Transcript Preventive Care: What to Know!

Employee Benefits Review
January 1, 2013
CHANGES FOR 2013!
• Changing to 2 health plans – PCB and HMO
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Preferred Care members will be changed to the Preferred-Care Blue PPO
Plan and Network effective January 1.
Preferred Care Blue network includes Liberty Hospital and Truman
Hospitals
• Women’s Preventive Care – Additional coverage
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Generic Contraceptive drugs 100%
Contraceptive implants, injectables & devices at 100%
Breastfeeding support, supplies (pumps) and counseling at 100%
• Voluntary Vision – Changing to EyeMed
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Same network of providers – EyeMed “Select” Network
Similar Plan Options – Exam & Materials and Materials Only Plan
• FSA – Healthcare Reimbursement Account
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New 2013 IRS Maximum Limitation - $2,500 per employee; total family
benefit of $5,000
• Voluntary Short-Term Disability - Aflac
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This benefit provides you with a portion of your monthly salary if illness
or injury keeps you from working
Health Care Reform
 Proposed for 2013
• W-2 Reporting of the cost of healthcare (2013)

William Jewell College will be required to report the annual cost ( employer cost) of
the health coverage provided to their employees on the annual W-2 Form, starting
with the 2012 W-2 and forward
• Uniform Summary of Benefits and Coverage (2013)

All health plans will be required to provide a uniform summary of the plan’s
benefits and coverage (SBC) and a uniform glossary of commonly used health
insurance and medical terms to participants
• FSA – Healthcare Reimbursement Account (2013)

IRS Maximum Limitation - $2,500 per employee; total family benefit of $5,000
2013 Medical Plan Options
• Blue-Care HMO (Health Maintenance Organization)
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Select a Primary Care Physician (PCP)
In-Network Coverage Only
In Metro Kansas City Area Coverage Only
Coverage for Urgent and Emergency Care while Traveling
No deductible or coinsurance
• Preferred-Care Blue PPO (Preferred Provider Organization)
• No selection of a PCP (Primary Care Physician)
• Freedom of Choice
• Lower your out pocket expenses when using network PPO providers
• In and Out of Network Coverage
• National and International Coverage
• Deductible and coinsurance
Blue-Care HMO
Select a PCP
YES
(FP, GP, IM, Ped)
Office Visits
$30 PCP* copay
$60 Specialist** copay
Inpatient Hospital
Services
/Outpatient Surgery
MRI, MRA, CT and
PET Scans –
Physician’s Office,
Imaging Center,
Outpatient Setting
Urgent Care
(Minute Clinics, Take
Care Centers)
Emergency Care
$250 copay per day up to $1,250 per member per calendar year
(applies to inpatient services at a hospital and outpatient surgeries at a
hospital or an outpatient facility)
$100 copay
Only one copay will apply for each provider on a specified date of service even
if multiple scans are performed
$60 copay
(office visit/lab only)
$100 copay if treated and released
Preferred-Care Blue
Annual Deductible
$2,500 individual / $5,000 family
Network Coinsurance
Member pays: 20% / BCBSKC pays: 80%
Non-Network Coinsurance
Member pays: 40% / BCBSKC pays: 60%
Out-of –Pocket Maximum
$4,500 individual / $9,000 family
$9,000 individual / $18,000 family
(Includes Deductible + Coinsurance)
Inpatient Hospital Services
