Celebrate …2008. Celebrate … Your health. New Principal Wellness program Additional resources...
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Transcript of Celebrate …2008. Celebrate … Your health. New Principal Wellness program Additional resources...
Celebrate…Your health.
New Principal Wellness program Additional resources within health plans
Your valuable benefit plans. Two new and improved consumer health plans Valuable plans at affordable cost in a market where costs
continue to rise at rapid rates from year to year
Your resources. Enhanced tools available from Anthem New Schurz Choice communication portal
Your choice. Continue year after year to have many options available
Meeting HighlightsNew or Changing for 2008
Wellness Program Medical Plan Options Flexible Spending Accounts Dental Dependent Supplemental Life Options Schurz Choice Communication portal ADP Employee Self Service portal
No Changes for 2008 Vision Group Life andAD&D Long Term Disability Employee Supplemental Life Options
2008 Benefit Overview
Benefit Administrator Change
Benefit/Plan Change
Cost Change Positive Impact vs. Negative
Impact
Wellness Program NEW- Principal NEW NEW- No Cost!
Positive
Medical No Yes Yes Positive for most
Dental No Yes Yes Positive
Vision No No No No Change
PCA (Health Reimbursement Account)
Yes Yes n/a Positive for most
Flexible Spending Accounts
Yes Yes n/a Positive
Group Life Insurance No No No No Change
Long Term Disability No No No No Change
Dependent Life Insurance
No Yes Yes Positive
What is Wellness? Worksite wellness programs are proactive, organized
programs that provide lifestyle and medical assistance that assist employees and their family members to promote and maintain good health
Wellness doesn’t just involve your physical health, it involves emotional, spiritual, occupational, social, and intellectual dimensions too
Wellness Makes $ense Most employees (83%) are in the low and medium
cost categories of healthcare spending Each risk factor avoided (such as high cholesterol or
high blood pressure) can save a company an average of $304 per risk factor per year
By keeping these employees out of the high-cost category, employees lead better lives and employers can potentially save thousands of dollars
To better compare the cost savings, look at a low-risk employee vs. a high risk employee. The difference between low- and high-risk categories is $2,882 per year, per employee
No. of Risk Factors Average Total Cost Per Year
0-2 $1,397
5 or more $4,279
Benefits of the Wellness Program
Better health for you and your family
Reduction in health insurance premiums for participation
Increased knowledge about your health and well-being
Culture of wellness in the workplace
Lower health care costs in the future
Wellness Program
Onsite health screenings for employees that include immediate results of a cholesterol panel, glucose, blood pressure, body composition, and a health risk analysis (HRA)
Quarterly “Words of Wellness” newsletters sent
to employees’ homes
Proven health coaching to high-risk individuals through email or phone
Trusted health information available to employees through Principal’s website
Important Information about Wellness
Principal Wellness program is open to all medical plan eligible employees
Regardless of whether someone: Elects medical coverage with Schurz Choice or not Elects Core or Alternate medical plan
All components are confidential- screening process, screening results, any health coaching discussions, calls, etc.
Reduced medical plan costs of $25 per month if you participate in the wellness program
To qualify for the premium incentive credit: Must complete the Principal screening (onsite or physician
packet) and complete the health questionnaire which is included in the Principal screening packet
How do I elect to participateGo through the ADP ESS enrollment
process- elect one of the following options:
PARTICIPATING: in the Principal Wellness program for 2008.
•Reduced premiums take effect January 1, 2008 (premium incentive credit)
•As long as you complete the Principal screening process in 2008, you will pay the reduced premiums for medical coverage.
NOT PARTICIPATING: in the Principal Wellness Program for 2008.
•Increased, non-wellness premiums take effect January 1, 2008 and continue through December 31, 2008 - UNLESS
•If you choose at the time of screening to go through the Principal Wellness screening process, Schurz will retroactively credit you the reduced premiums for medical coverage.
Why Participate in Wellness
You save $300 annually in medical plan premiums!
The on-site screening is valued at over $200.
You have the opportunity to improve or maintain your health status by being engaged in your health.
