OPEN ENROLLMENT 2012OPEN ENROLLMENT 2014

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FILICE INSURANCE AGENCYNINA GARDNER, MELANIE RUIZ

• Nina Gardner, J.D. – Your Employee Benefits Consultant – strategic benefit planning

• Melanie Ruiz – Your Account Manager – day-to-day administration – questions, plan design inquiries, claims and coverage issues, bil l ing questions, etc.

• CRLA’s Customized Website – Your Own Intranet• www.filice.com/benefits/crla

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EMPLOYEE BENEFITS APP

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ID CARDS APP

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OPEN ENROLLMENT

Open Enrollment is a once-a-year opportunity to make election changes

• Change plans• Add or drop coverage for yourself• Add or drop coverage for your dependents• Update l i fe insurance beneficiaries

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MID-YEAR QUALIFYING EVENTS

What changes can I make outside of Open Enrollment?

• If you do not make changes during open enrollment, the only t ime you can make an election or enrollment change is if you experience an eligible qualifying event.

• Common examples of qualifying events include, but are not l imited to the following:

Marriage or domestic partner unionDivorce or legal separationBirth or adoptionGain or loss of coverage

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IMPORTANT THINGS TO KNOWMEDICAL COVERAGE

• Changes you make to your elections are effective 8/1/2014

• Plan year 8/1/14 – 7/31/15• Deductibles and out of pocket maximums

are calendar year for medical. Deductible and maximum are plan year for the dental plan. Vision is calendar year.

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EMPLOYEE BENEFITS OVERVIEW

Anthem Blue Cross

Classic PPO 250/20/10

Value HMO 20/40/250/3 day

Kaiser

HMO 10

Dental – Direct Denta l

Vis ion – Anthem Blue Cross

Disabi l i ty (LTD) – employer paid & buy-up – Mutual of Omaha

Employer-paid L i fe Insurance and Voluntary L i fe Insurance – Mutual of Omaha

Employee Ass is tance Program

Travel Ass is tance

FSA

Commuter Plan

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MEDICAL• Kaiser – No Changes• Anthem Blue Cross – No Changes

• Kaiser: Must use Kaiser facility• Kaiser has a number of free

resources!• 24 hour nurse line• Email your doctor• Make or change appointments

online• Managing health issues (such

as quitting smoking or losing weight)

• Anthem Blue Cross: More f lexibil i ty in choosing providers

• Use Anthem network whenever possible

• Identify local urgent care clinics for assistance after hours when not an emergency

• 24/7 Nurse Line• Future Moms Maternity Program• Condit ion Care: Asthma,

diabetes, heart disease, coronary artery disease

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USE THE MAIL ORDER PHARMACY

ASK FOR GENERIC DRUGS

COMPARE PRICES AT DIFFERENT PHARMACIES

GO TO URGENT CARE INSTEAD OF THE EMERGENCY ROOM

MAKE SURE YOUR DOCTOR, LAB, HOSPITAL OR PHARMACY IS IN-

NETWORK

GET YOUR ANNUAL ROUTINE PHYSICAL EXAM AND

RECOMMENDED SCREENINGS

INQUIRE ABOUT THE COST OF SERVICES IN ADVANCE

ANTHEM CARE COMPARISON: QUALITY AND COSTS FOR MEDICAL

PROCEDURES AT HOSPITALS AND OTHER MEDICAL FACIL ITIES

TIPS – STRETCHING YOUR DOLLARS

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PREVENTATIVE CARE VS. DIAGNOSTIC CARE

Preventive = Deductible does not applyWhen you have no symptoms with no reason to think you aren't healthy and you get a service or test listed in the Preventive Health Care Guidelines, it's a "preventive service.”Carriers pay 100% for preventive services.

Examples of Preventative Services:Well Woman, Well Man, Well Child Annual Check Up In association with the Affordable Care Act Schedule of Care

Immunizations, Blood Pressure, Cholesterol, Diet Counseling for Adults at Risk for Chronic Disease, Type 2 Diabetes Screening for adults with high blood pressure, Tobacco use & Cessation Intervention.

