Transcript In Network - BCF Solutions

Open Enrollment 2012
Employee Benefits
1
Moderator
Faith Hites
Senior Account Manager, Group Benefits
Raffa Financial Services, Inc.
Brady J. Foster
Broker, Group Benefits
HMBS Group Insurance, LLC.
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Open Enrollment
Open Enrollment Means…
 You may enroll in coverage
 You may add or drop dependents
 You may change benefit plans – Medical, Dental, Vision
 If you are utilizing the Flexible Spending Account (FSA),
you Must elect new contributions to your
Medical Expense and Dependent Care Plans
 You Must re-elect your taxation choice on your Short
and Long-Term Disability benefits by completing the
paper form
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Important Information

Open enrollment begins December 5, 2011.

All Open Enrollment Elections Must be Made by December
16, 2011 – No Exceptions!

Medical, Dental, and Vision Open Enrollment Elections are
completed online through Benefit Mall. Instructions to log onto
Benefit Mall are available in your open enrollment packet.

If no changes are to be made to your Medical, Dental, and
Vision benefits, then you do not need to log onto Benefit Mall.
Your benefits from 2011 will renew automatically in 2012.

Paper forms will be provided for the FSA (Medical & Dependent
care) election, your HRA Acknowledgement, and your STD /
LTD taxation election. These forms Must be filled out and
submitted during Open Enrollment.
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Introduction
What’s New With Benefits…
 New POS Low Cost Medical Benefit Option for Local (VA,
DC, or MD) and Out of Area Employees (all other states).
Look for additional details on plan deductibles, co-pays,
etc… on the Medical Analysis page in your open enrollment
packet.
 Both the CareFirst HMO and POS plans from last year have
been eliminated in favor of a new Lower Cost POS Plan.
 The Dental Plan changed from Humana to Guardian
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Introduction
What’s Not Changing This Year…
 CareFirst PPO plan
 Reliance Standard for Life, Short-Term and LongTerm Disability
 FSA (Medical & Dependent Care ) and HRA
administration with The 125 Company
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Benefit Review
Discussion Topics…
 CareFirst Medical Plans (PPO vs. POS)
 HRA Card, Prescription & Vision Plans
 Guardian Dental Plan
 Reliance Standard Life & Disability Plans
 Flexible Spending Accounts (Medical & Dependent Care)
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Medical Plan Introduction and Pricing
CareFirst Health Plan Options for Local and Out of
Area Employees…
Option 1: Open Access POS (New!)
Option 2: Blue Preferred PPO
PPO Blue Preferred
NEW! POS
2012 cost
2012 Cost
Employee
$167.27
$112.80
Employee & Child
$317.81
$240.11
Employee & Spouse
$393.08
$296.98
Family
$459.99
$347.53
• All premiums are shown as monthly employee costs.
• To find your bi-monthly premium cost, divide the above amount by 2.
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Medical Benefits Terminology
Terms

Deductible the amount an individual must
pay for health care expenses before co-pays
& co-insurance begins to cover your medical
costs. BCF covers this expense by issuing you
an HRA card.

Co-insurance refers to the percentage of
money that an individual is required to pay
for services, after a deductible has been paid,
up to the annual out of pocket max.

Co-pay a predetermined (flat) fee that an
individual pays for health care services. For
example, the POS plan requires a $30
copayment for each office visit.

Out of Pocket Maximum a predetermined
amount that an individual must pay,
annually, before health care expenses will be
covered at 100% by Blue Cross Blue Shield.
Networks

