Transcript Slide 1

Open Enrollment
Plan Year 2015
October 27 - November 7
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• The Role of Garnett-Powers & Associates
(GPA) and the Insurance Carriers
• Review of all Benefits, Rates and Plan
Designs
• Explanation of the Patient Protection and
Affordable Care Act (ACA)
• Explanation of Online Open Enrollment
Process
• Special one time Open Enrollment for Additional
Life Insurance
• Q&A
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• Garnett-Powers & Associates (GPA) is the
broker/administrator and customer service provider
for the TABP.
• We design, market, implement and administer benefit
programs for Postdoctoral Scholars and Students at
many campuses throughout the U.S.
• We act as the liaison between the insurance carriers
and you by providing assistance with understanding
and accessing your benefits.
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• Open Enrollment provides an annual
opportunity for you to change your benefit
choices and add or delete dependents.
• If you are not making any changes, no action is
necessary.
• If you previously waived benefits, you may enroll.
• You are enrolling for the entire year. You
may make changes to your elections during the
year only if you have a change in family status or
experience a qualifying event.
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• Examples of qualifying life events are:
Marriage
Divorce
Birth of a child
Death of a dependent
Spouse gains or loses coverage due to
employment
Adoption or placement of adoption of a
child
Loss of coverage
Dependent arrival in the U.S.
Dependent loss of eligibility due to
attainment of age 26.
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• One time Open Enrollment to elect supplemental Life
and ADD plan without completing a medical history
statement.
• Guaranteed up to $100,000 of additional life insurance
• Open to everyone eligible for TABP
• Low cost
• Instructions on how to enroll on the GPA website
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Eligible Family Members Include:
• Legally married spouse, including same sex spouses if
married in a state that allows same sex marriage. Proof of
marriage is required.
• Domestic Partner - You must submit an Affidavit of Spousal
Equivalency to enroll your domestic partner. For information,
please review the Enrollment Instructions under ‘Enrollment’
as well as the Enrollment Form.
Note: Spouses and domestic partners who are eligible
for group medical coverage through another
employer are not eligible for the TABP Plan. By
enrolling a spouse or domestic partner you are
attesting that they meet the eligibility requirements.
• Natural or adopted children and children of a domestic partner to
age 26 regardless of student or marital status.
• Stepchildren may be included if they live with the member and
are supported at more than 50% and claimed on your tax return.
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Plan Name
Insurance Type
HMO
Medical
POS
Medical
HMO
Medical
DMO
Dental
DPPO
Dental
PPO
Vision
(Voluntary)
Life and AD&D
Life
STD/LTD
Disability
Company
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Provided by
and
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• Under
the Point of Service (POS) plan, the member
does not have to choose a Primary Care Physician
(PCP).You may use any provider.
• There are both in-network and out-of-network
benefit levels. You will receive higher
reimbursement if you use an in-network provider.
• You will need to satisfy a deductible before many
services will be paid by the plan.
Aetna POS Medical Plan
Medical Benefits
YOUR OUT-OF-POCKET COSTS
In-Network
Out-of-Network
Physician Office Visit
Specialist Office Visit
E-Visits to PCP
Walk-in Clinics
Hospitalization:
Inpatient
Outpatient
Pregnancy
Prescription Drugs:
Generic
Brand
Non Brand
Emergency Room Visits
$ 20 Copay
$ 30 Copay
$ 20 Copay
$ 20 Copay
40%*
40%*
40%*
40%*
20%*
20%*
20%*
40%*
40%*
40%*
$ 10 Copay
$ 30 Copay
$ 45 Copay
$150 Copay (waived if admitted)
Not covered
Not covered
Not covered
$150 Copay(waived if admitted)
Urgent Care
Routine Physical Exam
Routine Gynecological Exam
Routine Mammograms
Mental Health:
Outpatient
Inpatient
Annual Maximum Out-of-Pocket:
20% after $ 35 Copay
None
None
None
40% after $ 35 Copay
40%*
40%*
40%*
$ 30 Copay
20% *
$2,000 Individual
$4,000 Family
40%*
40%*
$4,000 Individual
$8,000 Family
$500
$1,500
Unlimited
$1,000
$3,000
Unlimited
Deductible:
Individual
Family
Lifetime Maximum
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*Coinsurance amounts after satisfaction of the deductible
For more detailed plan design information go to: www.garnett-powers.com/coh
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• Under the HMO model, the member must choose a
Primary Care Physician (PCP). Each family member may
have a different PCP.
• A PCP must be selected and indicated on the enrollment
form. Provider directory links are available on the GPA
website.
