Transcript 2015 OE PCEA

2015 Open Enrollment
PCEA
Open Enrollment
Enroll or make changes October 15 – November 14
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What’s New in 2015?
Kaiser Permanente Vision Plan Discontinued
$250 vision plan with Kaiser Permanente
discontinued
 Kaiser continues to provide routine
eye exam with a $15 co-pay.
 You may elect the $250 vision plan
through EBMS to have coverage for
glasses and contacts.
 You may elect to waive vision
coverage.
If you waive vision coverage, you will
still have coverage for routine eye
exams through the Kaiser medical plan.
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What’s New in 2015?
Option to Waive Vision or Dental Coverage
Vision
You may elect vision coverage for all
family members or waive vision
coverage for all family members.
Dental
You may elect dental coverage for all
family members or waive dental
coverage for all family members.
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What’s New in 2015?
Prescription Drug Annual Out-of-Pocket Maximum
Protects you from unlimited prescription drug costs.
EBMS
Kaiser Permanente
Prescription drug
costs applied to
medical annual
out-of-pocket
maximum
($1,250 / $3,750)
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 $2,000 annual
out-of-pocket maximum
per individual
 $6,000 annual
out-of-pocket maximum
per family of 3 or more
 Does not apply to the
annual medical out-ofpocket maximum
What’s New in 2015?
Health Care FSA - $500 Carry-Over
 IRS now allows up to $500 of
unused Health Care FSA dollars to
be carried over for use in the
following calendar year.
$500
 Only applies to Health Care FSA,
not Dependent Care FSA.
 2014 carry-over funds will be
available for use after all 2014
reimbursement requests submitted
during the 90-day run-out period
have been processed (expected
availability is April/May 2015).
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Open Enrollment
What can you change and when?
Open Enrollment Changes
 Medical plan selection
 Vision plan selection (some
exclusions apply)
 Dental plan selection (some
exclusions apply)
 Add or cancel dependent
coverage
 If you have waived coverage in
the past, you may enroll in the
health insurance plan.
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Changes Due to Qualifying Events
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Birth or adoption of a child
Marriage or divorce
Dependent’s loss of eligibility
Change in spouse’s employment
Loss of other health coverage
Dependent Eligibility
Who can you enroll on the health plan?
Dependent children - Up to age 26
 Your legal spouse
 Your same-sex domestic partner
Proof of relationship is required.
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
Natural child

