Open Enrollment Plan Year 2015 October 27 - November 7.
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Trainee and Affiliate Benefits Program (TABP) Effective January 1, 2015 Presented by Garnett-Powers & Associates, Inc. Open Enrollment Plan Year 2015 October 27 - November 7 City of Hope 1
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Transcript of Open Enrollment Plan Year 2015 October 27 - November 7.
Trainee and AffiliateBenefits Program (TABP)
Effective January 1, 2015
Presented by Garnett-Powers & Associates, Inc.
Open Enrollment Plan Year 2015
October 27 - November 7
City of Hope1
Agenda2
• The Role of Garnett-Powers & Associates (GPA) and the Insurance Carriers
• Review of all Benefits, Rates and Plan Designs
• Explanation of the Patient Protection and Affordable Care Act (ACA)
• Explanation of Online Open Enrollment Process
• Special one time Open Enrollment for Additional Life Insurance
• Q & A
• Garnett-Powers & Associates (GPA) is the broker/administrator and customer service provider for the TABP.
• We design, market, implement and administer benefit
programs for Postdoctoral Scholars and Students at many campuses throughout the U.S.
• We act as the liaison between the insurance carriers and you by providing assistance with understanding and accessing your benefits.
The Role of GPA and City of Hope
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What is Open Enrollment?
• Open Enrollment provides an annual opportunity for you to change your benefit choices and add or delete dependents.
• If you are not making any changes, no action is necessary.
• If you previously waived benefits, you may enroll.
• You are enrolling for the entire year. You may make changes to your elections during the year only if you have a change in family status or experience a qualifying event.
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What is Open Enrollment?(Continued)
• Examples of qualifying life events are:
Marriage
Divorce
Birth of a child
Death of a dependent
Spouse gains or loses coverage due to employment
Adoption or placement of adoption of a child
Loss of coverage
Dependent arrival in the U.S.
Dependent loss of eligibility due to attainment of age 26.
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Special Open Enrollment Additional Life Insurance
• One time Open Enrollment to elect supplemental Life and ADD plan without completing a medical history statement.
• Guaranteed up to $100,000 of additional life insurance
• Open to everyone eligible for TABP
• Low cost
• Instructions on how to enroll on the GPA website
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Family Member Eligibility
Eligible Family Members Include:
• Legally married spouse, including same sex spouses if married in a state that allows same sex marriage. Proof of marriage is required.
• Domestic Partner - You must submit an Affidavit of Spousal Equivalency to enroll your domestic partner. For information, please review the Enrollment Instructions under ‘Enrollment’ as well as the Enrollment Form.
Note: Spouses and domestic partners who are eligible for group medical coverage through another employer are not eligible for the TABP Plan. By enrolling a spouse or domestic partner you are attesting that they meet the eligibility requirements.
• Natural or adopted children and children of a domestic partner to age 26 regardless of student or marital status.
• Stepchildren may be included if they live with the member and are supported at more than 50% and claimed on your tax return.
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Benefits Offered Through the Trainee & Affiliate Benefits Program
Plan Name Insurance Type
Company
HMO Medical
POS Medical
HMO Medical
DMO Dental
DPPO Dental
PPOVision
(Voluntary)
Life and AD&D Life
STD/LTD Disability
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What is a POS Plan?
• Under the Point of Service (POS) plan, the member does not have to choose a Primary Care Physician (PCP).You may use any provider.
• There are both in-network and out-of-network benefit levels. You will receive higher reimbursement if you use an in-network provider.
• You will need to satisfy a deductible before many services will be paid by the plan.
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YOUR OUT-OF-POCKET COSTSMedical Benefits In-Network Out-of-Network
Physician Office Visit $ 20 Copay 40%*Specialist Office Visit $ 30 Copay 40%*E-Visits to PCP $ 20 Copay 40%*Walk-in Clinics $ 20 Copay 40%*Hospitalization:
Inpatient 20%* 40%*Outpatient 20%* 40%* Pregnancy 20%* 40%*
Prescription Drugs: Generic $ 10 Copay Not coveredBrand $ 30 Copay Not coveredNon Brand $ 45 Copay Not covered
Emergency Room Visits $150 Copay (waived if admitted) $150 Copay(waived if admitted)
Urgent Care 20% after $ 35 Copay 40% after $ 35 CopayRoutine Physical Exam None 40%*Routine Gynecological Exam None 40%*Routine Mammograms None 40%*Mental Health:
Outpatient $ 30 Copay 40%* Inpatient 20% * 40%*Annual Maximum Out-of-Pocket: $2,000 Individual $4,000 Individual
$4,000 Family $8,000 FamilyDeductible:
Individual $500 $1,000Family $1,500 $3,000
Lifetime Maximum Unlimited Unlimited
*Coinsurance amounts after satisfaction of the deductible For more detailed plan design information go to: www.garnett-powers.com/coh
Trainee & Affiliate Benefits Program
Aetna POS Medical Plan
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What is a HMO Plan?