Deductible then coinsurance
Office Visits
$40 copay
(includes lab services in physician’s office or network lab)
Urgent Care
(Minute Clinics, Take Care
Centers)
Emergency Care
$40 copay
(includes lab services in physician’s office or network lab)
$100 copay* then deductible then coinsurance
*Copays do not apply to deductible or OOP maximum
Hospital Locator www.bluekc.com
HMO
Blue Care Network
PPO Preferred Care Blue
Network
Center Point Medical Center
X
X
Children’s Mercy Hospitals
X
X
KU Medical Center
X
X
Lee’s Summit Hospital
X
X
Liberty Hospital
X
X
Menorah Medical Center
X
X
North Kansas City Hospital
X
X
NO
X
Olathe Medical Center
X
X
Overland Park Regional
X
X
Providence Medical Center
X
X
Research Medical Center
X
X
Shawnee Mission Medical Center
X
X
St. Joseph Medical Center
X
NO
St. Mary’s Medical Center
X
NO
Truman Medical Center (Hospital Hill and Lee’s
Summit)
X
X
Metro Hospitals
St. Luke’s (All Locations)
Preventive Care: What to Know!
Both BCBSKC plans will cover Preventive Care
Services at 100%
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Annual Physicals
Childhood Immunizations
Well Women Exams
PSA Tests
Services MUST be Preventive and received by
In-network providers
Effective January 1, 2013:
– Generic Contraceptive drugs at 100%
– Contraceptive implants, injectables & devices at
100%
– Breastfeeding support, supplies (pumps) and
counseling at 100%
•
Refer to the Routine Preventive Services flier
for additional services
Prescription Drug Coverage
Retail and Mail-Order
Certain drugs may require prior authorization, have quantity limitations or require step therapy
(Generics First). Refer to the Prescription Drug List in your packet for additional details.
Up to 34 day supply
In-Network Pharmacy
Tier 1: $10
Tier 2: $50
Tier 3: $70
Up to 102 day supply
(Save 1 month’s copay)
Mail-Order
Tier 1: $20
Tier 2: $100
Tier 3: $140
Disease Management Program from Blue Cross Blue Shield of Kansas City
The Healthy CompanionTM program provides information, education and one-on-one
telephonic support for Blue KC members who have been diagnosed with the following conditions:
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
 Depression
 Diabetes
 Heart Disease
 Heart Failure
 High Blood Pressure
 Stress and Anxiety (LiveWell)
How do you enroll?
• Automatic enrollment –member can choose to opt out of the program
• Self-enrollment
• Contact Healthy Companion at 816-395-2076 or toll free 1-866-859-3813
• Email to [email protected].
Points to Blue Deadline
• Points to Blue will end on
December 31, 2012.
• Remember you MUST
redeem your Points to Blue
by December 31,2012.
• My Rewards will begin
January 1, 2013.
2013 My Rewards Program
Step 1*
Step 2*
Complete the Onsite Health Screening (or alternate means screening form)
for 25 Points
Take the Health Risk Assessment (HRA) for 25 Points
*Steps 1 and 2 must be completed to be eligible to redeem My Rewards.
Step 3
Engage In Additional Activities for 25 Points
You may earn additional points by participating in the following activities:
• Lifestyle Coaching (goals met)
• Self-Directed Coaching Assessments
• Tobacco Cessation Program
• A Healthier You Worksite Wellness Programs
• Healthy Companion Condition Management (goals met)
• Little Stars Prenatal Assessment
My Rewards: Policy holders and spouses can redeem up to a total of $75 when 75
points are achieved.
www.bluekc.com
View Your Claims, Print a Temporary ID card & Find Rx Info
24-Hour Nurse Line
877-852-5422



