Transcript KCTCS 2009 Open Enrollment Training

KCTCS
OPEN ENROLLMENT 2015
October 13 – 30, 2014
HEALTH CARE REFORM
 The Kentucky Employee Health Plan (KEHP) is in compliance and meets all
requirements of the Affordable Care Act (ACA).
 Health care insurance is offered to all eligible employees.
 The Plan provides affordable health care insurance for eligible
employees.
 Employees may shop the kynect for coverage.
 Purchasing health insurance through kynect will:
 Disqualify the employee and dependents from receiving potential tax
credits
KCTCS PERSONNEL SYSTEM
CONTRIBUTION STRATEGY
 The state non-tobacco user contribution rate is reduced by
25 percent.
 KCTCS personnel system employees have reduced
out-of-pocket contributions.
 The $50 Benefit Allowance is available to eligible
employees to offset out-of-pocket benefit expenses.
2015 PLAN YEAR HIGHLIGHTS
 The four health plan options from 2014 will remain the
same – same benefits and employee contributions!
 Two ways to complete your LivingWell promise
 Anthem Blue Cross/Blue Shield is the new plan
administrator
 CVS/caremark is the new pharmacy benefits manager
 Waiver HRA eligibility changes
THE KEHP LIVINGWELL
PROMISE
 Requires members to do one of two things:
 Promise to take the HumanaVitality Health Assessment
(HA) between January 1 and May 1, 2015, OR
 Complete a HumanaVitality Check (Biometric screening)
between January 1 and May 1, 2015 AND
 Keep their contact information up-to-date in the KEHP
system.
THE KEHP LIVINGWELL
PROMISE
 If you did not complete your LivingWell Promise for 2014, you will
not be allowed to enroll in a LivingWell plan.
 If the LivingWell Promise is not fulfilled between Jan. 1 and May 1,
2015, the member will not be allowed to enroll in a LivingWell plan
for 2016.
 Both members of a LivingWell cross-reference payment plan
must take the Health Assessment or the HumanaVitality Check .
 Dependents CAN take the Health Assessment or
HumanaVitality Check , but are not required to do so.
HEALTH INSURANCE HIGHLIGHTS
Health and FSA/HRA elections from 2014 do NOT automatically
roll-over.
 Health elections, including all waivers, must be made in both PeopleSoft
and the KHRIS system.
 FSA/HRA, Dental and $50 Benefit Allowance elections must be made in
PeopleSoft.
 DEI (Department of Employee Insurance) has mailed IDs and instructions
for the KHRIS system to employees’ homes.
 Forms, information and the 2015 DEI Benefits Selection Guide are
available on the DEI web-site:
https://personnel.ky.gov/Pages/healthinsurance.aspx
THE PLANS!
•
•
•
•
LivingWell Consumer Driven Health Plan (CDHP)
LivingWell Preferred Provider Organization (PPO)
Standard PPO
Standard CDHP
There is no “free” plan. Each plan has some employee
contribution associated with it.
LIVINGWELL CDHP




LivingWell Promise required
Covers 100% in-network preventive care
Lowest co-insurance by member – 15% for in-network services
Embedded HRA
 Single receives $500; Couple, Parent + or Family receives $1000
 Use toward deductibles and out-of-pocket maximums
 Reduces deductible by 40%; out-of-pocket maximums by 20%
 Remaining funds rollover to next year if a CDHP is elected
 Lowest annual out-of-pocket maximum; best co-insurance percentage
LIVINGWELL PPO








