Flexible Benefits Flexible Benefits

Enrollment Enrollment

2009-2010 Plan Year2009-2010 Plan Year

Employee Benefits

Outline of PresentationOutline of Presentation

• Plan Year Highlights• Core Benefits• Benefit Choices• Life Events• Employee Contributions• Questions

Employee Benefits

Plan Year HighlightsPlan Year Highlights• Flexible Benefits Budget

– $2,700/year ($112.50/pay)– June 15, 2009

• Medical Insurance– No Plan Design Changes– Employee Contributions will remain the same.

• Dental Insurance– No Plan Design Changes– Decrease in Employee Contribution

Employee Benefits

Plan Year Highlights cont…Plan Year Highlights cont…

• Vision Insurance– No Plan Design Changes– Increase in Employee Contributions

• Flexible Spending Accounts– Loomis to AmeriFlex

• Life Insurance– AIG to SunLife– Special “Guaranteed Issue” Open Enrollment

Employee Benefits

Core BenefitsCore Benefits

• Core Life Insurance/ Core Accidental Death and Dismemberment (AD&D) Insurance– SunLife – $50,000 Core Life Insurance Benefit – $50,000 AD&D Insurance Benefit

• Long Term Disability– Provides 60% Of Monthly Base Pay ($4,500 Monthly Max)– Benefit Begins Following 180 Days of Continuous Disability– One-year services requirement

Employee Benefits

Core Benefits cont…Core Benefits cont…• Long Term Disability

– Provides 60% Of Monthly Base Pay ($4,500 Monthly Max)– Benefit Begins Following 180 Days of Continuous Disability– One-year services requirement

• Employee Assistance Program (EAP)

• Flexible Benefits Budget– $2,700/year ($112.50/pay)

Employee Benefits

Core Benefits Cont…Core Benefits Cont…• Tuition Remission

– Wilkes University– King’s College– Misericordia University

• Paid Holidays

• Vacation/Sick/Personal Leave

• 403(b) Retirement Savings Plan

• Bookstore Discount

• Wilkes-Barre YMCA

Employee Benefits

Benefit ChoicesBenefit Choices

• Medical Insurance• Prescription Plan• Dental Insurance• Vision Insurance• Voluntary Term Life Insurance• Voluntary AD&D Insurance• Flexible Spending Accounts

Employee Benefits

Medical InsuranceMedical InsuranceThree medical plan options:

• Blue Care HMO

• Blue Care HMO Plus – (formerly Blue Care POS)

• Blue Care PPO

www.bcnepa.com

Employee Benefits

Blue Care HMOBlue Care HMO

Benefits– Benefit Period : Calendar Year– Deductible: None– PCP Office Visit: $15 Co-pay– Specialist Office Visit: $30 Co-pay

Preventive Services– Immunizations: $15 Co-pay– Routine pediatric/adult and well child care: $15 Co-pay– Routine gynecological exam: $30 Co-pay– Mammography Screening/diagnostics: No Charge

Employee Benefits

Blue Care HMOBlue Care HMO

Emergency and Urgent Care– Emergency Room: $100 Co-pay– Urgent Care through your PCP: $15 Co-pay

Inpatient Services– Inpatient hospital services, including maternity: $100 per admission– Skilled Nursing Care (60 days per benefit period): $100 per admission

Mental Health– Inpatient services (30 days /benefit period): $100 per admission– Outpatient services (60 visits/benefit period): $30 per visit

Employee Benefits

Blue Care HMOBlue Care HMO

Outpatient Services– Chemotherapy, dialysis, or radiation: No Charge– High-tech Imaging (MRI, MRA, CT scans, pet scans, nuclear cardiology): $75

Co-pay– Diagnostic testing (lab tests, x-rays, etc.): No Charge– Maternity Care: $30 initial visit– Outpatient Surgery: $100 Co-pay

Other Services– Chiropractic Care (12 treatments/benefit period; ages 13+): $30 Co-pay– DME: $5,000 maximum/benefit period

