2019 State Health Plan Open Enrollment

Training for Health Benefit Representatives

Open Enrollment Dates: Sept. 29-Oct. 31, 2018

What We Will Cover Today• New State Health Plan Website• The Role of an HBR Prior To and During Open Enrollment• Overview of Changes• Plan Options• Premiums• Enrollment Process Overview• Communicating Open Enrollment to Members

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Introducing the State Health Plan’s New Website

• The new website has a new look and feel and is NOW mobile responsive!

• Changes to note: • Name change of eEnroll to

eBenefits• NC HealthSmart transition to

Health and Wellness

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Become a State Health Plan

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We need your help in communicating

this initiative to your employees!

New Explanation of Benefits (EOB) Coming Soon!

Current EOB

New & Improved EOB

These new and easier to read EOBs will be launched in August (draft version shown).

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New State Health Plan Member ID Cards for 2019Current ID Card

New & Improved ID Card

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All members will be receiving new ID cards this year. They will be mailed in late

November/early December.

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HBR Role for Open Enrollment

Your Critical Role as an HBR

• HBRs are the main avenue through which members receive benefit information.

• You serve as ambassadors for the Plan. • It is critical that you are knowledgeable about Plan changes prior to Open Enrollment.

• If you are well-prepared to handle questions, it will create a better member experience.

• Your role is to educate employees on benefits, NOT enroll them in the eBenefits system. eBenefits is a self-service system.

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Enrollment Overview

Action Required!

• ALL non-Medicare primary members will be moved to the 70/30 Plan effective Jan. 1, 2019.• Subscribers will see this change when they log in to eBenefits in October.

• Subscribers MUST take action to enroll in the 80/20 Plan and reduce their premium in either the 70/30 or 80/20 Plan.

• Failure to take action by Oct. 31st will result in:• Remaining on the 70/30 Plan for 2019• Paying more for subscriber-only premium for failure to complete the tobacco attestation.

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Plan Options

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• The State Health Plan will continue to offer two plan options to active employees and non-Medicare retirees for 2019:

Members pay a 20% coinsurance for eligible in-network services. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Affordable Care Act (ACA) Preventive Services performed by an in-network provider are covered at 100% by the Plan, at no cost to the member.

Services are subject to deductible and coinsurance maximum. Members pay 30% coinsurance for eligible in-network expenses. Similar to the 80/20, members pay a copay for some services (i.e., office visits, urgent care or emergency room visits). What is different on the 70/30 plan is that members also pay a copay for preventive office services. The deductible and coinsurance would apply to preventive services, like colonoscopies, performed in an outpatient setting.

Members can reduce their employee premium by completing the tobacco attestation in both plans!

80/20 Plan

70/30 Plan

Tobacco Attestation Change• By completing the tobacco attestation, employees can reduce

employee-only premium by $60 on both the 80/20 & 70/30 plans.

• New attestation language and required activity: • Employee must re-attest to not being a tobacco user or agree to visit

a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days of Open Enrollment or risk losing their credit.

• New hires enrolling during OE will be prompted to answer the tobacco attestation for 2018 and 2019 benefit year. While they need to answer the question twice, they can satisfy the requirement by completing either the QuitlineNC (2018) or the Minute Clinic (2019) tobacco cessation program.

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Subscribers enrolled through the Retirement Systems that select the 70/30 Plan do NOT need to complete the tobacco attestation.

How the CVS Minute Clinic Tobacco Cessation Program Works

1. During enrollment on the tobacco attestation screen, employee selects “I AM a tobacco user, BUT I agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days after the last day of Open Enrollment or from your initial hire date.”

2. Employee will then receive a letter which will include a CVS Minute Clinic Tobacco Attestation Voucher that will cover an initial visit (a $45 savings) + one follow-up (a $35 savings) visit for face-to-face tobacco cessation counseling.

3. Employee will need to bring the voucher to each session and present their State Health Plan ID card in order for the visit to be covered at 100% by the Plan (no charge to the member).

4. The initial visit is the only requirement to keep the premium credit.

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This will replace the QuitlineNC multi-call program enrollment requirement for the 2019 Plan benefit year. For subscribers that would like to utilize the

Voucher Program after Jan. 1, 2019, they will need to call CVS Caremark at 888-321-3124 and a voucher will be mailed to them.

