Transcript AETNA SOLE CARRIER FOR JANUARY 1, 2004
RISK MANAGEMENT & INSURANCE OCTOBER, 2014
AGENDA
What’s Not Changing
What’s Changing & New
MetLife Hospital Indemnity Plan
Flexible Spending Accounts (FSA)
MetLife Defender
Humana Resources
Reminders
Terms and Definitions
Humana On-Line Resources
Questions & Answers
Annual Enrollment 2015 Health Renewal
Humana Vitality
Humana Health Benefits
2015 Health Plan Payroll Deductions
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Annual Enrollment
October 15 thru October 27, 2014 ** 2 WEEK WINDOW!! **
Coverage Begins: January 1, 2015
Deductions begin: 12/5/14 – Support 12/12/14 – Instructional/Administrative/PTS
2015 Flexible Spending Account and & MetLife Legal deductions begin: 1/2/15 - Support 1/9/15 -Instructional/Admin/PTS
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What’s Not Changing
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Humana Dental – No change in benefits or deductions.
Met Life Dental – No change in benefits or deductions.
Eye Med Vision - No change in benefits or deductions.
Prudential Life – No change in benefits or deductions. All new or increased levels of coverage subject to medical underwriting approval. Spouse coverage amount may not exceed employee’s coverage amounts (Board life and/or optional term life).
Corporate Care Works EAP Plan – No changes.
(Employee Assistance Plan)
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What’s Changing & New
Humana Health Plans – Changes to Out of Pocket Max and National Point of Service (NPOS) Deductible. Payroll deduction changes. New employee + child/ren Tier.
RX Benefits – Co-pay changes.
Assurant Disability Insurance – No change in benefits or deductions. All increases subject to medical underwriting. HIP Plan has been discontinued.
New MetLife Programs –
Hospital Indemnity Plan
Defender Identity Theft Plan
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MetLife HOSPITAL INDEMNITY
Covered Benefits:
Hospital Admission - $500 Hospital Confinement - $250 per day, 30 day maximum
Inpatient Rehabilitation Unit - $100 per day, 15 day maximum – Accident only
Payroll Costs:
Employee Only - $8.00
Employee + Spouse - $13.00
Employee + Child(ren) - $17.00
Employee + Family - $21.00
Employees may use board credits if not enrolled in health plan.
Preexisting conditions apply 12/12 . (See certificate for full list of exclusions and limitations.)
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MetLife Defender
Benefits
ID Theft Monitoring
Personal Identity Monitoring and Security
Patented Peer-to-Peer Network Monitoring
Junk Mail Removal
Health Data Protection
Financial Data Protection
On-Line Child Safety Payroll Deduction
Employee Only - $9.00
Employee + Spouse - $15.00
Employee + Children - $12.00
Employee + Family - $18.00
Enrollment any time during the year through: 1-800-Get Met 8 (438-6388)
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Terms and Definitions
Co-payment
- the specified dollar amount that the member must pay for a covered service.
Deductible
- the amount of covered services that the member must pay per year before Humana pays benefits for covered services.
Co-insurance
- the % amount of a covered service that the member must pay. Example: An 80%/20% coinsurance means that Humana will pay 80% of the allowable charge and the member will pay 20%.
Medical Out-of-pocket limit
- the most a member would have to pay per calendar year before the Humana pays 100% of the in network cost. Excludes RX costs.
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2015 Health Renewal
Proposed 2015 health renewal was 11.6%. Final renewal after negotiations and plan design changes was approximately 5%.
Projected 2015 premium -$117.8M; $5.5 premium increase.
Overall the District will pay approximately 80% and employees will pay 20% of total premium.
New Five Tier Enrollment structure – Employee, Employee + Child(Children); Employee + Spouse, Family and Two Board Family.
New Humana Vitality Program
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Staff HMO
Key Features & Changes
Staff Network with a
Co-pays for all services; limited number of preventive services covered physicians.
at 100 %
Referrals to Specialists limited by PCP Choice.
Hospital co-pay $500 per day, 5 day maximum.
No Out-of-Network Benefit, except for emergencies.
Service areas Pinellas, Pasco, Hillsborough, Manatee, Polk, Sarasota, Hernando & Citrus.
Out of Pocket Maximum $3,500 (employee) and $7,000 (family).
Please confirm participation with Humana’s toll free customer service or website –NOT Doctor’s Office !
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NPOS Plan
Key Features & Changes
Broad National Point of Service (NPOS) Network – open access.
No Specialist referrals.
In-Network and Out-of Network benefits.
Deductible: $300/individual $600/family
Hospital co-pay -$500 per day, 5 day maximum.
