Transcript Ambercare

Ambercare
AMBERCARE
Open Enrollment Webinar 2015
October 24, 2014
Patricia A. Cole
Principal
Phoenix – 2325 East Camelback
Today’s Agenda
• Introduction
• What’s new for 2015
• Affordable Care Act (ACA)
• Core Benefits
– Medical – Blue Cross Blue Shield of New Mexico
– Health Savings Account – HSA Bank
– Dental – Delta Dental of New Mexico
– Vision – Vision Care Direct
– Basic Life & AD&D – UNUM
– Voluntary Life – UNUM
• Voluntary Benefits with Aflac
– Accident
– Critical Accident
– Short Term Disability
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What’s New for 2015
• Benefits now available to all full-time employees working an average of 30
hours per week
• Passive Enrollment
• No changes to medical or Rx plans
• No changes to life, dental or vision benefits
• Slight increase in medical and dental contributions (continue the same
percentage split)
• No change in vision contributions
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Affordable Care Act (ACA): Individual Mandate
Pay penalty
All individuals
must have health coverage
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OR
2015
Greater of $325 (single) | $975 cap (family)
or 2% of household income
By 2016
Greater of $695 (single) | $2,085 cap (family)
or 2.5% of household income
3
Public Programs in 2014
201
Medicaid and Public Exchanges
Medicaid
Expansion
Expanded to anyone
below 138% federal
poverty line.
Not all states have agreed
to expand coverage, (NM
has).
• In these states, federal
subsidies may be
available for certain
people to buy coverage.
• Those ineligible for
Medicaid or federal
subsidies may have no
option for subsidized
coverage other than
employer plan (if
available).
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Single
individual
Public Exchanges
Insurance plan options
available on exchanges that
are operated by states or
federal government (or a
state/federal partnership).
• Exchanges will conduct
open enrollment: Oct 1,
2013 to Mar 31, 2014.
• If household income is
between 100%/138% and
400% of federal poverty
level – and individual does
not have access to
affordable employer
coverage that provides
minimum value– federal
government will provide
subsidies to buy insurance
on exchanges.
% of
FPL**
Family of
four
Annual household income
Household income >400% of FPL
not eligible for subsidy through
marketplace
400%
$45,960
$94,200
300%
$34,470
$70,650
200%
$22,980
$47,100
150%
$17,235
$35,325
138%
$15,856
$32,499
100%
$11,490
$23,550
* Not all States have agreed to expand Medicaid to 138% of FPL
** Based on 2013 FPL
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Welcome to Open Enrollment 2015
Ambercare Home Health
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bcbsnm.com
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Blue PPO
• No referrals required
• Choose your own provider locally, nationally and
internationally
• Participating providers accept covered charges as their
maximum fee and will file claims
• Nonparticipating Providers, do not have contractual
agreements with Blue Cross Blue Shield, therefore member
will be responsible for charges above the BCBS allowable
fee
• Deductible and Coinsurance apply to almost all services
• Some services only require copayments
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Understanding your PPO or HSA Plan
• Copay – A set dollar amount you will pay
• Deductible – A specific dollar amount which must be met by
a member before the Plan begins to pay
• Coinsurance – A percentage of a covered service that you
are responsible for paying after the deductible has been met
• Out-of-Pocket Maximum – The maximum amount of
coinsurance, per year, you are required to pay out of your
own pocket after the deductible is met. The deductible and
copays for both medical and pharmacy will apply toward
meeting the out-of-pocket maximum.