• Under the HMO model, the member must choose a Primary Care Physician (PCP). Each family member may have a different PCP.
• A PCP must be selected and indicated on the enrollment form. Provider directory links are available on the GPA website.
• You are allowed to change your PCP once a month.
• Your PCP becomes your healthcare “gatekeeper.”
• If a member needs treatment from a Specialist or requires an In-Patient or Out-Patient hospital procedure, s/he must obtain a referral from their PCP prior to any type of consultation or treatment. If the referral is not obtained, no benefits will be paid.
• There is no Out-of-Network benefit (except in the case of an emergency).
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Trainee & Affiliate Benefits ProgramAetna HMO Plan
Medical Benefits Member PaysPhysician Office Visit $ 20 CopaySpecialty Office Visit $ 30 CopayHospitalization:
Inpatient $100 CopayOutpatient NonePregnancy $100 Copay
Prescription Drugs:Generic $ 10 CopayBrand Name $ 30 CopayNon Formulary $ 45 Copay
Emergency Room Visits $150 Copay (waived if admitted)Urgent Care $ 35 CopayRoutine Physical Exam NoneRoutine Gynecological Exam NoneRoutine Mammograms NoneMental Health:Outpatient $ 30 Copay
Inpatient $100 CopayAnnual Maximum Out of Pocket:
Individual $1,500Family $3,000
Deductible:Individual NoneFamily None
Lifetime Maximum Unlimited13
For more detailed plan design information go to: www.garnett-powers.com/coh
Trainee & Affiliate Benefits ProgramKaiser HMO Plan
Medical Benefits Member PaysPhysician Office Visit $ 20 CopaySpecialty Office Visit $ 30 CopayHospitalization:
Inpatient $100 CopayOutpatient $ 30 CopayPregnancy $100 Copay
Prescription Drugs:Generic $ 10 CopayBrand Name $ 35 Copay
Emergency Room Visits $150 Copay (waived if admitted)
Urgent Care $ 20 CopayRoutine Physical Exam NoneRoutine Gynecological Exam NoneRoutine Mammograms NoneMental Health:Outpatient $ 20 Copay
Inpatient $100 CopayAnnual Maximum Out of Pocket:
Individual $1,500Family $3,000
Deductible:Individual NoneFamily None
Lifetime Maximum Unlimited
14For more detailed plan design information go to: www.garnett-powers.com/coh
Prescription Mail Order Pharmacy
• You can order maintenance medications through Aetna’s and Kaiser’s Rx home delivery service for chronic conditions such as asthma, arthritis, diabetes, high cholesterol and heart conditions.
• The costs for the Aetna POS & HMO Plans are: $20 generic, $60 brand-name and $90 for non-formulary brand-name drugs up to a 90 day supply.
• The costs for the Kaiser HMO Plan are: $20 generic
and $70 brand-name up to a 90 day supply.
• It is a simple process and the mail order information is posted on our website under “Medical Plans.”
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Summaries of Benefits and Coverage
• Legally required Summaries of Benefits and Coverage for your medical plans will be available on our website no later than October 29.
• The Summaries of Benefits and Coverage follow the
recommended guidelines to show you your benefits in a standardized format to assist you in making your plan selections.
• You may request a paper copy at no charge by calling the toll-free number on your ID card.
• You may also print a copy directly off of the GPA website.
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Women’s Preventive Health Benefits
• Certain women’s preventive health benefits are available under the medical plans at no out-of-pocket cost to you.
• Routine gynecological care exams, routine adult physical exams and mammograms are covered at no cost.
• Other services include but are not limited to: Pre-natal maternity, screening for gestational diabetes, HPV DNA testing, screening and counseling for interpersonal and domestic violence, contraceptive methods and counseling, as well as breastfeeding support, supplies and counseling.
• FDA approved generic contraceptive drugs and devices are also covered.
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Other Preventive Health Benefits
• In addition to the Women’s preventative benefits there are other preventative services that are paid 100% with NO copay under the HMO and POS plans.
• Routine physical exams
• Well child care
• Routine Adult and Children Immunizations • Routine Eye exam
*Under the POS plan if going out of network an additional co-insurance is assessed.
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Aetna Wellness Programs
• Aetna Navigator - This is an online member portal that allows you to view your medical visits and claims status, print temporary ID cards and gain access to a wealth of tools and information. Access at www.aetna.com . Once you have your member ID, you may register for access to this site. There will be instructions on the website to assist you.
