welcome. cost share & rate changes benefit changes life insurance flexible spending...
TRANSCRIPT
Open Enrollment for 2015
October 20 through November 7
Welcome
Cost Share & Rate Changes Benefit Changes Life Insurance Flexible Spending Accounts Open Enrollment Process Qualifying Events Questions & Answers Raffle
Agenda
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Cost Sharing and Rate Changes
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Cost Share
FOP Represented Employees – Park Police80% / 20%
MCGEO Represented and Non-Union Merit Employees
80% / 20% 85% / 15% (Prescription and UHC EPO)
Term Contract Employees50% / 50%
Retired Employees80% / 20%
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Rate Changes
Self-Insured Plans
CIGNA Open Access Plus EPO – 0%
UHC EPO – 0%
UHC POS – 5.6% increase ($2.77 bi-weekly for single)
Prescription Plan – 14.8% increase ($1.53 bi-weekly for single)
UHC Medicare Complement – 25.7% increase ($10 monthly for single)
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Rate Changes
Fully Insured Plans
Vision Service Plan – 19.8% increase ($0.06 /$0.30/$0.54 bi-weekly)
United Concordia Dental – 0%
CIGNA Long Term Disability (LTD) FOP Plan – from $1.84 to $2.13 per $100 of benefit Non-FOP Plan and Supplemental LTD – 0%
Minnesota Life and Accidental Death & Dismemberment – 0%
Legal Resources – 0%
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Benefit Changes
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Benefit Plan Changes
Dental and Vision Coverage for Young Adults Effective January 1, 2015, M-NCPPC will extend
dental and vision coverage for young adults up to age 26 without proof of full-time student status to coincide with medical coverage
Employees may add previously terminated and new dependents by completing an enrollment form and submitting a copy of the birth certificate.
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Benefit Plan Changes
Vision Coverage We are switching from Vision Service
Plan’s Signature plan to their Choice plan, providing a greater benefit for covered services, but reducing the discount for non-covered items. Allow lenses every 12 months instead of
24 months for the Moderate Option Allow eye exams every 12 months
instead of 24 months for the Low Option
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Benefit Plan Changes
Vision Coverage Increase the frame allowance from $130 to
$200 for the High Option and from $130 to $150 for the Moderate and Low Options
Increase the contact lenses allowance from $130 to $150 for the High Option and keep at $130 for the Moderate and Low Options
Lower the discount on non-covered lens options from 35-40% to 20-25%. The member’s maximum out-of-pocket expense for these lens options will increase; e.g. $37 to $41 for anti-reflective coating and $23 to $31 for polycarbonates.
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Benefit Plan Changes
Sick Leave Bank
Current members of the bank will not have to contribute hours to participate for 2015
New members will have to contribute required hours
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Benefit Plan Changes
UHC SELECT EPO The schedule of when mammograms are covered was
changed back in 2012 to mirror the schedule under the UHC Choice POS plan but it was never communicated
Mammograms were previously covered every year The new frequency limits follow the current Maryland
Mandate for mammograms Ages 35-39, one baseline Ages 40-49, one every 2 years Ages 50+ - annually
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Specialty Drugs Step Therapy
Specialty drugs are medications that are used to treat specific low-incidence chronic and/or genetic conditions.
Similar to the generic step therapy implemented this year. We are implementing this for the following three specialty drug classes Auto-Immune, Multiple Sclerosis and Infertility
Members must try a lower cost drug for 30 days before they are approved for the higher cost drug.
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Specialty Drugs Step Therapy
The step therapy will apply only to new users of a medication.
When a prescription for one of the targeted specialty drugs is presented to the pharmacy, the pharmacy will check for previous use of an appropriate lower cost alternative.
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Prior Authorization for Compound Drugs
Compounding is the combining, mixing, or altering of ingredients to create a customized medication that is not otherwise commercially available.
We are implementing a Prior Authorization for compounded medications with an ingredient cost exceeding $300
The PA criteria require that any individual ingredient component being requested must be FDA approved in the same finished dosage form of the compound. For example, if an ingredient is not approved for topical
use, it will not be approved for topical use within a compound.