Local includes employees located in
VA (excluding Dalgren), DC, & MD

Out of Area includes all other BCF
employees

In Network includes doctors
participating in the Blue Cross Blue
Shield Network

Out of Network includes all doctors
not participating in the Blue Cross Blue
Shield Network
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CareFirst Open Access POS Health Plan
A Point of Service (POS) Plan is a hybrid between an HMO and PPO plan
offering the features of both plan types.
 A Primary Care Physician (PCP) must be selected. You DO NOT need referrals to see a
specialist. Instructions on how to find a doctor can be found in your enrollment package.
 There is a deductible that needs to be met with coverage.
 HRA cards WILL BE used to cover deductible expenses up to the in-network deductible
$ amount.
 After you meet your deductible, a co-payment is charged for all medical services.
 HRA cards DO NOT cover co-payments.
POS Networks
 Local POS plan is part of the Regional CareFirst Blue Choice Network (you must use this
network locally!)
 Out of Area POS plan is part of the National Blue Preferred / Blue Card Network. All
out of area employees may utilize the same network of doctors for both the POS & PPO plans.
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CareFirst PPO Health Plan
 The BCF Solutions VA Blue Preferred PPO plan has not changed.
 All Local and Out of Area employees are eligible to elect the PPO
plan option.
 The PPO is part of the National Blue Preferred / Blue Card
Network. This means you are eligible to use any Blue Cross Blue
Shield doctor from their nationwide network without a referral.
 After you meet your deductible, the PPO plan does not have a
co-pay associated with regular doctor visits.
 Just as last year, your HRA card will cover your in-network PPO
deductible.
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CareFirst – How to Find a Doctor
Click to find
a Provider
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CareFirst – How to Find a Doctor
PPO
POS – Local and
Out of Area
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CareFirst Health Plans
All CareFirst BCBS Health Plans are HRA’s…

The $ amount on the HRA debit card is equal to your In-Network deductible.

BCF management elected to cover all in-network employee medical deductible
expenses through the HRA debit card.

The HRA debit card can ONLY be used to pay for services that are subject to the
Medical Deductible, this includes:

Inpatient and Outpatient hospitalization services or surgeries

Emergency Services (Ambulance, Emergency Room, or Urgent Care)

Visits to your Primary Care Doctor or a Specialist

Lab and X-Ray Fees

Mental/Nervous or Substance Abuse hospitalizations or physician visits
* Please note this is not a complete and comprehensive list.
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CareFirst Health Plans
All CareFirst BCBS Health Plans are HRA’s…

Below are some examples of what the HRA debit card
CANNOT BE USED FOR.

Prescription Drug Co-Pays

Cosmetic Surgery

Vision Care

All Dental Expenses

All POS Co-Payments (after the deductible is met)

Any expense related to co-insurance after the deductible has been met
* Please note this is not a complete and comprehensive list.
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Additional HRA Information

HRA Website: www.125Company.com

How to use the HRA

Monitor your account

Upload “Explanation of Benefits/Receipts” to the website

Explanation of Benefits are mailed from BCBS and can also be found on the
CareFirst website

Don’t pay for your appointment while at the doctor’s office.

The doctor needs to first submit a claim to BCBS and then send you a bill. Wait for the bill
to be mailed to you.

If your HRA card is not accepted by the doctor you have two options
1.
You can pay for it out of pocket and then submit a reimbursement claim (form on
the BCF website)
2.
You can submit the reimbursement form with your EOB to 125 Company (form on
the BCF website) and once you receive the money, pay the bill.
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Prescription Drug Plan
Drug Benefit Description
 $15 Generic Drugs
 $35 Preferred Brand prescription or refill.

Preferred Brand is designated by CareFirst
 $60 Non Preferred Brand prescription or refill
 If you use a Non Preferred Brand name drug and a Generic is
available, you will pay the difference in the cost of the drugs.
 Injectables – you pay 50% up to a $100 Co-pay
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Prescription Drug Plan

All $ amounts are co-pays. The co-pay is Not covered by the HRA card.

Maintenance medications are eligible for the Mail Order Program, where
you can get 3 months of medication for only 2 co-payments. Forms and
information can be found online at www.carefirst.com

If the cost of the drug is less than the listed co-pay, the employee will only
have to pay the cost of the drug at the time the prescription is filled.
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CareFirst Plan Comparison – All Employees
Medical Benefit
(All are HRA Plans)
Blue Preferred
PPO
Open Access POS
In - Network
Out of Network
In - Network
Out of Network
Deductible (Individual)
$1,400
$2,800
$2,000
$4,000
Deductible (Family)
$2,800
$5,600
$4,000
$8,000
100%
70%
100%
80%
$2,800 / $5,600
$5,600 / $11,200
$7,000 / $14,000
$15,000 / $15,000
Maximum Benefit
Unlimited
Unlimited
Unlimited
Unlimited
Inpatient Hospital
Ded then $300
Ded then 70%
Ded then 100%
Ded then 80%
Outpatient Services
Ded then /$30 Dr
$300 facility
Ded then 70%
Ded then 100%
Ded then 80%
Ded then $30
Ded then 70%
Ded then 100%
Ded then 80%
Ded then $300
Ded then $300
Ded then $100
Ded then $100
Physician/Specialist
Ded then $30
Ded then 70%
Ded then 100%
Ded then 80%
Prescription Drugs
$15/$35/$60
$15/$35/$60
$15/$35/$60
$15/$35/$60
Co-Insurance
Out-Of Pocket Maximum
Lab & X-Ray
Emergency Room
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CareFirst Blue Vision Plus Plan

