II Annual Enrollment: APRIL 3 - MAY 1, 2019 El Benefits and rates

effective July 1, 2019

KNOW YOUR GIC BENEFITS

~ommonwealthofMassac~u~etts 2019-2020 Overview ~ Group Insurance Comm1ss1on

 

Annual Enrollment offers you the opportunity to review your benefit options and enroll in or change your coverage.

0 REVIEW THIS GUIDE TO IDENTIFY WHICH HEALTH INSURANCE PRODUCTS ARE OFFERED AND WHICH ONE IS THE BEST FOR YOU.

TIP: Use the locator m ap o n page 4 to find w hic h p roducts are o ffered in yo ur area. Based on that. you can use the rate char t o n page 5 and the "Benefits-at-a-Glance" o n pages 6-7 to d etermine w hic h p roduct is right for you.

0 CHECK WITH YOUR HEALTH AND OTHER INSURANCE CARRIERS ABOUT ANY PRODUCT OR TIER CHANGES. This includes q uestio ns about network coverage, provid ers, d rug tier s, o r wellness benefits. (See page 75 for carrier contact information.)

0 ATTEND A GIC BENEFIT FAIR TO HAVE YOIUR QUESTIONS ANSWERED IN PERSON. These events provide the c hance to speak w ith GIC staff and car rier representatives about the produc ts and benefits availab le to you. For the fu ll sched ule o f fair locations, dates and t imes, c heck our website here: blt.ly/ GICBenefltFalrs2019.

0 NEW HIRE? Check our website for Employment & Elig ib ilit y blt.ly/GICNewHlres

0 TURNING 65? Check our website for a v id eo to guide you through the next steps, whether you're retir ing or not: blt.ly/GICTurnlng65.

0 CHECK IF YOU ARE ELIGIBLE FOR THE BUY­OUT PROGRAM. If yo u have access to non-GIC health insurance through your sp ouse o r ano ther employer-sp onso red p lan, you m ay benefit from the Buy-Out p rogram. Go to blt.ly/ GICBuyOut to find out if you are elig ib le. Buy-Out form s m ust be m ailed d irectly to the GIC by May 1.

0 MAKE SURE YOU SUBMIT ALL FORMS TO YOUR GIC COORDINATOR NO LATER THAN MAY 1, 2019. A ll forms are available o n the G IC website (blt.ly/ GICForms). Changes go into effect Ju ly 1, 2019.

If you want to keep your current benefits, you do not need to complete any paperwork, as your coverage will continue automatically.

2

IMPORTANT REMINDERS

1. Employees can enroll in coverage for the first t ime at Annual Enrollment or within 60 days of a documented qualifying event. Qualify ing events inc lude marr iage, b irth/adopt io n of a ch ild, involuntary loss of other coverage, spouse's A nnual Enrollment or return from an approved FMLA or m ilitary leave.

2. New hires must enroll in coverage during their first ten days of employment.

3. Once you choose health care coverage, you cannot change products until the next Annual Enrollment period unless you have a qualifying event. Even if your doctor o r hospita l leaves your network you must remain enrolled in your selected p lan u n t il t he next A nnual Enrollment, unless you have an elig ib le q ual ify ing status change. You can find a list of q ualify ing status changes o n the GIC's A nnual Enro ll ment website at mass.gov/ gic-annual-enrollment

4. Physician and hospital copay tiers change each July 1. Please check w ith your health insurance carr ier to see if you r provider (s) o r hospit al t ier has changed.

5. Doctors and hospitals within your network may change during the year. If your p rov ider is no lo nger available, your health insurance car rier w i ll help you find a new one.

6. When checking provider coverage and tiers, be sure to specify the health insurance product's full name, such as "Tufts Health Plan Spirit" or "Tufts Health Plan Navigator," and not just "Tufts Health Plan." You r healt h insurance carr ier is t he best source for th is information.

 

• HEALTH INSURANCE PRODUCTS

Neighborhood Health Plan Prime is now called AIIWays Health Partners Complete HMO.

A lower copay of $150 for members who util ize freestand ing facilities for eye procedures and GI endoscopies. Copays for procedures at hospital outpatient facilities would remain the same at $250 this fisca l year.•

Check with your carrier to see if your provider is still in the network, or if copays have changed. See page 1S for carrier contact information.

a 0 •

PHARMACY BENEFITS OTHER BENEFITS

No changes If you are eligible for FSA benefits, Benefit Strategies is our new FSA vendor.

Read more about Benefit Strategies and any enrollment changes on pages 8 and 9.

·uniCare does not have a copay for members who utilize freestanding facilities for eye procedures and endoscopies.

Copay; A fixed d o llar am o unt (e.g .. $ 2 0 ) that you p ay for a covere d h ealth care service, suc h as a v isit to your

d octo r o r a specialist.

Deductible: A dollar amount you need to pay each year before your produc t pays for covered health care services.

