Post on 14-Jan-2016
RISK MANAGEMENT & INSURANCEOCTOBER, 2015
BENEFLEX 2016
ANNUAL ENROLLMENT
Annual Enrollment
2016 Health Renewal
Terms and Definitions
Humana Health Plan Changes
Rx4 Traditional Prescription Plan
2016 Health Payroll Deductions
Humana Vitality
Dental Plan Rate Changes2
Eye Med Vision Changes
Short and Long Term Disability
Flexible Spending Accounts (FSA)
Humana Resources
Reminders
Questions & Answers
AGENDA
Annual Enrollment
October 14 thru October 26, 2015
Coverage Begins: January 1, 2016
Deductions begin: 12/4/15 – Support 12/11/15 – Instructional/Administrative/PTS
2016 Flexible Spending Account and MetLife Legal deductions begin: 1/15/16 - Support 1/8/16 -Instructional/Administrative/PTS
3
2016 Health RenewalProposed 2016 health renewal was 9.3% over 2015
plan costs. After plan design changes , the increase was reduced to 6.5%
Projected 2016 premium is $121M; which equates to a $7.4M premium increase
Overall the District will pay approximately 76% of the overall costs-
New Humana Vitality Program can help offset the increase in costs if members reach Silver Status or above
4
Terms and Definitions
Co-payment - the specified dollar amount that the member must pay for a covered service. You will pay co-payments for services under the HMO Staff plan.
Co-insurance - the % amount of a covered service that the member must pay. Example: An 80%/20% coinsurance means that Humana will pay 80% of the allowable charge and the member will pay 20%.
5
Terms and Definitions
Deductible - the amount of covered services that the member must pay per year before Humana pays benefits for covered services.
Medical Out-of-pocket limit - the most a member would have to pay per calendar year before Humana pays 100% of the in network cost. Excludes Rx costs.
6
Terms and Definitions
DEDUCTIBLEYou pay 100% of
the cost up to the amount of the
deductible*
CO-INSURANCEYou pay 20% of
the cost up to the out of pocket
limit
OUT OF POCKET LIMIT
Humana pays 100% of the costs
after the costs reach $4000 for an individual,
$8000 for a family
7
*All individual deductible amounts will count toward the family deductible, but an individual will not have to pay more than the individual deductible amount.
HMO Staff
Very Narrow Primary Care Physician Network – Tampa Bay area only
No Out-of-Network Benefit except for emergencies
Referrals to Specialists limited by PCP Choice
Co-pays for all services; preventive services covered at 100%
Hospital co-pay: $500 per day, 5 day maximum
Increased Co-pays:
Emergency Room Co-pay from $300 to $500
Lab Co-pay from $0 to $25**or less if actual cost is less than the co-pay
Durable Medical Equipment: from $0 to $50
Out of Pocket Maximumfrom $3,500 to $4000(individual)from $7,000 to $8,000 (family)
KEY FEATURES CHANGES
Please confirm PCP participation with Humana customer service or online – NOT the doctor’s office!
National Point of Service Plan (NPOS)
Broad National Point of Service (NPOS) network – open access
No specialist referrals
In Network and Out of Network Benefits
Preventive services covered at 100%
Hospital co-pay: $500 per day, 5 day maximum
80%/20% coinsurance for physician visits, outpatient services, lab and x-rays after deductible
Deductiblefrom $300 to $400 (individual)from $600 to $800 (family)
Out of Pocket Maximumfrom $3,500 to $4000(individual)from $7,000 to $8,000 (family)
KEY FEATURES CHANGES
Good option for out of area retirees and students!
Consumer Directed Health Plan (CDHP)
HMO Premier Network – larger Tampa Bay network than the Staff HMO network
Network includes: Several Florida counties and a limited number of states outside Florida
NO out of network benefits
Preventive services covered at 100%
80%/20% coinsurance for physician visits, outpatient services, lab and x-rays, after deductible
Deductible $1500 (individual) $3000 (family)
Personal Care Allowance (PCA) $500 (individual) $1000 (family)
Rollover feature, however if you move to another plan any remaining PCA funds will be forfeited.
KEY FEATURES KEY FEATURES
Out of Pocket Maximumfrom $3,500 to $4000(individual)from $7,000 to $8,000 (family)
CHANGES
Which Health Plan is Right for You?
HMO CDHPNPOSMust stay in Network
Must Select a PCP
No Deductible - set co-pays for all services
Limited coverage area
Must get a referral to see a specialist
Must stay in Network
Not required to select a PCP
No referrals necessary
Must meet a deductible
Healthcare allowance provided
Not required to stay in Network
Not required to select a PCP
No referrals necessary
Must meet a deductible
Pinellas County Schools health insurance coverage meets the standard for minimum essential coverage and is considered affordable under the Affordable Care Act.
Benefit eligible employees who enroll in the Marketplace plans would not be eligible for Advanced Premium Tax Credits (tax subsidy) and would not receive premium assistance.
