Transcript Employee Benefits Blue Care HMO Benefits

Flexible Benefits
Enrollment
2009-2010 Plan Year
Employee Benefits
Outline of Presentation
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Plan Year Highlights
Core Benefits
Benefit Choices
Life Events
Employee Contributions
Questions
Employee Benefits
Plan 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…
• 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 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…
• 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…
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Tuition Remission
– Wilkes University
– King’s College
– Misericordia University
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Paid Holidays
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Vacation/Sick/Personal Leave
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403(b) Retirement Savings Plan
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Bookstore Discount
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Wilkes-Barre YMCA
Employee Benefits
Benefit Choices
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Medical Insurance
Prescription Plan
Dental Insurance
Vision Insurance
Voluntary Term Life Insurance
Voluntary AD&D Insurance
Flexible Spending Accounts
Employee Benefits
Medical Insurance
Three medical plan options:
• Blue Care HMO
• Blue Care HMO Plus
– (formerly Blue Care POS)
• Blue Care PPO
www.bcnepa.com
Employee Benefits
Blue Care HMO
Benefits
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Benefit Period : Calendar Year
Deductible: None
PCP Office Visit: $15 Co-pay
Specialist Office Visit: $30 Co-pay
Preventive Services
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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 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 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 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 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 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 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 PPO
Two Network Options
– Preferred
(www.bcbs.com)
– Non-Preferred
• Additional Costs
Employee Benefits
Blue Care PPO
Benefits
- Benefit period
- Deductible (Maximum 3 separate deductibles per family)
- Coinsurance (Insured responsibility)
- Coinsurance maximum (Maximum 3 separate coinsurance maximums per family)
- Lifetime maximum
- Precertification penalty (facility)
Insured Responsibility
Preferred
Non-Preferred
Calendar Year
$300
$600
None
20% of allowable charge
None
$3,000
Unlimited
$500,000
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%
Employee Benefits
Blue 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
No charge
No charge
20%
20%
No charge
$75 copay (after deductible)
No charge
$30 (after deductible)
20%
20%
20%
20%
No charge
No charge
No charge
20%
20%
20%
Inpatient Services
- Inpatient hospital services (unlimited days per benefit period)
- Skilled nursing care (60 days per benefit period)
Outpatient Services
- Chemotherapy, dialysis or radiation
- High-tech imaging (MRI, MRA, CT scans, pet scans, nuclear cardiology)
- Diagnostic testing (lab tests, x-rays, etc)
- Physical (20 visits per benefit period), speech (12 visits per benefit period), or occupational
therapy (12 visits per benefit period)
- Cardiac rehabilitation (36 visits/benefit period)
- Pulmonary therapy (18 visits/benefit period)
- Respiratory therapy (18 visits/benefit period)
Employee Benefits
Blue Care PPO
Other Services
- Allergy extract/injections
- Chiropractic care (18 treatments per benefit period ages 13 and up)
- Durable medical equipment/prosthetics/orthotics
- Home health services (100 visits/benefit period)
- Home infusion services
- Hospice care (180-day lifetime maximum)
- Surgery
- Maternity services (physician office visits)
- Primary Care Physician office visits (preferred not subject to deductible). Unlimited visits.
- Specialty Physician office visits (preferred not subject to deductible). Unlimited visits.
No charge
20%
$30 (after deductible)
20%
No charge
20%
$5,000 benefit period maximum
$30 (after deductible)
20%
$30 (after deductible)
20%
No charge
20%
No charge
20%
$30 initial visit
20%
$15 copay
$30 copay
20%
20%
Employee Benefits
Blue Care PPO
Mental Health
- Inpatient services (30 days/benefit period)
- Outpatient services (60 visits/benefit period)
No charge
20%
50%
50%
No charge
No charge
20%
20%
Substance Abuse
- Outpatient services (30 visits/benefit period; 120 visits/lifetime)
- Detoxification (7 days/admission; 4 admissions/lifetime)
- Inpatient non-hospital residential treatment (30 days/benefit period; 90 days/lifetime)
No charge 1st course; 50% 2nd 20% 1st course; 50% 2nd and
& subsequent courses
subsequent courses
Employee Benefits
Prescription Drug Coverage
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BCNEPA
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National Pharmacy Network - Express Scripts Inc.
https://member.express-scripts.com
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Based off of a formulary listing which includes all therapeutic
categories.