Out-of-Pocket Maximum: The maxim um amount you will pay eac h year for certain covered serv ices that app ly tow ard the m aximum, af ter w hich your product w ill begin to pay in full for these covered services.

Coinsurance: Your share of the costs o f a covered health care service, typically ca cu lated as a percentage of the am ount allowed for the serv ice p rov ided .

Out-of-Network Provider: A med ical p rovider w hic h has not contrac ted w ith yo ur insurance company for reim b ursement at a negotiated rate. Some health insurance produc ts, like HMOs, do not reim burse out-of-network providers at all. w hic h means that you would be responsible for the full am ount c r arged by yo ur do ctor.

Freestanding Facility: A fac ili t y that per form s procedures that is not ow ned by a hospital. Visit your carr ier's website for a list o f freestanding fac ili t ies.

GIC IS GOING GREEN!

THE GIC IS TAKING STEPS TO BECOME GREENER!

This year's Benefits Decision Guide uses less paper, but still provides the benefit information you need in a clear, easier to read format.

Th is guide costs less t o print and 1s better for OU' environment. In the fut ure. t he GIC w ill be reduc ing its use of paper and move tcward greater use of d ig ita l tools to communicate w it h our members. You can st ill f ind and download information about t he GICs benefits on our web site: mass.gov/ orgs/Group-lnsurance-Commission.

3

 

Where You Live Determines Which Health Insurance Product You May Enroll In.

MAINE

VERMONT ( NEW HAMPSHIRE

CONNECTICUT

NANTUCKET

Is the Health Product Available Where You Live?

BARNSTABLE Independence. A IIWays Complete. Navigator. Spir it , Basic. Community Choice. PLUS

BERKSHIRE Select. Independence. Primary Choice. HNE. Navigator. Spir it' . Basic. Community Choice. PLUS

BRISTOL Direct. Select. Independence. Pr imary Choice. AIIWays Complete. Navigator. Spir it. Basic . Community Choice. PLUS

DUKES Independence. A IIWays Complete. Navigator. Basic. PLUS

ESSEX Direct. Select. Independence. Pr imary Choice. AIIWays Complete. Navigator. Spir it. Basic . Community Choice. PLUS

FRANKLIN Select. Independence. Primary Choice. HNE. Navigator. Spir it , Basic. Community Choice. PLUS

HAMPDEN Direct'. Select. Independence. Pr imary Choice. HNE. Navigator. Spir it. Basic . Community Choice. PLUS

HAMPSHIRE Oirecr. Select. Independence. Pr imary Choice. HNE. Navigator. Spir it'. Basic . PLUS. Community Choice

MIDDLESEX Direct. Select. Independence. Pr imary Choice. A IIWays Complete. Navigator. Spir i t. Basic . Community Choice. PLUS

NANTUCKET Independence. A IIWays Complete. Navigator. Basic. PLUS

NORFOLK Direct. Select. Independence. Pr imary Choice. A IIWays Complete. Navigator. Spir i t. Basic . Community Choice. PLUS

PLYMOUTH Direct. Select. Independence. Pr imary Choice. A IIWays Complete. Navigator. Spir i t. Basic . Community Choice. PLUS

SUFFOLK Direct. Select. Independence. Pr imary Choice. A IIWays Complete. Navigator. Spir i t. Basic . Community Choice. PLUS

WORCESTER Direct. Select. Independence. Pr imary Choice. HNE. A IIWays Complete. Navigator. Spir it. Basic. Community Choice. PLUS

4

The UniCare State Indemnity Plan/Basic is the only health

insurance product offered

by the GIC that is available throughout the United States and outside of the country.

The bold tex t is a short ened vers ion of the full product name. These names are used to indicate which p roduct is ava ilable ,n each county.

DIRECT - Fa llon Health Direc t Care

SELECT - Fa llon Health Selec t Care

INDEPENDENCE - Harvard Pilgr im Independence

PRIMARY CHOICE - Harvard Pilg r im Primary Choice

HNE - Health New Eng land

ALLWAYS COMPLETE - A IIWays Health Partners Comp lete HMO

NAVIGATOR - Tuft s Health Plan Navigator

SPIRIT - Tuft s Health Plan Spir it

BASIC - UniCare State Indemnity Plan/ Basic

COMMUNITY CHOICE - UniCare State Indemnity Plan/ Community Cho ice

PLUS - UniCare State Indemnity Plan/ PLUS

Outside Massachusetts:

CONNECTICUT Independence. HNE' . Navigator· . Basic. PLUS'

MAINE Independence. Navigator ·. Basic . PLUS

NEW HAMPSHIRE Select". Independence. Navigator•. Basic. PLUS

NEW YORK Independence•. Navigator· . Basic

RHODE ISLA ND Independence. Navigator. Basic. PLUS

VERMONT Independence•. Navigator· . Basic. PLUS

'Not every city and town is covered in this county or state; contact the health insurance carrier to find out if you l ive in the service area. The product also has a limited network of providers in this county or state; contact the health insurance carrier to find out which doctors and hospitals participate.

