1 Health Insurance and Flexible Benefits Annual Open Enrollment May 1 – May 23, 2014 presented by...

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Health Insurance and Flexible Benefits

Annual Open Enrollment May 1 – May 23, 2014

presented by

Employment & Benefits

Department of Human Resources

Health Insurance and Flexible Benefits2014 Open Enrollment

Open Enrollment Options

Changes for July 1, 2014

Deadlines & Effective Dates

Benefits at a Glance COVA Care COVA HealthAware COVA High Deductible Health Plan (HDHP) TRICARE Voluntary Supplement

Premiums Effective July 1, 2014 Reflected on July 16 pay date

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Health Insurance and Flexible Benefits2014 Open Enrollment

Types of Membership

Eligible Dependents

Making Changes Outside Open Enrollment

Flexible Spending Accounts over-the-counter drug/medical expenses

How to Enroll/Make Changes

Resources and Questions

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Open Enrollment Options

• Health Care Coverage• enroll in or change your health plan• keep your current plan• consider optional buy-ups• add or remove eligible family members• waive health care coverage

• Premium Rewards• enroll or remain in COVA Care or COVA

HealthAware to qualify

• Flexible Spending Accounts (FSAs)• enroll in a health or dependent care FSA

Changes for July 1, 2014

New Premiums for all plans except COVA HDHP & TRICARE voluntary supplement

COVA Care•prescription drug copay tiers 2-4 increase $5 retail and $10 for home delivery

COVA HealthAware•two new “do rights” for the HRA

COVA Care & COVA HealthAware•Asthma/COPD and hypertension incentive programs added to MyActiveHealth

COVA Care, COVA HealthAware & COVA HDHP•Residential treatment centers added to behavioral health services

Flexible Spending Accounts (FSAs)•Period to file claims changes if your account ends before 06/30/15

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COVA Care & COVA HDHP Overviewadministered by Anthem & Delta Dental

COVA Care is a preferred provider organization (PPO)•Pay copayments or coinsurance•Must meet deductible for certain services

COVA HDHP is a high deductible health plan•Must meet deductible and then pay 20% coinsurance for service up to the out of-pocket limit•Allows member to set up a Health Savings Account (HSA) to help you pay for health care expenses or save towards retirement•Must set up HSA through local bank or financial institution

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COVA Care & COVA HDHP includes;•all doctors & hospitals in the Anthem BC/BS PPO network for medical, behavioral health and pharmacy services in Virginia and;•the BlueCare PPO & BlueCard Worldwide programs for coverage outside of VA•Both plans include an Employee Assistance Program (EAP)

Optional Buy-up are available for an additional premium

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Dental benefits are through the Delta Dental network•employee is responsible for co-pays and deductible if services are through the DD network•if services are outside the network, DD will pay the allowable charge and employee may be balanced billed by the provider

Consider your dental needs carefully•basic plan covers only routine exams and cleaning •expanded dental provides basic dental plan coverage plus coverage for primary, complex restorative and orthodontic services

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COVA HealthAwareadministered by Aetna

Plan includes an employer paid HRA•employee/retiree only = $600•employee/retire + spouse = $1200

Coverage paid at 100 % for in-network preventive medical, dental, vision, and hearing exams

Provides out-of-network coverage

Optional benefits (additional premium):•expanded dental•expanded dental & vision

Initial contribution to your HRA

Opportunity to earn more HRA contributions by completing “do rights”

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COVA HealthAwareadministered by Aetna

Earn “Do Rights” to Get More HRA Dollars•receive $50 in your HRA for each “do right” up to $150 for 3 activities•spouse also eligible for up to $150 for completing 3 “do rights”•total of up to $300 for both employee and spouse

Eligible “Do Rights”•routine annual physical exam•routine dental exam•routine vision exam (new)•annual flu shot•MyActiveHealth health tracker usage•MyActiveHealth coaching module completion (new)

Unused HRA funds roll over into the new plan year with no limit as long as you stay in the plan

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MyActiveHealthCOVA Care, COVA HDHP and COVA HealthAware Participants

MyActiveHealth allows you to access your health information 24/7

Go to www.MyActiveHealth.com/COVA•Health information in one place•Personalized health action items•Easy-to-use health tips, tools, and trackers

Programs include:•Health Insights to help manage chronic conditions

• Free prescription drugs & supplies when requirements are met• Diabetes management• Asthma and COPD (new)• Hypertension (new)

• Depending on Plan, hospital co-pay waiver or HRA contribution when requirements are met

• Bariatric surgery education

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MyActiveHealthCOVA Care, COVA HDHP and COVA HealthAware Participants

• Healthy Beginnings for expectant moms• Helps moms be healthier so their babies will be too• Includes incentives when you have certain conditions that qualify• Depending on Plan, hospital co-pay waiver or HRA contribution when

requirements are met

• Healthy Lifestyles• For those generally healthy but need help staying on track• Includes coaching on :

