Transcript State of Colorado Benefits

State of Colorado
Benefits
Coverage Dates
July 1, 2015 – June 30, 2016
Open Enrollment Dates
April 14, 2015 – May 14, 2015
Topics for Discussion
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Mandatory Enrollment
Eligibility
Premiums
Medical Plan Overview and Changes
Dental Plan Overview
Basic Life Insurance
Optional Life Insurance
Short- and Long-Term Disability
Health Savings Accounts
Flexible Spending Accounts
Voluntary Retirement Plans
On-line Enrollment
 MANDATORY PARTICIPATION!
 You may add/drop/change plans, add/drop dependent(s),
or enroll in or continue a flexible spending plan(s) or make
changes to Optional Life
 If you do not wish to participate in one or more plans you
still must “Waive Coverage” in Benefitsolver
 All enrollments/changes must be done through the State’s
online benefits administration system:
www.benefitsolver.com
 Please take this opportunity to review your plans, qualified
dependents, and beneficiaries!
 Access is available from work, home, or HR if assistance
is needed
Qualifying Events
 A qualifying event is an IRS approved change in
status which allows a change in benefits outside the
open enrollment period
 Typical qualifying events are birth of a child,
marriage, divorce, and loss of coverage
 The change in definition of a dependent will mean
that qualifying events will be very limited. (2011)
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Marriage of a child will no longer be a qualifying event
Change in the child’s financial dependence will no
longer be a qualifying event
Change in residence will no longer be a qualifying
event
 Qualifying events must be processed in Benefitsolver
within 31 days of the event. Contact HR for
assistance
Eligibility
Dependents
 Requirements as of 07/01/2011
 Spouse (same or opposite sex), common-law
spouse, SGDP or civil union partner
 An employee’s, spouse’s, SGDP or civil union
partner’s children through the month in which
they turn 26
 Marital status, financial status, dependent
status, or place of residence do not affect
children’s eligibility
Eligibility
Same Gender Domestic Partners
 Effective July 1, 2010, same gender domestic
partners and dependents of same gender domestic
partners are eligible for Medical and Dental
Insurance, Optional Life Insurance, Health Care
Flexible Spending, and Dependent Care Flexible
Spending.
 Definition-Same Gender Domestic Partner (SGDP)
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Must be at least 18 years of age
Same gender as the employee
Shared an exclusive relationship with the employee for
a minimum of one year with the intent for the
relationship to last indefinitely.
Not married to another person
 Check with the Benefits Office for documentation
requirements
Eligibility
Civil Union Partners
 Civil Union Partners and dependents of civil
union partners are eligible for Medical and
Dental Insurance, Optional Life Insurance,
Health Care Flexible Spending, and
Dependent Care Flexible Spending.
Documentation Requirement
 Proper documentation will be required for any
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spouses, common-law spouses, SGDPs, or
dependents added during open enrollment.
Documents include signed affidavits with supporting
documentation for common law marriage and Same
Gender Domestic Partnerships
Spouses and dependents will require birth and
marriage certificates
Proof of marital status is also required
A full listing of requirements is available on the
State’s benefits web page
Documentation must be provided to the CSM HR
Office or DPA Benefits Office
Patient Protection and
Affordable Care Act
 The State of Colorado medical plans meet
the minimum essential coverage and
affordability standards set by the ACA
 Remember, most individuals will need to
have health insurance in 2015 or face a
possible financial penalty.
 For more information: www.healthcare.gov
Plan
Definitions
 HMO means Health Maintenance Organization
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(Closed Network)
HDHP means High Deductible Health Plan
PPO is a Preferred Provider Organization
HSA is a Health Savings Account
FSA is a Medical or Dependent Care Flexible
Spending Account
Deductible is the amount paid out-of-pocket before
benefits become payable. However, you may have
access to co-payment based services without
satisfying the deductible
EOI is Evidence of Insurability (Medical
Questionnaire)
UHC is United Healthcare
Plan
Definitions
 Co-insurance is a percentage amount paid for
services. For instance if your co-insurance is 10% the
insurance company pays 90% of the bill and you pay
10%. Co-insurance payments normally count toward
your deductible
 Co-pay is a flat dollar amount paid for services
regardless of the cost of those services. For instance
$30 co-pay for an office visit. Co-payments do not
usually apply to the deductible
 Out-of-Pocket Maximum (OPM) The most you will
pay for covered services. Once you reach the OPM
the plan will pick up 100% of the costs
Premiums
 Employee contributions for medical have
increased or decreased depending on the
plan.