 

Rate Chart

BASIC LIFE INSURANCE ONLY - $5,000 Coverage

(Prem ium includes Basic Life Insurance)

UniCare State Indemnity Plan/ Basic with etc• (Comprehensive)

National

UniCare State Indemnity Plan/ Network

Basic without CIC

UniCare State Indemnity Plan/ PLUS

Tufts Health Plan Navigator Broad

Fallon Health Select Care Network

Harvard Pilgrim Independence Plan

Health New England Regional

AIIWays Health Partners Network Complete HMO

UniCare State Indemnity Plan/ Community Choice

Tufts Health Plan Spirit Limited

Fallon Health Direct Care Network

Harvard Pilgrim Primary Choice Plan

• CIC is an enrollee-pay-all benefit .

Mo nthly GIC Product Rates Effective July 1, 2019

FOR EMPLOYEES HIRED BEFORE

20%

FOR EMPLOYEES HIRED ON OR AFTER

25%

EMPLOYEE PAYS MONTHLY EMPLOYEE PAYS MONTHLY

$ 1.30 $ 1.63

INDIVIDUAL FAMILY INDIVIDUAL FAMILY

$258.87 $574.53 $310.74 $688.92

$207.49 $457.54 $259.36 $571.93

$140.03 $331.07 $175.05 $413.84

$150.33 $364.44 $187.92 $455.56

$163.09 $394.30 $203.87 $492.88

$178.61 $434.08 $223.27 $542.61

$Jl5.06 $271.66 $143.84 $339.58

$130.23 $335.67 $162.80 $419.59

$104.44 $255.80 $130.56 $319.76

$Jl4.09 $272.14 $142.62 $340.18

$121.02 $303.09 $15 1.28 $378.87

$130.0l $329.45 $162.52 $411.82

5

 

HEALTH INSURANCE PRODUCTS

PRODUCT TYPE

PCP Designation Required?

PCP Referral to Specialist Required?

Out-of-pocket Maximum Individual coverage

Family coverage

Fiscal Year Deductible Individual/ Family

Primary Care Provider Office Visit

Preventive Services

Specialist Physician Office Visit Tier 1 / Tier 2 / Tier 3

Retail Cl inic and Urgent Care Center

Outpatient Behavioral Health/Substanc,e Use Disorder Care

Emergency Room Care

Inpatient Hospital Care - Medical

Tier 1 Tier 2 Tier 3

Outpatient Surgery

Eye & GI procedures at freestanding facilities in Massachusetts

All other in Massachusetts

High-Tech Imaging

(e.g .. MRI. CT & PET scans)

Prescription Drugs

Retai l (up to a 30-day supply) Tier 1 / Tier 2 / Tier 3

Mail Order Maintenance Dru gs (up t o a 90-day supp ly) Tier I / Tier 2 / Tier 3

• . . UNICARE STATE

INDEMNITY PLAN/ BASIC with CIC

(Comp rehensive)

INDEMNITY

No

No

$5,000

$10 ,000

$500/$1.000

$20 I v isit

Most covered at 100% - no copay

$30 / $60 / $60 / visit

$20 I v isit

$20 I v isit

$100 / visit (waived if admitted)

$275 I admission with no tiering

$0

$250

$10 / $30 / $65

$25 I $75 I $165

UNICARE STATE TUFTS FALLON INDEMNITY HEALTH PLAN HEALTH PLAN/PLU1S NAVIGATOR SELECT CARE

PPO-TYPE POS HMO

No Yes Yes

No Yes Yes

$5,000 $5,000 $5,000

$10 ,000 $10 ,000 $10,000

$500/$1.000 $500/ $1.000 $500/ $1.000

$15 / visit for Cent- Tier 1: $10 / visit ered Care PCPs: $20 / Tier 2: $20 / v isit $20 I visit

v isit for other PCPs Tier 3: $40 / v isit

Most covered at Most covered at Most covered at 100% - no cop ay 100% - no copay 100% - no copay

$30 I $60 I $75 $30 I $60 I $75 $30 I $60 I $75 / v isit / v isit / v isit

$20 I v isit $20 I v isit $20 I visit

$20 I v isit $10 / v isit $20 I visit

$100 / visit $100 / v isit $100 / v isit (waived if admitted) (waived if admitted) (waived if admitted)

Maximum one copay per person per ca lendar year quarter Waived ,f read mit t ed w1th1n 30 d ays in the same ca lendar year

$275 I admission $275 I admission $275 I admission $500 / admission $500 I admission $500 / admission

$1,500 / admission $1.500 / admission $1.500 / admission

$0 $1S0 $1S0

$110 / $110 / $250 $250 $2S0

$10 / $30 / $65 $10 / $30 / $65 $10 / $30 / $65

$25 I $75 I $ 165 $25 I $75 I $165 $25 I $75 / $165

HARVARD PILGRIM

INDEPENDENCE PLAN

POS

Yes

Yes

$5,000

$10,000

$500 / $1,000

Tier 1: $10 / v isit Tier 2: $20 / visit Tier 3: $40 / v isit

Most covered at 100% - no copay

$30 I $60 I $75 / v isit

$10 retail c linic/ $20 urgent care

$10 / visit

$100 / v isit (waived if admitted)

$275 / admission $500 / admission

$1,500 / admission

$150

$2S0

$10 / $30 / $65

$25 / $75 / $165

Copays and deductibles that appear in bold i n this chart have changed effective July 1, 2019.