• nutrition, • exercise, • stress management and • quiting tobacco

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2014 Benefits at a Glance

In-Network Benefits

COVA Care You Pay

COVA HealthAware*

You PayCOVA HDHP

You Pay

Deductible – per plan year-One person-Two or more persons

$225$450

$1,500$3,000

$1,750$3,500

Out-of-pocket expense -limit – per plan year-One person-Two or more persons

$1,500$3,000

$3,000$6,000

$5,000$10,000

Doctor’s visits-Primary Care Physician-Specialist

$25$40

20% after deductible20% after deductible



In-Network Benefits

COVA Care You Pay

COVA HealthAware*

You PayCOVA HDHP You

PayHospital Services-Inpatient-Outpatient

$300 per stay $125 per visit



Emergency Room Visits

$150 per visit(waived if admitted)

20% after deductible 20% after deductible

Ambulance Travel

20% after deductible 20% after deductible 20% after deductible

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In-Network Benefits

COVA Care You Pay

COVA HealthAware*

You PayCOVA HDHP

You Pay

Outpatient diagnostic, laboratory, tests, shots and x-rays


Infusion services (includes IV or injected chemotherapy)


Outpatient therapy visits-Occupational, physical and speech therapy-Chiropractic (30-visit plan year limit per member)

$25 PCP/$35 specialist

$35

20% after deductible 20% after deductible

20% after deductible


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In-Network BenefitsCOVA Care

You Pay

COVA HealthAware*

You PayCOVA HDHP

You Pay

Applied behavior analysis (ABA) for autism spectrum disorder – ages 2 through 6-$35,000 annual limit

$25 per service



Behavioral Health VisitsMedical & non-medical prof visitsInpatient residential treatmentIntensive outpatient treatment (IOP)

$25$300 per stay$125 per episode of care

20% after deductible20% after deductible20% after deductible

20% after deductible20% after deductible20% after deductible

Employee Assistance Program (EAP)Up to 4 visits per incident

$0

$0

$0

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In-Network BenefitsCOVA Care You

Pay

COVA HealthAware*

You PayCOVA HDHP

You PayPrescription drugs – mandatory genericRetail Pharmacy

Home Delivery Pharmacy

Up to 34-day supply$15/$30/$45/$55

Up to 90-day supply$30/$60/$90/$110

Up to 34-day supply20% after deductible




Dental ServicesDiagnostic & preventive $0 $0 $0

Annual Routine Vision Exam Not Available $0 Not Available

Annual Routine Hearing Exam Not Available $0 Not Available

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In-Network Benefits

COVA Care You Pay

COVA HealthAware*

You PayCOVA HDHP

You Pay

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Wellness & preventive services

$0 $0 $0

Office visits at specified intervals, immunizations, lab and x-raysAnnual check-up visit (primary care physician or specialist), immunizations, lab and x-raysRoutine gynecological exam, Pap test, mammography screening, prostate exam (digital rectal exam), prostate specific antigen (PSA) test, and colorectal cancer screening



Pay

COVA HealthAware*

You PayCOVA HDHP

You Pay

Expanded Dental*Maximum benefit – per member

Deductible

Primary (basic) care

Complex restorative (inlays, onlays, crowns, dentures, bridgework)

Orthodontic- Lifetime maximum benefit

Optional Benefit$2000

$50/$100/$150



50% no deductible$2000


$50/$100/$150





$50/$100/$150




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Pay

COVA HealthAware*

You PayCOVA HDHP

You PayRoutine Vision(once every 12 months)

Routine eye exam

Optional Benefit

$40

Optional Benefit

Included in basic plan

Not Available

Eyeglass frames

Lenses-Eyeglass lenses (standard plastic, single, bifocal or trifocal) or-Contact lenses – *Conventional or *disposable

*non-elective

20% off balance after plan pays first $100

$20


Balance after plan pays $250


$20


Balance after plan pays$250

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In-Network Benefits

COVA Care You Pay

COVA HealthAware*

You PayCOVA HDHP

You PayRoutine Hearing(once every 48 months)Routine hearing exam

Optional Benefit

$40 Included in basic plan Not Available

Hearing aids and other hearing-aid related servicesBenefit maximum

Balance after plan pays $1,200$1,200

Not Available Not Available

Out-of-Network Optional BenefitPlan payment reduced by 25%. Provider may balance bill for amount above allowable charge

Additional deductible out-of-pocket limits apply. 40% coinsurance after deductible. Provider may balance bill for amount above allowable charge.

Not Available

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Health Plan Monthly PremiumsEffective 07/01/2014

Single Plus One Family

COVA Care

(with preventive dental)$75 $171 $230

COVA Care + Out-of-Network $89 $190 $256

COVA Care + Expanded Dental $100 $219 $303

COVA Care + Out of Network + Expanded Dental

$114 $238 $329

COVA Care + Expanded Dental + Vision & Hearing

$115 $244 $337

COVA Care + Out of Network + Expanded Dental + Vision & Hearing

$129 $263 $363

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Health Plan Monthly PremiumsEffective 07/01/2014

Single Plus One Family

COVA HealthAware

(with preventive dental)$26 $81 $96

COVA HealthAware + Expanded Dental

$51 $129 $169

COVA HealthAware + Expanded Dental & Vision

$59 $143 $188

COVA HDHP (with preventive dental)