LivingWell Promise required
Covers 100% in-network preventive care
Copays for some medical and all pharmacy (Rx) services
NEW – Rx have a separate out-of-pocket maximum for Rx co-pays to help
cap costs
NEW – Medical and/or Rx co-pays do NOT accumulate toward deductibles
2nd lowest co-insurance by member – 20% for in-network services
Lower deductibles, but higher premiums
Same out-of-pocket maximum as LivingWell CDHP
No HRA funds to help reduce member costs!
STANDARD PPO
 No LivingWell Promise required
 Covers 100% in-network preventive care
 Pharmacy costs are 30% of total in-network Rx cost within a
minimum/maximum range
 NEW – Rx have a separate out-of-pocket maximum for Rx co-pays to help
cap costs
 3rd lowest co-insurance by member – 30% for in-network services
 Same employee-paid contribution as LivingWell CDHP
 Higher deductibles than LivingWell PPO
 No HRA funds to help reduce member costs!
STANDARD CDHP
 No LivingWell Promise required
 Covers 100% in-network preventive care
 Embedded HRA
 Single receives $250; Couple, Parent + or Family receives $500
 Use toward deductibles and out-of-pocket maximums
 Reduces deductible by 40%; out-of-pocket maximums by 20%
 Remaining funds rollover to next year if CDHP is elected
 Lowest premiums in exchange for higher deductibles
 NEW – employee contribution rates have decreased slightly for Couple,
Parent Plus and Family plans
 The default plan at single coverage level if no election is made!
KCTCS E-BENEFITS
(EMPLOYEE SELF-SERVICE)
 The e-Benefits feature in PeopleSoft Self-Service will be used
again for this Open Enrollment.
 Enter elections for Health (including waivers), Dental, FSA,
HRA and $50 Benefit Allowance.
 To get there: Log into PeopleSoft and go to Employee SelfService.
KCTCS E-BENEFITS
(EMPLOYEE SELF-SERVICE)
KCTCS Open Enrollment will be a multi-step process:
1. October 13 (Monday) – 30 (Thursday), 2014:
 Begin your benefits enrollment through e-Benefits
 Review the cost of each benefit on the Enrollment Summary page
2. October 13 (Monday) – 30 (Thursday), 2014:
 Enroll for health insurance or waive health insurance in DEI (KHRIS)
website
 Print the confirmation page from DEI
3. November 10 (Monday) – 21 (Friday), 2014:
 If eligible, enroll in the KCTCS $50 Benefit Allowance through eBenefits
DEI ONLINE ENROLLMENT
Reminder! You MUST enroll for health insurance or waive health
insurance through the KHRIS system.
 Failure to enroll for health insurance or a waiver will result in automatic
enrollment in the Standard CDHP Single coverage
 DEI online access will be available October 13 - 30, 2014 at KHRIS.ky.gov
 Step-by-step instructions are available at the DEI website or KCTCS’
intranet site
 Do NOT enroll for Health Care Reimbursement (FSA) or Dependent Care
Reimbursement accounts through KHRIS.
 Enroll through e-benefits PeopleSoft Self Service for these!
DEI ONLINE ENROLLMENT
(CONTINUED)
 Once the online enrollment process is complete, print and save your
confirmation page as proof of enrollment.
 If you enter an e-mail address during the DEI enrollment process, a
confirmation message will be sent.
 See page 31 of the DEI Benefits Selection Guide for contact information to
answer KHRIS questions.
 Your KCTCS HR representative will be unable to answer questions
about the DEI website.
A PAPER APPLICATION IS REQUIRED IF…
 Anyone beginning or currently using the cross-reference payment
option, including but not limited to
 Any change to existing cross-reference coverage,