For a more detailed list please visit:

What is the Difference?

http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

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• NEW PREVENTIVE CARE GUIDELINES FOR WOMEN

COVER THE FOLLOWING SERVICES (COVERED AT 100%

WITHOUT COST SHARING):

• Well-women visits

• Gestational diabetes screening

• HPV DNA Testing for women 30 and older

• Sexually Transmitted infection counseling; HIV screening and counseling

• FDA approved contraception methods and counseling

• Breastfeeding support, supplies, and counseling

• Domestic Violence support, supplies, and counseling

• FOR ADDITIONAL DETAILS

• www.healthcare.gov/law/provisions/preventive/index.html

PREVENTIVE CARE FOR WOMEN

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• AVAILABLE ON FILICE WEBSITE

• Paper copies available from HR upon request

SUMMARY OF BENEFITS AND COVERAGE (SBC)

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BALANCED MEAL

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EXERCISE

• Walking is one of the easiest ways to get the exercise you need to stay healthy. • Experts recommend at least 2 hours of � moderate activity (such as brisk

walking, brisk cycling, or yard work) a week. It's fine to walk in blocks of 10 minutes or more throughout your day and week.

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• ANTHEM ONLINE RESOURCES:– Weight Loss: Jenny Craig, Weight Watchers, Lindora– Fitness Clubs: Curves, Bally’s, Gold’s– Family & Home: Health- and wellness-related books and products,

elder-care services, baby-proofing products– Vision, Hearing, Dental: Prescription glasses, sunglasses, laser

vision, contact lenses, audio logical services and testing, dental-related products

• KAISER RESOURCES:– Weight Loss– Smoking Cessation– Health Risk Assessment– Classes and Programs

WELLNESS RESOURCES

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•Kaiser Permanente encourages our members to live healthy and thrive. Get active and take control of these healthy resources. •For more information, visit www.kp.org or call Member services at

1-800-464-4000 English1-800-777-1370 TTY for the hearing/speech impaired

Health classes at Kaiser Permanente facilities. (Many classes are free.)

Healthy lifestyle programs help you

lose weight eat healthy manage diabetes

reduce stress quit smoking live with ongoing conditions

reduce pain manage depression get a good night’s sleep

Discounts on additional health care services give you more options

acupuncture massage therapy

Kaiser and Wellness

GOOD HEALTH ON THE GO

Mobile apps

Use your Smartphone or mobile device to fit wellness into your schedule.

Manage your care, find nearby facilities, and more

Stay fit with the free Every Body Walk! app—a fun, interactive tool to help you create and

maintain a daily walking routine Just download our free apps from the

App StoreSM or Google Play*

*App Store is a service mark of Apple Inc.

MAXIMIZE YOUR HEALTH

Wellness coaches

Experienced coaches are available by phone, at no cost to members.

Your coach will work one-on-one with you to help you set goals to improve your health

Get a personalized plan to help you lose weight, quit smoking, manage stress, eat right,

and more Coaching is available in English and Spanish

and no referral is needed

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COMMON INSURANCE TERM: DEDUCTIBLE• Deductible: The amount the insured person has to

pay before the insurance company starts to pay its port ion of costs for a covered health service

• Out of Pocket Maximum: The most you will pay in a year except for prescription drug copays. Prescription drug copays continue after the out of pocket maximum has been met.

• Co-insurance: The portion of the charges that you pay after you have met the deductible.

• Co-pays: Fixed amounts you pay for prescription drugs, off ice visit or x-rays.

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ANTHEM CLASSIC PPO 250/20/20Plan Features In-Network Out-of-Network

Deductible Per Member Per FamilyOut of Pocket Max Per Member Per Family

$250 (combined)$750 (combined)

$2,500 (includes ded.)$5,000 (includes ded.)

$250 (combined)$750 (combined)

$6,500 (includes ded.)$13,000 (includes ded.)

Preventive Care$0 (deductible waived) 30% after deductible

Office Visits $20 (ded. waived) 30% after deductible

Diagnostic Lab & X-ray 10% after deductible 30% after deductible

Hospital Services 10% after deductible 30% after deductible

Emergency Services $150 + 10% after ded. $150 + 10% after ded.