CVS Minute Clinic Tobacco Attestation Voucher

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For locations and hours visit www.cvs.com/minuteclinic

Tobacco Attestation Savings

80/20 Plan 70/30 Plan

Total employee-only monthly premium without credit $110 $85

Attest to being tobacco-free OR agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session, if a tobacco user.

$60 $60

TOTAL employee-only monthly premium with credit $50 $25

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2019 ChangesIndividual In-Network BenefitDesign

70/30 Plan(no changes) 2018 80/20 Plan 2019 80/20 Plan

Deductible $1,080 $1,250 $1,250

Coinsurance Percentage 30% 20% 20%

Preventive Coverage Cost-Sharing Applies 100% 100%

Medical OOP MaxPharmacy OOP MaxMedical Coinsurance MaxOverall OOP Max

NA$3,360$4,388

N/A

$4,350$2,500

N/A$6,850

NAN/AN/A

$4,890

PCP Copay $40 $10 (selected PCP)/$25 (non) $10 (selected PCP)/$25 (non)

Chiro/Therapies $72 $52 $52

Specialist Copay $94 $45 Designated/$85 (non) $80

Inpatient Hospital $337, then Ded/Coins. $0 or $450, then Ded/Coins. $300, then Ded/Coins.

Outpatient Hospital Ded/Coins. Ded/Coins. Ded/Coins.

ER Copay $337, then Ded/Coins. $300, then Ded/Coins. $300, then Ded/Coins.

Urgent Care $100 $70 $70

DrugsTier 1 Tier 2Tier 3Tier 4Tier 5 Tier 6

$16$47$74

10% up to $10025% up to $10325% up to $133

$5$30

Ded/Coins.$100$250

Ded/Coins.

$5$30

Ded/Coins.$100$250

Ded/Coins.

Preferred Diabetic Supplies*(e.g. Test Strips, Lancets, Syringes, Needles)Preferred Diabetic Supply brand is OneTouch

$10 $5 $5

*Non-preferred Diabetic Supplies will be priced at Tier 3

80/20 Plan Wellness Incentive

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Additional Wellness Activity Reduced Copay

Visit the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice.

$10 copay

The Blue Options Designated Provider Program will not be offered in 2019.

Pharmacy Benefit Reminders• CVS Caremark is the Pharmacy Benefits Manager for the State Health

Plan. Remember that the Plan continues to maintain a customized closed formulary, or drug list.

• The formulary is updated on a quarterly basis and members should always review it to see if there have been any coverage changes to their prescribed medications.

• An exception process is available to providers who believe that, based on medical necessity, it is in the members’ best interest to remain on the excluded drug(s).

Excluded drugs approved for coverage through the exceptions process will be at the tier 3 or tier 6 member copay level.

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Closed Formulary – In a “closed” formulary, certain drugs are excluded.

Pharmacy Benefit Reminders

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Individual In-Network Benefit Design 70/30 Plan 80/20 Plan

DrugsTier 1 Tier 2Tier 3Tier 4Tier 5 Tier 6

$16$47$74

10% up to $10025% up to $10325% up to $133

$5$30

Ded/Coins.$100$250

Ded/Coins.

Preferred Diabetic Supplies*(e.g. Test Strips, Lancets, Syringes, Needles). Preferred Diabetic Supply brand is OneTouch

$10 $5

• The Plan continues to receive feedback/complaints from employees that don’t understand the impact of the 80/20 Plan’s deductible/coinsurance design for Tier 3 and Tier 6 medications.

• Tier 3 and Tier 6 medications do not have a defined copay, but are subject to a deductible/coinsurance. This means that employees will have to pay the full cost of the medication until they meet their deductible. Once they meet their deductible, they will be responsible for the 20% coinsurance amount until they reach the out-of-pocket maximum. Medications that are subject to coinsurance in most cases will result in higher out-of-pocket costs to members.

• As a reminder, if an exception is approved for an excluded drug, it is only approved for coverage at the Tier 3 or Tier 6 member copay level.