• You are allowed to change your PCP once a month.
• Your PCP becomes your healthcare “gatekeeper.”
• If a member needs treatment from a Specialist or requires
an In-Patient or Out-Patient hospital procedure, s/he must
obtain a referral from their PCP prior to any type of
consultation or treatment. If the referral is not obtained,
no benefits will be paid.
• There is no Out-of-Network benefit (except in the case of
an emergency).
Aetna HMO Plan
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Medical Benefits
Physician Office Visit
Specialty Office Visit
Hospitalization:
Inpatient
Outpatient
Pregnancy
Prescription Drugs:
Generic
Brand Name
Non Formulary
Emergency Room Visits
Urgent Care
Routine Physical Exam
Routine Gynecological Exam
Routine Mammograms
Mental Health:
Outpatient
Inpatient
Annual Maximum Out of Pocket:
Individual
Family
Deductible:
Individual
Family
Lifetime Maximum
Member Pays
$ 20 Copay
$ 30 Copay
$100 Copay
None
$100 Copay
$ 10 Copay
$ 30 Copay
$ 45 Copay
$150 Copay (waived if admitted)
$ 35 Copay
None
None
None
$ 30 Copay
$100 Copay
$1,500
$3,000
None
None
Unlimited
For more detailed plan design information go to: www.garnett-powers.com/coh
Kaiser HMO Plan
Medical Benefits
Physician Office Visit
Specialty Office Visit
Hospitalization:
Inpatient
Outpatient
Pregnancy
Prescription Drugs:
Generic
Brand Name
Emergency Room Visits
Urgent Care
Routine Physical Exam
Routine Gynecological Exam
Routine Mammograms
Mental Health:
Outpatient
Inpatient
Annual Maximum Out of Pocket:
Individual
Family
Deductible:
Individual
Family
Lifetime Maximum
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Member Pays
$ 20 Copay
$ 30 Copay
$100 Copay
$ 30 Copay
$100 Copay
$ 10 Copay
$ 35 Copay
$150 Copay (waived if admitted)
$ 20 Copay
None
None
None
$ 20 Copay
$100 Copay
$1,500
$3,000
None
None
Unlimited
For more detailed plan design information go to: www.garnett-powers.com/coh
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• You
can order maintenance medications through
Aetna’s and Kaiser’s Rx home delivery service for
chronic conditions such as asthma, arthritis,
diabetes, high cholesterol and heart conditions.
• The costs for the Aetna POS & HMO Plans are: $20
generic, $60 brand-name and $90 for non-formulary
brand-name drugs up to a 90 day supply.
• The costs for the Kaiser HMO Plan are: $20 generic
and $70 brand-name up to a 90 day supply.
• It is a simple process and the mail order
information is posted on our website under
“Medical Plans.”
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• Legally required Summaries of Benefits and
Coverage for your medical plans will be available
on our website no later than October 29.
• The Summaries of Benefits and Coverage follow the
recommended guidelines to show you your
benefits in a standardized format to assist you in
making your plan selections.
• You may request a paper copy at no charge by
calling the toll-free number on your ID card.
• You may also print a copy directly off of the GPA
website.
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• Certain women’s preventive health benefits are
available under the medical plans at no
out-of-pocket cost to you.
• Routine gynecological care exams, routine adult
physical exams and mammograms are covered at
no cost.
• Other services include but are not limited to:
Pre-natal maternity, screening for gestational
diabetes, HPV DNA testing, screening and
counseling for interpersonal and domestic
violence, contraceptive methods and counseling,
as well as breastfeeding support, supplies and
counseling.
• FDA approved generic contraceptive drugs and
devices are also covered.
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• In addition to the Women’s preventative benefits there
are other preventative services that are paid 100% with
NO copay under the HMO and POS plans.
• Routine physical exams
• Well child care
• Routine Adult and Children Immunizations
• Routine Eye exam
*Under the POS plan if going out of network an additional coinsurance is assessed.
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• Aetna Navigator - This is an online member portal that allows
you to view your medical visits and claims status, print
temporary ID cards and gain access to a wealth of tools and
information. Access at www.aetna.com . Once you have your
member ID, you may register for access to this site. There will
be instructions on the website to assist you.
• Beginning Right – Provides a pregnancy risk survey and a wealth
of information to assist you with when either you or your spouse
become pregnant.
• Global Fit – Offers discounts to a nationwide network of fitness
clubs.
• Health Connections – Discounts are offered through this
program for spas, health foods and fitness clothing.
• Stress Management – Information available for better mental and
physical health.