PCS COVERAGE VS. THE HEALTHCARE MARKETPLACE
Pharmacy BenefitsRx4 Traditional replaces Rx3
RightSource Rx is now Humana Pharmacy
Pay two co-pays for a 90 day supply at a participating pharmacy or mail order through Humana Pharmacy (after deductible on Tier 3 & Tier 4 medications).
Tier/Plan Consumer Directed Health
Plan
Staff HMO National Point of Service (NPOS)
Employee $30 to $53 $48 to $71 $63 to $80
Employee + Spouse
$120 to $159 $158 to $195 $182 to $213
Employee + Child/Children
$115 to $146 $151 to $182 $175 to $200
Family $178 to $215 $230 to $266 $262 to $302
2 Board Family $85 to $120 $137 to $171 $169 to $207
14
2016 Health Plan Deductions
Humana Vitality is a wellness and rewards program for employees enrolled in a Humana health plan that gives its members an opportunity to: Set goals – create a personalized plan!Earn Vitality Points™ and shop at the Vitality Mall with Vitality
Bucks!Learn the value of making healthy choices to experience
personal results!
Employees reaching Silver Status or above by June 30, 2016, will be eligible for a premium credit during 2016 AND 2017!
Employee Only $10 credit per pay period Employee + Spouse $15 credit per pay period Employee + Child/ren $15 credit per pay period Employee + Family $20 credit per pay period
Better health, great rewards-it's all part of Humana Vitality!
Dental Plans/Rate Changes
16
Humana Comp Benefits
Employee Only $7.45 per pay
Employee + 1 $13.74 per pay
Employee + Family $20.07 per pay
2 Board Family $18.07 per pay
No plan design changes
Preventive services covered 100%
In-network benefits only
Co-pays for services
Met Life Dental
Employee Only $13.36 per pay
Employee + 1 $24.64 per pay
Employee + Family $35.56 per pay
2 Board Family $33.56 per pay
No plan design changes
Preventative services covered
100%
In-network and out-of-network
benefits
Reimbursement based upon
services (negotiated rates)
Eye Med Vision Plan
17
KEY FEATURES CHANGES
Free coverage for employee only May purchase coverage for dependents Routine eye exam once every calendar year - $10 co-pay Single vision lenses OR contact lenses once every calendar year
Frames once every two years National retail and private practice optometrists & ophthalmologists
Standard plastic lens co-pay from $10 to $15
Contact lens allowancefrom $90 to $11020% of balance over $110
Frame allowancefrom $90 to $110
RATES Employee Only Free Employee + 1 $2.83 Employee + Family $5.92
Short Term/Long Term Disability
Rate Decreases
No plan design changes
One time open enrollmentNo medical underwriting
Salary limitations and preexisting conditions apply
18
Flexible Spending Accounts (FSA)
19
A Health Care FSA could save you money if you or your dependents:
Have out of pocket health expenses like co-pays or deductibles
Take Tier 3 or Tier 4 prescription medications and have an Rx deductible
Wear glasses or contact lenses
Need orthodontia care, such as braces or other eligible dental expense
A Dependent Care FSA provides pre-tax reimbursement of out of pocket expenses related to dependent care, if you and your spouse are working or in school and:
Your dependent children under age 13 attend daycare, after-school care or summer day camp
Flexible Spending Accounts (FSA)
20
You decide how much to contribute:
Health Care FSA: $200 - $2500
Dependent Day Care FSA: $200 - $5000
Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31.
Receive a debit card – for Health Care Expenses. Not for Dependent Day Care.
Funds available for Health Care expenses on January 1, 2016
Look for Humana Access Visa cards last week in December (plain envelope)
What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana:
1. Visit www.MyHumana.com2. Have your Humana ID card
handy3. Go to Humana.com4. Click “Register for
MyHumana”5. Follow the easy steps to
register
21
24 Hour Humana Online Resources
Humana PCS Resources
Heather Keegan, RN – Patient AdvocateAssists employees with medical and provider issues. Coordinated Diabetes Care Program. Advocates for employees.
Jessica O’Connell, RN – Health & Wellness SpecialistFacilities wellness and health education programs, enrolls members in disease management, clinical programs and Humana Vitality.
Janet Lang - On Site Claims RepresentativeAssists employees with eligibility, claims and coverage issues.
22
RemindersChanges through Web only October 14 - 26th
Confirmation notices available on line for employees to print
Review health plan options and new Rx4 Traditional plan
Review new rates for dental plans
Review new rates and plan changes for vision
Review special disability open enrollment, reduced rates
Make sure your life insurance beneficiaries are current
Make sure you have enrolled only eligible dependents
Humana will mail everyone new ID Cards. Make sure your address on Employee Self Service is correct
Enroll in MyHumana so that you can participate in the Humana Vitality Program
23
QuestionsVisit our web site for current information, including full Beneflex Guide, Understanding your Rx4 Traditional plan, CDHP & FSA flyers at:www.pcsb.org/annual-enrollment
Call the Humana Hot Line:888-393-6765, 8:00 am – 8:00 pm, Monday thru Friday.
Call the PCS Benefits Help Line for enrollment assistance 588-6197, 8:00 am – 4:30 pm, Monday thru Friday.
Email us at houckc@pcsb.org
24