Plan is Administered by CareFirst and Davis Vision

Network – Davis Vision

Providers Can Be Located On-Line at
https://idoc.davisvision.com/davis/member/adv_doc_locate_
v2.asp
Vision Plus
2012 cost
Employee
$3.58
Employee & Child
$6.60
Employee & Spouse
$8.21
Family
$10.18
• All premiums are shown as monthly employee costs.
• To find your bi-monthly premium cost, divide the above amount by 2.
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CareFirst Blue Vision Plus Plan

Your CareFirst Medical plan does have vision coverage that will
cover most vision related needs. You will have to pay a copayment
at the time of your visit for an eye exam on both PPO and POS
plans. There are discounts for eyeglasses and contacts.

All eye injuries and eye related diseases are covered through your
CareFirst medical plan.

The Vision Plus benefit is for those individuals who need extra
vision coverage.

All in-network Vision Plus plan participants receive an annual eye
exam, frames, lens, and contacts with no copayments. All out of
network participants are required to pay a portion of your vision
services as illustrated on the next page.
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CareFirst Blue Vision Plus Plan
Overview of Vision Benefits…
Vision Benefits
Davis Vision Network
Exam Frequency
1 per 12 Months
Lenses Frequency
1 per 12 Months
Frame Frequency
1 per 12 Months
Co-Pays
Davis Vision Provider
Other Provider
Vision Exams
$0 Co-Pay
Plan Reimburses $45
Lenses (Single Vision)
$0 Co-Pay
Lenses (Bifocals)
$0 Co-Pay
Lenses (Trifocals)
$0 Co-Pay
Plan Reimburses
$52 - $181
depending on lens type
Frames
Contacts (Medically Necessary)
$0 Co-Pay for Tower
Collection; Plan
Allowance of $45 for
Non-Tower Collection
Plan Reimburses $45
$0 Co-Pay
Plan Reimburses $285
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Guardian Dental Plan

Plan is Administered by Guardian Dental

Network – PPO / Traditional Preferred

TX and GA employees have state mandated benefits

Providers can be located online at
www.guardiananytime.com/fpapp/FPWeb/home.process
Guardian Dental
2012 cost
Employee
$12.78
Employee & Child
$24.56
Employee & Spouse
$29.03
Family
$41.31
• All premiums are shown as monthly employee costs.
• To find your bi-monthly premium cost, divide the above amount by 2.
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Guardian Dental Plan – Non TX or GA
Overview of Dental Benefits…
Guardian Choice Plan
Guardian
Dental Benefits
PPO Value Plan (Fee Schedule)
PPO NAP Plan (90% UCR)
In - Network
Out of Network
In - Network
Out of Network
Deductible (Individual)
$50
Combined
$50
$50
Deductible (Family)
$150
Combined
$150
$150
100%
(No Deductible)
100%
(No Deductible)
100%
(No Deductible)
100%
(No Deductible)
Basic Services
100% After
Deductible
100% After
Deductible
80% After
Deductible
80% After
Deductible
Major Services
60% After
Deductible
60% After
Deductible
50% After
Deductible
50% After
Deductible
Preventive Care
Annual Maximum
$2,500 with Rollover
$2,500 with Rollover
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Guardian Dental Plan – TX and GA
Overview of Dental Benefits…
Guardian
Guardian PPO NAP Plan (90% UCR)
In Network
Out of Network
Deductible (Individual)
$50
Combined
Deductible (Family)
$150
Combined
Preventive Care
100% (No Deductible)
100% (No Deductible)
Basic Services
80% After Deductible
80% After Deductible
Major Services
50% After Deductible
50% After Deductible
Annual Maximum
$2,500 with Rollover
*Due to State Mandates al TX and GA employees must be on this plan
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Reliance Standard Benefits
Benefits are Staying the Same…
 Three (3) Employer-Paid Plans
 Group Short-Term Disability Insurance
 Group Long-Term Disability Insurance
 Group Term Life Insurance
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STD/LTD Benefits Terminology
Terms

Waiting Period or Elimination Period
the period of time that must lapse from the
onset of a disability, before you are eligible to
receive weekly or monthly benefits.

