City of Fort Worth Healthcare Plan OPEN ENROLLMENT PLAN...
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City of Fort Worth Healthcare Plan OPEN ENROLLMENT PLAN YEAR 2018 Presented By Human Resources Department October 1 – October 20 1
Transcript of City of Fort Worth Healthcare Plan OPEN ENROLLMENT PLAN...
City of Fort Worth Healthcare Plan
OPEN ENROLLMENTPLAN YEAR 2018
Presented By Human Resources Department
October 1 – October 20
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Health Plan’s Five Guiding Principles
• Need to maintain access to quality care that focuses on employee/retiree wellness and disease management
• Need to bend cost curve and drive down premium costs to employees/retirees and taxpayers
• Need affordable out-of-pocket costs to ensure access to care
• Want to maintain choice for employees/retirees who want/need it but at a cost to the employee for that flexibility
• Must make conscious policy decisions about who is covered by Fort Worth taxpayers and with what subsidy
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Important Facts
Open Enrollment is Mandatory for ALL Employees This Year
Open Enrollment Deadline for ALLPlans is October 20, 11:59 pm
Changes Are Effective January 1, 2018
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MEDICAL PLAN OPTIONS FOR 2018
United Healthcare Choice Network
• Free primary physician care
• Provides copays for specialists and prescription drugs
• Maintains lower deductibles and out of pocket costs
• Pediatrics , obstetrics and mental health services continue with network physicians outside of health centers
Health Center Plan
• High-deductible
• Health Savings Account (HSA) available to allow people to save for health costs on a pre-tax basis
• Members will be able to use the health centers at a discounted rate
Consumer Choice Plan
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Two Plan Options For 2018
All preventive care, including mammograms and colonoscopies, are free to members on both the Health Center Plan and the Consumer Choice Plan
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Keeping working employee spouses
• Reality - reduces revenue
• Theory - reduces costs
Staying on the plan Health Plan Rumor Control
FYI - Working retirees and working retiree spouses that are younger than 65 on the non-Medicare plan (same plan as active employees) are leaving the plan as of Jan 1, 2018. They must enroll in their current employer’s plan. However, if the non-Medicare retiree or retiree spouse loses their job provided health care insurance, then the retiree can return to the city’s plan within 30 days of loss of coverage.
All spousal coverage on the city’s health plan will be studied this year for further consideration in 2019 health care plan design.
Emergency Room UseHealth plan analysis this year revealed 1/3 of all visits made to the ER by
employees and non-Medicare retirees on the city’s current plan were for non-emergencies issues
In an effort to discourage non-emergency ER visits in 2018 copays will be: $500 copay for emergency room visits (but will be waived if admitted to the hospital)
$500 copay + 50% coinsurance after deductible if the visit is a non-emergency issue
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All stand alone emergency rooms are out of network
(any emergency room not connected to an actual hospital)
Urgent Care Options
Alternatives to Emergency Rooms for Non-Emergency Issues:
Telemedicine (Virtual Visits) • FREE (Health Center Plan)
• $40 (Consumer Choice Plan)
Urgent Care Clinics - CareNow
Convenience Care Clinic - Minute Clinics
Nurse line open – 24/7
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HEALTH CENTER PLAN DETAILS
(Free Primary Care)
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Introduction of EMPLOYEE HEALTH CENTERS established through
Texas Health Resources (THR)
All services at the health centers and satellite locations
are FREE
Health Center available for school age
children and up
Services open to all covered
family members
Control quality of care
Unlimited Health Center
office visits
Health Center Plan Convert Basic Plan to Health Center Plan:
Three health centers supported by five satellite locations in the North Texas area all open by April 2018
All members seen same or next day for sick appointments in Health Centers locations only
Staffed with quality doctors, physician assistants and nurse practitioners
No mandatory referrals required
Physician choice maintained with tiered copays within UHC network
Satellite Locations
3 Dedicated Health Center locations targeting Alliance, Burleson and Fort Worth areas Physicians at each location All Health Centers will not be ready
by January • Completion date targeted for no later
than April
5 Satellite Locations• Convenient locations all around North
Texas• All locations available in January • Not held to same metrics as dedicated
health centers
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1. Texas Health Family Care – Lake Worth6100 Lake Worth Blvd, Fort Worth
2. Medical Family Center of South West7001 Granbury Rd, Fort Worth
3. Hoffman Family Practice Associates PA2730 SW Wilshire Blvd, Burleson
4. Texas Health Family Care – Grand Prairie 2950 W. Camp Wisdom Rd, Grand Prairie
5. Texas Health Family Care – Weatherford2005 Fort Worth Highway, Weatherford
Tiered Physician Network
Primary Care (Family Medicine, Internists, OB/Gyn, Pediatricians)• All Health Center services are FREE
• Premium Care Designated Physicians includes = $60 co-pay
• Non Premium Care Designated Physicians = $60 co-pay + deductible and co-insurance
Specialists (All other physicians) • Premium Care Designated Physicians = $75 co-pay
• Non Premium Care Designated Physicians = $100 co-pay + deductible and co-insurance
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Physician designations are displayed publically on UnitedHealthcare'sphysician directories found on www.myuhc.com® or employees and retirees can always call to confirm before their appointment that the specialist is a premium care physician.