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PPO Benefits
Member’s Share
Benefits
PPO In-Network
PPO Out-of-Network
Deductible
$2,000 Individual
$4,000 Family
$6,000 Individual
$12,000 Family
Out-of-Pocket Maximum
$3,000 Individual
$6,000 Family
$9,000 Individual
$18,000 Family
$20 Copay
Primary Provider Office Visit
(deductible waived)
40%*
Preventive Care/Well Visits
No Charge
40%*
Inpatient Admission
20%*
40%*
Emergency Room
20%*
40%*
Urgent Care
20%*
40%*
Lab/X-Ray/MRIs
20%*
40%*
Outpatient Services
20%*
40%*
*After deductible
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High Deductible Health Plan (HDHP)
Member’s Share
Benefits
In-Network
Out-of-Network
Deductible
Individual
$2,000
$6,000
Family
$4,000
$12,000
Individual
$6,250
$18,750
Family
$12,500
$37,500
Preventive Care/Well Visits
No Charge
50%*
Inpatient Admission
20%*
50%*
Emergency Room
20%*
20%*
Urgent Care
20%*
50%*
Lab/X-Ray/MRIs
20%*
50%*
Retail Pharmacy Care
20%*
Not Covered
Out-of-Pocket Maximum
*After deductible
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Prescription Drug Benefit
In-Network Pharmacy Costs
Retail Pharmacy
Generic
Preferred Brand
Non-Preferred
PPO
$5
$20
$40
HSA*
25%
50%
50%
Home Delivery (Mail Order)
$187
(Up to a 90-day supply)
Generic
Preferred* Brand
Non-Preferred
PPO
$10
$40
$80
HSA
25%
50%
50%
$21
*Deductible must be met first
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More Doctors. More Hospitals.
More than 96%
of hospitals and
91% of doctors
Over 22,000 contracted in
New Mexico
nationwide
network
more
Nationwide
coverage when
traveling or living
outside of home
state
providers
more than
5,300
hospitals
Worldwide®
coverage
when traveling in
more than 195
countries
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How to Find a Provider
Log on: bcbsnm.com
Click on ‘Find A Doctor”
Call Customer Service
Toll-free 1-800-432-0750
OR Contact your
Call BlueCard Access 24/7
800-810-BLUE (-2583)
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physicians and ask
if they belong to the
BCBS PPO Network
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More Benefits. More Resources.
bcbsnm.com
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Self Service
Blue Access® for Members
Claims and Customer Service
Members can:
• Check status of claims
• View explanations of benefits
• Communicate with Customer
Advocates through e-mail
• View provider selections
• Order new ID cards or print
temporary copy
• Link to wellness site
(Well onTarget)
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Member Liability Estimator
• View Costs for 102 High
Volume, High Price Variability
Procedures
• Amount is Episodic (includes
facility and professional
components)
• Amount Displayed is Based
on BCBS Contracts
• Information Available
Nationally
• Number of Procedures
Represents Blue Cross
Members Only
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Integrated Provider Finder Demographics
• More Demographics
Information
• Website Design
Consistent with other
Search Engine Sites
• Ability To Compare
Three Facilities Side
By Side
• Combines Cost,
Quality and Member
Feedback for a ‘One
Stop Shop’ for Patient
Needs
• Connects Members
and Providers
Together Online
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Integrated Provider Finder Cost
• View Costs for 102 High
Volume, High Price Variability
Procedures
• Amount is Episodic (includes
facility and professional
components)
• Amount Displayed is Based
on BCBS Contracts
• Information Available
Nationally
• Number of Procedures
Represents Blue Cross
Members Only
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Our new wellness is for Everyone
• Integrated Health Assessment
• Life Points Reward Program
• Online Workplace Competitions
• Certified Wellness Coaching – stress
management, nutrition and physical
activity
• Personalized Wellness Communication
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BlueExtrasSM Discounts
Just for Being a Member!
Vision Care and
Eyewear – Discounts
Weight Management –
on
eyewear, contact lenses and
laser vision correction surgery
Discounts at Jenny Craig®´
on membership and food
Nutrition – Discounts on
Hearing Aids – Discounts
Seattle Sutton’s Healthy
Eating®´ meal plans; national
home delivery program
on hearing aids for members,
parents and grandparents
Complementary
Alternative Medicine –
Just for being a
Member!
Discounts on acupuncture,
health clubs, chiropractic,
naturopaths, spas, massage
therapy, vitamins and
supplements, and more
Under the My Coverage tab
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24/7 Nurseline
Advice anytime.