Employee Benefits

Blue Care HMOBlue Care HMO

Substance Abuse– Outpatient Services (30 visits/benefit period; 120 visits/lifetime):

No Charge– Detoxification (7days/admission; 4 admissions/lifetime): $100 per

admission– Inpatient non-hospital residential treatment (30 visits/benefit

period; 90 days/lifetime): No Charge for Initial Visit; 50% Subsequent Visits

Employee Benefits

Blue Care HMO PlusBlue Care HMO Plus

Two Network Options– FPH Network

• Blue Care HMO Benefit Plan Design

– Blue Card Network (www.bcbs.com)• Additional Costs

Employee Benefits

Blue Care HMO PlusBlue Care HMO Plus

Benefits– Benefit Period : Calendar Year– Deductible: $250.00 (Maximum 3 per family)– Coinsurance: 20%– Coinsurance (Maximum 3 per family): $1,000– Lifetime Maximum: $1,000,000– PCP Office Visit: 20%– Specialist Office 20%

Employee Benefits

Blue Care HMO PlusBlue Care HMO Plus

Coinsurance (20%) Applies To:• Preventive Services• Urgent Care through your PCP• Inpatient Services• Outpatient Services• Mental Health (50% for

Outpatient Services)• Substance Abuse (50% for

Inpatient Subsequent Visits)

Employee Benefits

Blue Care PPOBlue Care PPO

Two Network Options

– Preferred (www.bcbs.com)

– Non-Preferred • Additional Costs

Employee Benefits

Blue Care PPOBlue Care PPO

Benefits Preferred Non-Preferred

- Benefit period- Deductible (Maximum 3 separate deductibles per family) $300 $600

- Coinsurance (Insured responsibility) None 20% of allowable charge- Coinsurance maximum (Maximum 3 separate coinsurance maximums per family) None $3,000

- Lifetime maximum Unlimited $500,000- Precertification penalty (facility) None $500

Preventive Services - Childhood Immunizations (not subject to deductible; copay applies for office visits) No charge 20%

- Routine gynecological exam and pap smear (one per benefit period; not subject to deductible) $30 20%

- Routine mammography (one per benefit period, limited to age 40+; not subject to deductible) No charge 20%

Insured Responsibility

Calendar Year

Employee Benefits

Blue Care PPOBlue Care PPO

Emergency and Urgent Care Services- Outpatient emergency room visit (not subject to deductible; copay waived if admitted to hospital) $100 copay $100 copay

Inpatient Services - Inpatient hospital services (unlimited days per benefit period) No charge 20% - Skilled nursing care (60 days per benefit period) No charge 20%

Outpatient Services- Chemotherapy, dialysis or radiation No charge 20% - High-tech imaging (MRI, MRA, CT scans, pet scans, nuclear cardiology) $75 copay (after deductible) 20% - Diagnostic testing (lab tests, x-rays, etc) No charge 20% - Physical (20 visits per benefit period), speech (12 visits per benefit period), or occupational therapy (12 visits per benefit period)

$30 (after deductible) 20%

- Cardiac rehabilitation (36 visits/benefit period) No charge 20% - Pulmonary therapy (18 visits/benefit period) No charge 20% - Respiratory therapy (18 visits/benefit period) No charge 20%

Employee Benefits

Blue Care PPOBlue Care PPO

Other Services- Allergy extract/injections No charge 20% - Chiropractic care (18 treatments per benefit period ages 13 and up) $30 (after deductible) 20% - Durable medical equipment/prosthetics/orthotics No charge 20%

- Home health services (100 visits/benefit period) $30 (after deductible) 20% - Home infusion services $30 (after deductible) 20% - Hospice care (180-day lifetime maximum) No charge 20% - Surgery No charge 20% - Maternity services (physician office visits) $30 initial visit 20%

- Primary Care Physician office visits (preferred not subject to deductible). Unlimited visits. $15 copay 20% - Specialty Physician office visits (preferred not subject to deductible). Unlimited visits. $30 copay 20%