Premium Care Physicians
When selecting a doctor that is an
in-network provider, look for theTWO BLUE
hearts!
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Premium Care Physicians Specialist Categories
Family Medicine Internal Medicine Obstetrics & Gynecology Pediatrics Allergy Cardiology ENT Endocrinology
Gastroenterology General Surgery Neurology Neurosurgery, Orthopedics & Spine Nephrology Pulmonology Rheumatology Urology
Example: Specialist Non-Premium ProviderCopay + Deductible + Co-insurance
Office Visit Cost
Copay Deductible Coinsurance Your Cost Per Visit
Jamie has met NO deductible
$245 $100 $145 $0$245
($100 +$145)
Jane has only $75 left to pay towards
deductible$245 $100 $75 $70*.20=$14
$189($100+$75+$14)
Joe has met ALL of deductible
$245 $100 $0 $145*.20=$29$129
($100+$29)
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Flexible Spending AccountsContribute funds tax free
Not paired with insurance
Pay for out-of-pocket expenses Medical FSA – Maximum Contribution $2,550
Dependent Care FSA – Maximum Family Contribution $5,000
Adoption FSA – Maximum Contribution $13,400
Rollover $500 Medical FSA rolls over
Dependent Care and Adoption do not roll over
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Qualified Expenses
Medical
Dental
Vision
Chiropractor
Prescriptions
Some over-the-counter first aid supplies
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CONSUMER CHOICE PLAN DETAILS
(HSA Tax Savings Benefit)
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Physicians Network
• Full access to UHC network, but receive benefit for Premium Designated Doctors
• No referrals needed for specialists
• Can still use the Health Center at a reduced cost
Co-pay/Co-insurance
• Deductible increased to $2,700 individual/$5,400 family
• Out of pocket maximums increase to $6,550 individual/$13,000 family
• Pharmacy – deductible, then 20% co-insurance up to Out-of-Pocket maximum
Contributions
• City contributes $540/$1,000
• Premiums lower than Health Center Plan
Consumer Choice Plan
Health Savings Accounts Consumer Choice Plan - High Deductible
Health Plan
Health Savings Account (HSA)
Discovery Benefits
City Contribution: $540 employee
$1,000 family coverage
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Health Savings Accounts Pre-tax dollars to pay for out-of-
pocket health care expenses You own the account
No documentation needed
Grow your account through investments
Funds rollover fromyear to year
Doubles as a retirement account Withdrawal funds without a penalty at
age 65 for non-medical expenses (taxes apply)
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2018 Summary of Medical Plan BenefitsPlan Features Health Center Plan Consumer Choice Plan Annual Deductible· Individual $1,500 $2,700 · Family $3,000 $5,400 Total Out of Pocket Max – including deductibles, copays, coinsurance, prescription deductible, prescription copays· Individual $6,000 $6,550 · Family $12,000 $13,000 Physician Office Visit
· PCP (At Health Center) $0 copay $60 per visit· OBGYN/Peds (Premium Provider)
$60 copay 20% after deductible
· Specialist (Premium Provider) $75 copay 20% after deductible· PCP (Premium Provider) $60 copay 20% after deductible
· PCP (Not Premium Provider)$60 copay plus 20% after
deductible20% after deductible
· OBGYN/Peds (Not Premium Provider)
$60 copay plus 20% after deductible
20% after deductible
· Specialist (Not Premium Provider)
$100 copay plus 20% after deductible
20% after deductible
Emergency Room visits – for true emergencies only
$500 copay (waived if admitted) 20% after deductible
Choosing a Premium Provider means a lower copay and out of
pocket costs
Urgent Care: Health Center Plan = $75
Consumer Choice Plan = 20% after deductible
Non-emergency use of emergency rooms will be:
Health Center Plan = $500 then 50% after deductible
Consumer Choice Plan = 50% after deductible
Virtual Visits are free on the Health Center Plan and low cost