Round-the-clock health
and the wellness advice
from licensed
professionals
Advice isn’t just needed from 9 to 5.
Our 24/7 Nurseline is here to help.
• Nurses provide health advice and information,
help you to identify warning signs and administer
self-care, 24 hours a day
• Audio health library on 1,200 topics such as first aid,
kicking the smoking habit, fevers, sprains and more
24/7
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1-800-973-6329
Available in English and Spanish
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What if I Have Questions?
Personalized Service
Call your customer service team for:
•
•
•
•
•
•
•
•
Claim questions/status
1-800-432-0750
Network provider information
Toll-free
Membership and eligibility
Customer Service
Medical coverage questions
Inquiries (telephone and email)
Transition of Care information
ID card requests
Help with online tools
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Why Blue Cross and Blue Shield?
1 in 3 Americans is covered by a Blue Cross and Blue Shield plan
 More doctors and hospitals to choose from nationwide and
around the world
 The best in personalized customer service for questions,
inquiries, claims or help with online tools
 Online technology helps you access and manage your health and
wellness information
 Coverage everywhere you go – in the U.S. and around the world
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It’s about
helping
members
live more healthy
and productive
lives.
bcbsnm.com
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Considering a Health Savings
Account (HSA)?
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HSA Eligibility
To be an eligible individual and qualify for an HSA you:
• Must be enrolled in an HSA-compatible HDHP
• May not have other first dollar medical coverage (other types of
medical insurance)
• May not be claimed as a dependent on another person's tax return
• May not be enrolled in Medicare
– An individual can be Medicare eligible and have an HSA. However,
once enrolled in Medicare contributions to the HSA account must
stop. The individual can keep any funds in the account prior to
enrolling in Medicare and use those funds to pay for qualified
medical expenses tax-free
HSA contributions:
• The IRS determines the maximum annual contribution amounts. The
amounts are adjusted annually for inflation. Employee, employer or
any third party may make contributions on behalf of an eligible
individual
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Basic HSA Plan Concept
Part I: High Deductible Health Plan
2015
HSA
Concept
Single
Family
Min. Deductible
$1,250
$2,500
Max. Out of Pocket
$6,350
$12,700
Part II: Health Savings Account
Max. Contribution
Single
Family
For 2015
$3,350
$6,650
Covers illness or
injury after the
deductible, and
certain preventive
care services at no
cost to you
Pays for Qualified
Medical Expenses
not covered by the
health plan
• Out-of-pocket includes deductible & co-insurance
• Qualifying deductible ranges are limited by the maximum out-of-pocket.
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Basic HSA Concept
• Compare to an IRA
HSA
Tax-Deferred Growth
Earnings
Contributions
Contributions
Tax-Deductible/Pre-Tax
Contributions
Tax-Free Distributions
(For Qualified Medical Expenses)
Normal Tax
(NON-qualified expenses if you are 65 or older)
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Who is eligible for an HSA?
Individuals who are covered by an HSA-compatible health
plan are qualified if they are:
•
Not covered by any other non HSA-compatible health
plan
•
Not claimed as a dependent on another person’s tax
return (excluding spouses per Internal Revenue Code)
•
Not enrolled in Medicare
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Advantages of an HSA
• Funds roll over from year to year
– No “use it or lose it” philosophy
• Tax benefits on contributions, earnings and distributions
– Contributions are either pre-tax
(via paycheck) or tax-deductible
• Portability
– Funds follow you
– Tax-free withdrawals for Qualified Medical Expenses even
if qualifying coverage ends
• Long-term investment opportunities
– (Not FDIC insured)
• Control over healthcare dollars
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Tax Savings Example
Contribution
$3,000 per year for 25 years
Annual Medical Expenses
$500 per year
Tax Bracket
28% (Federal)
Average Interest Rate
2%
TAX SAVINGS ON CONTRIBUTIONS =
$17,500.00
TAX SAVINGS ON DEFERRED GROWTH =
$4,921.21
ACCOUNT BALANCE AT THE END OF 25 YEARS =
$80,075.75
For illustrative purposes only. Actual savings may vary. Visit www.hsabank.com and click
on Calculate Savings for a personalized estimate.