In order for Schurz to continue offering valuable health plans, your participation, understanding and advocacy for your health is key
Medical
Both plans are PPO plans- meaning you will receive the best benefit by utilizing Anthem BC/BS network providers (same as today)
Both plans have new tools available through Anthem Lumenos
Core 1200 Plan = Lumenos 1200 Core Plan Health Reimbursement Account included
Alternate 500 Plan = Lumenos 500 Alternate Plan Health Incentive Account included
Both plans have unlimited in-network preventive care that does not apply towards the deductible or out of pocket maximum
NEW Healthy Rewards program is available on both plans Allows you to earn dollars to be used for eligible medical expenses Dollars earned either go into your HRA (core plan) or HIA (alternate plan)
Core 1200 Plan- Single Coverage
$500HRA Dollars
$700Bridge
Coinsurance / Traditional Coverage
100% Preventive Care
100% Coverage
$1,200 Deductible
$2,500 In-Network Out of Pocket Maximum
Anthem Lumenos 1200 Core PlanIn Network Out of Network
HRA Allocation from Schurz $500 Individual Coverage
Individual Bridge (deductible)-applies to those with single coverage only
$700(combined deductible for in and out of network)
Member Coinsurance 20% 40%
Individual Out of Pocket Maximum-applies to those with single coverage only
$2,500 $5,000
Preventive Care 100% as outlined Deductible & Coinsurance
Colonoscopies(both preventive & diagnostic)
100% Deductible & Coinsurance
Retail /Mail Order Prescription Deductible & Coinsurance
Deductible & Coinsurance
Earn extra dollars toward your HRA
through the Healthy Rewards program
Core 1200 Plan- Employee +Dependent(s) Coverage
$1,400HRA Dollars
$1,000Bridge
Coinsurance / Traditional Coverage
100% Preventive Care
100% Coverage
$2,400 Deductible
$5,000 In-Network Out of Pocket Maximum
Anthem Lumenos 1200 Core Plan
In Network Out of Network
HRA Allocation from Schurz $1,400 Family Coverage (employee plus one or more dependents)
Family Bridge (deductible)-applies to anyone electing to cover 1 or more dependents
$1,000(combined deductible for in and out of network)
Member Coinsurance 20% 40%
Family Out of Pocket Maximum-applies to anyone electing to cover 1 or more dependents
$5,000 $10,000
Preventive Care 100% as outlined Deductible & Coinsurance
Colonoscopies(both preventive & diagnostic)
100% Deductible & Coinsurance
Retail /Mail Order Prescription Deductible & Coinsurance
Deductible & Coinsurance
Earn extra dollars toward your HRA
through the Healthy Rewards program
What is considered Preventive Care?
School and sports physicals also covered in full
Colonoscopies will also continue to be covered in full for in-network providers whether routine or diagnostic.
Key Components of Core PlanNo Copays for any servicesTo pay for bridge and coinsurance expenses –
Use roll-over PCA credits Use HCFSA Use your own cash
All medical plan expenses go towards Out of Pocket Maximum (HRA, Bridge and Coinsurance)
Mail order no longer has the buy 2 get 1 free 90 day supply is available for 90 day price
If you have dependents on the plan – Schurz HRA allocation = $1,400 Bridge = $1,000 Out of Pocket Maximum = $5,000 There is no individual bridge or deductible.