Prescription Medication No deductible

Generic Brand Formulary Brand Non-Formulary Specialty

$10$30$50

30% to $150/fill ($3,500 max)

50% + copay 50% + copay50% + copay50% + copay

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ANTHEM BLUE CROSS VALUE HMO 20/40/250/3 DAYPlan Features In-Network Only

Deductible Per Member Per FamilyOut of Pocket Max Per Person Per Family

$0$0

$3,000$6,000

Preventive Care $0

Office Visits $20/$40

Diagnostic Lab & X-ray No charge

In-Patient Hospital Services $250/day, up to 3 day max

Out-Patient Hospital Services $125/admit

Emergency Services $150

Prescription Medication Deductible Generic Brand Formulary Brand Non-Formulary Specialty

None$15$30$50

30% to $150/fill ($3,500 annual max)

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KAISER – HMO 10Plan Features In-Network Only

Deductible Per Member Per FamilyOut of Pocket Max Per Member Per Family

NoneNone

$1,500$3,000

Preventive Care Routine exam, screenings $0

Office Visits $10

Diagnostic Lab & X-ray No Charge

Hospital Services No Charge

Outpatient Surgery $10/procedure

Emergency Services $50

Prescription Medication Generic Brand and Specialty

$10 (100 day supply)$25 (100 day supply)

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MEDICATION ASSISTANCE PROGRAM I f you are taking a medicat ion that is for a chronic i l lness or

disease and cannot afford to pay your port ion, there may be help.

• The Partnership for Prescription Assistance Program is designed to help individuals, l ike YOU

save money without affecting your prescription drug need.

Not al l medicat ions wi l l qual i fy, but most drugs manufacturers provide low\free medic ine for: HIV- www.publichealthrx.com \ 888-311-7632 Diabetes- www.caldiabetes.org \ 916-552-9888 Asthma- www.pparx.org \ 888-477-2669 Depression- www.dbsalliance.org \ 800-826-3632

Other condi t ions and medicat ions may qual i fy. Please contact Kryz Novotnaj at (925) 962-1983 at Fi l ice

Insurance i f you need assistance with other condi t ions not l is ted above.

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OPEN ACCESS PLAN Direct Denta l PPO – You can see any dent is t , but you pay less in the network.

$1,500 annual (plan year) maximum benefit

Child Ortho: $1,500 lifetime maximum benefit

$50/individual; $150/family annual (plan year) in-network deductible

4 cleanings and 2 exams per year

Maximum Rollover: $700 Threshold, $350 in-network maximum rollover, $1,250 maximum rollover account limit (must be on plan for an entire year)

Tip: Always get a pre-determination of benefits from your provider for services over $300.

Plan des ign co- insurance levels

In Out

Preventative 100% 100%

Basic 90% 80%

Major 60% 50%

Ortho 50% 50%

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IN NETWORK ONLY PLAN Direct Dental – Only Access to In-Network Providers

$1,500 annual (plan year) maximum benefit

Child Ortho: $1,500 lifetime maximum benefit

$25/individual; $75/family annual (plan year) in-network deductible

2 cleanings and 2 exams per year

Tip: Always get a pre-determination of benefits from your provider for services over $300.

Plan design co-insurance levels

In

Preventative 100%

Basic 90%

Major 60%

Ortho 50%

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ANTHEM VISION PPO PLAN

Anthem Blue View Vision BV B1Co-Pay: $15

Exams: Every 12 months

Lenses: Every 12 months

Frames: Every 24 months (up to $130 + 20% off

remaining balance) OR

Contact Lens Care: Every 12 months (up to $130)

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DISABILITY

Long Term Disability – Mutual of Omaha

Benefit: 50% of salary – maximum benefit of $1,500/month

90 day elimination period

Own Occupation Period: 24 Months

Buy-up Option – Mutual of Omaha

Benefit: 60% of salary – maximum benefit of $7,500/month

Maximum Covered Payroll: $12,500 monthly

Buy-up Rate: $0.13 per $100 monthly covered payroll

Example: John Doe earns $2,500 per month$2,500 X 0.0013 = $3.25 (monthly)

$2,500 X 0.0006 = $1.50 (bi weekly)

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LIFE INSURANCE

$25,000 Employer-Paid Life Insurance

$25,000 AD&D

Accelerated Death Benefit: You can withdraw a percentage of your life benefit if terminally ill.

75% of the amount of the life insurance benefit is available if terminally ill, not to exceed $18,750

Conversion: In case of termination of employment, you can convert to an individual life policy within 31 days of termination.