 The State contributions towards medical
insurance has increased
 Employee and State contributions for dental
insurance have remained the same
 Optional Life insurance rates remain the
same
 Long Term Disability rates have changed
Co-Pay Plans
Rules of the Road
 The State of Colorado has two co-pay based plans. The
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Co-Pay Choice Plus (UHC) and the Kaiser DHMO
Deductibles can be met on an individual basis
You do not need to meet the deductible to use the co-pay
based services such as office visits or pharmacy services
Co-pays do not count toward meeting your deductible
Some services under these plans require co-insurance
Co-insurance generally does count toward your deductible
Most co-pays and co-insurance count toward your OPM
State of Colorado PPO (UHC)
Co-pay Choice Plus
In-Network
Out-of-Network
Deductibles
• Employee
• Family
$1,500
$3,000
$3,000
$6,000
Out-of Pocket Max
• Employee
• Family
$5,000
$10,000
$10,000
$20,000
Preventive Care
$0
50%
Primary Care Office
$30
50%
Specialist Office
$50
50%
Emergency Room
$500
$500
Out-Patient Surgery
20% + Deductible
50%
In-Patient Hospital
$1,000 co-pay + 20%
No Deductible
50%
Pharmacy – 30 Day
$10/$30/$50
$10/$30/$50
Mail Order – 90 Day
$25/$75/$125
Not Covered
Kaiser
DHMO
In-Network
Deductibles
• Employee
• Family
Out-of-Network
n/a
$750
$1,500
Out-of Pocket Max
• Employee
• Family
n/a
$2,000
$4,000
Preventive Care
$0
Not Covered
Primary Care Office
$30 + 10% (services)
Not Covered
Specialist Office
$50 + 10% (services)
Not Covered
Emergency Room
$500
$500
Out-Patient Surgery
10% + Deductible
Not Covered
In-Patient Hospital
10% + Deductible
Not Covered
Pharmacy – 30 Day
$10/$30
Not Covered
Mail Order – 90 Day
$20/$60
Not Covered
High Deductible Health Plans
Rules of the Road
 The State offers two HDHP plans one administered
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through UHC and one insured through Kaiser
You must satisfy the entire deductible before the plan
pays for any services including pharmacy
Services with the exception of pharmacy are based
on co-insurance
Co-insurance generally counts toward your
deductible
Most co-pays and co-insurance count toward your
OPM
State of Colorado (UHC)
High Deductible Health Plan
In-Network
Out-of-Network
Deductibles
• Employee
• Family
$1,500
$3,000
$4,500
$9,000
Out-of Pocket Max
• Employee
• Family
$3,000
$6,000
$9,000
$18,000
Preventive Care
$0
50%
Primary Care Office
20% + Deductible
50%
Specialist Office
20% + Deductible
50%
Emergency Room
20% + Deductible
$500
Out-Patient Surgery
20% + Deductible
50%
In-Patient Hospital
20% + Deductible
50%
Pharmacy – 30 Day
$10/$30/$50 + Deductible
$10/$30/$50 + Deductible
Mail Order – 90 Day
$25/$75/$125 + Deductible
Not Covered
Kaiser
High Deductible Health Plan
In-Network
Out-of-Network
Deductibles
• Employee
• Family
$1,500
$3,000
$3,000
$6,000
Out-of Pocket Max
• Employee
• Family
$2,000
$4,000
$4,000
$8,000
Preventive Care
$0
Not Covered
Primary Care Office
10% + Deductible
Not Covered
Specialist Office
10% + Deductible
Not Covered
Emergency Room
10% + Deductible
10% + Deductible
Out-Patient Surgery
10% + Deductible
Not Covered
In-Patient Hospital
10% + Deductible
Not Covered
Pharmacy – 30 Day
$10/$30 + Deductible
Not Covered
Mail Order – 90 Day
$25/$75 + Deductible
Not Covered
United Healthcare and
Paladina Health
 Available to employees and family members enrolled in the United
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Healthcare Co-Pay Choice Plus or HDHP Plans
Primary Care Clinics: 9 locations including 6 in the Denver Metro Area
Same and next day urgent appointments
No co-pay charge for Co-Pay Choice Plus members
No co-insurance for HDHP members once the deductible is satisfied
Many services and labs can be preformed on site