6

 

Yes

No

$5,000

$10 ,000

$400/$800

$20 I visit

Most covered at 100% - no copay

$30 / $60 / visit (No Tier 3)

$20 I visit

$20 I visit

$100 / visit

ALLWAYS H EA LTH

PARTNERS COMPLETE HMO

HMO

Yes

Yes

$5,000

$10,000

$500 I $1,000

$20 I v isit

Most covered at 100% - no copay

$30 / $60 / visit (No Tier 3)

$20 I v isit

$20 I v isit

$100 / visit

UNICARE STATE INDEMNITY PLAN/

COMMUNITY CHOICE

PPO-TYPE

No

No

$5.000

$10,000

$400/ $800

$15 / v isit for Cent-ered Care PCPs: $20 /

visit for other PCPs

Most covered at 100% - no copay

$30 I $60 I $75 / visit

$20 I visit

$20 I visit

$ 100 / visit

TUFTS HEALTH PLAN SPIRIT

EPO (HMO-TYPE)

No

No

$5,000

$10 ,000

$400/$800

$20 I visit

Most covered at 100% - no copay

$30 I $60 I $75 / visit

$20 I visit

$20 I visit

$100 / visit

FALLON HEALTH DIRECT CARE

Yes

Yes

$5,000

$10.000

$400/ $800

$15 / visit

Most covered at 100% - no copay

$30 I $60 I $75' / visit

$15 / v isit

$15 / v isit

$100 / visit (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted) (waived if admitted)

$275 / admission with no t iering

$150

$250

$10 / $30 / $65

$25 / $75 / $165

·Peace of Mind Program

Maximum one copay per person per ca lendar year quar ter Waived 1f read mitt ed w it hin 30 d ays in the same ca lendar year

$275 / admission w ith no tiering

$150

$250

$10 / $30 / $65

$25 / $75 / $165

$275 / admission w ith no tiering

$0

$ 110

$10 / $30 / $65

$25 / $75 / $ 165

$275 / admission $500 / admission

No Tier 3

$150

$250

$10 / $30 / $65

$25 / $75 / $165

$275 / admission with no t iering

$150

$250

$10 / $30 / $65

$25 / $75 / $165

HARVARD PILGRIM PRIMARY

CHOICE PLAN

HMO

Yes

Yes

$5,000

$10.000

$400/ $800

$20 I visit

Most covered at 100% - no copay

$30 / $60 I v isit (No Tier 3)

$20 I v isit

$20 I visit

$100 / visit (waived if admitted)

$275 / admission $500 / admission

No Tier 3

$150

$250

$10 / $30 / $65

$25 / $75 / $165

Out-of-pocket maximums apply to medical and behavioral health benefits across all health insurance products. Prescription drug (Rx) benefits are included in the out-of-pocket maximums for all health insurance carriers.

7

 

Do any of these circumstances apply to you?

Marr iage or remarr iage

Legal separatio n

Divorce

Address change

Birth o r ad o ption of a c hild

Legal g uard ianship o f a child

Remarr iage of a former spouse

Questions?

m El

1.617.727.2310, TDD/TTY 711

mass.gov/servlce-detalls/glc-quallfylng­llfe-events-and-your-optlons

Dependent age 19 to 26 w ho is no lo nger a fu ll -t ime stud ent

Dependent other than full-time stud ent w ho has moved out o f your health plan 's ,erv ice area

Death of a covered sp ouse. depend ent o r beneficiary

Life insurance beneficiary c hange

You have GIC COBRA coverage and become elig ible for o ther coverage

If any of the above circumstances applies to you, you must notify the GIC within 60 days of your family status changes. Failure to do

so can result in financial liability to you.

Benefit Strategies is the new administrator for the GIC's Flexible Spending Account (FSA) benefit!

As of July 1, 20 19. all claim s m ust be fi led w ith Benefi t Strategies. includ ing claim s from the 2019 plan year.

What is a Flexible Spending Account (FSA)?

A n FSA i~ ;m n r.r.rn m t thnt n lln ws y rn I tn sP.t ;isirlP. p rP.- tn x mnnP.y tn hP.lp yrn J r,ny fnr r.P.rt n in lifP. P.Xf)P.nsP.s ThP.~P.

accounts red uce your federal and state tax liabil it ies and increase your available income. The GI: offers two types of FSAs, administered by Benefit Strategies: Health Care Spend ing Acco unt (HCSA) and Dependent Care Assistance Program (DCAP). Yo u can use these FSAs to help p ay for q uali fied health care and dependent care expenses.