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Online Calculation Tools
Is an HSA Right for Me?
Allows you to compare a traditional health plan and an HSA qualified plan to
determine potential savings http://hsabank.com/hsabank/Education/HSA_Right_For_Me.aspx
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Calculation Tools
Determine Healthcare User Type
• Shows you how you can
maximize the advantages of an
HSA in any stage in life.
If you’re using Internet Explorer, click here for
the demo. If you’re using other browsers,
click here.
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How to Contribute
Who Makes Contributions?
• Accountholder
• Employer
• Third Party
Contributions from all sources count toward
the annual maximum.
Annual IRS Maximum
How Are They Made?
•
Through your employer
Payroll deductions may be an option
Year
Individual
Family
Online through Internet Banking
2015
$3,350
$6,650
–
•
–
•
•
(regardless of deductible)
One-time or recurring from an external
account
Checks
Transfers or rollovers
–
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Individuals and/or their spouses, over the age of 55
and not enrolled in Medicare can make an
additional $1,000 catch-up contribution annually.
(HSA, IRA)
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Distribution Options
• Debit card from Visa®
• Reimbursement from Internet Banking
to an external account
• HSA checks
• Withdrawal Form
– Mail to HSA Bank
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Qualified Medical Expenses
A Qualified Medical Expense is incurred to maintain
the health of the accountholder or the accountholder’s
spouse or dependents. The following are included:
•
•
•
•
•
Doctor and hospital visits
Medical equipment
Dental care, braces, dentures
Vision care, glasses, contacts
Medications, (over-the-counter items
with a Rx stating medical condition)
• Medical related transportation
*A list of Qualified Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf. As
described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, over-the-counter medications are considered
Qualified Medical Expenses for HSA purposes.
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Other Qualified Medical Expenses
• Premiums for long-term care insurance
– Limited to amount listed in 213(d)(10)
of the Internal Revenue Code
• Premiums for COBRA
• Premiums for coverage while receiving unemployment
compensation
• Premiums for individuals over age 65
– Retirement health benefits
– Medicare premiums
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Investment Options
HSA Bank offers a unique opportunity to invest HSA funds
in self-directed investment accounts. HSA Bank offers:
• TD AMERITRADE investment accounts
• Mutual Fund Selection investment accounts
**Investment products are not FDIC insured, are not a deposit or other obligation of or guaranteed by the
bank, and are subject to investment risks including possible loss of principal amount invested.
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Service and Support
• Toll-free Bankline
24-hour account access via
touch tone phone
(800)-565-3512
• Toll-free Client Assistance Center
(800)-357-6246
7 a.m. – 9 p.m., CT, Monday – Friday
• Toll-free Spanish Language Assistance Line
(866)-357-6232
7 a.m. – 9 p.m., CT, Monday – Friday
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What does Your Future Hold?
For more information, please visit:
www.hsabank.com
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Dental, Vision and Life
Insurance
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Delta Dental of New Mexico Dental Plan Details
• Diagnostic and Preventive Service
– 100% benefit
- Includes: exams, fluoride, x-rays, sealants for children (to age 15),
routine or periodontal cleanings *
- *People with specific at-risk health conditions may be eligible for additional cleanings or
fluoride treatment. The patient should talk with his or her dentist about treatment.
• Basic Services
– 80% benefit
- Includes: filings, root canals, gum disease, extractions, oral surgery
• Major Services
– 50% benefit
- Includes: crowns, bridges, dentures, implants
• Orthodontic Services (children up to age 19)
– 50% benefit
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Dental Plan Details
• PPO Dental plan
In-Network - The lowest cost of care applies when services are received
from Delta Dental PPO dentist. These dentists will not bill patients for any
amount over Delta Dental Approved Fees.
Out-of-Network – Delta Dental Premier or Non-participating dentists may
balance bill patients for amounts over Delta Dental approved fees and or
any other amount disallowed by Delta Dental.
