2013 benefit options presentation
DESCRIPTION
2013 Benefit Options Presentation. Plan Year January 1 through December 31, 2013. The Employee Benefit Options Guide. How to access the Guide : View the Guide on the O SEEGIB website at www.sib.ok.gov or www.healthchoiceok.com Complete the online request to get one by mail - PowerPoint PPT PresentationTRANSCRIPT
1
2013 Benefit Options PresentationPlan Year January 1 through December 31, 2013
2
How to access the Guide:
• View the Guide on the OSEEGIB website at www.sib.ok.gov or www.healthchoiceok.com
• Complete the online request to get one by mail
• Contact your Insurance Coordinator• Contact OSEEGIB Member Services
The Employee BenefitOptions Guide
• 2013 Plan Changes• Health Plans• Dental Plans• Vision Plans• HealthChoice Life Insurance Plan• Eligibility
3
Topics
For More Information
• 2013 Employee Benefit Options Guide• Frequently Asked Questions at
www.sib.ok.gov or www.healthchoiceok.com
• Plan websites and customer service representatives
• Your Insurance Coordinator • OSEEGIB Member Services
4
5
Click the links below to access a particular section of this presentation.
• 2013 Plan Changes• HealthChoice Health Plans• Dental Plans• Vision Plans• HealthChoice Life Insurance Plan• Eligibility
Index
2013 PLAN CHANGES
6
7
There are no eligibility changes for plan year 2013.
Eligibility Changes
Tobacco-free Attestation• To enroll in or remain enrolled in the
HealthChoice High or Basic Plan, you must attest that you and your covered dependents are tobacco-free
The Attestation is available:• On the OSEEGIB website• By calling HealthChoice Member
Services8
HealthChoice Plan Changes
If you cannot complete the Attestation, you must either:• Enroll in the quit tobacco program AND
complete three coaching calls, or• Provide a letter from your doctor indicating
it is not medically advisable for you or your dependent to quit tobacco.
If you do not complete the Attestation or complete one of the reasonable alternatives as defined previously, you will be enrolled in the HealthChoice High Alternative or Basic Alternative Plan with a higher deductible and out-of-pocket limit. 9
HealthChoice Plan Changes
HealthChoice Dental
• Plan year maximum is increasing to $2,500
10
Dental Plan Changes
Superior Vision
• $25 copay for standard progressive lenses in-Network; plan pays up to $49 out-of-Network
• 5% to 50% discount off surgical fees for laser vision correction
11
Vision Plan ChangesNEW!
There are no changes to the HealthChoice Life Insurance Plan for Plan Year 2013
12Return to Index
HealthChoice Life Insurance Plan Changes
Continue End Presentation
HEALTHCHOICEHEALTH PLANS
13
Available Plans
• HealthChoice High• HealthChoice High Alternative• HealthChoice Basic • HealthChoice Basic Alternative• HealthChoice S-Account• HealthChoice USAUsing a HealthChoice Network Provider will lower your out-of-pocket costs.
14
Click here to view HealthChoice plan changes
When using a Network Provider:• $30 copay for primary care office visits• $50 copay for specialist office visits• Annual deductible $500 for an
individual or $1,500 for a family• Plan pays 80% and member pays 20%
of Allowed Charges up to the out-of-pocket limit of $2,800 for an individual or $8,400 for a family
High
15
16
High AlternativeWhen using a Network Provider:• Benefits the same as High Plan except
deductible and out-of-pocket limit• Annual deductible $750 for an
individual or $2,250 for a family• Plan pays 80% and member pays 20%
of Allowed Charges up to the out-of-pocket limit of $3,050 for an individual or $9,150 for a family
When using a Network Provider:• Office visit copays do not apply• Plan pays first $500 then member pays
next $500 as deductible; $1,000 deductible for a family of two or more
• Plan then pays 50% until the out-of-pocket limit is met; $5,500 for an individual or $11,000 for a family
• Plan then pays 100% of Allowed Charges
Basic
17
18
When using a Network Provider:• Office visit copays do not apply• Plan pays first $250 then member pays
next $750 as deductible; $1,500 deductible for a family of two or more
• Plan then pays 50% until the out-of-pocket limit is met; $5,750 for an individual or $11,500 for a family
• Plan then pays 100% of Allowed Charges
Basic Alternative
Plan designed for members with a Health Savings Account (HSA)When using a Network Provider:• Combined $1,500 deductible for an
individual and $3,000 for a family*• Entire deductible must be met before
benefits are paid (including prescriptions)• $50 copay for office visits• The calendar year out-of-pocket limit is
$3,000 for an individual or $6,000 for a family
*Individual deductible does not apply if two or more family members are covered.