on the Consumer Choice Plan
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PLAN RATES
(Premium Paid Per Paycheck)
Per Paycheck Employee Ratefor Health Center Plan
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Employee OnlyEmployee +
Spouse
Employee +
Child(ren)
Employee +
Family
Health Center
Plan$48.18 $238.37 $177.85 $333.47
*Rates listed assume that all VIVERAE requirements have been met
Per Paycheck Employee Rate for Consumer Choice Plan
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Employee OnlyEmployee +
Spouse
Employee +
Child(ren)Employee + Family
Consumer Choice
Plan$0.00 $161.66 $115.77 $242.50
*Rates listed assume that all VIVERAE requirements have been met
Compare Costs
Health Center Plan Consumer Choice PlanPremium
Difference*
Per Paycheck Month Per Paycheck Month Month
Premium (Individual) $48.18 $104.38 $0 $0 $104.38
Premium (Emp +Spouse) $238.37 $516.47 $161.66 $350.27 $166.20
Premium (Emp +Child(ren)) $177.91 $385.34 $115.77 $250.83 $134.51
Premium (Emp + Family) $333.47 $722.51 $242.50 $525.41 $197.10
Deductible $1,500 Individual$3,000 Family
$2,700 Individual$5,400 Family
City Contribution to Health Savings Account
N/A $540 Individual$1,000 Family
*Participants in the Consumer Choice Plan could contribute that premium difference in their Health Savings Account pre-tax to save for future medical expenses.
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PHARMACY PLAN
New Provider OptumRx
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https://www.optum.com/content/dam/optum3/optum/en/resources/videos-podcasts/Stats%20update%202017_For_Web_Site.mp4
As a pharmacy care services company, OptumRx® goes beyond traditional pharmacy benefit management.
The pharmacy plan was effective October 1, 2017.
Health Center Pharmacy Plan
Retail Mail Order/Select 90
Generic 20% coinsurance, $10 min/$20 max 20% coinsurance, $25 min/$50 max
Brand Formulary 20% coinsurance, $30 min/$50 max 20% coinsurance, $75 min/$125 max
Brand Non-Formulary 20% coinsurance, $50 min/$70 max 20% coinsurance, $125 min/$175 max
Specialty 20% coinsurance, $200 max 20% coinsurance, $200 max
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No change to Consumer Choice Pharmacy Plan Maintenance medications still obtained through mail order or Walgreens
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SURGERYPLUS
(Option for Non-Emergent Surgeries)
Low Costs
Health Center EPO
Deductible $1,500 $1,500
Coinsurance $4,050 $0
What You Pay $5,550 $1,500
Savings $4,050
Consumer Choice
Deductible $2,700 $2,700
Coinsurance $4,750 $0
What You Pay $7,450 $2,700
Savings $4,750
$37,362
$24,551
$13,535
$9,116
$3,673
$20,445
$15,690
$8,268
$4,817$1,976
KneeReplacement
LaparoscopicSleeve
Gastrectomy
ShoulderArthroscopy
GallbladderRemoval
Carpal TunnelRelease
National SurgeryPlus
What you Pay
Total Knee Replacement
Market Price Comparison
Insurance vs SurgeryPlus
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Most Common ProceduresOver Hundreds of Non-Emergent Procedures are Covered
Spine:
– Laminectomy / Laminotomy
– ALIF / PLIF / ACDF
– 360 Spinal Fusion
– Artificial Disk
Wrist & Elbow:
– Elbow Replacement
– Elbow Fusion
– Wrist Fusion
– Wrist Replacement
– Carpal Tunnel Release
Foot & Ankle:
– Bunionectomy
– Hammer Toe Repair
– Ankle Arthroscopy
– Ankle Replacement
General Surgery:
– Gallbladder Removal
– Hernia Repair
– Thyroidectomy
Genitourinary:
– Hysterectomy
– Tubal Ligation
– Bladder Repair
Knee:
– Knee Replacement
– Knee Replacement Revision
– Knee Arthroscopy
– ACL/MCL/PCL Repair
Hip:
– Hip Replacement
– Hip Replacement Revision
– Hip Arthroscopy
Shoulder:
– Shoulder Replacement
– Shoulder Arthroscopy
– Rotator Cuff Repair
– Bicep Tendon Repair
To learn more, call the City of Fort Worth’s dedicated line at
1-855-200-9508 or visit www.MySurgeryPlus.com/CFW32
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DENTAL PLANS
