Transcript Health Insurance and Flexible Benefits Annual Open Enrollment May 1 – May 23, 2014 presented by Employment & Benefits Department of Human Resources.

Health Insurance and Flexible
Benefits
Annual Open Enrollment
May 1 – May 23, 2014
presented by
Employment & Benefits
Department of Human Resources
1
Health Insurance and Flexible Benefits
2014 Open Enrollment
Open Enrollment Options
Changes for July 1, 2014
Deadlines & Effective Dates
Benefits at a Glance
 COVA Care
 COVA HealthAware
 COVA High Deductible Health Plan (HDHP)
 TRICARE Voluntary Supplement
Premiums Effective July 1, 2014
 Reflected on July 16 pay date
2
Health Insurance and Flexible Benefits
2014 Open Enrollment
Types of Membership
Eligible Dependents
Making Changes Outside Open Enrollment
Flexible Spending Accounts
 over-the-counter drug/medical expenses
How to Enroll/Make Changes
Resources and Questions
3
Open Enrollment Options
• Health Care Coverage
• enroll in or change your health plan
• keep your current plan
• consider optional buy-ups
• add or remove eligible family members
• waive health care coverage
• Premium Rewards
• enroll or remain in COVA Care or COVA
HealthAware to qualify
• Flexible Spending Accounts (FSAs)
• enroll in a health or dependent care FSA
4
Changes for July 1, 2014
New Premiums for all plans except COVA HDHP & TRICARE
voluntary supplement
COVA Care
•
prescription drug copay tiers 2-4 increase $5 retail and $10 for
home delivery
COVA HealthAware
•
two new “do rights” for the HRA
COVA Care & COVA HealthAware
•
Asthma/COPD and hypertension incentive programs added to
MyActiveHealth
COVA Care, COVA HealthAware & COVA HDHP
•
Residential treatment centers added to behavioral health services
Flexible Spending Accounts (FSAs)
•
Period to file claims changes if your account ends before 06/30/15
5
COVA Care & COVA HDHP Overview
administered by Anthem & Delta Dental
COVA Care is a preferred provider organization (PPO)
• Pay copayments or coinsurance
• Must meet deductible for certain services
COVA HDHP is a high deductible health plan
• Must meet deductible and then pay 20% coinsurance
for service up to the out of-pocket limit
• Allows member to set up a Health Savings Account
(HSA) to help you pay for health care expenses or
save towards retirement
• Must set up HSA through local bank or financial
institution
6
COVA Care & COVA HDHP Overview
administered by Anthem & Delta Dental
COVA Care & COVA HDHP includes;
• all doctors & hospitals in the Anthem BC/BS PPO
network for medical, behavioral health and pharmacy
services in Virginia and;
• the BlueCare PPO & BlueCard Worldwide programs
for coverage outside of VA
• Both plans include an Employee Assistance Program
(EAP)
Optional Buy-up are available for an additional premium
7
COVA Care & COVA HDHP Overview
administered by Anthem & Delta Dental
Dental benefits are through the Delta Dental network
•
•
employee is responsible for co-pays and deductible if
services are through the DD network
if services are outside the network, DD will pay the
allowable charge and employee may be balanced billed by
the provider
Consider your dental needs carefully
•
•
basic plan covers only routine exams and cleaning
expanded dental provides basic dental plan coverage plus
coverage for primary, complex restorative and orthodontic
services
8
COVA HealthAware
administered by Aetna
Plan includes an employer paid HRA
•
•
employee/retiree only = $600
employee/retire + spouse = $1200
Coverage paid at 100 % for in-network preventive medical,
dental, vision, and hearing exams
Provides out-of-network coverage
Optional benefits (additional premium):
•
•
expanded dental
expanded dental & vision
Initial contribution to your HRA
Opportunity to earn more HRA contributions by completing
“do rights”
9
COVA HealthAware
administered by Aetna
Earn “Do Rights” to Get More HRA Dollars
•
•
•
receive $50 in your HRA for each “do right” up to $150 for 3
activities
spouse also eligible for up to $150 for completing 3 “do rights”
total of up to $300 for both employee and spouse
Eligible “Do Rights”
•