S-Account
19
• For members who live and work outside of Oklahoma and Arkansas for more than 90 consecutive days
• Benefits are the same as the HealthChoice High Plan
• Members have access to the USA Plan’s nationwide provider network
USA
20
Network Pharmacy Benefits
21
• Prescriptions can be filled at HealthChoice Network Pharmacies
• Benefits are the same for all plans; S-Account members must meet the Plan deductible before benefits are paid
• You are responsible for the cost difference when choosing a brand-name if a generic is available
Network Pharmacy Benefits
22
When purchasing up to a 30-day supply:• Generic – cost of medication up to a
$10 copay• Preferred brand-name – maximum
copay of $30• Non-Preferred brand-name –
maximum copay of $60
Network Pharmacy Benefits
23
When purchasing up to a 90-day supply• Generic – cost of medication up to a
$25 copay• Preferred brand-name – maximum
copay of $60• Non-Preferred brand-name –
maximum copay of $12090-day fill does not apply to medications with quantity or dosage limits
Network Pharmacy Benefits
24
• Certain prescription tobacco cessation medications for a $0 copay
• A calendar year pharmacy out-of-pocket limit of $2,500 per person (does not apply to S-Account Plan)
• Specialty medications must be purchased through Accredo Health, the HealthChoice specialty care, delivery service pharmacy
Return to Index Continue End Presentation
DENTAL PLANS
25
26
• Assurant Freedom Preferred• Assurant Heritage Plus with SBA
(Prepaid)• Assurant Heritage Secure (Prepaid)• CIGNA Dental Care Plan (Prepaid)• Delta Dental PPO• Delta Dental Premier• Delta Dental PPO – Choice• HealthChoice
Dental Plans Available
27
All the dental plans have the same core benefits which are divided into four different classes:
• Preventive Care includes cleanings, bitewing x-rays, and routine oral exams
• Basic Care includes fillings, extractions, root canals, endodontics, and periodontics
Dental Benefits
* HealthChoice and Assurant Freedom Preferred have a 12-month waiting period for orthodontic care unless you provide proof of prior group dental coverage.