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VOLUNTARY LIFE

Employee: $10,000 increments up to 5 t imes annual salary to a maximum of $300,000

Spouse: $5,000 increments up to 100% of employee elected amount to a maximum of $150,000

Dependent: $10,000 chi ld: 14 days to 21 (to age 25 i f ful l - t ime student)

Guarantee Issue Amount for new hires only: $150,000 (employee)/ $30,000 (spouse)/ $10,000 (chi ld)

AD&D: Optional. Benefi t equal to l i fe amount.

Accelerated Death Benefi t : 75% to a max of $225,000

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EMPLOYEE ASSISTANCE PROGRAM

24/7 online resources and confidential telephonic consultation with licensed EAP consultants who provide assistance and guidance on:• Family, relationship and parenting issues• Emotional and stress-related issues• Conflicts at home or work• Alcohol and drug dependencies• Financial issues• Depression• Parenting• On-line resources and tools

Up to 3 in-person counseling sessions every 6 months with a licensed mental health professional.

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WORLDWIDE EMERGENCY TRAVEL ASSISTANCE

■ Whether your travel is for business or personal reasons, our worldwide emergency travel assistance program goes with you when you travel to a foreign country or just 100 miles or more from home.

■ If you, your spouse or your dependent children need immediate assistance anywhere in the world.

The need for emergency travel assistance is growing.

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• Benefit Resource, Inc.• FSAs help you pay eligible health care and dependent care expenses on a pre-tax basis

Tax advantage: When you save pre-tax dollars in your FSA, you’ll also lower your overall

taxable income.

• There are three components of the FSA that you can take advantage of:• Health care FSA - employees can elect pre-tax deductions of up to $2,000 annually to

use towards eligible medical, Rx, dental and vision expenses• Dependent care FSA – employees can elect pre-tax deductions of up to $5,000

annually to use towards eligible child (12 and under) and adult day care expenses.

$2,500 if married and filing separately. • Pre-tax Premiums

Use-it-or-lose-it forfeiture rule: unused dollars are not returned to you!Submit your receipts by November 15 for expenses incurred during the benefit year.

FLEXIBLE SPENDING ACCOUNTS

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TAX SAVINGS EXAMPLE

MEDICAL FSA

Annual Savings Example With FSA WithoutJill's taxable income is: 50,000$ 50,000$ Contribution to FSA 2,000$ -$ Taxable Income 48,000$ 50,000$ Real Spendable Income 38,871$ 38,418$ Tax Savings 453$

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Use at qualified merchants (pharmacy,

doctor, dentist, vision, etc.)

If prompted at the point of sale, choose

credit not debit

Always retain your receipts

HOW TO USE BENIVERSAL® FOR MEDICAL EXPENSES

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SUBSTANTIATION PROCESS

If we cannot match the charge to your plan summary, we may require substantiation.

If so, you will receive an email from BRI asking for a receipt or an Explanation of Benefits (EOB)

You can send it to us by Fax, uploading it online, or from your smart phone with the BRI app

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CASH REIMBURSEMENT CLAIMSSUBMIT REIMBURSEMENT CLAIMS FOR ALL

DEPENDENT CARE EXPENSES AND THOSE MEDICAL

EXPENSES FOR WHICH YOU COULD NOT USE YOUR

BENIVERSAL® CARD

REIMBURSEMENT IS AVAILABLE IN TWO WAYS:

A check mailed to your home address

Direct deposit into your checking/savings account (you can

set up direct deposit via your online account or by mailing

or faxing the direct deposit authorization form)

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BRI MOBILE APP

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WEBSITE LOGIN

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Enter your Company Code = CRLAMember ID = Social Security Number Password = Home Zip Code (unless previously changed)

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YOUR HOME PAGE

Your home page allows you to resolve receipt requests, view a table of eligible expenses, review your account balance and transaction detail, submit claims, set up direct deposit and obtain any forms you may need.

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IMPORTANT DATESMAKE YOUR ELECTION BY JULY 12 FOR THE 2014 /2015 PLAN YEAR.