routine annual physical exam
• routine dental exam
• routine vision exam (new)
• annual flu shot
• MyActiveHealth health tracker usage
• MyActiveHealth coaching module completion (new)
Unused HRA funds roll over into the new plan year with no limit as
long as you stay in the plan
10
MyActiveHealth
COVA Care, COVA HDHP and COVA HealthAware Participants
MyActiveHealth allows you to access your health information 24/7
Go to www.MyActiveHealth.com/COVA
•
•
•
Health information in one place
Personalized health action items
Easy-to-use health tips, tools, and trackers
Programs include:
•
Health Insights to help manage chronic conditions
•
•
Free prescription drugs & supplies when requirements are met
•
Diabetes management
•
Asthma and COPD (new)
•
Hypertension (new)
Depending on Plan, hospital co-pay waiver or HRA contribution when
requirements are met
•
Bariatric surgery education
11
MyActiveHealth
COVA Care, COVA HDHP and COVA HealthAware Participants
•
Healthy Beginnings for expectant moms
•
•
•
•
Helps moms be healthier so their babies will be too
Includes incentives when you have certain conditions that qualify
Depending on Plan, hospital co-pay waiver or HRA contribution when
requirements are met
Healthy Lifestyles
•
•
For those generally healthy but need help staying on track
Includes coaching on :
•
nutrition,
•
exercise,
•
stress management and
•
quiting tobacco
12
2014 Benefits at a Glance
In-Network
Benefits
Deductible – per plan year
-One person
-Two or more persons
Out-of-pocket expense -limit –
per plan year
-One person
-Two or more persons
Doctor’s visits
-Primary Care Physician
-Specialist
COVA Care
You Pay
COVA
HealthAware*
You Pay
COVA HDHP
You Pay
$225
$450
$1,500
$3,000
$1,750
$3,500
$1,500
$3,000
$3,000
$6,000
$5,000
$10,000
$25
$40
20% after deductible
20% after deductible
20% after deductible
20% after deductible
13
2014 Benefits at a Glance
In-Network
Benefits
Hospital Services
-Inpatient
-Outpatient
COVA Care You
Pay
COVA
HealthAware* You
Pay
COVA HDHP You
Pay
$300 per stay
$125 per visit
20% after deductible
20% after deductible
20% after deductible
20% after deductible
Emergency Room Visits
$150 per visit
(waived if admitted)
20% after deductible
20% after deductible
Ambulance Travel
20% after deductible
20% after deductible
20% after deductible
14
2014 Benefits at a Glance
In-Network
Benefits
COVA Care You
Pay
COVA
HealthAware*
You Pay
COVA HDHP
You Pay
Outpatient diagnostic,
laboratory, tests, shots and xrays
20% after deductible
20% after deductible
20% after deductible
Infusion services (includes IV or
20% after deductible
20% after deductible
20% after deductible
$25 PCP/$35 specialist
20% after deductible
20% after deductible
$35
20% after deductible
20% after deductible
injected chemotherapy)
Outpatient therapy visits
-Occupational, physical and
speech therapy
-Chiropractic (30-visit plan year
limit per member)
15
2014 Benefits at a Glance
In-Network Benefits
Applied behavior analysis (ABA) for
autism spectrum disorder – ages 2
through 6
-$35,000 annual limit
COVA Care You
Pay
COVA
HealthAware*
You Pay
COVA HDHP
You Pay
$25 per service
20% after deductible
20% after deductible
Behavioral Health Visits
Medical & non-medical prof visits
Inpatient residential treatment
Intensive outpatient treatment (IOP)
$25
$300 per stay
$125 per episode of care
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20% after deductible
Employee Assistance Program (EAP)
Up to 4 visits per incident
$0
$0
$0
16
2014 Benefits at a Glance
COVA Care You
Pay
In-Network Benefits
Prescription drugs –
mandatory generic
Retail Pharmacy
COVA
HealthAware*
You Pay
COVA HDHP
You Pay
Up to 34-day supply
$15/$30/$45/$55
Up to 34-day supply
20% after deductible
Up to 34-day supply
20% after deductible
Up to 90-day supply
$30/$60/$90/$110
Up to 90-day supply
20% after deductible
Up to 90-day supply
20% after deductible
Dental Services
Diagnostic & preventive
$0
$0
$0
Annual Routine Vision Exam
Not Available
$0
Not Available
Annual Routine Hearing Exam
Not Available
$0
Not Available
Home Delivery Pharmacy
17
2014 Benefits at a Glance