$5,000 benefit period maximum

Employee Benefits

Blue Care PPOBlue Care PPO

Mental Health - Inpatient services (30 days/benefit period) No charge 20%

- Outpatient services (60 visits/benefit period) 50% 50%Substance Abuse- Outpatient services (30 visits/benefit period; 120 visits/lifetime) No charge 20% - Detoxification (7 days/admission; 4 admissions/lifetime) No charge 20%

- Inpatient non-hospital residential treatment (30 days/benefit period; 90 days/lifetime) No charge 1st course; 50% 2nd & subsequent courses

20% 1st course; 50% 2nd and subsequent courses

Employee Benefits

Prescription Drug CoveragePrescription Drug Coverage

• BCNEPA

• National Pharmacy Network - Express Scripts Inc. https://member.express-scripts.com

• Based off of a formulary listing which includes all therapeutic categories.

• Co-pay will depend on what tier the prescription drug is categorized.

• Formulary:http://www.bcnepa.com/PDF/RxFormulary3.pdf .

Employee Benefits

Prescription Drug CoveragePrescription Drug Coverage

Express Scripts Network Pharmacy Retail Copay (30-day supply) Tier 1 $15.00 Tier 2 $30.00 Tier 3 $50.00 Home Delivery Copay (90-day supply) Tier 1 $30.00 Tier 2 $70.00 Tier 3 $150.00

Employee Benefits

Prescription Drug CoveragePrescription Drug Coverage

Three Ways to Save Money on your Prescription Drug Costs:

• Tier 0 (Zero)

• Request Generic Medications • Utilize the Mail Order Pharmacy Program

Employee Benefits

Prescription Drug CoveragePrescription Drug Coverage

Tier 0 (Zero)

• July 1, 2008

• 65 Generic Drugs

• Co-pay Free

• List of Drugs www.bcnepa.com

Employee Benefits

Dental InsuranceDental Insurance• Provider: United Concordia

• Two Dental Plans– Basic – Enhanced

• Flexibility

• Maximum Allowable Charge (MAC)

• Website Functions

Employee Benefits

Dental InsuranceDental InsuranceBenefits/Services Basic EnhancedDiagnostic and Preventive 100% MAC* 100% MAC*Basic Services 100% MAC* 100% MAC* After DeductibleMajor Services Not Covered 50% MAC* After DeductibleOrthodontics (Dependent Children to Age 19) Not Covered 50% MAC* After DeductibleDeductible N/A $50 Individual/$150 Family

PredeterminationPlan Maximums (Dental) $1,000 PP/CY $1,200 PP/CYPlan Maximums (Orthodontia) N/A $1,000/Chld/Lifetime

Required for treatment plans of $150 or more, or the extraction of 6 or more teeth.

Employee Benefits

Dental InsuranceDental Insurance

Provider Charge 45.00$ 45.00$ Allowable Charge 30.00$ 30.00$ Member Responsibility -$ 15.00$ Payment to Provider 30.00$ 45.00$

Routine Examination (Maximum Allowable Charge Example)Network Dentist Out-of-Network Dentist

Provider Charge 45.00$ 45.00$ Allowable Charge 30.00$ 30.00$ Member Responsibility -$ 15.00$ Payment to Provider 30.00$ 45.00$

Routine Examination (Maximum Allowable Charge Example)Network Dentist Out-of-Network Dentist

Employee Benefits

Vision InsuranceVision Insurance

Provider: Davis Vision Inc.