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Premium Rates

2019 Premium Rates (80/20 & 70/30 Plan)

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Monthly Premium Rates 2019 Rates *80/20 Plan Subscriber Only $50.00Subscriber + Child(ren) $305.00Subscriber + Spouse $700.00Subscriber + Family $720.00

70/30 Plan Subscriber Only $25.00Subscriber + Child(ren) $218.00Subscriber + Spouse $590.00Subscriber + Family $598.00

*Assumes completion of tobacco attestation. The employee-only premium will be $60 higher per month if the tobacco attestation is not completed. NOTE: 70/30 Plan for retiree-only coverage remains premium free.

2019 Premium Rates (High Deductible Health Plan)

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Monthly Premium Rates 2019 Rates

HDHP

Subscriber Only $96.00

Subscriber + Child(ren) $284.00

Subscriber + Spouse $513.00

Subscriber + Family $617.00

Employer Contributions• The State Budget provides an increase of 4% in the monthly employer

contributions:• Active Employer Contribution Rate: $518.64• Medicare Primary Employer Contribution Rate: $403.06 • Non-Permanent Full-time Employer Rate (HDHP): $141.75

• As a reminder, the current monthly employer contribution rate for active employees is $498.68.

• 2019 rate sheets will be available on the Plan's website soon. • The monthly employer contributions above will be effective January 1,

2019, which means they should be reflected in December's payroll deductions.

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January Invoices• January invoices

• Can be scheduled to run any time after December invoice has been paid

• Contact the Blue Cross NC Billing Department at 800-245-7319 or stateppoinvoice@bcbsnc.com

• Please remember to request the invoice date to be changed back to your regular preferred schedule.

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High Deductible Health Plan (HDHP) Reminder!• As a reminder, employees selecting the HDHP

will enroll this year through eBenefits.• The HDHP features a higher deductible than

other traditional medical and pharmacy benefit plans.

• Employees should check with HBRs to confirm their eligibility prior to enrolling.

• Employees eligible for this plan will click eBenefits at the top of the State Health Plan home page, then register with a user name and password before enrolling.

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Open Enrollment Communications

Communicating Open Enrollment to Members

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• Communications will begin in August:• Direct mail• Telephone Town Halls (for retirees)• Webinars

Remember to process terminations for members turning 65 and retiring in the next couple of months so they receive the

appropriate mailers.

• Resources available on the Plan’s website will include:• Videos • Decision guides• Rate sheets• Comparison charts• Benefit Booklets• Summary of coverage documents

SEPT 2018

OCT 2018

AUG 2018

Extended Call Center Hours

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• The Eligibility and Enrollment Support Center will have extended hours:

• Monday – Friday, 8:00 a.m. – 10:00 p.m.• Saturday 8:00 a.m. – Noon.

• Encourage your employees not to wait until the last minute! Longer hold times occur the first and last week of Open Enrollment.

855-859-0966

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Open Enrollment eBenefits Work Flow

Member Home Page at Login

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Click Get Started

Adding Dependents

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Make any needed changes to your

dependents, then click Next.

Begin Enrollment

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Click Begin

Enrollment

Reason for Change

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Select Open

Enrollment

Click Next to continue

Who do you want to cover?

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Click Next

Plan Selection

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Review options and click “Select plan”

and “Next” to continue.

This HR note will display.

Tobacco Attestation and Premium Credit

Select Answer,

then click Next

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Select Answer, then click Next

Medical Summary Page

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Other options to edit Premium Credit, Additional Insurance and Primary Care Provider will follow.

Click “Edit” to modify tobacco survey answer if

you need to.

Click “Edit” to update additional insurance if

you need to.

Click “Edit” to add a Primary Care Provider

if you need to. Click Save

Review Elections and Select Save!

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Click “Save changes” to complete enrollment

process

Confirmation Page

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Click to view and print Confirmation Statement

Confirmation statement example.

Important Points to Reinforce for Members

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• Members need to SAVE their choices at the end of the enrollment process.

• Many members overlook this vital, final step and therefore fail to complete enrollment!

• All enrollment choices will be displayed for confirmation – but the member isn’t finished yet!