• Major Care includes dentures, bridgework, crowns, and implants
• Orthodontic Care* is covered for members under age 19 and members age 19 or older with temporomandibular joint dysfunction (unless otherwise noted)
28
Dental Benefits
• Preventive Care is covered at 100%• A $25 deductible applies to Basic and
Major Care. After the deductible:• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care under age 19 covered
at 60%; lifetime maximum benefit $2,000 • All other services have a combined
$2,000 maximum annual benefit
Freedom Preferred Dental Plan
29
• No deductible or annual maximum for general dentist
• You must select a Primary Care Dentist for each covered person
• Preventive Care is covered at 100%• Copay schedule applies to other services• Orthodontic Care for children and adults• The Special Benefit Amendment provides
an additional discount for network specialists
Heritage Plus with SBA Dental Plan
30
• No deductible or annual maximum with general dentist
• You must select a Primary Care Dentist for each covered person
• Preventive Care is covered at 100%• Copay schedule applies to other
services• Orthodontic Care for children and
adults
Heritage Secure Dental Plan
31
• No deductible or maximum annual benefit
• You must select a Primary Care Dentist for each covered person
• After a $5 copay, routine cleanings, x-rays, and evaluations are covered at 100%
• A copay schedule applies to other services, including specialist care
• Orthodontic Care for children and adults
Dental Care Plan
32
• Preventive Care is covered at 100% • $25 annual deductible for Basic and
Major Care• Preventive Care is covered at 100%• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care for children and adults
is covered at 60% with a $2,000 lifetime maximum benefit
• $2,500 maximum annual benefit for other services
Delta Dental PPO
33
• A $50 combined deductible applies to Diagnostic, Preventive, Basic, and Major Care
• Preventive Care is covered at 100%• Basic Care is covered at 70%• Major Care is covered at 50%• Orthodontic Care for children and adults
is covered at 60% with a lifetime maximum of $2,000
• $3,000 maximum annual benefit
DeltaDental
Premier
34
• You must select a Primary Care Dentist for each covered person
• No deductible for Preventive or Basic Care
• $100 deductible for Major Care• Copay schedule for all other services • Orthodontic Care for children and adults
has a maximum lifetime benefit of $1,800
• $2,000 maximum annual benefit for Preventive, Basic, and Major Care
Delta Dental PPO – Choice
35
When using a Network Provider:• Preventive Care is covered at 100%• A $25 deductible applies to Basic and
Major Care• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care is covered at 50% —
no lifetime maximum• A $2,500 calendar year maximum
applies to all other services
Dental
36Return to Index Continue End Presentation
VISION PLANS
37
38
• Humana CompBenefits VisionCare Plan• Primary Vision Care Services (PVCS)• Superior Vision Plan• United Healthcare Vision• Vision Service Plan (VSP)
Vision Plans Available
• Each vision plan has its own provider network
• A copay schedule for services and materials
• The toll-free number and website address of each plan is listed in the Employee Benefit Options Guide
• Contact each vision plan for specific benefit questions
39
Vision Plans Overview
When using an in-network provider:• $10 copay for an annual eye exam• $25 copay for lenses and frames; one
pair per year• Discounts are available for other vision
services and lens options• Contact lenses are available instead of
glasses; $130 allowance• Discount through TLC for laser surgery
40
When using an in-network provider:• There is no copay or limit on the
number of eye exams• Lenses and frames are sold at wholesale
cost• There is no limit on the number of pairs
of glasses • Benefits available for contact lenses• Discount through TLC for laser surgery
41
When using an in-network provider:• $10 copay for eye exams; one per year• $25 copay for lenses and frames; one pair
per year• Contact lenses – available instead of
glasses; $25 copay/standard fitting then plan pays 100% or $25 copay/specialty fitting then plan pays up to $50
• Discounts available for other vision services and lens options, including laser vision correction
42
When using an in-network provider:• $10 copay for eye exams; one per year• $25 copay for lenses and frames; one pair
per year• Lens UV coating and tints are covered in
full• Contact lenses are available instead of
glasses• Discounts available for other vision
services and lens options including laser vision correction
43
When using an in-network provider:• $10 copay for eye exams; one per year• $25 copay for lenses and frames; one
pair per year• No copay for contact lens exam with
network provider• Contact lenses are available instead of
glasses• Discounts are available for glasses and
other vision benefits, including laser vision correction
44Return to Index Continue End Presentation
LIFE INSURANCE PLAN
45
Basic and Supplemental Life for You• First $20,000 of life coverage (Basic Life)• All additional coverage is known as
Supplemental Life• $500,000 of Supplemental Life coverage
is available with an approved Life Insurance Application
• Basic Life and the first $20,000 of Supplemental Life include Accidental Death and Dismemberment (AD&D) benefits 46
Employee Life
During initial enrollment:• You can enroll in Guaranteed Issue
(two times your annual salary rounded up to the next $20,000) without a Life Insurance Application
• You can apply for amounts above Guaranteed Issue; a Life Insurance Application is required
47
Employee Life
During Option Period: • You can enroll in Basic Life• You can enroll in Supplemental Life• You can enroll in up to $500,000 of
Supplemental Life insurance coverage• An approved Life Insurance Application
is required
48
Employee Life
• Keep your beneficiary designation up-to-date
• Beneficiaries can be changed at any time• Review your beneficiaries if you have a
change, such as a marriage, divorce, death of a family member, or birth of a child
• Beneficiary Designation Forms are available online, from your Insurance Coordinator, or by calling OSEEGIB Member Services
49
Beneficiary Designation
All three options offer $1,000 of coverage for dependents under six months of age.