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Prior Authorization for Compound Drugs
When a member presents a prescription that requires PA to the pharmacy, the pharmacist will advise the member that their physician will need to call Caremark.
If the prescribed therapy meets nationally approved clinical guidelines then the prescription will be approved.
Our current drug program already has the PA process in place for other drugs such as medications for acne, antifungals, anabolic steroids, testosterone and erectile dysfunction.
Compounded drugs prescribed to treat any non-covered condition will be rejected.
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Pharmacy Advisor Program
The Pharmacy Advisor Counseling program helps improve members’ health through one-on-one pharmacists counseling (face to face and by phone), tailored messaging, and coordination with health care providers at the most critical point in therapy.
This program reinforces adherence from the first time a prescription is filled and throughout recommended usage, and closes gaps in care for the 10 most prevalent and costly chronic conditions: Diabetes Hypertension Dyslipidemia (High Cholesterol) Coronary Artery Disease Congestive Heart Failure Asthma Coronary Obstructive Pulmonary Disease (COPD) Depression Osteoporosis Breast Cancer
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Pharmacy Advisor Program
In addition to improving adherence and closing gaps in care, the program identifies potential drug interactions and other safety concerns such as managing potential non-critical side effects. When a member presents a prescription to be filled,
based on his or her prescription history, the pharmacist will consult with the member if he or she determines that other prescription regimens are missing, if the member is not refilling prescriptions in a timely manner, or if there potential side effects.
The pharmacist may contact the member’s physician for additional information or refer the member to his or her health plan’s disease management program.
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SilverScript Medicare Part D
The prescription plan for Medicare eligible retirees and employees on long term disability (LTD) who are eligible for Medicare will be converted to a Medicare Part D prescription plan.
The administrator of the prescription drug program for retirees, LTD employees and their dependents who are on Medicare will change from CVS/Caremark to SilverScript® Insurance Company, a CVS/Caremark company.
SilverScript® is a Medicare Part D group prescription plan. This new plan is a combination of two separate plans called an Employer Group Waiver Plan (EGWP) + Wrap Plan.
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SilverScript Medicare Part D
The main part of the plan, EGWP, is the Medicare Part D plan that uses a standard Medicare Part D formulary drug plan and the second part of the plan, the Wrap, is the current CVS/Caremark plan which will be a supplement to fill in the gap for drugs that Medicare Part D doesn’t cover.
This concept is similar to a Medicare Supplement plan around Medicare Parts A & B for medical care.
There will be minimal disruptions to Medicare eligible retirees and our co-pays will remain the same as those retirees under 65 who are enrolled in the CVS/Caremark Prescription Drug plan.
When retirees become eligible for Medicare due to age or disability, they will be moved over to the SilverScript® Medicare Part D prescription plan.
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Paper Reduction Initiative
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Paper Reduction
Everyone should have received a letter from Patti Barney announcing open enrollment and changes
All open enrollment documents and forms are available on our website at www.mncppc.org or on our intranet, inSite, by clicking the link for 2015 Open Enrollment.
Those that don’t have access to the internet may
request a hard copy of the enrollment packet or a specific form from local benefits coordinators or the Health & Benefits Office.
Open Enrollment Guide Employee Benefits Handbook Schedule of Open Enrollment meetings Excerpt of Benefit Changes and Highlights Contribution Rate Sheets Supplemental Information for Retirees Summary of Benefits Coverage (SBC) for each health plan Application for Benefits Enrollment Form Flexible Spending Form – Must complete each year Sick Leave Bank Form – Use only if enrolling for the first time Legal Resources Form - Use only if enrolling for the first time
Documents Online
your HEALTH · your MEDICAL · your DENTAL
your INSURANCE · your FLEXIBLE SPENDING
your BENEFITS · your CHOICES
YOUR 2015
OPEN ENROLLMENT
October 20 through November 7
Open Enrollment Link
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Life Insurance
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Supplemental Life Insurance
Currently, the maximum is 3 times salary capped at $300,000
Employees can now elect supplemental life insurance up to five times their base salary up to a maximum of $750,000.
