OE Presentation For Open Enrollment 2016

OE Dates

SHBP (Medical Coverage ONLY) and Employee Express (All Non-Medical Coverage)–Website opens at 12 a.m. October 19, 2015–Website closes at 11:59 p.m. November 6,

2015– If you registered last year, you’ll need to

change your password.

SHBP Website at ADP• www.myshbpga.adp.com • DO NOT PROCRASTINATE! 300,000+ members all

need to make an election in the same 19 day period! • Make changes as often as you like. The last change

you make before the website closes will be your election for 2016.

• Be sure to click “Finish,” then print the confirmation page and keep for your records.

Employee Express Changes (I)• Go to Employee Express to elect, drop, or change:

• Flexible Spending MUST be re-elected each year.• HFSA-Medical Flexible Spending Account• NFSA-Dependent Day Care Flexible Spending Account• If you have Dental, you will not need to re-elect the coverage

this year.

--DENTAL --VISION--SHORT/LONG TERM DISABILITY --LIFE INSURANCE--FLEXIBLE SPENDING ACCOUNTS --LIFE LOCK

Employee Express Changes (II)• Before making elections in Employee Express, be

sure to add your dependents.• Social Security Numbers, Dates of Birth, and phone

numbers are required for any dependents.• If electing Dental and Vision, be sure you specify

which dependents should be covered.• LifeLock can NOT protect your dependents without

SSN, DOB, and phone number.

True OE for Short Term Disability (STD) plans I

• STD replaces your salary if you become ill or injured and have exhausted your sick leave.

• Without sick days or STD, you may have little or no income to live on.

• We offer two options depending on your needs• A 15 day waiting period that replaces 50% of salary at a cost

of $1.36 per $1,000 of monthly salary• A 45 day waiting period that replaces 60% of salary at a cost

of $0.96 per $1,000 of monthly salary

True OE for Short Term Disability (STD) plans II

• No health questionnaire required to elect STD this year—if you elect it, you will have the coverage.

• Pre-existing clause still applies so, for example, someone already pregnant won’t have the pregnancy as a covered disability.

• Encourage anyone who does not have STD to consider it, unless they do not need their salary to live, or have 6 months of sick leave.

True OE for Group Term Life plans• No health questionnaire required to elect life

insurance this year for yourself, spouse, or child(ren).• You must have coverage on yourself equal to or

greater than what you elect on your spouse or child(ren).

• Electing even $10,000 this year preserves your right to increase coverage later with no HQ.

Permanent Life & Critical Illness• Individual Policies that you own & keep, even when you

resign or retire, but pay for via payroll deduction.• Life coverage available for you, spouse, child, grandchild.• Critical Illness pays a flat amount for 1st diagnosis of:

• Call 1-877-422-3312 to inquire about or elect coverage.

-- INVASIVE CANCER -- HEART ATTACK-- STROKE -- KIDNEY FAILURE-- BLINDNESS-- MAJOR ORGAN TRANSPLANT-- CORONARY BYPASS (25%)

-- ALS-- PARALYSIS OF TWO LIMBS-- CARCINOMA IN SITU (25%)

Long Term Care Insurance (LTC) I• Coverage pays for nursing home, assisted living, and

home care (not the same thing as Long Term Disability)• Income and assets can be exhausted by one spouse,

leaving little for the survivor to live on• Average cost of care in metro Atlanta:

Home care--$2,160/month (4 hours/day)Adult Day Care--$1,800/month (8-12 hours/day)Assisted Living--$3,060/monthNursing home care--$5,910 for a semi-private room and $6,630 for a private room

Long Term Care Insurance (LTC) I I• Individual Policy that you own & keep, even when you

resign or retire, but pay for via payroll deduction.• Coverage available for you, spouse, parents &

grandparents, parents- and grandparents-in-law.• You choose the amount of coverage you need per day

and for how many years• The older you are, the higher the premium• Call LTC Solutions at 877-286-2852 for more information

Where To Find OE Information• www.myfultonbenefits.com

On the landing page you will find all information for Open Enrollment:Rate SheetsDecision GuidesComparisons, Brief videos, andLinks to BCBSGA, UHC, and Kaiser.