Certain prescriptions can be filled in office at a lower cost than through
a pharmacy
24/7 access to your personal physician via their personal cell phone
State of Colorado pays the membership fees
You must register at www.paladeniahealth.com/colorado or by calling
1-866-808-6005
Vision Benefits
 Vision Care Exam
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Vision exams are covered through medical
insurance and may be subject to deductibles,
co-pays, or co-insurance. Contact lens exams
are normally subject to additional charges
 Hardware
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UHC Plans: $25 materials co-pay plus $130
frames allowance every two years. Contact
Lenses $150 every two year. Must use innetwork provider
Kaiser: $150 every two years (Kaiser Optical
Department)
United Healthcare
 www.myuhc.com – UHC Members Website
 Online Health Assessment
 Health Discount Program
 Allows members to enjoy a 10%-50% discount on
qualifying health and wellness purchases
 24 Hour NurseLine Services
 Health and Wellness programs including healthy
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pregnancy, weight management, healthy back
programs, and more
Online treatment cost estimator
Quicken Health Expense Tracker
www.welcometouhc.com/colorado - UHC NonMember website
Paladina Health www.paladinahealth.com/colorado or
1-866-808-6005
Kaiser
 www.kp.org – Kaiser Members Website
 My Health Manager
 Request/View appointments
 Refill prescriptions
 View and learn about test results
 Communicate via secure email with your health care
providers!
 Complete a personal health assessment
 Estimated service costs
 Online programs for weight-loss, fitness, nutrition,
and more
 Information about medical conditions and prescription
drugs
Making A Choice
Things to Consider
 What types of services do you normally use? Office visits, a
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couple of E.R. visits a year or just preventive care?
Do you have major surgery planned in the next year?
What is your risk tolerance?
Remember you have an Out-of-Pocket Maximum. HDHP plans
may have a lower OPM
Look at the difference in the cost of premiums. Not just for a
single month but over the course of a year
Would you have funds available to cover the deductible if
needed on a HDHP?
Could you contribute to an HSA or Flex account to cover
deductibles?
Consider using United Healthcare and Kaiser’s online tools to
estimate expenses for particular services. Look at your current
EOB’s (if available) for the cost of frequent services
Benefitsolver
MyChoice
 When you start the Open Enrollment process
in Benefitsolver you will have an option to
click on the MyChoice tool
 MyChoice will ask you a series of questions
related to your health and your family
member’s health if applicable
 Using this information it will make plan
recommendations for you
 You must still select a plan and enroll. You
don’t have to choose the MyChoice
recommendation
Medical Insurance
Supplement Program
 A program designed to offer financial assistance in
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covering medical premium costs for low-income state
employees with at least one eligible child
Must have a 2014 calendar year household income
three time (3x) or less of the federal poverty level
Complete details and tables available on the State of
Colorado’s Employee Benefits web page
All applications must be filed online (State’s website)
and completed by May 14th
Contact Human Resources if you need assistance
scanning documentation or with the application
process
Dental Plan Highlights
 Basic and Basic Plus Plans
 Composite fillings (white fillings) are now covered for
all teeth (2011)
 Necessary dental implants are now covered (2012)
 Members with certain health conditions are eligible for
cleanings up to 4 times per year if deemed necessary.