Provider Delta Dental
Delta Dental Benefits – DPPO
Dental PPO (DPPO)
DDPO - Low Option* DPPO - High Option
Deductible$50 per person/ $150 per family $50 per person/$150 per family
Annual Maximum $1,000 per person $1,500 per person
Provider Unlimited - PPO Network available Unlimited - PPO Network available
Preventive & Diagnostic Care Plan pays 100% with no deductible Plan pays 100% with no deductible
Basic Restorative Care Plan pays 50% Plan pays 80%
Major Restorative Care Plan pays 50% Plan pays 50%
Orthodontia NA Plan pays 50%
*You may be balance billed for going to a non-Delta Dental PPO network dentist. You will be billed the difference between the PPO fee and the Delta Dental Premier dentist fee or the Out-of-Network dentist fee.
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Delta Dental Benefits - DHMODeltaCare Prepaid (DHMO)
DHMO - Low Option DHMO - High Option
DeductibleNone
Annual Maximum None
Provider Member must use participating provider
Preventive & Diagnostic Care You pay fixed copayments according to the plan's schedule of benefits
Basic Restorative CareYou pay fixed copayments according to the plan's schedule of benefits- Specialist referral
is required under this plan.
Major Restorative CareYou receive a 25% discount to see a
specialist and a referral is required under this plan.
You pay fixed copayments according to the plan's schedule of benefits- Specialist referral
is required under this plan.
Orthodontia You pay fixed copayments according to the plan's schedule of benefits
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Dental Rates Semi - Monthly
DPPO High DPPO LowEmployee Only $15.84 $10.67Employee + Spouse $32.47 $20.28Employee + Child(ren) $41.98 $23.48Employee + Family $53.06 $33.08
DHMO High DHMO LowEmployee Only $6.77 $4.57Employee + Spouse $11.66 $7.83Employee + Child(ren) $13.55 $8.15Employee + Family $20.67 $12.19
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OTHER BENEFITS
Life Insurance, Long Term Disabilityand more…
Life Insurance - VOYA
Open Enrollment (Plan Year 2018) Can increase 1 times without Evidence of Insurability (EOI)
Enrolling for first time or increase beyond 1 times salary requires EOI and approval from VOYA
Can decrease coverage online without EOI
Employee maximum five (5) times salary
Spousal life flat $50,000
Dependent child life $10,000
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Long Term Disability (LTD) - UNUM
Open Enrollment (Plan Year 2018) Increasing coverage will require Evidence of Insurability (EOI) and approval by
UNUM
Can decrease coverage online without EOI
40% and 60% plans offered with 90 or 180 day wait
To calculate premiums: http://unuminfo.com/CityofFortWorthLTDCalc
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457 Deferred Compensation Plan TIAASet aside pre-tax or post-tax (ROTH) money for retirement
Minimum contribution $10.00/pay period
Enroll online anytime through TIAA’s websitewww.tiaa.org/fortworth
Investment in a variety of funds available
2017 maximum $18,000
2017 catch-up contribution $5,500 over age 50 Special catch-up contribution within 3 years of retirement Contact Benefits or TIAA
You can contribute a percentage of your salary for 201840
BENEPLACE
Discount Site Tickets Big ticket items
Voluntary Benefits Allstate - accident, cancer and critical
illness coverage Vision Insurance Legal Protection Home, Auto and Pet Insurance
www.beneplace.com/cofw
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HELP/COMMUNICATIONS WHERE TO FIND MORE
INFORMATION
Go online to the Open Enrollment page
FORTWORTHTEXAS.GOV/OPENENROLLMENT
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On the city’s webpage you can learn more about:
Plan Comparisons
Plan Design
Open Enrollment Meeting Dates
ALEX – Your Online Benefits Counselor
Healthcare Vendors
Frequently Asked Questions (FAQs)
WANT TO LEARN MORE ABOUT YOUR BENEFITS THIS YEAR?