PAYROLL DEDUCTIONS WILL OCCUR IN EQUAL AMOUNTS FROM EACH BIWEEKLY PAYCHECK BEGINNING IN AUGUST 2014

YOU SHOULD RECEIVE YOUR BENIVERSAL ® CARDS BY THE MIDDLE OF AUGUST UNLESS YOU ALREADY HAVE A CARD. ANY CHARGES

ELIGIBLE 8 /1 SHOULD BE SUBMITTED VIA CLAIM FORM UNTIL YOU GET YOUR CARD.

ELIGIBLE SERVICES MUST HAVE BEEN PROVIDED DURING THE PLAN YEAR OR DURING THE 2 ½ MONTH GRACE PERIOD FOLLOWING THE

END OF THE PLAN YEAR. THE GRACE PERIOD ENDS OCTOBER 15 , 2015 . YOU HAVE UNTIL NOVEMBER 15 , 2015 TO SUBMIT CLAIMS.

EXPENSES HAVE TO BE INCURRED INSIDE THE PLAN YEAR AND BEFORE THE END OF THE GRACE PERIOD. CONTINUE TO USE YOUR CARD FOR EXPENSES INCURRED DURING THE 2014 /2015 PLAN YEAR

UNTIL THE NEW PLAN YEAR STARTS AND YOUR GRACE PERIOD ENDS.

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RECEIVING BENIVERSAL® CARDS

Cards are mailedto employees’ homes after enrollment

Beniversal® Cards are activated via a toll-free phone call

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CUSTOMER SERVICE

• Go online: www.benefitresource.com

• Email: participantservices@benefitresource.com

• Call BRI Participant Services:

800-473-9595 (5 am – 5pm PST)

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• Commuter Benefits is a federal transportation benefit program that allows employees to save on their transit costs by deducting their commute expenses pre-tax from their paycheck each months.

• You can deduct $130 per month from your paycheck on a pre-tax basis for transit, and an additional $245 per month for parking at your transit or carpool pick-up location.

• This plan is managed by CRLA.

COMMUTER BENEFIT

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ENROLLMENT INSTRUCTIONS

OE per iod to make en ro l lmen ts , changes , o r te rmina t ions to your bene f i t s , w i l l be f rom 6 /27 /14 to 7 /13 /14 .   Changes can on ly be made dur ing th is t ime per iod . 

To en ro l l , you w i l l no longer be us ing paper en ro l lmen t fo rms , you w i l l be us ing the new Paycom Bene f i t s Admin is t ra t ion sys tem.   A l though we a re no longer us ing en ro l lmen t fo rms , a l l emp loyees a re requ i red to comp le te the Ra te Shee t , loca ted on the bene f i t s webs i te .   P lease f i l l ou t the co r rec t Ra te Shee t .   There i s one fo r those who make 40k o r more annua l l y and one fo r those who make under 40k annua l l y.   A lso , i f you a re e lec t ing vo lun ta ry o r buy-up coverage g rea te r than the guaran tee i ssue amoun t , you w i l l need to f i l l ou t an Ev idence o f Insu rab i l i t y fo rm, a lso loca ted on the bene f i t s webs i te .   These two fo rms must be submi t ted to HR no la te r than 7 /13 /14 .

 

You w i l l be mak ing your OE e lec t ions th rough Paycom Bene f i t s Admin is t ra t ion in Paycom Emp loyee Se l f Serv ice .   P lease be su re to a t tend your Paycom Bene f i t s Admin is t ra t ion Tra in ing today a t 1 :00 PM, o r v iew the reco rd ing , be fo re us ing Bene f i t s Admin is t ra t ion .   The reco rd ing w i l l be on the bene f i t s webs i te , a long w i th the OE web ina r reco rd ing , by Monday morn ing .   Even though you may no t wan t to make changes to your bene f i t s fo r the 2014 to 2015 p lan year, you w i l l s t i l l need to con f i rm your bene f i t e lec t ions , en te r you r dependen t in fo rmat ion , and con f i rm your con tac t in fo rmat ion on Bene f i t s Admin is t ra t ion .  

I f you have any bene f i t s ques t ions , p lease con tac t Me lan ie Beranek .   Fo r any Paycom Bene f i t s Admin is t ra t ion ques t ions a f te r the t ra in ing , p lease con tac t your HR Depar tmen t . ”

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QUESTIONS?

?