 Ending a cross-reference payment option, or
 An employee paying by cross-reference with a retiree.
 Anyone with a disabled dependent
 KRS retirees – contact KRS for their paper application
 Retirees who have returned to work and are age 65 or older
 New employees hired between September 1 and December 31
NO COST, IN-NETWORK
PREVENTIVE CARE
 All plans cover an extensive list of preventive services by a
network provider without charging a co-pay or co-insurance,
even if the annual deductible hasn’t been met.
 Provides for such services as immunizations, preventive
screenings, well-child and well-adult visits
DEPENDENT ELIGIBILITY
Dependent Eligibility to Age 26
 The dependent:
 can be married (coverage does not extend to his/her spouse or children),
 does not have to reside with the plan-holder, and
 can remain on the parent’s plan regardless of whether the dependent is
eligible to enroll in his/her own employer-sponsored plan through his/her
employer
 All contribution deductions are based on a pre-tax basis.
TOBACCO USE DECLARATION
 The Commonwealth is committed to fostering and promoting wellness
and health in the workforce.
 Focus on tobacco use – not just on smoking
 Applies to spouses and dependents as well as KEHP member
 KEHP plans provide support through Tobacco Cessation Programs.
 Cooper Clayton 12-week program of OTC NRT products
 The Kentucky Quit Line provides unlimited OTC NRT products
 Rx from a physician for unlimited OTC NRT products or free
prescriptions of Chantix
2015 Plan Comparisons
(IN-NETWORK)
HRA
Annual
Deductible
Out of
Pocket
Maximum
N/A
Standard
CDHP
Your
Co-Insurance
(30-day
supply)
(hospital,
surgery, etc)
(payment
amount)
30%
70%
30%
Rx
CoPays
(in-network)
Standard
PPO
Benefit
Payments
Office
Visit
CoPays
$750 Single
$1500 Family
$3500 Single
$7000 Family
(medical)
$2500 Single
$5000 Family
(Rx)
N/A
$250 Single
$500 Family
$1750 Single
$3500 Family
$3500 Single
$7000 Family
N/A
Deductible,
then 30%
70%
30%
LivingWell
PPO
N/A
$500 Single
$1000 Family
$2500 Single
$5000 Family
(medical)
$2500 Single
$5000 Family
(Rx)
$25 PCP
Copay
$45
Specialist
Copay
$10
$35
$55
80%
20%
LivingWell
CDHP
$500 Single
$1000Family
$1250 Single
$2500 Family
$2500 Single
$5000 Family
N/A
Deductible,
85%
15%
Min
$10
$20
$60
Max
$25
$50
$100
then 15%
21
WAIVING HEALTH INSURANCE
NEW FOR 2015
 Per federal law, only employees having other group health plan coverage
that provides minimum value are eligible to waive KCTCS health coverage
 These employees may choose to enroll in the Waiver General Purpose
HRA, and
 Must declare in writing that they have other group health plan
coverage.
Note: If you or your spouse is contributing to a Health Savings Account (HSA),
consult a tax advisor prior to enrolling in an HRA or FSA.
WAIVING HEALTH INSURANCE
NEW FOR 2015
(CONTINUED)
 Employees having coverage purchased through kynect or other
governmental plans such as TRICARE, Medicare or Medicaid are no
longer eligible for Waiver General Purpose HRA.
 These employees may enroll in the new Waiver Dental/Vision Only
HRA or elect to enroll in a KEHP health plan.
WAIVING HEALTH INSURANCE
 The employer contribution toward either Health Reimbursement Account
(HRA) will continue to be $175 per month ($2,100/year).
 Unused monies in the same type of HRA carry over to the next year if
coverage is waived from year to year.
 Unused monies do not rollover between the General Purpose HRA and the
Dental/Vision HRA.