Health Reimbursement Account Details
Annual Schurz Contribution to HRA
Employee Only Coverage
$500
Employee + One or more Dependents
$1,400
Administered by Anthem
First dollar payment No deductible to be satisfied first HRA will pay before FSA
Any unused PCA balances will transfer from WageWorks to Anthem
Unused balances are intended t0 carry over from year-to-year and intended to be available for Retiree Health Premium Fund
Direct payment to providers (hospital and physicians) vs. employees
Pharmacy will know if HRA dollars available and charge patient appropriately
Anthem’s Lumenos 1200 Core Plan
Stay healthy with Preventive Care coverage
Your employer makes an annual allocation to your account
Use your account dollars to pay for medical care and prescription drugs
Earn more dollars to your HRA through Healthy Rewards Incentive
After HRA funds are spent, you pay an out of pocket amount to satisfy your bridge
Your 2008 HRA + Bridge = Deductible
Traditional Health Coverage then covers additional expenses
Deductible + Traditional Coverage = OOPM
Meet Mary Jones – 1200 Core Plan Single Coverage
HRA
$500 funded by annual employer allocation
Plus
Additional dollars available through Healthy Rewards
Preventive Care100% In Network
Traditional Health Plan Coverage80% Network Provider
60% Non-Network Provider
$700 Bridge(Deductible equals $1,200
minus $500 HRA allocation)
Mary Jones’ Lumenos PPO Core Plan
$500 Year 1 allocation plus $50 reward for completing Health Assessment via anthem.com
$550
Expenses: Ob/Gyn visit & lab tests – $350Office Visit– $150
$500
Paid by Preventive Care benefit at 100% $350
Paid from HRA & applied to deductible $150
HRA Rollover to Year 2 $400
Meet The Smiths – 1200 Core PlanFamily Coverage
The Smiths’ Lumenos PPO Core Plan
$1,400 Year 1 allocation plus $50 reward for completing Health Assessment via anthem.com
$1,450
Expenses: Preventive visits & lab tests – $500
Physical therapy - $800
Prescription drugs – $200
$1,500
Paid by Preventive Care benefit at 100% $500
Paid from HRA & applied to deductible $1,000
HRA Rollover to Year 2 $450
HRA
$1,400 funded by annual employer
allocation
Plus
Additional dollars available through Healthy Rewards
Preventive Care100% In Network
Traditional Health Plan Coverage80% Network Provider
60% Non-Network Provider
$1,000 Bridge(Deductible equals $2,400
minus $1,400 HRA allocation)
Year 1
Meet The Smiths- 1200 Core PlanFamily Coverage
The Smiths’ Lumenos PPO Core Plan
HRA Balance: $1,400 Year 2 allocation plus $450 roll-over from Year 1 plus $50 reward for completing Health Assessment and $300 reward for enrolling and graduating from Personal Health Coach program for a diabetes condition
$2,200
Expenses: Preventive visits & lab tests – $300
Hospital and surgery - $10,000
Prescription drugs – $500
$10,800
Paid by Preventive Care benefit at 100% $300
Deductible paid from Year 2 HRA allocation plus Year 1 Roll-over and Healthy Rewards program
$2,200
Remaining deductible to be satisfied by Smiths $200
Charges paid by Traditional Health Coverage
(80% x $8,300 = $6,640) $6,640
Smiths pay coinsurance under Traditional Health Coverage (20% x $8,300 = $1,660) $1,660
Total amount paid by HRA (applied to deductible) $2,200
Total amount Smiths pay (remaining deductible & coinsurance) $1,860
Year 2
Alternate 500 Plan- Single Coverage
$500Bridge /Deductible
Coinsurance / Traditional Coverage
100% Preventive Care
100% Coverage
$1,000 Out of Pocket Maximum
OOPM does not include any prescription drug copays
Anthem Lumenos 500 Alternate Plan
In Network Out of Network
Individual Deductible (Bridge)- applies to those with single coverage only
$500(combined in and out of network deductible)
Member Coinsurance 20% 40%
Individual Out of Pocket Maximum -applies to those with single coverage only
$1,000 $2,000
Preventive Care 100% Deductible & Coinsurance
Colonoscopies(both preventive & diagnostic)
100% Deductible & Coinsurance
Pharmacy benefits shown on following slide
Earn dollars into a Health Incentive
Account by participating in
Healthy Rewards
What is considered Preventive Care?
School and sports physicals also covered in full
Colonoscopies will also continue to be covered in full for in-network providers whether routine or diagnostic.