Examples of qualified HCSA expenses:

Physician office visits

Prescr ip t ion d rug copayments

Med ical ded uctibles and co-insurance

Examples of qualified DCAP expenses:

Daycare payments

Certain before/after school care

Certain summer cam ps

Learn more about the HSCA and DCAP, view other qualified expenses, and/or enroll In your FSA benefits by visiting benstrat.com/glc-fsa.

8

 

',,, s

:.o, • benefft1stra tegj<;~

How will an FSA help me save on taxes?

A n FSA allows yo u to set aside money from eac h paycheck for elig ib le expenses before your taxes are taken from your paycheck. This means there is less income to tax each month. A lso, yo u are not taxed w hen you f ile a c laim and are reim bu rsed !

For example:

BREAKDOWN OF NOT PARTICIPATING PARTICIPATING IN HCSA OR DCAP PLAN

$30,000

PAYCHECK & DEDUCTIONS IN HCSA OR DCAP PLAN

Gross Yearly Pay $30.000

HCSA Annual Contribution (Pre-Tax) $0 ($2,000)

DCAP Annual Contribution (Pre-Tax) $0 ($4,000)

Taxable Income $30,000 $24,000

Sample Tax Withholdings of 30% ($9,000) ($7,200)

Yearly Health Care Expenses ($2,000 post-tax) $2,000 (Claims reimbursed)

Yearly Daycare Expenses ($4,000 post-tax) $4,000 (Claims reim bursed)

Net Avai lable Income $15,000 $16,800

Who is eligible and when do I enroll?

Active state emp loyees w ho are elig ib le for GIC benefi ts may partic ipate in the HCSA and/or DCAP programs.

FSA Enrollment for the 2020 Plan Year: April 3 - May 1, 2019

During the GIC's spr ing 2019 A nnual Enrollment period, state employees can enroll in FSA benefits for the Plan Year o f July 1, 2019 - June 30 , 2020 . These plans require that participants re-enroll each year.

New State Employees and Change In Status: New state employees and employees w ho have a q uali fying stat us change d uring the year m ay enro ll for part ial-year benefits. For HCSA, new hire benefits begin at the same time as other GIC benefits. For DCAP, coverage b egins on the first d ay of employment.

What else d,o I need to know?

It is important t o note, the IRS has a strict "use-it -or-lose it" ru le, w hich means that m oney left in a p re-t ax account at the end o f a p lan year is forfeited, so consid er your electio n carefully.

2 ½-Month Grace Period: If you still have money le ft in your FSA at the end o f the p lan year, you have an add itio nal 2 ½ months to incur claim s. For the 20 20 fisc al year, you have until September 15, 20 20 to incur claim s and until October 15. 20 20 to subm it them.

Administrative Fee: Fo r the 2020 Plan Year, there is a f lat $2.00 administrative fee, p er m onth. per part icipant. w hether yo u enro ll in one o r both p lans.

KEY FSA DATES I Open Enrollment: April 3 - May 1, 2019

2019 Plan Year 2020 Plan Year

Plan Year: July 1, 20 18 - June 30 , 2019

2 ½ month Grace Period: July 1, 2019 -September 15. 2019

Claim filing deadllne: Oc tober 15, 2019

Questions?

• Plan Year: July 1, 2019 - June 30, 20 20

• 2 ½ month Grace Period: July 1, 20 20 -September 15, 20 20

• Clalm fillng deadline: October 15. 20 20

Co ntact Benefi t Strateg ies for more inform atio n and see the Partic ipant Handb ook for ad d it ional Plan Rules ( found on Benefit Stra tegies website).

RI Toll Free: 1.877.FlexGIC (1.877.353.9442) l~I benstrat.com/ glc-fsa

9

 

The Mass4You Employee Assistance Program ( EA P) is available to all active. state and municip al employees and their families w ho are eligible for GIC benefits, to help achieve better work/life balance.

Enro llment in GIC health insurance coverage is not requi red to access the many Mass4You EAP work/ life and other support services. Through Mass4You, GIC benefits-eligible employees and their families can find easy access to a comprehensive suite of free. confid ential sup port available 24/ 7, including :

Three in-person or Tele-EAP (virtual) counseling visits per issue per year - at no cost

30 -m inute telephonic o r in-person legal or mediation consultatio n per issue per year- at no cost

Guidance from a f inancial adv isor to help w ith debt , foreclosure, financ ial p lanning and more

Get referrals for a variety o f Work-Li fe convenience services: child care, elder care and more

Access to Optum's 24/ 7 confidential Substance A buse Treatment Help line and a licensed c linician

No formal enro llment is required. Contact Mass4You to learn more:

m 1.844.263.1982 1•1 llveandworkwell.com

TTY Support: 711 +1.844.263.1982

Substance Use Treatment Helpline: 1.8SS.780.59SS

GIC Rx: Prescription Drug Benefits --

The GIC contracts w ith Express Scripts (ESI) to manage the p rescription drug benefi t for all GIC non-Medicare health insurance products. You are required to use your ESI ID card when filling your prescriptions. You will be able to access a broad network of retail pharmacies to fill a 30-day supply and can fill a 9 0 -day sup ply through mail order or at a CVS Pharmacy.