Conditions include pregnancy, cardiovascular disease,
diabetes, kidney failure, and suppressed immune
system. Verification of a covered condition from a
physician will need to be on file with the dental office.
Dental Plan Highlights
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Basic and Basic Plus Plans
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Delta Premier Dentists are now considered Innetwork (2012)
No balance billing when using a Premier Dentist
If you are currently using a Premier Dentist you
should see your costs decrease
Premier dentists have a higher contract rate than
PPO dentists. If co-insurance applies it is still
usually less expensive to use a Delta PPO
Dentist
Dental Plans
 Both the Basic and Basic Plus plans cover in-network preventive
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care twice a year at no charge
Reminder! Preventive care costs will no longer count toward the
annual maximum benefit!
Basic
 Maximum $1000 annual benefit per person
 Deductible $50 Employee / $150 Family
Basic Plus
 Maximum $2000 annual benefit per person
 Additional Orthodontia benefit
 Deductible $50 Employee / $150 Family
For the greatest cost savings use a Delta PPO dentist
Delta Dental
EyeMed Vision Care Discount Program
 Available for employees and dependents
enrolled in a Delta Dental Plan
 Offers discount exams and hardware through
designated providers
 www.eyemedvisioncare.com/deltadental
 1-866-246-9041
Basic Life
 New! Coverage is 1x base salary or $50,000
whichever is greater
 Mines will continue to pay this premium
 You are encouraged to check your
beneficiaries
Optional Life
 Optional Life is available for employees, spouses, and same
gender domestic partners through Minnesota Life
 Employees are eligible for up to $500,000 in increments of
$10,000
 Spouses and same gender domestic partners are eligible for
up to 50% of the amount elected by the employee
 Different rates for employees and spouses
 Children are eligible for either $5,000 or $10,000 in coverage
 Employees, spouses, and SGDPs must complete the
Evidence of Insurability form and submit to Minnesota Life.
 Enrollment is now available year round
 Evidence of insurability is required if you are increasing your
elected amount or enrolling for the first time during O.E!
Make sure to click on the Minnesota Life link during your
Benefitsolver registration session to complete the EOI
questionnaire
Optional Life
Child (Dependent) Life
 Child Life is available for dependent children and
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dependent children of SGDPs
Employee must be enrolled in Optional Life
Dependents are only eligible for coverage through
the month in which they turn 26
All dependents are covered for one flat rate
No evidence of insurability is required for children
All children covered under Child Life must be listed
as dependents in Benefitsolver and enrolled under
the dependent life plan
Life Insurance
Additional Benefits
 Available to employees with Basic Life and/or
Optional Life insurance through Minnesota
Life
 Travel Assistance
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Helps coordinate care during medical
emergencies if you are more than 100 miles
from home. Includes locating doctors offices,
hospitals, replacement of lost/stolen
prescriptions, eyeglasses, repatriation
services, plus much more.
Not a substitution for medical/dental insurance
Life Insurance
Additional Benefits Continued
 Will Preparation and Legal Services
 Free 30 minute consultation with an attorney plus legal
referrals
 Create legally valid wills, financial power of attorney,
and living wills online
 Download legal forms
 Legal Information Library
 Financial Counseling for Beneficiaries
 Receive free independent and objective financial
counseling
 Information on these services is available on the
Department of Personnel and Administration’s
website
Short Term Disability
 The State has a new disability insurance carrier,
Unum
 There are no changes to the Short-Term Disability
plan (6 month coverage) and Mines continues to pay
the full premium.
Long Term Disability
 You insure your car and your house are you insuring your
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income?
New carrier, Unum
During this Open Enrollment period only anyone can enroll in
LTD coverage. No evidence of insurability required!