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Co-pay will depend on what tier the prescription drug is categorized.
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Formulary:http://www.bcnepa.com/PDF/RxFormulary3.pdf .
Employee Benefits
Prescription Drug Coverage
Express Scripts
Network Pharmacy
Retail Copay (30-day supply)
Tier 1
Tier 2
Tier 3
$15.00
$30.00
$50.00
Home Delivery Copay (90-day
supply)
Tier 1
Tier 2
Tier 3
$30.00
$70.00
$150.00
Employee Benefits
Prescription Drug Coverage
Three Ways to Save Money on your Prescription Drug Costs:
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Tier 0 (Zero)
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Request Generic Medications
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Utilize the Mail Order Pharmacy Program
Employee Benefits
Prescription Drug Coverage
Tier 0 (Zero)
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July 1, 2008
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65 Generic Drugs
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Co-pay Free
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List of Drugs
www.bcnepa.com
Employee Benefits
Dental Insurance
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Provider: United Concordia
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Two Dental Plans
– Basic
– Enhanced
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Flexibility
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Maximum Allowable Charge (MAC)
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Website Functions
Employee Benefits
Dental Insurance
Benefits/Services
Diagnostic and Preventive
Basic Services
Major Services
Orthodontics
(Dependent Children to Age 19)
Deductible
Predetermination
Plan Maximums (Dental)
Plan Maximums (Orthodontia)
Basic
100% MAC*
100% MAC*
Not Covered
Enhanced
100% MAC*
100% MAC* After Deductible
50% MAC* After Deductible
Not Covered
N/A
50% MAC* After Deductible
$50 Individual/$150 Family
Required for treatment plans of $150 or more, or the
extraction of 6 or more teeth.
$1,000 PP/CY
$1,200 PP/CY
N/A
$1,000/Chld/Lifetime
Employee Benefits
Dental Insurance
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
Employee Benefits
Vision Insurance
Provider: Davis Vision Inc.
Plan: Fashion Excellence Gold
Employee Benefits
Vision Insurance
FREQUENCY OF SERVICE
Eye Exams, Frames, Lenses, Contacts
12 Months Each
BENEFITS
IN-NETWORK
OUT-OFNETWORK
Amount
Amount
Covered
Reimbursed
Eye Exam (Optometrist
100%
$40
or Ophthalmologist)
Standard Lenses (Pair)
– Single Vision
100%
$30
– Bifocal
100%
$40
– Trifocal
100%
$60
– Lenticular / Aphakic
100%
$80
Frames
Fashion level
100%
Up to $30
Designer Level
$20
Up to $40
Premier Level
$40
Up to $60
Retail Allowance
Up to $100
Up to $80
Contacts (In lieu of
glasses)
100%
$48
– Standard (Hard/Soft
Daily
$75 Off
$48
Wear Spherical)
Provider
– Specialty (e.g.
Charge
Disposables,
Gas Permeables)
Employee Benefits
Voluntary Term Life
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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.
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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.
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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&D
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Employee Coverage – Increments of $10,000 up to a maximum
benefit of $500,000.
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Spouse Coverage – Increments of $10,000 up to a maximum
benefit of $250,000.
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Dependent Child(ren) Coverage – Increments of $2,000 up to a
maximum benefit of $50,000.
Employee Benefits
Flexible 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
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 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 Choices
Legal Services Plan
Long Term Care Insurance
Employee Benefits
Life Events
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Change In Status Spouse’s or Dependent’s Open Enrollment
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Dependent Care Changes
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Cost or Coverage Changes Within The Employer’s Plan
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HIPAA Special Enrollment Rights
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Judgment, Decree Or Court Order
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Enrollment/Ceasing To Be Enrolled In Medicare Or Medicaid
(does not apply to CHIP)
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Family Medical Leave Act (FMLA) Special Requirements
Employee Benefits
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 Contributions
• Medical Insurance Deductions- SAME
• Dental Insurance Deductions-Decrease
• Vision Insurance Deductions- Slight Increase
• Rate Sheet- HR Website- Ben Info & Forms
Employee Benefits
Wellness Programs
• YMCA Membership
• Wilkes Fitness Facilities
• Weight Watchers at Work
• College Town Challenge
• Lunch & Learns
Employee Benefits
Open Enrollment Procedures
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Review all Open Enrollment information.
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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.
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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
Questions