Benefit Percentage the amount payable to
you, based on a percentage of the your
income prior to disability. The proceeds are
limited to an overall maximum amount.

Duration of Benefits the amount of time
you are able to collect disability income

Benefit Maximums the maximum amount
of disability income you are allowed to
receive based on your salary at the time of
injury. Amounts are paid weekly for STD and
monthly for LTD
Tax Choice Option

Payment on Premium you can opt
to pay the initial taxes on the premium
payments to avoid paying taxes on your
disability income benefits once you are
receiving them.

Payment on Benefit you will pay
taxes on any disability income benefits
you receive.
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Short-Term Disability Insurance
 Waiting Period (0 Days Accident/7 Days Sickness)
 Benefit Percentage (60%)
 Duration of Benefits (13 Weeks)
 Benefit Weekly Maximum ($1,500)
 You Must re-elect your taxation choice on your ShortTerm Disability benefits by completing the paper form
 Tax Choice Option – Payment on Premium or Benefit
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Long-Term Disability Insurance
 Waiting Period (90 days)
 Benefit Percentage (60%)
 Duration of Benefits to Age 65 / Social Security Normal
Retirement Age (SSNRA)
 Benefit Monthly Maximum is ($7,500)
 You Must re-elect your taxation choice on your LongTerm Disability Benefits by completing the paper form
 Tax Choice Option– Payment on Premium or Benefit
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Disability Insurance
Procedure
Employees seeking to use BCF’s disability insurance are required to provide notice
to their Supervisor of the need to utilize their STD or LTD benefits. Employee
requests are submitted via the BCF Leave Request Form (found on the BCF
Website).
To receive disability benefits, a claim form must be submitted. The Reliance STD
Claim Form can be found on the BCF website. Please return this form to HR.
Supervisors will forward the Leave Request Form to HR. If an employee is
uncomfortable discussing or providing information on a medical condition, the
employee may contact HR directly. In this case, HR will notify the Supervisor and
inform them of the request and decision. Every effort will be made to maintain
employee privacy regarding the medical condition.
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Group Life Insurance
 Two (2) Times Annual Salary
Class I - Regular Benefit
2 x Salary to $200,000
Class II - Tax Relief Benefit
2 x to $50,000. Employees who
elect Class II do so to avoid paying
tax on the amount over $50,000
 Class I: Maximum Benefit of $200,000
 Maximum Benefit Without Medical Questionnaire
 In the event that something should happen to you, your
beneficiary will need to contact your direct manager who
will start the claims process with the HR Manager.
31
FSA – Medical Expenses
Pre-Tax Contributions for Eligible Out of Pocket
Medical expenses…
 Up to $3,000 can be set aside to pay for eligible
medical expenses for plan year 2012
 Full amount elected can be accessed
immediately
 An FSA can be used to pay for medical, dental,
vision, or prescription expenses.
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FSA - Dependent Care Account
Pre-Tax Contributions for Eligible Dependent Care
Expenses…
 Up to $5,000 can be set aside to pay for eligible
Dependent Care expenses for plan year 2012
 Expenses are reimbursable as contributions
become available through your payroll
deductions. Reimbursement form is located on
the BCF website
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Reminder - Important Information
 All Open Enrollment Elections Must be Made
by December 16, 2011 – No Exceptions!
 Medical, Dental, and Vision Open Enrollment
Elections are completed online through Benefit
Mall. Instructions to log onto Benefit Mall are
available in your open enrollment packet.
 There will still be paper forms that must be
filled out for the FSA (Medical Expense &
Dependent Care) election, HRA
Acknowledgement, and your STD / LTD
taxation election.
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Reminder - Important Information
 Forms to be filled out and submitted to HR:
 FSA – Medical and Dependent Care
 STD / LTD Taxation Election
 HRA Acknowledgement
 These forms MUST be returned even if you
are not making changes!
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Questions
Who can I call with Additional Questions?

BCF Human Resources Department



PMA/S4 – Sunita Gupta; 703-817-9475; [email protected]
Defense & Space – Dina Johns; 703-717-9937; [email protected]
Triad – Mike Parker; 626-793-7314; [email protected]

Angela Fitzpatrick, Raffa Financial Services
BCF’s Dedicated Customer Service Representative
240-403-2546

Brady J. Foster, HMBS Group Insurance,
BCF’s Dedicated Insurance Broker
949-630-2523, cell 949-244-6421; [email protected]
Thank You For Your Participation…
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