Note: If you or your spouse is contributing to a Health Savings Account (HSA),
consult a tax advisor prior to enrolling in an HRA or FSA.
REQUIRED DOCUMENTATION
FOR WAIVER HRA
 Required as a result of the ACA
 Members enrolling in the Waiver General Purpose HRA
must submit a written declaration attesting to enrollment
in another group health plan that provides minimum
value.
 Members enrolling in the Waiver Dental/Vision Only HRA
do not need to attest to enrollment in another plan.
FLEXIBLE SPENDING ACCOUNT (FSA)
VS. HRA
 In addition to the HRA, an employee may fund a Health Care Flexible
Spending Account (FSA) to reimburse unpaid qualified medical expenses
(deductibles, co-pays, co-insurance, dental, vision, etc.)
 If you have both a FSA and a HRA, reimbursement will come from your
FSA account balance first.
 The FSA balance is forfeited at the end of the plan year (12/31/14) and 2½
month grace period (3/15/15).
 The waiver HRA will not roll-over if you change your plan selection.
FLEXIBLE SPENDING ACCOUNTS (FSA)
Two FSA’s are available:
 Health care account for medical expenses
 Minimum $5 per paycheck (including $50 Benefit Allowance);
annual maximum of $2,500
 Per new Federal regulations, only $500 of employer contributions
may be used to fund a FSA
 Dependent day care account for dependent care expenses
 Minimum $5 per paycheck
 Maximum contribution is dependent upon federal tax filing
status, up to $4,992
FLEXIBLE SPENDING ACCOUNT (FSA)
 Employees who wish to enroll in a FSA must do so every year – IRS
regulation.
 Enrollment must be made through e-Benefits.
 FSA enrollees may use the Benny card (for health expenses) or file a paper
claim for reimbursement.
 Claims for reimbursement can be made for any dependents up to age 26.
 Substantiation for a Benny Card charge may be required.
FLEXIBLE SPENDING ACCOUNT (FSA)
(CONTINUED)
 Termination date for a FSA and a HRA is the day employment ends or the
day the employee retires.
 90 days to file claims for reimbursement of expenses incurred through
your last date of service.
 Note: If you or your spouse is contributing to a Health Savings Account
(HSA), consult a tax advisor prior to enrolling in an HRA or FSA.
HEALTH REIMBURSEMENT ACCOUNT (HRA)
HRAs are not available to:
 A retiree who has gone back to work and elects coverage
under the retirement system,
 Retirees, or
 Spouse of a hazardous duty retiree
GENERAL PURPOSE WAIVER HRA
PRE-PAID BENNY CARD:
A TIP FOR THE PHARMACY
If you waived coverage because you are covered under a spouse’s plan:
 Use your spouse’s health plan card first to pay for prescriptions.
 Then use your Chard-Snyder HRA Benny Card to pay for any remaining copay or coinsurance amounts.
 This saves your HRA money for future use, instead of paying the bulk
of that Rx cost with your HRA money.
MEDICARE AND AN HRA
If you are enrolled in Medicare and waive your KCTCS insurance,
 If you are over age 65, enrolled in Medicare and choose to waive health
insurance through the KEHP, you are NOT eligible to enroll in the Waiver
General Purpose HRA.
 You ARE eligible to enroll in the Waiver Dental/Vision ONLY HRA.
 You must enroll ALL your dependents who would have claims reimbursed
under your Waiver Dental/Vision ONLY HRA account, due to federal
Medicare reporting requirements.
 This enrollment must be made in e-Benefits and will be a necessary
part of your online enrollment.
HRA AND FSA REIMBURSED EXPENSES
Save ALL Your Itemized Receipts!
 If you want money specifically used from a Dental/Vision HRA, submit
a paper claim indicating such.
 Otherwise, money will be debited from the FSA first!
 The IRS requires proof (substantiation) that expenses are qualified
under your plan’s benefits.
 Also save your explanations of benefits (EOBs) in case there is a
request to verify an expense.
 If a refund is needed:
 The card should be credited by the provider.
 If the provider refunds the member directly, the member will
be required to refund the card (per IRS guidelines.)
DEPENDENT CARE
FLEXIBLE SPENDING ACCOUNT
 The maximum amount that can be contributed is based on the employee’s
tax filing status.
 Check the Chard Snyder paper enrollment form for maximums.
 Reimbursement is done by claim form only.
 The Benny card is not available for use with the Dependent Care FSA.
 Direct deposit of reimbursements is available.
 The plan maximum contribution is $4,992 per year.
 Retirees are not eligible to participate.
WEB ENROLLMENT: FSA AND HRA
 KCTCS employees will NOT enroll for FSA and/or HRA coverage through
the DEI Website.
 Employees waiving coverage must waive insurance through the DEI
website.
 A message will appear that states that KCTCS is a non-participating
agency and to contact the Insurance Coordinator.
 You must enroll through PeopleSoft e-Benefits.
$50 BENEFIT ALLOWANCE
 Available to KCTCS personnel system regular, full-time employees enrolled
in single healthcare coverage or who have waived healthcare coverage
 May be used for:
 Health or dental insurance premiums,
 Healthcare FSA (FSA enrollment must be completed in e-Benefits), or
 Purchasing voluntary supplemental benefits
 NEW -- Per new Federal regulations, only $500 of employer contributions
may be used to fund a FSA
 The remaining $100 may be used to purchase another benefit or
forfeited
 May not be used to purchase Group Life Insurance or Supplemental Long
Term Disability
$50 BENEFIT ALLOWANCE
(CONTINUED)
 You will need to pre-plan for your $50 Benefit Allowance election during
the initial open enrollment period (October 13 – 30.)
 Important: If you allocate all or part of this benefit to a FSA, you
must enroll in your FSA during the initial enrollment period. You
will not be able to go back and enroll later.
 In November, you will receive an email notice if eligible to enroll in the
$50 Benefit Allowance.
 Enrollment will be November 10 – 21.
 $50 Benefit Allowance enrollment election must be completed in eBenefits in November to participate in 2015.
DENTAL OPEN ENROLLMENT
Three Dental Plans for 2015:




 Delta Dental
 Comp Benefits
 Health Resources
o reduced premiums for 2015!
o annual benefit per member increased to $1200 for 2015!
Dental coverage will “rollover” from 2014 to 2015.
Verify your coverage in e-Benefits.
Verify your dentist’s participation in the plan of your choice.
If you wish to add or drop family members, terminate coverage or change
carriers, a new enrollment must be completed in e-Benefits.
2014 INSURANCE/BENEFIT CARDS
Health Insurance and Prescription Drugs

New ID cards will be issued for all plans.

New WageWorks Healthcare VISA Cards will be issued for CDHP plan HRAs.
Dental

New cards will be issued only if coverage is changed.
FSA and HRA

A new Benny card will be issued to new enrollees or if the current card expires at
the end of 2014.

Only one Benny card is issued if the employee has both a FSA and waiver HRA.

Remaining waiver HRA balances from 2014 do not rollover until April 2015.
LIFE AND AD&D INSURANCE
OPEN ENROLLMENT
 No changes in rates for 2015.
 Paper applications must be completed and returned to your local HR
Department. This enrollment will NOT be done through e-Benefits.
 No proof of insurability is required for an increase of one level of coverage
(for example, 2x to 3x salary).
 Employee must have an existing Optional Life and AD&D plan to
increase coverage level.
 Moving from the Basic coverage ($20,000) to 1x salary does not
satisfy this requirement.
2015 LIFE AND AD&D RATES
Employee Age
Life and AD&D Rate
Monthly Rate per
$1,000 Salary
0-29
0.080
30-34
0.100
35-39
0.110
40-44
0.120
45-49
0.170
50-54
0.250
55-59
0.450
60-64
0.680
65-69
1.290
70-74
2.080
75 +
3.770
OPTIONAL DEPENDENT
LIFE RATES
Dependent Plan
Flat Rate
Option 1
• Spouse $10000
• Child(ren) under 6 months - $2500
• Children 6 months or older - $5000
$4.50/month
Option 2
• Spouse $5000
• Child(ren) up to 6 months - $1500
• Children 6 months or older - $3000
$2.30/month
Option 3
• Spouse $5000
• No coverage for children
$2.00/month
Option 4
• Spouse $10,000
• No coverage for children
$4.00/month
Option 5
• No coverage for spouse
• Child(ren) up to 6 months - $2500
• Children 6 months or older -- $5000
$0.50/month
REMINDER: NO DOUBLE DIPPING!
KRS 18A.225 (13)
“Any employee who is eligible for and elects to participate in the state
health insurance program as a retiree, or the spouse or beneficiary of a
retiree, under any one (1) of the state-sponsored retirement systems
shall not be eligible to receive the state health insurance contribution
toward health care coverage as a result of any other employment for
which there is a public employer contribution. This does not preclude a
retiree and an active employee spouse from using both contributions to
the extent needed for purchase of one (1) state sponsored health
insurance policy for that plan year.”
(Note: KRS does not pay for dependent coverage, except for hazardous duty
retirees. The spouse of a non-hazardous duty retiree can elect the Waiver HRA.)
RETIREES RETURNING TO WORK
KTRS Retiree
 KTRS retirees returning to active employment MUST select
coverage through the active employer (KCTCS).
KRS Retiree
 KRS retirees returning to active employment and becoming eligible
for KEHP coverage with KCTCS MAY be ineligible for KRS coverage.
Retirees should consult KRS for specific guidance.
QUALIFYING EVENTS
Qualifying Events (QE’s) – changes permitted outside the Open
Enrollment period
 QE application must be signed within the QE time frame.
 QEs for cross-reference payment plans require Insurance Coordinators’
signatures from both agencies.
 Supporting documentation must be submitted with the QE application.
 Verification of dependent/spouse must be included with application.
 Coverage will not be activated until applicable verification is received.
 Effective date of QE will be subject to federal guidelines – coverage will be
activated retroactively if needed.
SUPPLEMENTAL VENDORS

Supplemental insurance products are available from a variety of vendors:

AFLAC

Colonial Life Insurance

Washington National Insurance

Lincoln National Life Insurance Co.

Life Insurance of Alabama

Midland National Life

AccuFlex Services Inc. (National Teacher’s Assoc.)

TransAmerica

Premiums can be deducted from your semi-monthly paycheck.

Depending on your health insurance elections, you may also use the $50 Benefit Allowance
to purchase supplemental benefits.

Enrollment is NOT available through e-Benefits.

Paperwork must be submitted to local HR Departments.
KEHP WELLNESS BENEFITS
KEHP’s Wellness Program has several initiatives:
 HumanaVitality Program
 Vitality HealthyFood
 5% off Great for You foods at Wal-Mart
 Free flu shots
 Compass SmartShopper – www.compasssmartshopper.com
Visit the “LivingWell” KEHP wellness website for further information at
www.livingwell.ky.gov
CONTACT INFORMATION
▪ Your first point of contact should be your HR Benefits Representative!
 (Enter college contact information here)
▪ For assistance with DEI online access, use the contact numbers on page 31
of the DEI 2015 Benefits Selection Guide.
▪ Information and forms are located on KCTCS intranet.