Anthem Lumenos 500 Alternate PlanRetail= 30 day supply In Network Out of Network
Retail- Generic $10 Copay
Retail- Brand Name Preferred or Formulary
$25 Copay
Retail- Brand Name Non-Preferred or Non-Formulary
$50 Copay
Retail- Injectible Drugs (Tier 4) 25% Cost Share; Up to maximum of $1,000
Mail Order= 90 day supply In Network Out of Network
Mail order- Generic $20 Copay
Mail order- Brand Name Preferred or Formulary
$50 Copay
Mail order- Brand Name Non-Preferred or Non-Formulary
$100 Copay
Mail order- Injectible Drugs (Tier 4) 25% Cost Share; Up to maximum of $1,000
None of the above shown copays track towards the deductible or out-of-pocket maximum
Alternate 500 Plan- Family Coverage
$1,000Bridge /Deductible
Coinsurance / Traditional Coverage
100% Preventive Care
100% Coverage
$2,000 Out of Pocket Maximum
OOPM does not include any prescription drug copays
Anthem Lumenos 500 Alternate Plan
In Network Out of Network
Family Deductible (Bridge)- applies to those with famil coverage only
$1,000(combined in and out of network deductible)
Member Coinsurance 20% 40%
Individual Out of Pocket Maximum -applies to those with family coverage only
$2,000 $4,000
Preventive Care 100% as outlined Deductible & Coinsurance
Colonoscopies(both preventive & diagnostic)
100% Deductible & Coinsurance
Same pharmacy copays for family
Earn dollars into a Health Incentive
Account by participating in
Healthy Rewards
Key Components of Alternate PlanCopays for prescription drugs do not
apply to Out of Pocket Maximum
Mail Order copays continue to be buy 2 get 1 free
Health Incentive Account Details
Administered by Anthem
Any PCA balance will not transfer from Wage Works into HIA
Unused balances are intended t0 carry over from year-to-year but are not available for Retiree Health Premium Fund
Direct payment to providers (hospital and physicians) vs. employees
Cannot use Health Incentive Account dollars for prescription copays
Meet Mary Jones- PPO 500 Alternate PlanSingle Coverage
No HRA available
Members are eligible for Healthy Incentive Account
Program
Preventive Care100% In Network
Traditional Health Plan Coverage80% Network Provider
60% Non-Network Provider
$500 Deductible
Mary Jones’ Lumenos PPO Alternate Plan
Expenses: Ob/Gyn visit & lab tests – $350Prescription drugs – $150
$500
Paid by Preventive Care benefit at 100% $350
Copay paid by member- not applied to the deductible $50
Meet The Smiths – PPO 500 Alternate PlanFamily Coverage
The Smiths’ Lumenos PPO Alternate Plan
Expenses: Preventive visits & lab tests – $500
Physical therapy - $800
Prescription drugs – $200
$1,500
Paid by Preventive Care benefit at 100% $500
Paid by member & applied to deductible* $800
Copays paid by member- not applied to deductible $60
No HRA available
Members are eligible for Healthy Incentive Account
Program
Preventive Care100% In Network
Traditional Health Plan Coverage80% Network Provider
60% Non-Network Provider
$1,000 Deductible
If the there are dollars available in the Healthy Incentive Account, which would be earned through the Healthy Rewards program, the HIA dollars could be used towards the deductible.