• Beginning Right – Provides a pregnancy risk survey and a wealth
of information to assist you with when either you or your spouse become pregnant.
• Global Fit – Offers discounts to a nationwide network of fitness clubs.
• Health Connections – Discounts are offered through this program for spas, health foods and fitness clothing.
• Stress Management – Information available for better mental and
physical health.
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Kaiser Wellness Programs
• Kaiser Website - This is an online member portal that allows you to view your medical visits and claims status, print temporary ID cards and gain access to a wealth of tools and information. Access at www.kp.org .
• Discounts – Kaiser offers a variety of health discounts. See their website for more information.
• Disease Management Programs – classes are available for a variety of health conditions.
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EAP Program
• City of Hope pays the cost of this benefit
• The employee assistance program provides access
to confidential counseling for a variety of issues, including:
• Stress• Family issues• Bereavement• Financial Issues
• You are entitled to three visits per issue per year and phone counseling.
• The services are available by phone or online 24/7/365
• Phone Number: (888)293-6948• Website: www.eapbda.com
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Trainee & Affiliate Benefit Program
Aetna Dental HMO Plan Annual Maximum: Unlimited
In-NetworkMember Pays
Calendar Year Deductible None
Diagnostic and Preventive Care-Routine Exams No Charge-Teeth Cleanings No Charge-X-Rays No ChargeBasic Procedures-Fillings No Charge-Endodontics $0- $225 Copay-Periodontics $10- $140 Copay-Oral Surgery $0- $60 CopayMajor Procedures-Crowns $150-$170 Copay-Bridgework $150 -$170Copay-Dentures $185- $200 CopayOrthodontia-Adolescent $1 845 Copay-Adult $1,845 Copay
For more detailed plan design information go to: www.garnett-powers.com/coh 23
Trainee & Affiliate Benefit ProgramAetna Dental PPO Plan
Annual Maximum $1,500 per person
Calendar Year Deductible
Diagnostic and Preventive Care-Routine Exams-Teeth Cleanings -X-RaysBasic Procedures-Fillings-Endodontics-Periodontics-Oral SurgeryMajor Procedures-Crowns-Bridgework-DenturesOrthodontia-$1,500 Lifetime Maximum
For more detailed plan design information go to: www.garnett-powers.com/coh
PPO NetworkMember Pays
$ 50 per individual$150 per family
0% (no deductible)
20%
50%
50%
Out-of-Network Member Pays
$ 75 per individual$225 per family
20%
60%
70%
70%
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Voluntary Vision Plan
• This plan is voluntary, which means you are responsible for the monthly cost for you and your enrolled dependents.
• The enrollment instructions and rates can be found on the GPA website.
• You will use your SSN and name to make an appointment with a provider.
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Vision Benefits In-Network Out-of-NetworkMember Pays Member Pays
Eye Exam (every 12 months) $10 Copay up to $35 Allowance
Frames (every 24 months) $120 Allowance up to $60 Allowance (20% off remaining balance)
Lenses (every 12 months)Single $10 Copay up to $35 AllowanceBifocal $10 Copay up to $49 Allowance
Trifocal $10 Copay up to $74Allowance
Contact Lenses (every 12 months) $135 Allowance up to $108 Allowance
For more detailed plan design information go to: www.garnett-powers.com/coh
Trainee & Affiliate Benefit ProgramVoluntary Vision Plan
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Life and AD&D Insurance
• Premiums are paid by the City of Hope.
• The plan pays $50,000 in the event of your death.
• The plan pays an additional $50,000 if your death is
due to a covered accident.
• The AD&D feature pays a benefit in the event of a loss of sight, limbs, hearing, etc.
• Accelerated Benefit Provision – Allows eligible members, who are terminally ill to receive a benefit of up to 75% of their life insurance benefit if they are diagnosed as terminally ill.
• All J-1 Visa holders and their dependents will have the required medical evacuation coverage of $10,000 and repatriation of mortal remains coverage of $7,500 included in this plan.
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Supplemental Life Insurance
• For those of you who are interested in additional life Insurance. We have made arrangements with The Standard to allow all eligible TABP members to enroll in this Excellent benefit.
• You are guaranteed up to $100,000 of additional life
life insurance.
• No medical history statement to fill out and a very low cost to you.
• Don’t miss out on this one time special Open Enrollment for Additional life insurance.
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Short-Term Disability Insurance (STD)
• Premiums are paid by the City of Hope.
• The plan pays up to 60% of the first $2,500 weekly
pre-disability earnings.
• The maximum weekly benefit is $1,500 per week.
• This benefit is offset by other disability income, such as Worker’s Compensation and CA State Disability.
• The minimum benefit is $15.00
• The benefit waiting period is 0 days for disability caused by an accidental injury and 7 days for disability caused by sickness or pregnancy.