80/20% co-insurance for physician visits, outpatient services, lab and x-rays.
Out of Pocket Maximum $3,500 (employee) and $7,000 (family).
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CDHP
– Key Features & Changes
HMO Premier Network which
is a larger Tampa Bay area network than the Staff HMO Network.
$ 1,500 (employee) and $3,000 (family) deductible with a $500 (employee) and $1,000 (family) allowance.
Network includes: Pinellas, Pasco, Hillsborough and several other Florida counties
as well as a limited number of states outside of Florida.
80%/20% In–Network Co insurance once deductible has been met.
Out of Pocket Maximum - $3,500 (employee) and $7,000 (family)
NO Out-of-Network benefits If you move to another plan for 2015, any remaining PCA funds will be forfeited as of December 31, 2014.
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Pharmacy Benefits
No deductible on Tier 1 Drugs $20 copay
Deductible ($250 Single/$500 Family) on Tier 2 & Tier 3 Drugs. After deductible: Tier 2 -$55 co-pay Tier 3 -$95 co-pay
Preferred Retail Pharmacy Network – Sam’s Club, Walmart, and CVS.
Non-Preferred Network – available with additional 30% coinsurance after applicable deductible and copay.
Three month supply for two co-pays still available (after applicable deductible) at retail locations.
Right Source Mail Order still available.
RightSourceRx
2015 Health Plan Deductions
Tier/Plan Employee Consumer Directed Health Plan $30 Staff HMO $48 National Point of Service (NPOS) $63 Employee + Spouse Employee + Child/Children Family $120 $115 $178 $158 $151 $230 $182 $175 $262 2 Board Family $85 $137 $169
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Humana Vitality
For Employees & Dependents enrolled in Humana Health Plan.
On Line Wellness Plan.
Complete Vitality Check & HRA.
Provides Personalized Plan.
Access to tools and resources to meet your goals.
Earn Points to Receive Prizes.
Reach “Silver Status”, receive payroll credit in 2016.
Improve your health and well-being.
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24 Hour Humana Online Resources
What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana: 1. Visit www.MyHumana.com
2. Have your Humana ID card handy 3. Go to Humana.com
4. Click “Register for MyHumana” 5. Follow the easy steps to register
Humana PCS Resources
Heather Keegan, RN – Patient Advocate Assists employees with medical and provider issues. Coordinated Diabetes Care Program. Advocates for employees.
Jody Lowry, RN – Health & Wellness Specialist Facilities wellness and health education programs, enrolls members in disease management, clinical programs and Vitality.
Janet Lang - On Site Claims Representative Assists employees with eligibility, claims and coverage issues .
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Flexible Spending Account (FSA)
FSA Plan Deductions are taken pre-tax over 20 pays.
You save Social Security and Income Tax – you increase your take home pay.
Reimbursed for Dependent Day Care (Dependent Care FSA)
Up to $5000 for two working parents Pretax savings for day care expenses Children up to age 13
Reimbursed for eligible Medical Expenses (Medical FSA) :
Medical, dental, vision co-pays, co-insurance & deductibles
Prescription drug costs
Contact Lenses & Prescription Eyeglasses
Lasik & other vision improvement surgery
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Flexible Spending Account
You decide how much to contribute:
Health Care FSA: $200 - $2500
Dependent Day Care FSA: $200 - $5000
Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31.
Receive a debit card – for Health Care Expenses. Not for Dependent Day Care.
Amount available for Health Care Expenses on Jan. 1, 2015. Use for deductibles, co-pays, co-insurance and other eligible expenses.
Look for Humana Access Visa cards last week in December – plain envelope.
Reminders
Changes through Web only October 15 thru 27th.
Confirmation notices available on line for employees to print.
Review health plan options and new enrollment tiers.
Review new MetLife offerings – Hospital Indemnity Plan and Defender Identity Theft Protection.
Make sure your life insurance beneficiaries are current.
Make sure you have enrolled only eligible dependents.
Humana will mail everyone new ID Cards. Please make sure your address on Employee Self Service is correct.
Enroll in MyHumana so that you can participate in the Humana Vitality Program.
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Questions
Visit our web site for current information, including full Beneflex Guide, enrollment and benefit module videos, CDHP & FSA flyers at www.pcsb.org/annual-enrollment .
Call the Humana Hot Line - 888-393-6765, 8:00 am – 8:00 pm, Monday thru Friday.
Call the PCS Benefits Help Line for enrollment assistance 588-6197, 8:00 am – 4:30 pm, Monday thru Friday.
Email us at [email protected]
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