Prescription Drug Deductible

A ll GIC non-Medicare medical products have a fiscal year Rx deduc tible o f $100 indiv idual/$200 family. The p rescription drug deductible is separate from your health product deductible. Once you've paid your p rescriptio n deductib le, your covered drugs will be subject to copayment.

Drug Copayments

A ll GIC health p ro ducts provide benefits for prescription drugs using a three-tier copayment structure in which your copayments vary, d epend ing on the drug d ispensed . Contact ESI with q uestio ns about your specific medicatio ns. Please note. covered medications may change in January and July.

Tier 1: You pay the lowest copayment. This tier is primarily made up of generic drugs, although some b rand name drugs may be included. Generic drugs have the same active ingredients in the same strength as their b rand name counterparts. Brand name drugs are almost always significantly more expensive than generics.

Tier 2: You pay the mid-level copayment. This tier is p rimarily made up of brand name drugs, selected based on reviews of the relative safety, effectiveness and cost of the many brand name d rugs on the market. Some generics may also be included.

Tier 3: You pay the highest copayment. This t ier is primarily made up of the brand name drugs not included in Tiers 1 or 2. Generic or b rand name alternatives for Tier 3 drugs may be available in Tiers 1 o r 2.

Questions?

m 1.8SS.283.7679 EJ express-scrlpts.com/glcRx

10

 

• Are you eligible?

To be eligib le. you must have other non-GIC health insurance coverage through another employer-sponsored plan that meets Internal Revenue Service "minimum value" criteria and must maintain GIC basic life insurance.

What is the Buy-Out Program?

Under the Buy-Out plan, eligible state employees receive 25% of the full-cost monthly p remium in lieu of health insurance benefits for one 12-month period of time. Employees in HR/CMS and UMASS agencies w ill receive the remittance monthly in their paycheck;

employees of housing and other autho rit ies wi ll receive a monthly check. The amount of payment depends on your health p lan and coverage.

When to Enroll

For Example:

State employee with Tufts Health Plan Navigator family coverage:

Full cost monthly premium:

Monthly 12-month benefit =

$1,815.72

25% of this premium

Employee receives 12 payroll deposits or monthly checks ot:·

Yearly Earnings (12 monthly payments):•

$453.93

$5,447.16

•subject to federal, Medicare, and state taxes

There are two buy-out periods, and your reimbursement w ill be determ ined based on the GIC p roduct you are enrolled in at t he end o f the covered period.

During Annual Enrollment: If you were insured w ith the GIC on January 1, 2019 or before, and continue your coverage t hrough June 30, 20 19. you may apply to buy out your health plan coverage effective July 1, 2019 .

October 2 - November 1, 2019: If you are insured w ith the GIC on July 1, 2019 o r before. and continue your coverage t hrough Decem ber 31, 2019. you may apply to buy out your health p lan coverage effective January 1, 2020. The enrollment period for t h is buy-out w ill be October 2 - November 1, 2019.

Form Submission

Send the completed Buy-Out form to the GIC no later than May 1, 2019 for the July 1, 2019 buy-out or November 1. 2019 for the January 1. 2020 buy-out. Forms received after the deadline w ill not be accepted.

For any questions, or to get more Information, contact the GIC:

m , .s,7.727.2310 l'!'I blt.ly/GICBuyOut

Pre-Tax Premium Deductions

The Commonwealth normally ded ucts the employee's share of basic li fe and healt h insurance premiums on a pre-tax basis. During Annu al Enrollment, or w hen you have a quali fied status change as outlined on the pre-tax form . you have t he opportunity to change the tax status of your premiums:

If your deductions are n ow taken on a pre-tax basis, you may elect to have them taxed, effective July 1, 2019.

If you previously c hose not to take t he pre-tax option, you may switch to a pre-tax basis, effective July 1, 2019.

For more Information about Pre-Tax Deductions contact your Payroll Coordinator or the GIC.

11

 

Long Term Disability (LTD): Special Enroll _.,, _ II

What is it?

LTD insurance is an income replacement p rogram that financ ially protects you and your fam ily in the event you beco m e d isab led and are unable to perform the m aterial and substantial duties o f your jo b. Unum is the GIC's Long Term Disability ( LTD) Car rier. If you are unab le to work for 90 consecutive days due to il lness or injury, this program p rovid es income replacement. Benefits include:

A tax-free benefit o f 55% o f a par tic ipant's g ross m onthly salary, up to a maxim um benefi t o f $10,0 0 0 per m onth, up to the age of 65. If a part icipant is d isab led on o r aft er ag e 6 2, benefits m ay co ntinue after age 65;

• A benefit for par t ial d isab ilities;

A 36-m onth benefit for behavioral health disab ili t ies;

A rehabili tatio n and return-to -work assistance benefi t;

A dependent care expense benefit; and

Part ial benefits, even if you are receiv ing other income benefits, w ith a m inim um of $100 o r 10 % o f your gross m on thly benefi t am ount - whichever is higher.