PPO 1200 Core Plan CostMONTHLY COST Wellness Participation Non-Wellness
Participation
Employee Only $37.29 $62.29
Employee + Spouse $97.34 $122.34
Employee + Child(ren) $67.13 $92.13
Employee + Family $127.17 $152.17
BI-WEEKLY COST Wellness Participation Non-Wellness Participation
Employee Only $17.21 $28.75
Employee + Spouse $44.93 $56.46
Employee + Child(ren) $30.98 $42.52
Employee + Family $58.69 $70.23
WEEKLY COST Wellness Participation Non-Wellness Participation
Employee Only $8.61 $14.37
Employee + Spouse $22.46 $28.23
Employee + Child(ren) $15.49 $21.26
Employee + Family $25.35 $35.12
PPO 500 Alternate Plan CostMONTHLY COST Wellness Participation Non-Wellness
Participation
Employee Only $100.48 $125.48
Employee + Spouse $193.72 $218.72
Employee + Child(ren) $143.38 $168.38
Employee + Family $304.11 $329.11
BI-WEEKLY COST Wellness Participation Non-Wellness Participation
Employee Only $46.38 $57.92
Employee + Spouse $89.41 $100.95
Employee + Child(ren) $66.17 $77.71
Employee + Family $140.36 $151.90
WEEKLY COST Wellness Participation Non-Wellness Participation
Employee Only $23.19 $28.96
Employee + Spouse $44.70 $50.47
Employee + Child(ren) $33.09 $38.86
Employee + Family $70.18 $75.95
New Anthem Lumenos Tools
Health Advocates available to employees (888) 523-5898
Online access to health information Cost estimator tools Hospital ranking tools Health Reimbursement Account balance information Claim status
Healthy Rewards program to earn additional dollars either into Health Reimbursement Account (Core Plan) or Health Incentive Account (Alternate Plan) $50 reward for completing health questionnaire (one
per family) $100 reward for participating in health coaching
program $200 reward for successful completion of the health
coaching program $50 reward for successful completion of the smoking
cessation program and/or weight management program
Healthy Reward dollars = money into either your HRA or HIA, in turn money you can use for eligible medical plan expenses
Importance of Knowing Cost
• Will allow your dollars, whether it’s the HRA/HIA or your own money, to stay in your pocket or last longer
•Will allow you to be a good consumer of healthcare, in turn keeping costs level over time
41
Where to find additional cost info
•Call Anthem customer service
•Talk to your physician or pharmacist
•Use the Anthem Lumenos website• instructions included in your packet
Prescription Drug Cost Info
• Review prescription drug costs for retail and mail order
• View alternatives, including generics and over-the-counter
• Find information on drug interactions
Using Your Anthem Plan
When you visit a network doctor:• Show your new Lumenos ID card
• Take advantage of discounts provided
• A claim is filed for you
• Payments from your HRA (if enrolled in Core plan and have available balance) and from your Traditional Health Coverage made directly to your doctor
When you visit a doctor that is not in the network:• Show your ID card
• Pay for the services received
• File a claim
HRA applies to Core Plan Only
Anthem Reminders
•You will receive a new ID card from Anthem
•To view your 2008 plan information or claim information, you will need to re-register on the Anthem website- www.anthem.com on or after January 1st
•This is where you will view your medical plan and HRA balance
•To view your 2007 plan or claim information, continue using your current log on information
•Same network you have today
•January 1st is when the new plans take effect and you can start accessing the new programs available with Anthem Lumenos
How to decide
•Estimate your medical expenses
•Use the resources available to you
•Consider your current PCA dollars•PCA dollars only roll-over to Core Plan with HRA
•Add up the annual cost of the plans•Core plan much more affordable
46
What is a flexible spending accountYour pre-tax money set aside for
healthcare or dependent care expenses
Healthcare = medical, dental, vision, prescriptions and over the counter items
Dependent care = care for a dependent up to age 13 or older if they are not able to care for themselves (could be child or spouse)
Changes to FSA plans for 2008
Anthem will be the new administrator Single point of contact for Medical, Health
Reimbursement Account, Vision and Flexible Spending Accounts
Schurz $100 matching contribution for Health Care FSA option is no longer available
No auto claims roll-over feature available Anthem & Met Life will substantiate expenses so no
receipts will need to be submitted when debit card used Employees must maintain receipts in the event Anthem or
the plan requests a copy
Annual Maximums
Increase in Health Care Maximum $3,500
Same Dependent Care Maximum $5,000 or $2,500 if married filing separately
2007 Flexible Spending ClaimsYou have until March 31st 2008 to file
claims for 2007
Any 2007 claims should continue to be submitted to Wage Works for reimbursement
Anthem Flexible Spending Debit Card
•New debit cards will be issued to all Anthem FSA participants
•You must keep your receipts according to IRS guidelines
Direct Deposit
Employees may elect to enroll in the ACH Direct Deposit option with Anthem FSA
Log on to anthem.com once enrolled to complete the process
Dental
Two year lock period removed No longer required to stay in the dental plan for
two years.