In-Network
Benefits
Wellness & preventive
services
COVA Care You
Pay
$0
COVA
HealthAware*
You Pay
$0
COVA HDHP
You Pay
$0
Office visits at specified intervals, immunizations, lab and x-rays
Annual check-up visit (primary care physician or specialist), immunizations, lab and x-rays
Routine gynecological exam, Pap test, mammography screening, prostate exam (digital
rectal exam), prostate specific antigen (PSA) test, and colorectal cancer screening
18
2014 Benefits at a Glance
In-Network Benefits
Expanded Dental
*Maximum benefit – per member
Deductible
Primary (basic) care
Complex restorative (inlays, onlays,
crowns, dentures, bridgework)
Orthodontic
- Lifetime maximum benefit
COVA Care You
Pay
COVA
HealthAware*
You Pay
COVA HDHP
You Pay
Optional Benefit
$2000
Optional Benefit
$2000
Optional Benefit
$2000
$50/$100/$150
$50/$100/$150
$50/$100/$150
20% after deductible
20% after deductible
20% after deductible
50% after deductible
50% after deductible
50% after deductible
50% no deductible
$2000
50% no deductible
$2000
50% no deductible
$2000
19
2014 Benefits at a Glance
In-Network Benefits
COVA Care You
Pay
COVA
HealthAware*
You Pay
Routine Vision
(once every 12 months)
Optional Benefit
Routine eye exam
$40
Included in basic plan
Eyeglass frames
20% off balance after plan
pays first $100
20% off balance after plan
pays first $100
$20
$20
15% off balance after plan
pays first $100
15% off balance after plan
pays first $100
Balance after plan pays
$250
Balance after plan pays
$250
Lenses
-Eyeglass lenses (standard
plastic, single, bifocal or trifocal)
or
-Contact lenses –
*Conventional or *disposable
*non-elective
COVA HDHP
You Pay
Optional Benefit
Not Available
20
2014 Benefits at a Glance
In-Network
Benefits
COVA Care You
Pay
COVA
HealthAware*
You Pay
COVA HDHP
You Pay
Routine Hearing
(once every 48 months)
Routine hearing exam
Optional Benefit
$40
Included in basic plan
Not Available
Hearing aids and other
hearing-aid related services
Benefit maximum
Balance after plan pays
$1,200
$1,200
Not Available
Not Available
Out-of-Network
Optional Benefit
Plan payment reduced by
25%. Provider may balance
bill for amount above
allowable charge
Additional deductible outof-pocket limits apply. 40%
coinsurance after
deductible. Provider may
balance bill for amount
above allowable charge.
Not Available
21
Health Plan Monthly Premiums
Effective 07/01/2014
Single
Plus One
Family
COVA Care
(with preventive dental)
$75
$171
$230
COVA Care + Out-of-Network
$89
$190
$256
COVA Care + Expanded Dental
$100
$219
$303
COVA Care + Out of Network +
Expanded Dental
$114
$238
$329
COVA Care + Expanded Dental +
Vision & Hearing
$115
$244
$337
COVA Care + Out of Network +
Expanded Dental + Vision &
Hearing
$129
$263
$363
22
Health Plan Monthly Premiums
Effective 07/01/2014
Single
Plus One
Family
COVA HealthAware
(with preventive dental)
$26
$81
$96
COVA HealthAware + Expanded
Dental
$51
$129
$169
COVA HealthAware + Expanded
Dental & Vision
$59
$143
$188
$0
$0
$0
COVA HDHP + Expanded Dental
$25
$48
$73
TRICARE Voluntary Supplement
$61
$120
$161
COVA HDHP
(with preventive dental)
23
Premium Rewards
Already earning a Premium Reward?
•
keep it through 06/30/15 as long as you stay in COVA Care or
COVA HealthAware
How to Earn a Premium Reward
•
•
•
•
be enrolled in COVA Care or COVA HealthAware
complete and submit both a Health Assessment and a Biometric
Screening by May 31, 2014
go to www.myactivehealth.com/cova to begin
if you do not have access to the Internet or need help call
ActiveHealth at 866-938-0349
24
Premium Rewards
Health Assessment
•
go to the health assessment link to answer the questions
• click “complete and save”
• you or your spouse need to register separately and complete your
own health assessment
Biometric Screening
• go to the biometric screening link
• print either a:
•
•
•
Biometric Screening Physician Form and take it to your doctor or
Lab Corp authorization to take to a location convenient for you
follow all instructions on the form or authorization
25
Premium Rewards
New to COVA Care or COVA HealthAware on July 1, 2014?