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• Kaiser Website - This is an online member portal
that allows you to view your medical visits and
claims status, print temporary ID cards and gain
access to a wealth of tools and information. Access
at www.kp.org .
• Discounts – Kaiser offers a variety of health
discounts. See their website for more information.
• Disease Management Programs – classes are
available for a variety of health conditions.
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• City of Hope pays the cost of this benefit
• The employee assistance program provides access
to confidential counseling for a variety of issues,
including:
• Stress
• Family issues
• Bereavement
• Financial Issues
• You are entitled to three visits per issue per year
and phone counseling.
• The services are available by phone or online
24/7/365
• Phone Number: (888)293-6948
• Website: www.eapbda.com
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Provided by
Aetna Dental HMO Plan
Annual Maximum: Unlimited
Calendar Year Deductible
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Diagnostic and Preventive Care
-Routine Exams
-Teeth Cleanings
-X-Rays
Basic Procedures
-Fillings
-Endodontics
-Periodontics
-Oral Surgery
Major Procedures
-Crowns
-Bridgework
-Dentures
Orthodontia
-Adolescent
-Adult
In-Network
Member Pays
None
No Charge
No Charge
No Charge
No Charge
$0- $225 Copay
$10- $140 Copay
$0- $60 Copay
$150-$170 Copay
$150 -$170Copay
$185- $200 Copay
$1 845 Copay
$1,845 Copay
For more detailed plan design information go to: www.garnett-powers.com/coh
Aetna Dental PPO Plan
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Annual Maximum $1,500 per person
PPO Network
Member Pays
Out-of-Network
Member Pays
Calendar Year Deductible
$ 50 per individual
$150 per family
$ 75 per individual
$225 per family
Diagnostic and Preventive Care
-Routine Exams
-Teeth Cleanings
-X-Rays
Basic Procedures
-Fillings
-Endodontics
-Periodontics
-Oral Surgery
Major Procedures
-Crowns
-Bridgework
-Dentures
Orthodontia
-$1,500 Lifetime Maximum
0% (no deductible)
20%
20%
60%
50%
70%
50%
70%
For more detailed plan design information go to: www.garnett-powers.com/coh
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Provided by
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• This plan is voluntary, which means you are
responsible for the monthly cost for you and your
enrolled dependents.
• The enrollment instructions and rates can be
found on the GPA website.
• You will use your SSN and name to make an
appointment with a provider.
Voluntary Vision Plan
Vision Benefits
In-Network
Member Pays
Out-of-Network
Member Pays
Eye Exam (every 12 months)
$10 Copay
Frames (every 24 months)
$120 Allowance up to $60 Allowance
(20% off remaining balance)
Lenses (every 12 months)
Single
Bifocal
Trifocal
$10 Copay
$10 Copay
$10 Copay
up to $35 Allowance
up to $35 Allowance
up to $49 Allowance
up to $74Allowance
Contact Lenses (every 12 months) $135 Allowance up to $108 Allowance
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For more detailed plan design information go to: www.garnett-powers.com/coh
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Provided by
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• Premiums are paid by the City of Hope.
• The plan pays $50,000 in the event of your death.
• The plan pays an additional $50,000 if your death is
due to a covered accident.
• The AD&D feature pays a benefit in the event of a
loss of sight, limbs, hearing, etc.
• Accelerated Benefit Provision – Allows eligible
members, who are terminally ill to receive a benefit
of up to 75% of their life insurance benefit if they
are diagnosed as terminally ill.
• All J-1 Visa holders and their dependents will have
the required medical evacuation coverage of
$10,000 and repatriation of mortal remains coverage
of $7,500 included in this plan.
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• For those of you who are interested in additional
life Insurance. We have made arrangements with
The Standard to allow all eligible TABP members to
enroll in this Excellent benefit.
• You are guaranteed up to $100,000 of additional life
life insurance.
• No medical history statement to fill out and a very
low cost to you.
• Don’t miss out on this one time special Open
Enrollment for Additional life insurance.
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Provided by
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• Premiums are paid by the City of Hope.
•
The plan pays up to 60% of the first $2,500 weekly
pre-disability earnings.
•
The maximum weekly benefit is $1,500 per week.
•
This benefit is offset by other disability income,
such as Worker’s Compensation and CA State
Disability.
•
The minimum benefit is $15.00
•
The benefit waiting period is 0 days for disability
caused by an accidental injury and 7 days for
disability caused by sickness or pregnancy.
•
The maximum benefit period is 180 days.
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• Premiums are paid by the City of Hope.
•
The Benefit Waiting Period is 180 days of
disability. This program starts when the Short
Term Disability ends.