CHAT WITH ALEX
VISIT ALEX ATwww.fortworthtexas.gov/openenrollment/alex
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HEALTHCARE STARTS WITH COMPASS.
How Compass Takes Care of You
UNDERSTAND YOUR BENEFITS
Receive guidance in
understanding your benefits
throughout the year.
FIND A GREAT DOCTOR
Find the best doctors, dentists &
eye-care professionals in your
area and network that meet
your preferences & healthcare
needs.
GET HELP WITH MEDICAL BILLS
Have your medical bills reviewed
to make sure you are not
overcharged.
SAVE MONEY ON MEDICAL CARE
Get price comparisons before receiving care.
Depending on doctor, hospital or facility, costs
can vary by hundreds or thousands of
dollars—even in-network.
PAY LESS FOR PRESCRIPTIONS
Let Compass compare
medication prices and explore
lower cost options for you.
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BEATRIZ BYERSHEALTH PRO CONSULTANT
Healthcare Redefined.
Moved recently or looking for a new provider? We’ll
find great doctors, dentists and eye care professionals
for you and your family.
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Upcoming medical procedure? We’ll estimate your
out-of-pocket cost to ensure you pay a fair price.
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Tired of overpaying for brand-name prescriptions?
Let Compass research the most cost-effective options
for the prescriptions you’re taking.
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Wondering if a medical bill is correct? We’ll make
sure you’re not overbilled.
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COMPASS
Confidential and Proprietary – Intended for Compass Customers Only
Monday through Friday 8AM – 6PM Central
Dig
ital
Co
mm
un
icat
ion
s •Roundup city e-newsletter articles posted as needed
•HRC Open Enrollment training during monthly conference call
•PeopleSoft messages and reminders
•Emails to HRCs with important info as needed
Dir
ect
Mai
l • Postcards mailed to homes
• Letter in August that OE will be Oct 1 - Oct 20 and what to expect (targeted at retirees)
• Benefits pamphlet/ booklet mailed to homes in Sept
• Reminder OE postcards in October that it’s mandatory
Op
en E
nro
llmen
t (
OE)
Web
pag
e • 24/7 Access
• Q&A updated as needed (daily/ weekly)
• Rates and plan details clearly listed
• Comparison charts
• Benefits contact info
• Vendor info and links to their websites
• ALEX 24/7 online healthcare counselor access
Op
en E
nro
llmen
t (O
E) M
eeti
ngs
• July-August info sessions for departments upon leader request
• OE meetings for employees starting late Sept
• One on One meetings with Benefits team upon request
Vis
ual
Sig
nag
e • Posters in departments
• Door clings where appropriate at city buildings and entrances to major departments (ex. Water, Police, IT)
• Pop-up signs at open enrollment meetings
Human Resources Open Enrollment Communications
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HOW TO ENROLL ONLINE ALL EMPLOYEES MUST USE THE
PEOPLESOFT SELF-SERVICE SYSTEM
Mandatory Online Enrollment
Enroll from any desktop or laptop: my.fortworthtexas.gov
Upload proof documents online – birth certificates, marriage license, etc.
Online enrollment help available:
Kiosk in HR Benefits Office: Monday -Friday 8:00 AM – 5:00 PM
Extended HR Benefits Office Hours Tuesdays in October
10/10 and 10/17 from 8:00 AM – 7:00 PM
See your Human Resources Coordinator (HRC)
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City of Fort Worth HR Benefits Office200 Texas Street, Fort Worth, TX 76102
City Hall, Lower Level
817-392-7782
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QUESTIONS