Eligibility and Enrollment

Active state emp loyees w ho are elig ible for GIC benefits are elig ib le for LTD.

New State Employees: Elig ib le employees m ay enroll in LTD w itho ut p rov d ing evidence of g ood health.

Current State Employees: During this Speclal Enrollment Period ( Aprll 3 - June 14, 2019), elig ible active state employees can enroll for LTD w ith no evidence of g ood heal th as long as they have not been p reviously decl ined. Be sure to use the special LTD Open Enrollment Fo rm , availab le on the GIC's website and through your GIC Co ordinator, to enro ll. Coverage w ill b e effective October 1, 2019 .

EMPLOYEE AGE

Under Age 24

25-29

30- 34

35- 39

40-44

45-49

Questions?

m 1.877.226.8620

MONTHLY GIC PLAN RATES

EMPLOYEE PREMIUM Per $700 of Monthly Earnings

$0.08

$0.10

$0.14

$0.17

$0.35

$0.47

llllllll bit.ly/OtherGICBeneflts

12

so- 54

55 - 59

60 - 64

65- 69

70 and over

EMPLOYEE PREMIUM Per $700 of Monthly Earnings

$0.57

$0.70

$0.67

$0 .38

$0.22

 

Life insurance, insured by The Hartford Li fe and A ccid ent Insurance Company, helps p rovide for your family's econom ic well-being in the event of your death. This benefi t is paid to your desig nated beneficiaries.

Basic Life Insurance: The Commonwealth o ffers $5,000 of Basic Li fe Insurance.

Optional Life Insurance: Optio nal Life Insurance is availab le to prov ide eco nom ic support for your family. This term insurance allows you to inc rease your coverage up to eig ht t imes your annual salary, up to a m aximum of $1.5 m illion. Term insurance pays yo ur d esignated beneficiary in the event of yo ur death. It has no cash value. This is an employee-pay-all benefi t.

Optional Life Insurance

Yo u must be enrolled in Basic Life Insurance in o rder to app ly for Optio nal Life Insurance.

New State Employees: You may enroll in Optio nal Life Insurance for a coverage a m ount o f up to eig ht t imes your salary, w it ho ut p rovid ing evidence of good health.

Current Employees During the Year: State employees active ly at work may app ly for the first time o r apply to increase their coverage at any time d uring the year. After you app ly, you w ill rece ive instructio ns for comp let ing a person al health app licat io n for The Hart ford's review and app roval. The GIC w ill determ ine the effect ive date if The Har t ford app roves the ap plication.

Current Employees with a Qualified Family Status Change

Em p loyees w ho have a q uali fied family stat us change d uring the year may enro ll in or inc rease their coverage w ithout any medical review in an am o unt up to a coverage lim it no t to exceed four t imes their salary p rovid ed that the GIC receives p ro of, w ithin 31 days, of the quali fy ing event. Fam ily status c hanges include the follow ing events:

Marr iage B irth o r ado pt ion of a c hild Divorce Death of a spouse

Optional Life Insurance Non-Smoker Benefit

At in it ial enrollment or during A nnual Enro llment if you have been tobacco-free (have not sm oked cigarettes, cigars o r a p ipe no r used snuff, chewing to bacco o r a n icotine d elivery system) for at least the past 12 months, you are elig ib le for reduced non-sm oker O pt io nal Li fe Insurance rates. Yo u w ill be req uired to period ically recert ify your no n-sm oking status in ord er to qualify for the lower rates. Changes in smoking status m ade during Annual Enro llment w ill beco me effective July 1, 2019 .

Optional Life Insurance Rates (lncludin•g AD&D)

MONTHLY GIC PLAN RATES - Per $1,0 00 of Coverage

ACTIVE EMPLOYEE AGE SMOKER RATE NON-SMOKER RATE

Under Age 35 $0 .10 $0 .0 4

35 - 44 $0 .12 $0 .05

45-49 $0 .20 $0 .0 7

50-54 $0 .33 $0 .14

55 - 59 $0 .53 $0 .21

60 - 64 $0 .79 $0 .31

65 - 69 $1.45 $0 .70

70 and over $2.57 $1.16

Questions?

m 1.617.727.2310 m bit.ly/ GICLifelnsuranceBooklet

13

 

Eligibility

The GIC Dental/Vision Plan covers state employees w ho are not covered by co lective bargaining or do not have another Dental and/ or Visio n Plan through the Commonwealth. The p lan p rimarily covers managers, Legislato rs, Legislative staff, and certain Executive Office staff. Employees of autho rit ies, municipali t ies, hig her educatio n, anc the Judicial Trial Court system are not eligib le fo r the GIC Dental/Vision Plan.