New four tier rate structure Employee only Employee + Spouse Employee + Child(ren) Employee + Family
Slight increase to dental cost for 2008
Metlife Passive PPO Dental Plan Summary
Member Out of Pocket
Individual Deductible $25
Family Maximum Deductible $100
Preventive Care 20%
Restorative 20%
Major Restorative 50%
Orthodontics 50%
Annual Maximum Benefit per Person
$1,500
Lifetime Orthodontic Maximum Benefit per Person (separate from annual maximum)
$1,500
You may continue to see the dentist of your choice. If you use a Metlife dentist, you may receive a discount.
Met Life Dental Plan CostMONTHLY
Employee Only $5.15
Employee + Spouse $10.31
Employee + Child(ren) $10.82
Employee + Family $15.98
BI-WEEKLY
Employee Only $2.38
Employee + Spouse $4.76
Employee + Child(ren) $4.99
Employee + Family $7.38
WEEKLY
Employee Only $1.19
Employee + Spouse $2.38
Employee + Child(ren) $2.50
Employee + Family $3.69
Dependent Life Insurance
Spouse only benefit 10K, 20K, 40K
Child only benefit 5K, 10K, 20K Child benefit may not exceed the spouse benefit
if both are elected
If electing for the first time during open enrollment- must complete evidence of insurability on spouse
Communication PortalDoes not replace ADP Employee Self Service
Link from ADP Employee Self Service portal Employees can link to ADP from this site- Click on
General benefit, health and wellness information posted here
Links to various administrator websites
Access to claim forms
ADP Enrollment via ESS
Open Enrollment Period October 29 – November 9
Single sign on this year through ESS
Link to current benefits elected
Link to election process
Option to request 2008 Medical Summary Plan Documents from Anthem
What Happens NextYou will receive a confirmation statement
in the mail Review the statement for errorsIf something is listed incorrectly, please
notify your local HR Representative immediately.
No Changes for 2008Vision
Remains with Anthem Blue Vision/EyeMed Must elect medical coverage in order to have vision
benefits May not use Health Reimbursement Account dollars for
vision expenses
Group Life and AD&D Hourly employees= 1 x annual earnings up to $150,000 Salary employees = 2 x annual earnings up to $150,000
Long Term Disability The benefit begins after 180 days of a continuous
disability. If you elect this coverage, Schurz will pay the premium
for the first $18,000 of covered earnings. You pay the premium on earnings above $18,000.
Employee Supplemental Life and AD&D Options
Anthem VisionIn Network Out of Network
ExamLimited to one per member every 12 months (from date of service)
$10 Copay Reimbursement up to $35
Lenses - Limited to one set of lenses per member every 12 months
Single Vision Lenses $20 Copay Reimbursement up to a maximum of $25
Bifocal Vision Lenses $20 Copay Reimbursement up to a maximum of $40
Trifocal Vision Lenses $20 Copay Reimbursement up to a maximum of $55
Lenticular Vision Lenses $20 Copay Reimbursement up to a maximum of $80
Progressive Lenses Covered up to Bifocal amount less copay
Reimbursement up to a maximum of $40
Frames - Limited to one set of frames per member every 12 months
Covered up to $120 retail value before $20 Copay
Reimbursement up to a maximum of $45
Contact Lenses – in lieu of lenses and frames
$20 Copay; $105 Plan Maximum
Reimbursement up to a maximum of $105
Employee Supplemental Life and AD&D OptionsEmployee = 1-4 x annual earningsSingle or Family CoverageEvidence of Insurability is not requiredEmployees pays all of premium via
payroll
Enrolling in Supplemental Life If you are enrolling for the first time and you
are not a new hire you will be required to complete an Evidence of Insurability form. www.schurzchoice.essbenefits.com Complete and return the form to your HR Representative
by January 22nd
What Happens NextBetween now and November 9th
You review benefit information on ADP Employee Self Service portal & Schurz Choice web communication portal
Make any benefit election changes online
Mid- December You will receive a confirmation statement in the mail
outlining the benefits you are enrolled in for 2008 If you elect:
Medical- You will receive a new Anthem Lumenos ID card
Flexible Spending- You will receive a new Anthem FSA debit card