• Members then need to scroll down and click SAVE to record their enrollment choices. Otherwise, it will be as if they never enrolled.

• Printing out their confirmation statement is also recommended!

The choices you pickWill NOT stickUnless you SAVE themWith a CLICK!

New Enrollments During October 1 – December 1• Newly eligible/enrolling members during and after OE

• Will be automatically prompted to complete their OE elections• Must complete the tobacco attestation for 2018 and 2019

• Enrollment approvals • As we do every year, we will be reminding you to approve the OE

elections as soon as possible throughout OE• Elections that are not approved by the end of OE will be approved in

mass by Benefitfocus• New 2018 enrollments completed during this time may be included in

the “mass approvals”

• Please remember to set new hires up as quickly as possible to ensure they have the full 30 days to complete their enrollment

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Medicare Retiree Plan Changes

2019 Medicare Retiree Plan Options

• Medicare retirees will have the following plan options for 2019:• UnitedHealthcare Medicare Advantage Base Plan• UnitedHealthcare Medicare Advantage Enhanced Plan• 70/30 Plan

• ALL Medicare primary members enrolled in the 70/30 Plan will be moved to the UHC Medicare Advantage BASE Plan effective Jan. 1, 2019. If they want a different plan option they will need to take action!

• Encourage your retirees to attend Medicare Outreach meetings in September & October!

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Important Note: Members are no longer able to edit/add Medicare information, they must call the Eligibility and Support Center or have their

HBR update it.

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Dependent Eligibility Verification

Dependent Eligibility Reminder• Open Enrollment is the time to add/drop dependents and/or change

plans • Outside of OE, there must be a QLE to add/drop dependents

• Within 30 days of the event• Dependent verification documentation is required for all

dependents. It is the HBR’s responsibility to ensure the proper documentation is uploaded for all new dependents, including dependents added during OE: • Full list of required documents on the Plan’s website

• Documents should be uploaded and stored on eBenefits• Contact HBR Support at Benefitfocus or your Account Manager

for help

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Coming Soon!

Health & Wellness Resources • Pursuing its goal to reduce costs and build value, the State Health Plan is

streamlining its population health management services. The Plan is eliminating those services already provided by other vendors (such as health coaches). As a result, from Sept. 30-Dec. 31, 2018, the Plan will not be offering the following services for eligible members:

• An Online Personal Health Portal• Disease and Case Management services for those with chronic

obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, diabetes and hypertension

• The Plan is working with Blue Cross NC, its third party administrator, to offer services to eligible members beginning January 1, 2019.

• The Plan encourages members to work with their health care provider and community resources during this short time period.

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HBR University

• HBR University will be an online training tool for HBRs that will allow the Plan the ability to issue and track training to ensure that HBRs have the knowledge and guidance necessary to perform their duties as they relate to the Plan.

• An announcement will be coming soon on how to register and the appropriate next steps to get started.

• We hope this tool will be your one-stop shop for training, reference guides and tools regarding the Plan.

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Any Questions?• HBR SUPPORT LINE

800-422-5249• BEACON HBRs can call HBR Support line for general questions• Reach out to BEST Shared Services for member-specific issues and billing

• 919-707-0707 (in Raleigh) or 866-622-3784• Submit a ticket to SVC_OSC.best <best@osc.nc.gov

• ELIGIBILITY AND ENROLLMENT Support Center for Members855-859-0966

• CVS CAREMARK (PHARMACY BENEFITS)888-321-3124

• BLUE CROSS AND BLUE SHIELD OF NC(BENEFITS, CLAIMS and HRA)888-234-2416

• iTEDIUM (PREMIUM BILLING, DIRECT BILL/COBRA)877-679-6272

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www.shpnc.orgwww.nctreasurer.com

Thank You!

This presentation is for general information purposes only. If it conflicts with federal or state law, State Health Plan policy or your benefits booklet, those sources will control. Please be advised that while we make every effort to ensure that the information we provide is up to date, it may not be updated in time to reflect a recent

change in law or policy. To ensure the accuracy of, and to prevent the undue reliance on, this information, we advise that the content of this material, in its entirety, or any portion thereof, should not be reproduced or broadcast without the express written permission of the State Health Plan.