Step-child

Child of your same-sex domestic partner

Legally adopted child

Child under your legal guardianship

Child over age 26 who is medically certified
as disabled and incapable of self-support.
Medical Plans
Deductible and Out-of-Pocket Maximum
EBMS PPO Medical Plan
Kaiser Permanente
1-Party
Family
1-Party
Family
$250
$750
$250
$750
Out-of-Pocket
In-network
$1,250
$3,750
$1,250
$3,750
Out-of-Pocket
Out-of-network
$2,250
$6,750
N/A
N/A
Deductible
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Medical Plans
Preventive Care
EBMS
In-Network
EBMS
Out-ofNetwork
Kaiser
Permanente
Routine Baby
and Child Exams
$0
40%
$0
Immunizations
$0
40%
$0
Routine GYN
$0
40%
$0
Mammograms
$0
40%
$0
Preventive
Exams and Labs
$0
40%
$0
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Medical Plans
Provider Services
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EBMS
In-Network
EBMS
Kaiser
Out-of-Network Permanente
Office Visits
20%
40%
$15/$25 co-pay
Allergy Shots
20%
40%
$5 co-pay
In-office
Surgery
20%
40%
$5 co-pay
Labs
20%
40%
$10 co-pay
X-rays
20%
40%
$10 co-pay
Mental
Health &
Chemical
Dependency
20%
40%
$15 co-pay
outpatient;
20% inpatient &
residential
Maternity
fee/provider
20%
40%
$0
Medical Plans
Inpatient and Outpatient Services
EBMS
In-Network
EBMS
Out-of-Network
Kaiser
Permanente
Maternity Hospital
20%
40%
20%
Inpatient Hospital
20%
40%
20%
Outpatient Surgery
20%
40%
20%
Emergency Room
(true emergency)
$100 co-pay,
no deductible
$100 co-pay,
no deductible
20%
Emergency Room
(non-emergency)
20% after
$100 co-pay,
no deductible
40% after
$100 co-pay,
no deductible
20%
Urgent Care
$50 co-pay,
no deductible
40%
$15 co-pay
Ambulance
20%
20%
20%
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Prescription Drug Benefit
EBMS
Participating
Annual
Out-of-Pocket
Maximum
EBMS NonParticipating
$2,000 / $4,000 / $6,000
Kaiser
Permanente
Accrues to Medical
out-of-pocket
($1,250 / $3,750)
Retail – 30 day supply
Generic
$10 co-pay
Preferred*
30%
Min $25; Max $55
Non-Preferred
30%
Min $45; Max $75
Member must pay
pharmacy in full
and submit claim
for
reimbursement
$10 co-pay
$20 co-pay
$20 co-pay
Mail Order – Up to 90 day supply
Generic
$20 co-pay
Preferred*
30%
Min $50; Max $110
Non-Preferred
30%
Min $90; Max $150
*Preferred list may change without notice.
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$20 co-pay
N/A
$40 co-pay
$40 co-pay
Vision
Traditional
Vision
$250 Vision
Eligibility
Closed to New
Open to All
Exam Freq.
Once every 12 mo.
Once every 12 mo.
Exam (<18)
100% in-network
$25 out-of-network
100% in-network
60% out-of-network
Exam (>18)
100% in-network
$25 out-of-network
Frames
$40 every 24 mo.
Lenses
$89 single
$125 bifocal
$158 trifocal
$50 lenticular
Contacts
$100
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Up to $250 every
calendar year for
any combination of
exam, frames,
lenses, or contacts.
Kaiser
Permanente
Routine eye
exams covered
under Kaiser
medical plan.
Not covered.
May enroll in
$250 Vision
plan.
Dental
Traditional
Incentive
Eligibility
Open to All
Closed to New
Deductible
$0
$0
Benefit Max
$1,500
$1,000
Preventive
100%
70%/80%/90%/100%
Basic
80%
70%/80%/90%/100%
Major I
60%
70%/80%/90%/100%
Major II
60%
50%
Orthodontia
50% up to $1,000
50% up to $1,000
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How does the health plan work?
Preventive Care (plan pays 100% with no deductible for in-network services)
Annual
Deductible
You pay
100% of the
cost of your
medical care
until your
expenses
reach your
deductible.
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Use this
account to
pay for
deductibles,
coinsurance,
and co-pays.
You must meet your deductible
before your co-insurance shares the cost of services
Preventive Care (plan pays 100% with no deductible for in-network services)
Annual
Deductible
You pay
100% of the
cost of your
medical care
until your
expenses
reach your
deductible.
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Once you
meet the
deductible
of:
Use
$250this
account to
(Individual)
pay for
deductibles,
coinsurance,
and$750
co-pays.
(Family)
After your deductible is met,
co-insurance will pay up to 80% of the cost of medical services
Preventive Care (plan pays 100% with no deductible for in-network services)
Annual
Deductible
You pay
100% of the
cost of your
medical care
until your
expenses
reach your
deductible.
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Once you
meet the
deductible
of:
Use
$250this
account to
(Individual)
pay for
deductibles,
coinsurance,
and$750
co-pays.
(Family)
Coinsurance
The plan pays
80% for
in-network
services and
60% for
out-of-network
services.
Once you meet the annual maximum,
the plan pays the rest!
Preventive Care (plan pays 100% with no deductible for in-network services)
Annual
Deductible
You pay
100% of the
cost of your
medical care
until your
expenses
reach your
deductible.
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Once you
meet the
deductible
of:
Use
$250this
account to
(Individual)
pay for
deductibles,
coinsurance,