3/12 exclusion period
Individuals enrolled currently in The Standard’s policy will not
have an exclusion period and enrollment will transfer to Unum
Rates have changed many people will pay less
Reduced rates for vested employees
More flexible than PERA’s definition of Disability Retirement
including long-term partial disability
Exclusions and limitations apply
Health Savings Accounts (HSA)
 Allows you to use pre-tax dollars to pay for qualified
medical expenses as they occur or to save for
qualified expenses in the future
 Unused funds roll over from year to year
 To be eligible you must be enrolled in an HSA
qualified plan
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HDHP with HSA (United Healthcare)
HMO High Deductible Health Plan (Kaiser)
 Health Savings Accounts can be arranged through
financial institutions including the Credit Union of
Colorado
 The School of Mines does not offer salary deduction
for HSAs however, you may be able to direct part of
your paycheck to your HSA account through direct
Flexible Spending Accounts
 Healthcare Flexible Spending allows you to
deduct money on a pre-tax basis from your
paycheck to pay for unreimbursed medical
expenses such as deductibles, co-pays, eye
glasses, and dental care
 Dependent Care Flexible Spending allows
you to deduct money on a pre-tax basis to
pay for qualified child care expenses. This
account does not cover medical expenses for
children/dependents
 Both plans lower your taxable income by the
amount contributed to the plans!
Flexible Spending Accounts
 The maximum contribution for the Healthcare
Flexible Spending Account is $2,550
 Remember, if your spouse is eligible for a
flexible spending account through their
employer, they may also be able to deduct up
to $2,550
Flexible Spending Accounts
 Important! You must re-enroll in flexible spending
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accounts each year during open enrollment
Healthcare FSA maximum annual contribution is
$2,550
Dependent Care FSA (does not cover medical
expenses) annual contribution is $5,000 per family
Money not used during the plan year is forfeited for
the Dependent Care FSA and all but $500 for the
Healthcare FSA (starting June 30, 2015)
Starting January 1, 2011, over the counter
medications will not be reimbursable under flexible
spending without a prescription
Flexible Spending Account
 Starting June 30, 2015, you can rollover up to
$500 in unused Healthcare Flex dollars into
the next plan year
 A Debit Card is available for Healthcare
Flexible Spending Accounts!
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.50 cent charge per month deducted from your
flex account balance
Eliminates the filing of most claim forms
Does not relieve you of record keeping
responsibilities – Keep your Documentation!
Flexible Spending Account
Changes
 A “Limited Purpose” Healthcare Flexible
Spending Account has been added (2014).
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Allows individuals contributing to a Health
Savings Account (HSA) to contribute to a
Healthcare Flexible Spending account to cover
dental and vision expenses
Voluntary Retirement Plans
 It is never too early or late to start saving for
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retirement!
The School of Mines offers a variety of voluntary pretax retirement plans including:
The PERA 457 Deferred Compensation Plan
The PERA 401(k) Plan
The 403(b) plan which is available through four
vendors
Pre-tax contributions do not lower your highest
average salary as calculated by PERA
The Roth 403(b) (post-tax) plan which is available
through three vendors
Voluntary Retirement Plans
 You may enroll in a voluntary retirement plan
at any time
 Contact Human Resources for plan
information
 Enrollment forms should be sent to the
vendor
 Contact Human Resources or Payroll for a
salary deduction form
Enrollment Tips
 All dependents in Benefitsolver will need to have a
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social security number listed as well as the tax
dependent and full-time student fields filled in
If Benefitsolver is missing any of this information for
existing dependents you will be required to complete
it before moving forward
If you can’t remember your Benefitsolver user name
and/or password click on “Forgot Password” and
follow the recovery instructions. You must format the
information exactly as shown. The company key is:
soc
You will receive a confirmation number when your
transaction is complete
If you are having difficulties with Benefitsolver please
call the Benefits Office at (303) 273-3052 for
assistance
Resources
 United Health Care
www.welcometouhc.com/colorado
 1-877-283-5424
Kaiser Permanente
 www.kaiserpermanente.org
 303-338-3800
Delta Dental
 www.deltadentalco.com
 1-800-489-7168
Department of Personnel and Administration
 www.colorado.gov/dpa/dhr/benefits
CSM Human Resources
 (303) 273-3052
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