$0 $0 $0

COVA HDHP + Expanded Dental $25 $48 $73

TRICARE Voluntary Supplement $61 $120 $161

Premium Rewards

Already earning a Premium Reward?•keep it through 06/30/15 as long as you stay in COVA Care or COVA HealthAware

How to Earn a Premium Reward•be enrolled in COVA Care or COVA HealthAware•complete and submit both a Health Assessment and a Biometric Screening by May 31, 2014•go to www.myactivehealth.com/cova to begin •if you do not have access to the Internet or need help call ActiveHealth at 866-938-0349

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Premium Rewards

Health Assessment•go to the health assessment link to answer the questions•click “complete and save”•you or your spouse need to register separately and complete your own health assessment

Biometric Screening•go to the biometric screening link•print either a:

• Biometric Screening Physician Form and take it to your doctor or• Lab Corp authorization to take to a location convenient for you• follow all instructions on the form or authorization

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Premium Rewards

New to COVA Care or COVA HealthAware on July 1, 2014?

Follow the steps in the Spotlight to receive the rewards

Complete both requirements by July 31, 2014•premium rewards begins August 1, 2014

Complete both requirements by August 31, 2014•premium rewards begin September 1, 2014

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Types of Membership

• Employee Single – employee only

• Employee Plus One – employee plus one eligible family member (spouse or child)

• Family Coverage - employee and two or more eligible family members

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Eligible Dependents

• Legally married spouse

• Natural and adopted children, stepchildren, children placed for adoption under age 26

• Unmarried children in the court-ordered sole, permanent custody of the employee

• Must reside full-time with the employee • Employee provides more than half of dependent’s support• Court ordered custody must be awarded prior to the child’s

18th birthday

• Disabled children

Eligibility Documentation

Legally Married Spouse Photocopy of marriage certificate and top portion of first page of employee’s recent Federal tax return

Natural or Adopted Children Photocopy of birth certificate showing employee’s name or photocopy of legal adoptive or pre-adoptive agreement

Stepchildren Photocopy of birth certificate showing employee’s spouse’s name and photocopy of marriage certificate and photocopy of top portion of first page of employee’s recent Federal tax return

Unmarried children in court-ordered sole, permanent custody of employee

Photocopy of birth certificate and photocopy of Final Court Order with presiding judge’s signature 29

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Flexible Spending AccountsPlan Year 2014-2015

FSA available to all eligible employees• Save on health care out-of-pocket costs• Pay for eligible medical or dependent care expenses with

pre-tax dollars

FSA Open Enrollment concurrent with Health Insurance Open Enrollment

July 1, 2014 Effective Date for New Accounts

FSAs are use it or lose it so don’t overestimate expenses

If you take no action, you will have no FSA

Flexible Spending AccountsPlan Year 2014-2015

Maximum Contributions:•Health FSA: up to $2,500•Dependent Care FSA: up to $5,000

• depending on tax filing status

Minimum Contribution: $10 per pay period

Administrative Fee: $3.65 monthly on a pre-tax basis for one or both FSA accounts

If enrolled in COVA HealthAware, the HRA pays health expenses first

If enrolled in FSA for only part of plan year you must file for claims within three months after coverage period ends (new)

If account ends 06/30/15 you still have until 09/3015 to file for reimbursement

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Flexible Spending AccountsFSA Benefit Card

Annual contribution available on July 1, 2014

Will automatically receive an Elite VISA Benefit card when you enroll in Medical FSA

• instructions on using the new card will be provided with the card – read carefully

Card accepted when:• used with a provider, i.e., doctor or hospital, and the

charge is equal to the co-pay amount• Over-the-counter and prescriptions purchases only

accepted at IIAS certified merchants • IIAS = inventory information approval system

ALEX is Back and ALEX can Help!

ALEX is an online interactive assistant designed to help you decide which plan may be the most cost-effective for you.

Visit www.alexforcova.com and follow the prompts. ALEX will:

• ask questions about your individual needs;

• explain the plans offered;

• estimate the lowest cost plan option for you; and

• provide a plan comparison.

The final decision is yours! 33

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Open EnrollmentHow to Enroll/Make Changes

Enroll on-line• Go to www.DHRM.virginia.gov• Click on the Employee Direct link and register a

new account.• Must use your 7-digit Employee Number

• Number is included in the ID number used in Payline and is also within the ID number on the HI card

• Date of Birth entered as (MM/DD/YYYY)• Valid state or personal E-mail Address

• Employee Direct available 24/7• Enroll using paper forms

• Drop by Human Resources• No Appointment Necessary• Deadline Friday, May 23, 2014 at 5:00 p.m.

2014 Open Enrollment

Department of Human Resources314B Tyler Place, 2nd Floor

831-5008

Larry Ashby, Mgr, Employment & Benefits

Carmella Carter, HR Generalist

Alicia Dials, HR Generalist

Jack Wright, Sr. HR Generalist35

1 Health Insurance and Flexible Benefits Annual Open Enrollment May 1 – May 23, 2014 presented by...

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