and$750
co-pays.
(Family)
Coinsurance
Out-of-Pocket
Maximum
The plan pays
80% for
in-network
services and
60% for
out-of-network
services.
The plan pays
100% of
eligible
expenses if
you have met
the annual
maximum from
your own
pocket.
Flexible Spending Accounts (FSA)
reimburse your out-of-pocket expenses with tax-free dollars
Preventive Care (plan pays 100% with no deductible for in-network services)
Annual
Deductible
You pay
100% of the
cost of your
medical care
until your
expenses
reach your
deductible.
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Once you
meet the
deductible
of:
Use
$250this
account to
(Individual)
pay for
deductibles,
coinsurance,
and$750
co-pays.
(Family)
Coinsurance
Out-of-Pocket
Maximum
The plan pays
80% for
in-network
services and
60% for
out-of-network
services.
The plan pays
100% of
eligible
expenses if
you have met
the annual
maximum from
your own
pocket.
Flexible
Spending
Account
Use this
account to
help pay for or
reimburse your
deductible,
co-insurance,
and co-pays.
Flexible Spending Accounts (FSA)
help you pay for health care expenses tax-free!
 Set aside up to $2,500 per calendar year
 Deducted from paycheck before taxes
 Eligible health care expenses not
covered by health insurance can be
paid with tax-free dollars:
 Deductible, co-pays, co-insurance
 Glasses and contacts
 Dental care, and more
 Benny Card to pay eligible health care
expenses directly from your FSA
 NEW! $500 Carry-Over
Benny Card Tips and Tricks
 Keep your receipts
 Respond to documentation requests
 Pre-pay for medical services with
caution
 Don’t use Benny Card in 2015 to pay
for 2014 expenses
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Flexible Spending Accounts (FSA)
help you pay for dependent care expenses tax free!
 Set aside up to $5,000 per calendar year
 Deducted from paycheck
 Eligible child or elder care
expenses paid tax-free
 Dependents under age 13, or any
age if incapable of self-care
 After/Before school care
 Day camp
 Preschool
 Babysitter
 Use it or lose it!
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Employee Assistance Program (EAP)
Available 24/7/365 for free!
EAP provides:
 Confidential counseling
 Legal consultation
 Financial consultation
 Identity theft recovery assistance
 Home ownership program
 Wellness coaching
 Smoking cessation
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City-paid Basic Life Insurance and AD&D
protects your loved ones
 Guaranteed protection for your
designated beneficiaries
 $40,000 life insurance policy
 $40,000 accidental death &
dismemberment (AD&D) policy
 Automatically enrolled as a
benefit-eligible employee
 You may change your
beneficiaries at any time
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Voluntary Life Insurance and AD&D
gives you added peace of mind
 Provides additional protection for you and your family
 Premiums are paid after-tax from your paycheck
Life insurance (Standard)
 $10,000 - $500,000 for yourself and/or
your spouse/same-sex domestic partner
 $2,000, $5,000, or $10,000 for your
children
 Apply any time during the year, medical
underwriting required
AD&D (Hartford)
 $25,000 - $300,000 for yourself or
yourself and your family
 Apply any time during the year
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Long Term Disability
protects a portion of your income if you become disabled
 Plan pays if you are disabled and
unable to work for more than 90
days
 Pays 60% of the first $8,333 of your
pre-disability earnings, reduced by
deductible income.
 Automatically enrolled as a benefiteligible employee.
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Long Term Care Insurance
helps pay for nursing facility or in-home care
 Plan helps preserve financial
security when you or a covered
family member requires long term
care in a facility or at home.
 Must be unable to perform two or
more activities of daily living for
more than 60 days.
 May apply for a monthly facility
benefit of $1,000 to $6,000 for 2
years, 4 years, or unlimited
duration.
 Apply anytime during the year,
medical underwriting is required.
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Deferred Compensation
Are you saving enough for retirement?
 Save for your future retirement and save on taxes today!
 Set aside (defer) money from your
paycheck before taxes
 2015 annual deferral limits are:
 $18,000, if you are under age 50
 $24,000, if you are 50 years or older
 $36,000, if you are within 3 years of
retirement (restrictions apply)
 Pay taxes upon withdrawal of funds in
retirement.
 Sign up or change your deferral amount
any time during the year.
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Open Enrollment Forms
due by 5:00 p.m., Friday, November 14, 2014
If you are changing medical,
vision, or dental plans, or
adding or canceling
dependent coverage,
If you or your covered
dependents have other
health insurance coverage,
If you would like to
participate in flexible
spending for 2015,
complete this form:
complete this form:
complete this form:
Questions?