• The maximum benefit period is 180 days.
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Long-Term Disability Insurance (LTD)
• Premiums are paid by the City of Hope.
• The Benefit Waiting Period is 180 days of disability. This program starts when the Short Term Disability ends.
• The plan will pay up to 60% of the first $8,333 of your monthly pre-disability earnings.
• The maximum monthly benefit is $5,000.
• This benefit is offset by other disability income, such as Worker’s Compensation and CA State Disability.
• Once approved, benefits are payable each month while you are disabled up to age 65.
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Health Care Exchange
• The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010.
• The ACA requires that most people who are either citizens or legal residents must have health insurance coverage, or pay a tax if they do not.
• The intent of the ACA is make health care coverage available to those who are uninsured in the U.S.
• All states are required to offer a Health Care Exchange, either through the federal government, on their own or through a partnership between the state and the federal government.
• California’s Exchange is provided by Covered California.
• U.S. citizens and most legal residents are eligible for plans on the exchange.
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Health Care Exchange(Continued)
• There are differing levels of coverage and cost, as well as several insurance carriers offering the plans.
• In order to be eligible for the Premium Tax Credit, also known as a subsidy, a person must meet certain eligibility requirements:
Their employer offers coverage where the plan design does not meet the coverage requirements of the ACA.
Certain poverty-level income conditions are met.
The cost of employee-only coverage
exceeds 9.5% of an employee’s wages.
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Health Care Exchange(Continued)
Important ACA Information Specifically for Enrollees in the City of Hope TABP
• The Aetna and Kaiser plans meet or exceed the plan requirements of the ACA.
• To the best of our knowledge, the cost of single coverage for the plans does not exceed 9.5% of an eligible Trainee’s wages/stipend.
• It is highly unlikely that anyone enrolled in the City of Hope TABP medical coverage will be eligible for a subsidy through the exchange.
• For more information, please visit California Healthcare Marketplace at www.coverdca.com .
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The Open Enrollment Process
• Go to the GPA website at www.garnett-powers.com/coh and click on “Open Enrollment”. • Next, click on the “Open Enrollment Form Instructions” link and print the instructions for assistance with completing the open enrollment form properly.
• Once you have the instructions, go directly to the “Open Enrollment Form Login” link. This will take you to a login page where you will choose “Returning User” and provide your City of Hope ID number and previously created password.
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• Once done, click “Submit” and you will be taken to the Dashboard where you will be able to view your current enrollment and also complete your Open Enrollment form with any desired benefit changes.
• Once complete, please click “Submit and Create Printable Enrollment Form” which will send your form to our secure database and also allow you to print a copy of your enrollment form for your records.
• An e-mail will be sent no later than November 14, 2014 confirming your new enrollment status.
• ID cards for any new coverage will be mailed to your home directly from the Insurance Carriers.
The Open Enrollment Process (Continued)
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City of Hope TABP Plan Year 2015
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Monthly Rates PremiumPaid by
City of HopePaid by
Participant
Aetna Medical HMO Participant $ 351.71 $293.68 $58.03Participant + Spouse $773.76 $622.49 $151.27Participant + Child(ren)
$633.06 $509.30 $123.76
Family $1,090.31 $877.15 $213.16
Aetna Medical POS
Participant $499.36 $416.97 $82.39Participant + Spouse $883.85 $702.22 $181.63Participant + Child(ren)
$838.90 $666.51 $172.39
Family $1,183.47 $940.27 $243.20
Kaiser Medical Plan
Participant $368.29 $307.52 $60.77Participant + Spouse $699.75 $555.95 $143.80Participant + Child(ren)
$662.93 $526.70 $136.23
Family $957.56 $760.78 $196.78Aetna Dental HMO
Participant $17.52 $14.02 $3.50
Participant + Spouse $39.95 $17.98 $21.97Participant + Child(ren)
$40.04 $18.02 $22.02
Family $52.74 $23.73 $29.01
Aetna Dental PPO
Participant $57.18 $45.74 $11.44Participant + Spouse $121.80 $54.81 $66.99Participant + Child(ren)
$126.95 $57.13 $69.82
Family $195.56 $88 $107.56EyeMed Voluntary Vision
Participant $7.92 $0 $7.92Participant + Spouse $15.04 $0 $15.04Participant + Child(ren)
$15.84 $0 $15.84
Family $23.28 $0 $23.28
Information Sources
For general inquiries and customer serviceregarding enrollment, general benefit questionsand confirmation, you should contact:
Garnett-Powers & Associates, Inc.
Website:
www.garnett-powers.com/coh
Toll Free Phone:
800-261-7109 Fax #:
949-583-2929
Email Address:
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