Access to Care Advisors to help you with symptoms or answer
health-related questions
How Can They Help?
◦ Gain convenient access to quality care
◦ Become better informed about healthcare
◦ Gain confidence when speaking to providers
◦ Become educated on self-care for non-urgent situations
◦ Improve knowledge of drugs and medications
24 hours a day…365 days a year!
Exclusively For Our Members
▪ Blue365 online resources include:
 Tools to help employees make the best choices about their health
 Select discounts and savings on products and services they can use to improve
and maintain health
▪ Select companies include:
Independent companies that do not provide Blue Cross and/or Blue Shield products or services and are solely responsible for the services provided.
YMCA, Discover Vision and Sabates Eye Care provide discounts in the Kansas City metropolitan area only.
Preferred-Care Dental
BluePremier Network
Type I
Deductible
Type II
None
Type III
$50 / $150
Type IV
None
Blue Cross Pays
(Preferred-Care Dental
and Out-Of-Area
Providers)
100%
80%
50%
50%
80%
70%
40%
50%
Dental X-rays
Root Canal
Complete or
Partial
Dentures
Routine Oral Exam
Tooth Extraction
Blue Cross Pays
(Non-Preferred-Care
Dental Providers within
our Operating Area)
Covered Services
Orthodontia ( to age
19):
Cephalometric X-rays.
Cleaning – two each
calendar year
Bridge
Recementing
Surgery of
Gums
Diagnostic casts.
Periodontal
Scaling
Calendar Year
Maximum
Lifetime Maximum
$1,000 per person for all services
None
N/A
$1,000 Preferred
Flexible Spending Accounts
Information + Enrollment = Savings
WILLIAM JEWELL COLLEGE
What is an FSA anyway?
An FSA adds spendable income and covers many expenses.
You may redirect part of your paycheck into a pretax account.
FSA Benefit Buckets Available:
1- HEALTHCARE FSA: Medical, Dental, Vision, Pharmacy & approved OTC.
$2,500
New 2013 IRS Maximum Limitation
and/or
2- DEPENDENT CARE FSA: Daycare expenses.
$5,000
You can participate in one or both types of FSA
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How will it benefit me?
• Paycheck Advantages:
- Increased take-home pay
- Lower income taxes
$$ Double benefit $$
Average family of four in the U.S. can save hundreds of dollars in taxes. ….
• Immediate availability of Healthcare
account funds
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Expenses covered?
Medical & Dental
Dependent Care
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Deductibles & co-pays
Prescription drugs
Vision (exams, glasses, laser eye surgery,
contact lens solution)
Diabetic supplies
Hearing Aids
Medical travel expenses
Chiropractic services
Dental (cleanings, fillings, orthodontia,
dentures)
And many more!
*Over the counter….what qualifies….
Daycare (child under age 13)
Private Nanny or Babysitter
Adult Daycare
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How to submit claims
Option 1: The Benny Card. The card is used at the point of service at hospitals, doctor’s offices and pharmacies. The card
cannot be used to purchase over-the counter medication without a prescription. Save all receipts as you may be asked to
substantiate your expense. Keep your Benny Cards!
NEW !!
Grace Period is now available on Benny Card Swipes and Manual Claims for 75 days
For the 2013 plan year, the last day to use your 2013 funds is March 16, 2014
Option 2: Paper Claims. Fax or mail a claim form to Phillips Resource Network with an Explanation of
Benefits (EOB) and/or receipt. Receipts must include a patient name, date of service, type of service and dollar
amount.
2012 PLAN YEAR: On January 1, 2013, your Benny Card will be loaded with your new plan year
dollars. Please DO NOT use your card to go back and pay for any services in 2012.
2013 PLAN YEAR: 75 day extension on allowable expenses with an additional 30 days to submit
claims from any monies remaining from the 2013 bucket.
Services must be incurred while actively employed and will be applied to the applicable plan year.
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Things to remember…
• Choose plan election amounts carefully
Use it or Lose it Rule
• Contribution amounts can only be changed during the plan year due to a
qualifying event (i.e., marriage or birth of a child)
• Expenses are reimbursed through an FSA after they are incurred; prepayments are reimbursed as services are received
Participation at any level will increase your take home pay!
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We’re here to help!
PLEASE DIRECT QUESTIONS TO PHILLIPS RESOURCE NETWORK, INC.
OUR PHONE NUMBER AND EMAIL ADDRESS IS ON EVERY CLAIM FORM.
REMEMBER BY ENROLLING IN THIS PLAN, THE MONEY YOU REDIRECT IS
NOT SUBJECT TO FEDERAL, STATE, OR SOCIAL SECURITY TAXES!
Every employee must complete a 2013 FLEX form
even if waiving coverage or not making any changes
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William Jewell College
Employer Paid Benefits
Basic Life Insurance
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1 times annual salary for employees
$50,000 minimum amount to $150,000 maximum
Dependent Life Insurance if Enrolled in Family BCBS Health Insurance
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$2,000 benefit for spouse
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$1,000 benefit for children from 14 days to 20 (26 if full time student) years of age
Basic Accidental Death and Dismemberment
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$25,000 for employees
Long Term Disability
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60% of monthly salary to $5,000 maximum benefit
Payable after 120 days of disability
Payable to later of age 65 or SSNRA
William Jewell College
Voluntary (Employee Paid) Options
Voluntary AD&D
Voluntary Life