• Links & instructions will also be e-mailed periodically.

Info On Local Coverage

Info on Each Plan

Also at myfultonbenefits.com

What’s New for 2016? Telemedicine!

• Telemedicine-see and talk to a participating doctor via smartphone, tablet, or computer with a webcam

• HMO members make their regular office visit co-pay• HRA members pay their percentage (15% Gold, 20%

Silver, 25% Bronze) even if you have not met your deductible yet

• Available with all carriers• Check your carrier’s website for more information

What’s New for 2016? Incentive Rollover!

• Wellness Incentive Credits will rollover between all BCBS and UHC plans

• Change plans without losing what you’ve earned• Credits will transfer in April 2016• Credits will roll IN to Kaiser, but you will not earn

credits with Kaiser• Kaiser members can earn a $240 VISA gift card

What’s New for 2016? Bariatric Pilot!

• Year 2 of the pilot program• Submit an application by February 4th, 2016• If you applied this year, you must apply again next

year• 75 total members will be randomly chosen state-

wide across all plans• Find more info at www.dch.Georgia.gov/shbp

What’s New for 2016? HDHP Improvement!

• Individual family members can now meet a Single deductible and out-of-pocket (OOP) amount

• No longer have to meet the entire Family deductible for coverage

• Single deductible is $3,500; EE + Spouse, EE + Child(ren), and EE + Family is $7,000

• Single OOP is $6,450; EE + Spouse, EE + Child(ren), and EE + Family is $12,900

What’s New for 2016? Charitable Fund Online!

• No more forms! (well, almost)• Make one-time and annual elections in

Employee Express• Forms are not personalized, and used only for

those who contribute by personal check.

What’s New for 2016? Charitable Fund Online!

What’s Changing for 2016? Vision Premiums

There will be a slight increase in vision premiums for 2016. Changes are:• Employee Only--$6.72 (increase of $0.26)• Employee + 1--$12.10 (increase of $0.46)• Employee + Family--$18.82 (increase of $0.72)

Medical Plan OptionsCarrier\Plan HRA HMO HDHP RX WELLNESS

BCBSGA YES(BRONZE, SILVER, GOLD) YES NO EXPRESS SCRIPTS HEALTHWAYS

UHC NO YES YES EXPRESS SCRIPTS HEALTHWAYS

KAISER NO YES NO KAISER KAISER

Definitions (I)• Deductible—the $ amount you must pay before

charges are paid by the carrier; may be offset by HRA credits

• Co-pay—a fixed amount paid for a service, such as an office visit, prescription, or ER visit

• Co-insurance—the % you must pay after the deductible is met; the carrier pays the larger %

Definitions (II)• Out-of-pocket maximum (OOP)—when your

deductible + co-insurance equal the OOP, the plan pays 100% of covered charges for the rest of the year.

• HRA credits—dollars given by SHBP under the plan to offset the deductible or to pay for Rx

• Negotiated rate—the amount agreed to be charged and accepted between a provider and carrier

SHBP Plan Info (I)

SHBP Plan Info (II)

Important Facts about the 2016 Health Coverage (I)

• Provider network will vary between BCBSGA, UHC, and Kaiser.• BCBSGA network is identical for HRA and HMO plans.• Rx are again managed through Express Scripts for all BCBSGA

and UHC plans. Kaiser manages their own.• Rx co-pays and co-insurance may have an impact on the

deductible and OOP amounts:

Rx coverage HRA HMO HDHP

Deductible No No Yes

Out-of-pocket Yes Yes Yes

Important Facts about the 2016 Health Coverage (II)

• No pre-existing conditions, no referrals needed for a specialist with BCBS and UHC

• Only 1 ID card for Medical, Rx, and Wellness• Mail order Rx and Disease Management programs continue in

HRA and HMO plans• HDHP plan has no Disease Management• HRA credits from 2015 roll over• HRA credits are no longer lost when moving to the HMO or

HDHP plan

Important Facts about the 2016 Health Coverage (III)

• A single person can’t satisfy more than the Single deductible (and OOP) with EE + Spouse, EE + Child(ren), EE + Family

• A person in acute treatment on 1/1/16 can apply for Transition of Care (continue w/non-participating Dr.)

