Transcript Document
Open Enrollment
Presentation
January 2010
Agenda
Changes to BigBand’s Benefit Programs
Overview of Plans
What You Need to Do
Important Paperwork
Life Changes
Overview of Benefits Programs
The following slides are condensed
overview of BigBand’s benefits
For details, please consult providers’ plan
documents
Filice Insurance Services/Resources
Dedicated Account Management team
Eric Pogue – 925-299-7212; [email protected]
Chris Kelly – 925-299-7216; [email protected]
Alaina Kelly – 925-299-7213; [email protected]
Assistance with claims, eligibility, forms, carrier issues,
etc.
Customized benefits website:
www.filice.com/benefits/bigband
Blue Shield HMO Plan Design
Blue Shield HMO
Deductible (facility deductible)
$1,500 per member
Co-payment maximum
$2,000 per member
Primary Care Physician Visits
$15 (deductible does not apply)
Routine physicals / well-child
$15 (deductible does not apply)
No cost for vision / hearing screenings or medically necessary immunizations
Emergency
$100 (Waived, if admitted)
Outpatient Surgery
Facility deductible, then $100 / surgery
Hospitalization
Facility deductible, then 10%
Prescription (Mail Order = 2 times these co-pays for up to a 90-day supply)
Generic
$10 (deductible does not apply)
Brand Formulary
*** $25 (deductible does not apply)
Non-Formulary
*** $40 (deductible does not apply)
*** $250 Calenday-year Brand-name Drug Deductible
What is a deductible reimbursement plan? (Commonly
referred to as a Health Reimbursement Account)
A company-sponsored deductible reimbursement plan.
Reimburses employees and their dependents for any
allowable medical expenses under the company
sponsored plan
Set up in accordance with IRS Code Section 105: medical
reimbursements to employees are not considered taxable
income to the employees or their dependents.
Kaiser HMO (HRA) Plan Design
Kaiser HMO (HRA)
Deductible
$2,000 self only & one member in a family of 2, or more
Deducbile
$4,000 for an entire family of 2, or more members
Co-payment maximum
$4,000 self only & one member in a family of 2, or more
Co-payment maximum
$8,000 for an entire family of 2, or more members
Primary Care Physician Visits
$20 (after deductible)
Routine physicals
$20 (deductible does not apply)
Well-child
$10 (deductible does not apply)
Emergency
20% (after deductible)
Outpatient Surgery
20% (after deductible)
Hospitalization
20% (after deductible)
Prescription (Mail Order varies)
Generic
$10 (deductible does not apply)
Brand Formulary
$30 (deductible does not apply)
Blue Shield PPO Plan Design (HRA)
Blue Shield (Shield Spectrum PPO Savings Plus 2250 Deductible Plan
Deductible:
$2,250 / individual - $4,500 / family (in or out-of-network combined)
Out-of-Pocket Max.
$3,000 / individual - $5,500 / family (in or out-of-network combined)
Co-Insurance
80% in-network – 50% out-of-network
Office Visit
20% in-network (after deductible) – 50% out (after deductible)
Preventive / well-child No charge (deductible does not apply) – Not covered out-of-network
Other covered non-preventive services subject to the deductible
Emergency
20% (after deductible) – in or out-of-network
Outpatient Surgery
20% in-network (after deductible) – 20% out (after deductible)
Hospitalization
20% in-network (after deductible) – 50% of $600 + excess
Prescription
(Mail Order = 2 times these co-pays for up to a 90-day supply)
Generic
$10 (you must meet your deductible before co-pays begin)
Brand Formulary $25 (you must meet your deductible before co-pays begin)
Non-Formulary
$40 (you must meet your deductible before co-pays begin)
The BigBand Health Reimbursement Arrangement and
the Comparative Costs
SINGLE EMPLOYEE
Monthly premium costs:
$42.10 for the Blue Shield HMO
$60.11 for Kaiser (HRA)
$79.89 for the Blue Shield PPO (HRA)
Annual deductible exposure:
$1,500 facility deductible for Blue Shield HMO
$1,000 for Kaiser HRA (BigBand will fund up to the first $1,000 via the HRA)
$1,000 for Blue Shield PPO (BigBand will fund up to the first $1,250 via the HRA)
Office Visits
$15 (no deductible) for the Blue Shield HMO
20% for Blue Shield PPO (after deductible) BigBand funds $1,250 via HRA
$20 for Kaiser (after deductible) BigBand funds $1,000 via HRA
Inpatient care exposure:
$1,500 for the HMO
$1,000 for Kaiser ($2,000 - $1,000 HRA funding)
$1,750 for Blue Shield ($3,000 - $1,250 HRA funding)
The BigBand Health Reimbursement Arrangement and
the Comparative Costs (for a family)
FAMILY
Monthly premium costs:
$201.17 for Blue Shield HMO
$180.32 for Kaiser (HRA)
$228.84 for Blue Shield PPO (HRA)
Annual deductible exposure:
$1,500 facility deductible (per member) for Blue Shield HMO
$2,000 for Kaiser HRA (BigBand will fund up to the first $2,000 via the HRA)
$2,000 for Blue Shield PPO (BigBand will fund up to the first $2,500 via the HRA)
Office Visits
$15 (no deductible) for the Blue Shield HMO
20% for Blue Shield PPO (after deductible) BigBand funds $2,500 via HRA
$20 for Kaiser (after deductible) BigBand funds $2,000 via HRA
Inpatient care exposure:
$1,500 for the HMO
$2,000 for Kaiser ($4,000 - $2,000 HRA funding)
$3,000 for Blue Shield ($5,500 - $2,500 HRA funding)
Dental Plan Design
Delta Dental PPO
Questions ? Call 1-800-765-6003
Provider Directory = www.deltadentalins.com
Services
Deductible *
$50 / individual - $150 / family
Annual Maximum
$1,500
Co-Insurance
In
