount that a person must pay before insurance coverage for medical expenses can begin. The total amount paid each year by the member for the deductible, coinsurance, copayments and other health care expenses, excluding the premium. After reaching the out-of -pocket maximum, the plan pays 100% of the allowable charges for covered services the rest of the year. Plan Comparison Chart Primary Care Physician (PCP) required? Referral required to see a specialist? In-network benefits? Non-emergency out-of-network benefits? Emergency coverage? PPO Preferred Provider Organization EPO Exclusive Provider Organization HMO Health Maintenance Organization 8
Flexible Spending Accounts NEW 2018 ADMINISTRATOR NAVIA BENEFIT SOLUTIONS! CURRENT PARTICIPANTS Beginning January 1, 2018, outstanding claims for Plan Year 2017, including expenses incurred during the Blackout Period (see below) and the grace period (January 1, 2018 through March 15, 2018) must be submitted to Navia. 2017 Plan Year claims must be submitted by May 15, 2018, or you forfeit any remaining monies in your account. If you have remaining monies in your account at the end of the Plan year (December 31, 2017) and currently utilize a debit card, your account balance will be placed on the new card issued by Navia only if you re-enroll for Plan Year 2018. If you do not re-enroll for Plan Year 2018, you may submit a claim form, along with a receipt for expenses incurred, to Navia. BLACKOUT PERIOD: DECEMBER 11 - DECEMBER 31 As part of the change in Administrators, there is a Blackout Period beginning at midnight on Monday, December 11 where current participants will not be able to use their debit card or file claims for reimbursement. The ASIFlex debit card will be disabled and you will no longer be able to submit claims to ASIFlex on their smart phone application or their website. It is important for current participants to know that you may still incur expenses during the Blackout Period, but must submit your claims to Navia on or after January 1, 2018. DEBIT CARD If you choose to utilize the debit card, your Navia debit card should arrive on or around January 1, 2018. You may use the debit card for Health Care and Commuter Plan benefits, but not for Dependent Care benefits. Please Note: be sure to keep itemized receipts and/or insurance carrier Explanation of Benefit forms in the event that you need to provide substantiating documentation for your debit card transactions. Health Care FSA The Health Care FSA provides you with an opportunity to use pretax dollars to pay for out-of-pocket medical, dental, vision and hearing expenses for you, your spouse and any of your dependents (even if they are on a different insurance plan) up to $2,600 per year. 9 Dependent Care FSA CHANGES TO COMMUTER PLAN ADMINISTRATION The Dependent Care FSA is used for workrelated child care expenses and to pay for work-related expenses for older tax dependents who are not capable of self-care up to $5,000 per household, per calendar year ($2,500 if married and filing separate income tax returns). Beginning January 1, 2018, all commuter elections will be submitted directly to Navia via their website. You have the option to set up a recurring election or make a different election from month to month. In addition, you have the flexibility to choose whether your monthly election gets loaded onto your debit card or distributed to you via check or direct deposit to your bank account. Mass Transit/Van Pooling Account You can set aside pretax money to pay for work-related commuting expenses for bus or van pooling up to $130 per month. Parking Account You can set aside pretax money to pay for parking expenses you incur at or near your work place, or from where you commute up to $250 per month. 9
Frequently Asked Questions When will I see the biweekly deductions for the new health insurance premiums and/or the flexible spending account(s) come out of my payroll check? If applicable, you will see the first deductions on your January 12, 2018 paycheck. What do I need to do if I decide not to change health or dental plans or make any dependent changes? No further action is required on your part. However, if you wish to opt out or enroll/reenroll in an FSA for the 2018 plan year, you must submit the applicable documents by the deadline. If I m making Open Enrollment changes online, 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. Can I change to another health or dental plan and/or make dependent changes after the Open Enrollment period ends? No. If forms are not received by Employee Benefits by 5:00pm on Thursday, November 9, 2017, you will not be able to make plan changes until next Open Enrollment, unless you experience a qualifying event. Under the Anthem EPO plan will I be able to keep my same doctor? Yes. The Anthem EPO network uses the same network of doctors as the Anthem PPO. Providers who currently accept Anthem HMO and PPO will also accept the Anthem EPO insurance. What is the process to transition from an Anthem HMO or PPO plan to the new Anthem EPO Plan and keep the same provider? As a current health plan enrollee in an Anthem HMO or PPO plan, tell your provider of the change in coverage. They will take a copy of your new ID card for their records. No further action is required. What if I have a scheduled procedure/ test after December 17, 2017? Anthem will work with members that have pre-approved procedures/tests under their current Anthem HMO plan to ensure a smooth transition to the Anthem EPO plan. Members are required to contact Anthem as soon as possible to avoid delay. Can I go out-of-network with the Anthem EPO plan? Emergency care is the only out-of-network coverage permitted under this plan. Where can I find a list of local pharmacies that will accept EmpiRx insurance? www.empirxhealth.com or (877) 262-7435. Will 90 day supplies be available at local covered pharmacies under EmpiRx or just available through mail order? Yes, 90 day supplies will continue to be covered at your local pharmacy in addition to the EmpiRx Health Mail Order Pharmacy, Benecard Central Fill. Is the Live Health Online service available for Anthem EPO members? Yes. Live Health Online is available for all Anthem members. Copays are as follows: Anthem EPO: $15, Anthem PPO 250: $20, Anthem PPO 1000: $45, Anthem HDPPO 1500: $49, Anthem HDPPO 3000: $49. Will current Rx refills be honored by EmpiRx or will employees need a new Rx? EmpiRx will honor all prescriptions that have remaining refills. However, members will need to present their new ID card to their pharmacist. What if I have additional questions that are not listed here? You can find additional Frequently Asked Questions (FAQs) located on our Open Enrollment website at www.co.fresno.ca.us/ openenrollment. 10
HUMAN RESOURCES Employee Benefits Division ADDRESS 2220 Tulare Street, 14th Floor Fresno, CA 93721 PHONE (559) 600-1810 FAX (559) 455-4787 EMAIL HRbenefits@co.fresno.ca.us STOP MAIL Stop #188 MEDICAL ANTHEM BLUE CROSS Phone (800) 759-3030 www.anthem.com/ca KAISER PERMANENTE Phone (800) 464-4000 www.kaiserpermanente.org DENTAL DELTA DENTAL DPPO Phone (800) 765-6003 www.deltadentalins.com DELTACARE USA DHMO Phone (800) 422-4234 www.deltadentalins.com VISION VISION SERVICE PLAN (VSP) Phone (800) 877-7195 www.vsp.com PRESCRIPTION EMPIRX Phone (877) 262-7435 www.empirxhealth.com FLEXIBLE SPENDING ACCOUNT NAVIA BENEFIT SOLUTIONS Phone (800) 669-3539 www.naviabenefits.com