Deductible – $50 per person with a maximum of $150 per family
– Does not apply to preventive services or orthodontic services
• Maximum – $1,500 annual per person
• Orthodontic Maximum – $1,500 lifetime
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VisionCare Direct
• 12/12/24 Benefit
– Eye Exam benefit every 12 months
– Lenses every 12 months
– Frame allowance every 24 months
• $15 copay for exam and materials
• Frame allowance up to $130
• Elective contact lenses allowance up to $130 (in lieu of lenses and frames)
• Necessary contact lenses allowance up to $250
• Non-member provider benefit provided at reduced benefits
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UNUM Life Insurance Details
• Group Term Life Insurance and Accidental Death & Dismemberment
– $25,000 benefit
– $25,000 additional for accidental death
– Additional benefits for an accidental dismemberment such as a loss of
foot, loss of sight, loss of speech or hearing
– Benefit is provided to all eligible full-time employees
• 100% paid by Ambercare
• Benefits reduce at age 65
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UNUM Voluntary Term Life Insurance Details
• Purchase in $10,000 increments to a maximum of 5x salary, not to exceed
$500,000
• Guaranteed issue amounts for New Hires and those who enroll during this
enrollment:
– Employee: $120,000
– Spouse guarantee issue is $20,000
– Life insurance can be purchased on children (to age19 or up to age 23
FT student)
- Benefit $10,000
• If you are currently enrolled in supplemental life, you can increase your
election up to $120,000 with no medical questions. If you waived
coverage previously and are elected coverage now, you are subject to
medical evidence of insurability (EOI)
• Benefits are portable if you leave Ambercare
• Rates are based on your attained age
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Voluntary Aflac Benefits
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What is Voluntary Insurance?
•
Voluntary insurance plans are not designed to replace insurance you already
have.
•
•
Voluntary insurance enhances your existing benefits package.
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Benefits can be used to help pay expenses that other insurance plans don’t
cover.
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Features of Aflac Plans
•
Fast Claims Payment—Most claims are processed in about four days.
•
Unlimited Claims—There is no limit on the number of claims a
certificateholder can file.
•
Payroll Deduction—Premiums are paid by convenient payroll deduction.
•
Portable Coverage—Employees can continue through bank draft or direct
billing as long as the master policy stays in force.
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Products Offered
The following products will be offered during your enrollment:
• Group Accident Insurance
• Group Critical Illness insurance
• Group Disability
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Accident Insurance
Group Accident Insurance from Aflac helps pay for out-of-pocket costs that
arise when you have a covered accident such as fractures, dislocations and
lacerations.
More than 50 benefits are payable including the following:
• Emergency treatment
• Hospital admission
• Intensive care unit
• Ambulance transportation
• Wellness testing
Nonoccupational coverage is available.
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Critical Illness Insurance
Group Critical Illness Insurance from Aflac provides cash benefits if you’re
diagnosed with or treated for a covered critical illness, such as cancer, a heart
attack, or a stroke. More importantly, the plan helps you focus on recuperation
instead of the distraction and stress over the costs of medical and personal
bills.
Guaranteed Issues amounts:
• $20,000 for employee coverage
• $10,000 for spouse coverage
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Disability Insurance
Group Disability Insurance from Aflac helps pay a portion of your income so
that you can focus on taking care of yourself instead of your bills.
Benefits include:
• Total Disability
• Partial Disability
• Waiver of Premium
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Open Enrollment
• This is your opportunity to make changes:
– Enroll in or drop benefits
– Enroll or drop dependents
– Change medical plan options
• After 11/14/14, you cannot change your election until 1/1/2016 unless you
have a “qualifying event”
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What do I need to do?
• If you are not making any changes to your current
election, you do not need to do anything
• If you want to make a change to your current election,
you must go into Day Force Benefit Enrollment. Make
sure you submit your election
• If you want to check your current benefits, go into Day
Force Benefit Summary (not Benefit Enrollment)
• Open enrollment ends on by Friday November 14th
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Questions?