Out (Subject to Usual, Customary & Reasonable)
Preventive
-
100%
100%
Basic
-
90%
80%
Major
-
60%
50%
Orthodontics (child only)
50%
50% ($1,000 Lifetime Maximum)
Pre-determination Review (Recommended for services > $300)
Dental Plan Design (Buy-up Option)
Delta Dental PPO
Questions ? Call 1-800-765-6003
Provider Directory = www.deltadentalins.com
Services
Deductible *
$50 / individual - $150 / family
Annual Maximum
$2,000 in-network / $1,500 out-of-network
Co-Insurance
In
Out (Subject to Usual, Customary & Reasonable)
Preventive
-
100%
100%
Basic
-
90%
80%
Major
-
60%
50%
50%
50% ($1,500 Lifetime In & $1,000 Lifetime Out))
Orthodontics (adult & child)
Pre-determination Review (Recommended for services > $300)
Vision Plan Design
Vision Service Plan
Questions ? Call 1-800-877-7195
Provider Directory = www.vsp.com
Services
Co-pay
$25 (does not apply to contacts)
Exams:
Once every 12 months
Lenses:
Once every 12 months
Frames ($120 allowance)
Once every 24 months
Contact Lenses ($120 allowance) Once every 12 months
*** Laser Vision Correction Discounts ***
* See fee schedule for out-of-network benefits
Life/AD&D and Disability
Sun Life
Questions ? Call 1-800-247-6875
Website = www.sunlife-usa.com
Life Insurance
1.5 times basic annual salary to a maximum of $375,000
Voluntary Life up to 5 times salary (maximum benefit = $500,000)
Disability
STD = 66 2/3% of weekly earnings to a maximum of $2,309 per week
7-day elimination period
LTD = 66 2/3% of monthly pay to maximum monthly benefit of $10,000
90-day elimination period
Employee Assistance Program
Employee Assistance Program
Need Assistance ? Call 1-877-327-4753
Website = www.guidanceresources.com
Company ID # ZB3042Q
Assistance with the following:
Confidential Counseling on Personal Issues
Legal Information, Resources and Consultation
Financial Information, Resources and Tools
Information, Referrals and Resources for Work-Life Needs
Online Information, Tools and Services
The Importance of Having a Will
Assist America Travel Assistance)
Provides medical assistance when traveling more than 100 miles from home
Need Assistance ? Call 1-800-872-1414 in the United States
Need Assistance ? Call 301-656-4152 outside of the United States
Assistance with the following:
Medical Consultation and Evaluation
Hospital Admission Guarantee
Emergency Evacuation
Critical Care Monitoring
Medically Supervised Repatriation
Prescription Assistance
Care for minor children
Legal and Interpreter Referrals
Return Mortal Remains
Pension Dynamics (Flexible Spending)
Questions ? Call 800-888-1998
Website = www.pensiondynamics.com
Medical Expenses
Medical Reimbursement Limit = $3,000
Eligible Expenses
Non-Eligible Expenses
Over-the-Counter Reimbursements
Dependent Care
$5,000 limit
Educational versus Custodial
Day Camp versus Overnight Camp
Voluntary Pet Insurance
VPI Pet Insurance
Nation’s largest & oldest provider
Plan is completely portable
Discounts (5% core policies / 10% for 2-3 pets)
Low deductible of $50
Vaccination & Routine Care coverage available
Easy Enrollment
www.petinsurance.com/nbg
866-332-7620
Customer Care
my.petinsurance.com
800-USA-PETS
Pre-Paid Legal
Pre-Paid Legal plan
Telephone Conversations (unlimited)
Letters/Phone Calls on your behalf (one per subject)
Unlimited Document Review (10-pages per document)
Identity Theft Shield (Kroll Background America)
Detailed Credit Report (Experian / FICO Score / Analysis
Continuous Credit Monitoring (Daily)
Safeguard for Minors
Children under age 18
Continuous Credit Monitoring
Liberty Mutual Auto & Home
Voluntary Benefits
Car Insurance
Liability
Medical Payments / Personal Injury
Uninsured / Underinsured Motorists
Collision
Comprehensive
Mechanical Parts Replacement
Car Windshield Repairs
New Car Replacement
Homeowners Insurance
Your Home
Your Possessions
Your Liability
Maximizing Health Benefits
Utilize benefits that provide for preventive coverage
Semi-annual dental cleanings and exams
Annual eye exam
Be a savvy consumer – can save you $$$
Choose plans that fit your situation best
Familiarize yourself with spouse’s/partner’s plan
Question doctor regarding procedures and necessity,
generic prescriptions, billing rates, joining carrier’s innetwork listing, referrals to in-network specialists
Open Enrollment - BeneTrac
BeneTrac: We will notify you when you can access the system for
enrollment.
BCBS MA / Delta Dental & VSP – If you are enrolled and you do not
want to make any changes, you do not need to do anything but you
should review your BeneTrac account and click “finalize”.
Group Life/AD&D and Disability - You are automatically enrolled for
the group benefits.
Voluntary Life – If electing to increase your Voluntary Life, or enroll for
the first time, please complete an application. If you are adding to
existing coverage, or a new enrollment exceeding the Guarantee
Issue amounts, you will also need to complete an Evidence of
Insurability Form.
Flexible Spending Accounts for 2010 – If you are enrolling, you must
re-elect your contributions in BeneTrac, even if you were enrolled last
year.
Life Changes
Must be done within 31 days from Qualifying Event
Birth or adoption of a child or dependent change
Marriage, divorce, or domestic partner
Child(ren) – Full-time students between the ages of 19
and 25
Spouse’s change of employment
Temporary assignment outside of coverage area