Enrollment

During Annual Enrollment o r w ithin 60 days o f a qualifying stat us change, eligible employees may enroll in GIC Dental/Vision benefits and change their dental p roduct selection.

Dental Benefits

Metro politan Li fe Insurance Company (MetLife) b L1 1e ccrr ier fu r L1 1e u e 11Ld l µur liu 11 u r Lile GIC Dental/Vision Plan. There are two dental p-oduct options:

The PPO Product (also known as the Met Life Value Plan), and

The Indemnity Product (also known as the Met Life Classic Plan)

For more information, Including covered services, out-of-network benefits, and providers, contact MetLife directly:

m ,.866.292.9990

l!!I metllfe.com/glc

GIC Dental/ Vision Rates

Vision Benefits

Davis Vision is the v ision provider for the v ision µ ur liu11 u r L11e GIC De11l dl/Vi:. iu 11 P ld 11. Mer11l.Jer:.

receive basic services every 24 months (age 19-60) o r every 12 months (age 18 or und er and 61 or over) at no cost:

Routine eye examinations

Fashio n and designer frames

Lenses

Scratch-resistant lens coating

For more information, Including copayment amounts, providers, and discount programs, contact Davis Vision:

m ,.800.650.2466

l~I davisvision.com (client code: 7852)

MONTHLY GIC DENTAL/ VISION RATES - Effective July 1, 2019

PLAN INDIVIDUAL COVERAGE FAMILY COVERAGE

PPO (Value) Plan $4.72 $14.65

Indemnity (Classic) Plan $6.33 $19.66

14

 

Contact Information

Who to Contact if You Have a Question About ...

Anything related to: ENROLLMENT OR ELIGIBILITY

For example:

How do I enroll?

How do I change my p lan?

W here should I send my forms?

Problems fi lling out the form

Contact the Group Insurance Commission or your GIC Coordinator

1.617.727.2310, TDD/ TTY 711

mass.gov/ gic-annual-enrollment

HEALTH INSURANCE CARRIERS

AIIWays Health Partners

Fallon Health

Harvard Pilgrim Health Care

Health New England

Tufts Health Plan

UniCare State Indemnity Plan

Pharmacy Benefits Manager

Health Care Spending Account (HCSA) and Dependent Care Assistance Program (DCAP)

Life/AD&D Insurance

Long Term Disability

Dental Benefits

Vision Benefits

Anything related to: HEALTH INSURANCE PRODUCT AND COVERAGE

For example:

Changes in coverage

F inding a p rovider

Tiered doctor & hosp ital lists

What tele-health options are offered?

F itness and wellness programs offered

Contact your health insurance carrier d irectly

PHONE WEBSITE

1.866.567.9175

1.866.344 .4442

1.800.542.1499

1.800.842.4464

1.800.870.9488

1.800.442.9300

1.855.283.7679

1.877.353.9442

1.617.727.2310

1.877.226.8620

1.866.292.9990

1.800.650.2466

15

allwayshealthpartners.org/ g ic -members

fa llonhealth.org/gic

harva rdp i lg r im.org/gic

healthnewengland .org/gic

tuftshealthplan.com/gic

unicarestateplan.com

express-scripts.com/gicRx

benstrat.com/gic -fsa

b it.ly/OtherGICBenefits

mass.gov/gic/ltd

metli fe.com/gic

dav isvisio n.com (cl ient code: 7852)

 

~ommonwealth of Massachusetts ~ Group Insurance Commission

P.O. Box 8747 Boston, MA 02114

COMMONWEALTH OF MASSACHUSETTS

Charles D. Baker, Governor Karyn Polito, Lieutenant Governor

Group Insurance Commission Roberta Herman, M.D., Executive Director 19 Staniford Street, 4th Floor Boston, Massachusetts

l!JI Telephone: 1.617.727.2310

TDD/ TTY: 711

••• Mailing Address Group Insurance Commission P.O. Box 8747 Boston, MA 02114

Website: mass.gov/orgs/ group-insurance-commission

Commissioners

*Current as of March, 2019. For more information, v isit mass.gov/orgs/ group-insurance-commission.

Valerie Sull ivan (Public Member) , Chair

Gary Anderson, Commissioner of Insurance

Michael Heffernan, Secretary of Administrat ion and Finance (or his designee)

Theron R. Bradley (Public Member)

Edward T. Choate (Public Member)

Tamara P. Davis (Public Member)

Kevin Drake (Council 93, AFSCME, AFL-CIO)

Jane Edmonds (Public Member)

Joseph Genti le (AFL-CIO, Public Safety Member)

Christine Hayes Clinard, Esq. (Public Member)

Bobbi Kaplan (NAGE)

Adam Chapd elaine (Massachusetts Municipal Association)

Ei leen P. McAnneny (Public Member)

Timothy D. Sullivan, Ed.D. (Massachusetts Teachers Association)

Anna Sinaiko, MPP, PhD (Health Economist)