Follow the steps in the Spotlight to receive the rewards
Complete both requirements by July 31, 2014
• premium rewards begins August 1, 2014
Complete both requirements by August 31, 2014
• premium rewards begin September 1, 2014
26
Types of Membership
• Employee Single – employee only
• Employee Plus One – employee plus one
eligible family member (spouse or child)
• Family Coverage - employee and two or
more eligible family members
27
Eligible Dependents
• Legally married spouse
• Natural and adopted children, stepchildren, children
placed for adoption under age 26
• Unmarried children in the court-ordered sole,
permanent custody of the employee
• Must reside full-time with the employee
• Employee provides more than half of dependent’s support
• Court ordered custody must be awarded prior to the child’s
18th birthday
• Disabled children
28
Eligibility Documentation
Legally Married Spouse
Photocopy of marriage certificate
and top portion of first page of
employee’s recent Federal tax
return
Natural or Adopted Children
Photocopy of birth certificate
showing employee’s name or
photocopy of legal adoptive or preadoptive agreement
Stepchildren
Photocopy of birth certificate
showing employee’s spouse’s name
and photocopy of marriage
certificate and photocopy of top
portion of first page of employee’s
recent Federal tax return
Unmarried children in court-ordered
sole, permanent custody of
employee
Photocopy of birth certificate and
photocopy of Final Court Order with
29
presiding judge’s signature
Flexible Spending Accounts
Plan Year 2014-2015
FSA available to all eligible employees
• Save on health care out-of-pocket costs
• Pay for eligible medical or dependent care expenses with
pre-tax dollars
FSA Open Enrollment concurrent with Health Insurance
Open Enrollment
July 1, 2014 Effective Date for New Accounts
FSAs are use it or lose it so don’t overestimate expenses
If you take no action, you will have no FSA
30
Flexible Spending Accounts
Plan Year 2014-2015
Maximum Contributions:
• Health FSA: up to $2,500
• Dependent Care FSA: up to $5,000
•
depending on tax filing status
Minimum Contribution: $10 per pay period
Administrative Fee: $3.65 monthly on a pre-tax basis for one
or both FSA accounts
If enrolled in COVA HealthAware, the HRA pays health
expenses first
If enrolled in FSA for only part of plan year you must file for
claims within three months after coverage period ends (new)
If account ends 06/30/15 you still have until 09/3015 to file for
reimbursement
31
Flexible Spending Accounts
FSA Benefit Card
Annual contribution available on July 1, 2014
Will automatically receive an Elite VISA Benefit card when
you enroll in Medical FSA
• instructions on using the new card will be provided with
the card – read carefully
Card accepted when:
• used with a provider, i.e., doctor or hospital, and the
charge is equal to the co-pay amount
• Over-the-counter and prescriptions purchases only
accepted at IIAS certified merchants
•
IIAS = inventory information approval system
32
ALEX is Back and ALEX can Help!
ALEX is an online interactive assistant designed to help
you decide which plan may be the most cost-effective
for you.
Visit www.alexforcova.com and follow the prompts.
ALEX will:
• ask questions about your individual needs;
• explain the plans offered;
• estimate the lowest cost plan option for you; and
• provide a plan comparison.
The final decision is yours!
33
Open Enrollment
How to Enroll/Make Changes
Enroll on-line
• Go to www.DHRM.virginia.gov
• Click on the Employee Direct link and register a
new account.
• Must use your 7-digit Employee Number
• Number is included in the ID number used in Payline and is
also within the ID number on the HI card
• Date of Birth entered as (MM/DD/YYYY)
• Valid state or personal E-mail Address
• Employee Direct available 24/7
• Enroll using paper forms
• Drop by Human Resources
• No Appointment Necessary
• Deadline Friday, May 23, 2014 at 5:00 p.m.
34
2014 Open Enrollment
Department of Human Resources
314B Tyler Place, 2nd Floor
831-5008
Larry Ashby, Mgr, Employment & Benefits
Carmella Carter, HR Generalist
Alicia Dials, HR Generalist
Jack Wright, Sr. HR Generalist
35