Choice of $10,000 increments of coverage not to exceed
the lesser of 5 times salary or $500,000 maximum
benefit for employees.

Choice of $5,000 increments of coverage not to exceed
½ of employee amount or $250,000.

Choice of $2,500 increments of coverage for children
after 6 months of age to a maximum benefit of $10,000.

You or your spouse may elect or increase coverage by
two increment levels on a guaranteed acceptance basis
during your company’s defined annual open enrollment
period, provided that you or your spouse have not been
previously declined for coverage.

Choice of $25,000 increments of coverage not to exceed
10 times salary or $500,000 maximum benefit for the
employees on the Employee Only Plan or Family Plans

Spouse provided 60% of employee amount when
children are not covered on the Family Plan.

Spouse provided 50% of employee amount when
Children are covered for 10% of the employee amount
not to exceed $15,000 on the Family Plan.

There is an annual open enrollment for coverage on
Voluntary AD & D.
EyeMed Exam & Materials Plan
In Network
Member’s Cost
Exam with dilation as necessary
$10 copay
Frequency:
Examination
Lenses or Contact Lenses
Frame
Exam Options:
Standard Contact Lens Fit and Follow-Up:*
Premium Contact Lens Fit and Follow-Up:**
Out of Network
Allowance
$30
Once every 12 months
Once every 12 months
Once every 24 months
Up to $40
10% off retail price
N/A
N/A
$130 allowance, 20% off balance
$65
Standard Plastic Lenses:
Single Vision
Bifocal
Trifocal
Standard Progressives
$25 copay
$25 copay
$25 copay
$90
$25
$40
$60
$40
Lens Options
UV Coating
Tint (Solid and Gradient)
Standard Scratch-Resistance
Standard Polycarbonate
Standard Polycarbonate-Kids under 19
Standard Anti-Reflective Coating
Other Add-Ons and Services
$15
$15
$15
$40
$40
$45
20% off retail
N/A
N/A
N/A
N/A
N/A
N/A
$130 allowance, 15% off balance
over $130
$130 allowance, plus balance over
$130
$104
$104
$200
Frames:
Any available frame at provider location
Contact Lenses (Materials Only)
Conventional
Disposable
Medically Necessary
EyeMed Materials Only Plan
Materials Only Plan
In Network
Member’s Cost
Frequency:
Lenses or Contact Lenses
Frame
Frames:
Any available frame at provider location
Out of Network
Allowance
Once every 12 months
Once every 24 months
&0 Copay ; $130 allowance, 20% off balance over $130
$65
Standard Plastic Lenses:
Single Vision
Bifocal
Trifocal
Standard Progressives
Premium Progressives
Lenticulars
$0 copay
$0 copay
$0 copay
$65
$65,80%of charge less $120 allowance
$0 copay
$25
$40
$63
$40
$40
$63
Lens Options
UV Coating
Tint (Solid and Gradient)
Standard Scratch-Resistance
Standard Polycarbonate
Standard Polycarbonate-Kids under 19
Standard Anti-Reflective Coating
Other Add-Ons and Services
$15
$15
$15
$40
$40
$45
20% off retail
N/A
N/A
N/A
N/A
N/A
N/A
Contact Lenses (Materials Only)
Conventional
Disposable
Medically Necessary
$0 Copay $130 allowance, 15% off balance over $130
$130 allowance, plus balance over $130
$0 copay, paid-in-full
$104
$104
$200
EyeMed – Providers
• One of the largest, and most diverse vision panels
• Includes thousands of private practice optometrists, ophthalmologists
and opticians
• Composition of panel – 75% independent, 25% retail
• Includes the nation’s top optical retailers, including:
EyeMed’s -Unmatched Value
• Separate fit/follow-up and contact lens allowances allows members to
only pay up to $40 for their fit/follow-up and use their contact lens
allowance in full for the purchase of contact lenses
• 20% discount on any balance that exceeds frame allowance
• 15% discount on any balance that exceeds contact lens allowance
• 40% off additional unlimited pairs of eyeglasses after initial benefit is used
• 15% off retail price of LASIK or PRK procedures at US Laser Vision locations
or 5% off any promotional price
• Consistent pricing at all provider locations
Online Management for Members
• Once registered online at www.eyemedvisioncare.com the member will
be able to:
– Locate a provider – choose the “Select” network
– View benefit details
– Order replacement ID card
– View claims
New Benefit Offering for
William Jewell College Employees
• Guaranteed-issue Short-Term Disability
• Guaranteed, renewable to age 70
• Benefits paid regardless of any other insurance
• 3-Month Benefit for illness or off-the-job accident
• $500 to $3000 in monthly benefit guaranteed issue
• Waiting period defined by each individual’s needs
• Partial disability benefit
• Payroll deduction
Income Replacement Example
• Jewell employees are provided long-term
disability that begins after 120 days for an
illness or off-the-job accident.
• Aflac short-term disability can be
purchased to provide income
replacement for the first 90 days, reducing
the income gap to only 30 days
Example: $34,000 Annual Salary
Age: 18 - 49
• 14/14
– 14 calendar days waiting for an off-the-job
accident
– 14 calendar days waiting for an illness
• 3 Month Benefit period
• Qualify for $1,700 Monthly Benefit
• $28.73 monthly premium
Example: $50,000 Annual Salary
Age: 18 - 49
• 14/14
– 14 calendar days waiting for an off-the-job
accident
– 14 calendar days waiting for an illness
• 3 Month Benefit period
• Qualify for $2,500 Monthly Benefit
• $42.25 monthly premium
Commerce Bank
Special employee banking benefits
No ATM fee when using the on-campus ATM
located in Yates-Gill College Union
The End!
IMPORTANT
•
Forms to turn in:
• 2013 FLEX form
• Enrollment forms for Aflac or EyeMed
• Any changes to other benefits
Open Enrollment: November 2 through November 20th
*ALL applications and changes must be turned in no later than November 20th
•
Examples of changes include:
• Changing plan options
• Adding or Removing dependents
• Address or phone number changes
• Changing beneficiary designation
If you have any additional questions please contact the Office of Human Resources.