This will be a good time to enroll in life insurance if not already covered. Proof of good health is required before coverage is approved
A special enrollment will take place during the first quarter of 2015, but employees can enroll at anytime during the year
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Dependent Life Insurance
Current coverage for spouses and children: $2000 for spouse and $1000 for each child at a flat rate of 43 cents per month
Increased coverage options starting 3/1/15. $10,000/$5000 at 2.45 per month $20,000/$10,000 at 4.90 per month $30,000/$15,000 at 7.35 per month
Proof of good health is required for spouses for option 3 only, none is required for children up to age 26
A special enrollment will take place during the first quarter of 2015
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Flexible Spending
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Flexible Spending Accounts
The purpose of flexible spending accounts is to reduce your taxable income by paying for certain health care and dependent care on a tax-free basis
Deductions are taken from your pay before taxes are applied, reducing your taxable income
Yearly limits for health care expenses is $2,500 and $5,000 for dependent care expenses
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Flexible Spending Accounts
Must enroll every year
Dependent care is for dependents under age 13
Must use by March 15th following the end of the plan year and submit claims by March 31st
Unused amounts are forfeited
FSA decision tool is posted online
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Open Enrollment & Qualifying Life Events
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Open Enrollment Process
Open Enrollment starts 10/20/14 and ends 11/07/14 at 5:00P.M.
This is the time you can add, drop or change plans; and remove or add dependents
Paper Reduction Initiative In preparation for Employee Self Service Forms must still be submitted to the Health & Benefits
office Request copies from benefit coordinators or the Health
& Benefits Office if you don’t have access to a computer
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Open Enrollment Process
If adding a dependent (child and/or spouse) please submit a copy of the birth certificate and/or the marriage certificate.
Complete a Legal Resources and/or Sick Leave Bank enrollment form if terminating coverage or enrolling for the first time. These benefits automatically rollover
You must re-enroll in the Flexible Spending Accounts (FSA) every open enrollment period (even if you are not making changes)
If applying for Domestic Partner Benefits (DPB), employees must the complete DPB Affidavit and enrollment application. Employees currently enrolled with a domestic partner must submit the Domestic Partner Certification form and enrollment application.
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Open Enrollment Process
All forms must be submitted by 11/07/14, close of business, 5:00P.M.
Forms may be submitted in the following manner Interoffice mail Hand deliver Certified mail Overnight carrier Email to [email protected]
Don’t send to individual specialists Fax to 301-454-1687
Except for FSA, if you are not making any changes, YOU DO NOTHING!!!
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Qualifying Life Events
Your marriage or divorce, annulment, or legal separation;
Your child’s marriage, divorce or annulment; A birth, adoption or change in a child's custody; A change in your or your spouse's or child’s
employment status, including part-time, full-time or retirement;
A change in your or your spouse's insurance (cost or coverage);
Commencement of or return from an unpaid leave of absence taken by you or your spouse;
Your dependent child no longer meets the eligibility requirements of a dependent;
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Qualifying Life Events
The death of your spouse, domestic partner or child;
Your relocation out of your plan’s coverage area;
Your domestic partnership ends; Your spouse’s open enrollment period; A change in dependent eligibility due to a
plan design change; A change in the dependent care
arrangements; A change in eligibility for a Commission plan
(i.e. Medicare Complement Plan)
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Qualifying Life Events
What should I do if I have one of these events – complete an application for benefit enrollment and submit to H&B within 45 days
If I fail to act during this period what is my recourse – failing to act means you wait until the next open enrollment period to make changes
Are there any special circumstance that allow me to enroll outside of the 45 days – NO!!!! Employees must act within the 45 day period or wait until the next open enrollment period.
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Qualifying Life Events
We continue to learn of employees who fail to add newborns timely or drop a spouse after a divorce. It is imperative that you notify the Health & Benefits office within 45 following any qualifying event if you wish to add, drop or make changes to your current elections Failure to act in a timely manner will cause you unnecessary expenses for which you will be responsible. If you are unsure contact the H&B staff and we can answer any questions surrounding a qualifying event. Do not rely on co-workers’ or doctors office staff’s advice.
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Questions ?
Answers