Premier OptionSpouse $20,000Child $10,000
Standard OptionSpouse $10,000Child $5,000
Low OptionSpouse $6,000Child $3,000
50
You must be enrolled in Basic Life coverage to enroll your eligible dependents in Dependent Life.
Dependent Life
Return to Index Continue End Presentation
ELIGIBILITY
51
An education employee must be:• Currently employed, eligible for TRS,
and working at least four hours a day or 20 hours a week
A local government employee must be:• Currently employed, regularly
scheduled to work 1,000 hours or more per year, and cannot be listed as a temporary or seasonal employee
52
Eligible Employees
Eligible dependents include:
• Your legal spouse (including common-law)
• Your daughter, son, stepdaughter, stepson, eligible foster child, adopted child or child legally placed with you for adoption up to age 26, whether married or unmarried
• Disabled dependents over age 26 with approved documentation
53
Eligible Dependents
54
• Other unmarried dependent children up to age 26, upon completion of an Application for Coverage for Other Dependent Children
• Guardianship papers or a tax return showing dependency can be provided in lieu of the application
Other Dependent Children
• If you insure one dependent, all eligible dependents must be insured
• You can exclude dependents who do not reside with you, are married, are not financially dependent on you for support, have other group insurance, or are eligible for Indian or military benefits
• A spouse can be excluded by signing the Spouse Exclusion Certification statement on the back of the form
55
Dependent Eligibility
Certain qualifying events allow you to make a midyear change, examples include:
• Marriage• Divorce• Adoption• Death• Childbirth• Gain or loss of other group insurance
Notify your Insurance Coordinator within 30 days
of the event or wait until the next annual Option Period.
56
Midyear Qualifying Events
Option Period Enrollment/Change Form:• Your Insurance Coordinator will
provide the deadlineInsurance Enrollment Form:• Return your form to your Insurance
Coordinator within 30 daysInsurance Change Form:• Return your form to your Insurance
Coordinator within 30 days of a qualifying event
57
Deadlines for Forms
Tobacco-free Attestation:• Must be completed as part of the
Option Period enrollment process. • The Attestation can be completed
online or returned to your Insurance Coordinator.
58
Deadlines for Forms
• OSEEGIB mails you a Confirmation Statement when you enroll or make changes to coverage
• If your Confirmation Statement is incorrect, contact your Insurance Coordinator immediately
59
Confirmation Statements
If you do not make changes during the annual Option Period and are not automatically enrolled in a HealthChoice alternative plan, no Confirmation Statement will be sent; keep your enrollment form as verification of coverage
60
Confirmation Statements
• HealthChoice High and Basic require a completed tobacco-free Attestation
• To enroll in dental or life coverage, you must have group health insurance
• If excluding your spouse, your spouse must sign the Spouse Exclusion Certification
• Return your signed and dated forms to your Insurance Coordinator by the set deadline
• Notify your Insurance Coordinator if you have a change of address 61
Reminders
• The 2013 Employee Benefit Options Guide
• Plan websites and toll-free numbers available in your Option Period packet
• The FAQ section of the OSEEGIB website• OSEEGIB Member Services at 1-405-
717-8780 or toll-free 1-800-752-9475 TDD users call 1-405-949-2281 or toll-free 1-866-447-0436
• Your Insurance Coordinator62
Questions
Return to Index