Plan: Fashion Excellence Gold

Employee Benefits

Vision InsuranceVision InsuranceFREQUENCY OF SERVICE Eye Exams, Frames, Lenses, Contacts 12 Months Each

IN-NETWORK OUT-OF-NETWORK

BENEFITS

Amount Covered

Amount Reimbursed

Eye Exam (Optometrist or Ophthalmologist)

100% $40

Standard Lenses (Pair) – Single Vision – Bifocal – Trifocal – Lenticular / Aphakic

100% 100% 100% 100%

$30 $40 $60 $80

Frames Fashion level Designer Level Premier Level Retail Allowance

100% $20 $40

Up to $100

Up to $30 Up to $40 Up to $60 Up to $80

Contacts (In lieu of glasses) – Standard (Hard/Soft Daily Wear Spherical) – Specialty (e.g. Disposables, Gas Permeables)

100%

$75 Off Provider Charge

$48

$48

Employee Benefits

Voluntary Term LifeVoluntary Term Life• Employee Coverage – Increments of $10,000 to the lesser of 5X

salary or $300,000. Guaranteed Issue amount of $150,000 when first eligible for coverage and during this open enrollment period.

• Spouse Coverage – Increments of $10,000 up to a maximum benefit of $100,000. Guaranteed Issue amount of $30,000 when first eligible for coverage and during this open enrollment period.

• Dependent Child(ren) Coverage – Increments of $2,500 up to a maximum benefit of $10,000. All Dependant Child(ren) coverage is a guarantee issue.

Employee Benefits

Voluntary Term AD&DVoluntary Term AD&D• Employee Coverage – Increments of $10,000 up to a maximum

benefit of $500,000.

• Spouse Coverage – Increments of $10,000 up to a maximum benefit of $250,000.

• Dependent Child(ren) Coverage – Increments of $2,000 up to a maximum benefit of $50,000.

Employee Benefits

Flexible Spending AccountsFlexible Spending Accounts

• Medical Spending Accounts– $3,000/Plan Year– Use It Or Lose It Provision

• Dependent Care Spending Accounts– $5,000/Plan Year– Use It Or Lose It Provision

Employee Benefits

Flexible Spending Accounts Flexible Spending Accounts cont…cont…

• PY 2008-2009 – Loomis: prior to 06/01/2009– Human Resources: after 06/01/2009

• PY 2009-2010 – AmeriFlex

• Special Open Enrollment Sessions– Monday, April 6th and Thursday, April 9th

Employee Benefits

Flexible Spending AccountsFlexible Spending Accounts

If you are currently enrolled in a Flexible Spending Account, you must re-enroll for the new plan

year. You will not be automatically enrolled.

Employee Benefits

Additional Benefit ChoicesAdditional Benefit Choices

Legal Services Plan

Long Term Care Insurance

Employee Benefits

Life EventsLife Events• Change In Status Spouse’s or Dependent’s Open Enrollment

• Dependent Care Changes

• Cost or Coverage Changes Within The Employer’s Plan

• HIPAA Special Enrollment Rights

• Judgment, Decree Or Court Order

• Enrollment/Ceasing To Be Enrolled In Medicare Or Medicaid (does not apply to CHIP)

• Family Medical Leave Act (FMLA) Special Requirements

Employee Benefits

Please Note: Please Note:

• The benefit change must be consistent with the Life Event.

• You may add or delete dependents during the plan year, when you experience a Life Event.

• You must contact the Human Resources Development Office within 30 days of the Life Event, and provide the required documentation, or the change will not take place until the next Open Enrollment.

Employee Benefits

Employee ContributionsEmployee Contributions

• Medical Insurance Deductions- SAME

• Dental Insurance Deductions-Decrease

• Vision Insurance Deductions- Slight Increase

• Rate Sheet- HR Website- Ben Info & Forms

Employee Benefits

Wellness ProgramsWellness Programs

• YMCA Membership

• Wilkes Fitness Facilities

• Weight Watchers at Work

• College Town Challenge

• Lunch & Learns

Employee Benefits

Open Enrollment ProceduresOpen Enrollment Procedures

• Review all Open Enrollment information. • If you are not making any changes to your benefit elections or do

not wish to enroll or continue to participate in a Flexible Spending Account, no further action is needed on your part.

• If you are making any benefit changes or participating in a Flexible Spending Account, you must return all paperwork to Brigid Peet, Benefits Coordinator (x4644) by Friday May 1, 2009.

Employee Benefits

QuestionsQuestions