•
The plan will pay up to 60% of the first $8,333 of
your monthly pre-disability earnings.
•
The maximum monthly benefit is $5,000.
•
This benefit is offset by other disability income,
such as Worker’s Compensation and CA State
Disability.
•
Once approved, benefits are payable each month
while you are disabled up to age 65.
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• The Patient Protection and Affordable Care Act (ACA) was
signed into law on March 23, 2010.
• The ACA requires that most people who are either citizens or
legal residents must have health insurance coverage, or pay a
tax if they do not.
• The intent of the ACA is make health care coverage available to
those who are uninsured in the U.S.
• All states are required to offer a Health Care Exchange, either
through the federal government, on their own or through a
partnership between the state and the federal government.
• California’s Exchange is provided by Covered California.
• U.S. citizens and most legal residents are eligible for plans on
the exchange.
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• There are differing levels of coverage and cost, as
well as several insurance carriers offering the plans.
• In order to be eligible for the Premium Tax Credit,
also known as a subsidy, a person must meet certain
eligibility requirements:
 Their employer offers coverage where the
plan design does not meet the coverage
requirements of the ACA.
 Certain poverty-level income conditions are
met.
 The cost of employee-only coverage
exceeds 9.5% of an employee’s wages.
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Important ACA Information Specifically for
Enrollees in the City of Hope TABP
• The Aetna and Kaiser plans meet or exceed the plan
requirements of the ACA.
• To the best of our knowledge, the cost of single coverage
for the plans does not exceed 9.5% of an eligible
Trainee’s wages/stipend.
• It is highly unlikely that anyone enrolled in the City of
Hope TABP medical coverage will be eligible for a
subsidy through the exchange.
• For more information, please visit California Healthcare
Marketplace at www.coverdca.com .
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• Go to the GPA website at
www.garnett-powers.com/coh and click on “Open
Enrollment”.
• Next, click on the “Open Enrollment Form
Instructions” link and print the instructions for
assistance with completing the open enrollment
form properly.
• Once you have the instructions, go directly to
the “Open Enrollment Form Login” link. This will
take you to a login page where you will choose
“Returning User” and provide your City of Hope
ID number and previously created password.
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• Once done, click “Submit” and you will be taken to
the Dashboard where you will be able to view your
current enrollment and also complete your Open
Enrollment form with any desired benefit changes.
• Once complete, please click “Submit and Create
Printable Enrollment Form” which will send your
form to our secure database and also allow you to
print a copy of your enrollment form for your
records.
• An e-mail will be sent no later than November 14,
2014 confirming your new enrollment status.
• ID cards for any new coverage will be mailed to
your home directly from the Insurance Carriers.
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Monthly Rates
Premium
Paid by
City of Hope
Paid by
Participant
Aetna Medical HMO
Participant
Participant + Spouse
Participant + Child(ren)
Family
$ 351.71
$773.76
$633.06
$1,090.31
$293.68
$622.49
$509.30
$877.15
$58.03
$151.27
$123.76
$213.16
$499.36
$883.85
$838.90
$1,183.47
$416.97
$702.22
$666.51
$940.27
$82.39
$181.63
$172.39
$243.20
$368.29
$699.75
$662.93
$957.56
$307.52
$555.95
$526.70
$760.78
$60.77
$143.80
$136.23
$196.78
$17.52
$39.95
$40.04
$52.74
$14.02
$17.98
$18.02
$23.73
$3.50
$21.97
$22.02
$29.01
$57.18
$121.80
$126.95
$195.56
$45.74
$54.81
$57.13
$88
$11.44
$66.99
$69.82
$107.56
Participant
Participant + Spouse
Participant + Child(ren)
$7.92
$15.04
$15.84
$0
$0
$0
$7.92
$15.04
$15.84
Family
$23.28
$0
$23.28
Aetna Medical POS
Participant
Participant + Spouse
Participant + Child(ren)
Family
Kaiser Medical Plan
Participant
Participant + Spouse
Participant + Child(ren)
Family
Aetna Dental HMO
Participant
Participant + Spouse
Participant + Child(ren)
Family
Aetna Dental PPO
Participant
Participant + Spouse
Participant + Child(ren)
Family
EyeMed Voluntary Vision
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For general inquiries and customer service
regarding enrollment, general benefit questions
and confirmation, you should contact:
Garnett-Powers & Associates, Inc.
 Website:
www.garnett-powers.com/coh
 Toll Free Phone:
800-261-7109
 Fax #:
949-583-2929
 Email Address:
[email protected]
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Thank you for joining us today!
Questions?