• In/Out-of-network deductibles and OOP amounts are completely separate—one does not satisfy the other

• New employees in October and November must make the New Hire election and Open Enrollment election at least one day apart

Wellness Requirements Remain• All plans earn Wellness Incentives; only HDHP members have

a threshold before they can be used• WBA and Biometric Screening BOTH required to earn $240 in

incentives• Earn another $240 in incentives (in increments of $40) with

telephone coaching or an online well-being plan over a 6 month period

• Spouse can earn $480 also if covered• Kaiser members earn a $240 VISA gift card

Going out to the Federal Exchange• SHBP plans are “adequate” and “affordable” as defined by

ACA• Any person may purchase coverage on the exchange for any

reason• Access to adequate and affordable plan through employer

prohibits receiving federal subsidy• Any FCS employee purchasing exchange coverage will have to

pay the whole cost of the coverage• Exchange coverage premiums can NOT be payroll deducted

and are after tax

Strategy For Making an Election (I)• As always, look at how you use health care.• Minimal users might prefer the lower cost plans.• People with frequent office visits might prefer an

HMO plan.• Remember that premiums are always deducted,

while you may not always need services.• Consider the level of benefits + premium + HFSA

amount.

Strategy For Making an Election (II)• The choice is going to come down to personal

preference about costs, convenience, and freedom.• Pay less premium per month, but more for services

when they are rendered• Kaiser is self-contained—only one place to go for

everything• Having freedom to choose an out-of-network doctor

means electing an HRA or HDHP plan

Health Flexible Spending Account (HFSA) I

• Set aside amounts to pay co-pays, meet deductibles, and pay for Rx

• HFSA can also be used for dental and vision services• Can be used for dependents’ charges even if

spouse/children are not on an FCS plan.IMPORTANT! HFSA is used for ALL family member’s expenses. NFSA is used only to pay for day care while you work, not for medical expenses for dependents.

Health Flexible Spending Account (HFSA) II

• Choose from $300 to $2,600 for the year• Set aside only what you know you will spend,

because unused money over $500 is forfeited. Up to $500 remaining at the end of the year can be rolled over to 2017.

• E-claims tracker makes reimbursement almost painless.

Health Savings Account (HSA)• HSA is very different from HFSA• HSA only available if you have a HDHP• FCS does not offer an HSA—need to set up privately

at a bank or broker• If you have an HSA, you can NOT use the HFSA

Where To Go For More Information• Blue Cross Blue Shield

– www.bcbsga.com/shbp or call 855-641-4862

• United Healthcare– www.shbp.welcometouhc.com or call 888-364-6352

• Kaiser Permanente– www.my.kp.org/shbp or call 855-512-5997

• Open Enrollment materials– www.myfultonbenefits.com – click the green button for the Employee Benefits

Center (the Open Enrollment information should be on the landing page)

• FCS Plans (Dental, Vision, Disability, Life, ID Theft, Flexible Spending– www.myfultonbenefits.com – click the green button for the Employee Benefits

Center, then click “Employee Benefits” or call 470-254-6845

Where To Go To Make Elections• Health Elections: www.myshbpga.adp.com• FCS Plans: Employee Express• You can reach everywhere you need to get from

www.myfultonbenefits.com

Miscellaneous • Leave Administration Class will be recorded on

Edivate and on the Employee Portal• Anyone eligible for--but not enrolled in--the Sick

Leave Bank will receive an email with a link to enroll.• All those that missed re-electing Dental last OE can

elect now with no penalty• Biometric screening scheduling going on now

Questions

benefits@fultonschools.com470-254-6845