Transcript Open Enrollment Power Point Presentation

Timeline for Submitting Forms
 Open enrollment is October 6 through November 14
 Forms must be returned to Risk, Compensation &
Benefits by November 14, 2011
 You can
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Change medical plans
Add or delete dependents
Enroll in voluntary benefit programs
Enroll in the Flex plan
 You must enroll each year to participate in the flexible spending
account program
 Please Note: If you do not want to make a change to
your Group Health plan, you do not have to do anything
• Behavior based – change your habits
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Small steps result in BIG CHANGES
• Proactive management of health
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Preventative health services
Wellness
• Long term approach
• Develop a plan, work the plan, monitor the plan, CELEBRATE
your success
• Usually no or low cost
• Bottom Line
– live longer,
– live happier,
– live wealthier
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Subtract your age
=
The number of years you have left on the
planet
How Many Of You Can “Say Yes” to All 5?
I am within 5 pounds of my ideal body weight
I exercise 30 minutes or more most days of week
I eat a healthy diet with 5 fruits/vegetables most days
I don’t use tobacco products
I have 2 or fewer alcoholic drinks per day
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100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
91%
82%
71%
Cancers
70%
Stroke
Heart Disease
Diabetes
Sources: Stampfer, 2000; Platz, 2000; Hu, 2001
Wellness
• Key component of your health care
– Preventative & Proactive
– Works one-on-one and confidential
– Supports behavior change, designed to assist
each person at their own pace
– Many of your fellow employees have been
successful
• Our Wellness Coaches are here to assist with:
Stress Management
Weight Loss
Nutrition
Tobacco/Smoking
Cessation
Disease Management
Exercise
Lifesigns
• A head to toe annual preventive physical exam providing
information you need to develop your personal care plan,
putting you in control of your health.
– Works hand in hand with Wellness Coaches, PCP and Behavior Health
Benefits, 100% confidential
• Lifesigns seeks to complement your relationship with your
existing PCP and can forward results electronically to your
physician at your request
• For CH/C participants test results will be sent to Care
Coordinators.
Hearing and Vision tests
Electrocardiogram
Blood tests
Screening ultrasound
Chest x-ray
Physician consult
Body fat percentage &
BMI
Age/gender options
Complete lab panel 60+
tests
Employee Assistance Program
Mines and Associates Counseling
• Problem Assessment
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Short Term Counseling or Referral
Coaching for Behavior modification
After-Care Follow-Up
Crisis Intervention
24 Hour Emergency Service
Workplace Reintegration
Child or aging parent
assistance
Health Quiz III
• Wellness, Lifesigns, Employee Assistance
Program, Preventive health services and
some Behavior health services cost each
CLV employee?
• Nothing, these services are free to all CLV
employees
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CONFIDENTIAL
Choose a Family
Doctor/PCP
• Primary Care Physician your “family” doctor
– Specially trained to work with you to coordinate
your overall healthcare
– Understands you and your needs best
– Takes the confusion out of what to do next,
where to do it
– An in-network PCP can help keep money in your
pocket by reducing your out-of-pocket expenses
– Focus on preventive and scheduled health
maintenance services.
Live Longer – Live Better
• Use the tools we have provided to assist
you in becoming well and engaged
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Lifesigns
Wellness Coaches
PCP and Prevention
EAP
Dental/Vision
Health plan
PART II
2012 Group Benefit Plans
There when you need it!
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CONFIDENTIAL
2012 Changes
By making small plan changes CLV has been
able to keep 2012 premiums low – most are at
or below 2011 rates.
 Sierra PPO Changes – increase Out-of-Pocket maximum
 Increase in prescription co-payments
 Lower premium rates
 C H/C changes – increase Out-of-Pocket maximum
 Increase in co-insurance
 No change in EE only and EE + 1 premium rates
 Dental Plan Changes – increase from $2,000 annual maximum
benefit to $2,500 annual maximum benefit
 Premium rate increase
Rate chart – Employee Bi-Weekly
Contribution
CDHP
Sierra
PPO
HPN HMO
Vision
Dental
EE Only
$0
$0
$0
$0
$0
EE + 1
$126.79
$124.62
$74.77
$1.01
$6.76
EE + 2
$256.99
$197.00
$118.38
$3.06
$15.69
Health care is very confusing
Call for Help…
IT ALL STARTS HERE
What will the
“Care Coordinators”
help me with?
Care
Coordinators
I can help you
with all your
healthcare
questions.
1-877-498-5981
5:30 AM – 6:00 PM PST
Monday – Friday
Claims
Network
Pharmacy
Providers
Single Point Patient Service
• Benefits
• Claims Questions
• Find In-Network Providers
• Patient Advocacy
• Nurse Coaching
HR
Preventive Care 100%
100% coverage – No deduction from HRA
Let’s Review How CDH Works
Health Reimbursement
Account
(Annual Allocation)
Bridge
(Employee’s responsibility)
Traditional Health
Coverage
Coinsurance Maximum
Single
2-Person
Family
$1,000
$2,000
$3,000
$500
$750
$1,000
80% providers with discounts
60% of R&C with providers without
discounts
$2, 500
$3,500
$4,500
$2500
$3750
$5000
All employees enrolled in CDH must submit a City of Las Vegas Other
Insurance Form
2012 Plan Changes
Co-Insurance (without Bridge)
Current
In-Network
90%
Out – Network
70%
2012
80%
60%
OPM In-Network
Employee
Employee + 1
Family
$2500
$3500
$4500
$2000
$3000
$4000
OPM Out of Network
Employee
N/A
$6000
Employee +1
N/A
$7000
Family
N/A
$9000
**in-network accumulates toward out-of-network max
2012 Plan Changes
Pre Notification is required for:
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Outpatient surgery
MRIs, MRAs, & PET Scans
Oncology services (chemotherapy and radiation therapy)
Home health care and services
Durable medical equipment rentals and purchases over $500
Hospice care
Speech, physical and occupational therapies
Dialysis
Prior Authorization is required for:
 Transplant services
 In Patient services
 Gastric bypass surgery
Early notification of high cost procedures notifies Care Coordinators to assist
patients through a health care event, lowering cost and improving quality.
Note: Anytime a pre-notification/auth is submitted, you will receive a
confirmation letter from the Care Coordinators.
Coordinated Health/Care
Pharmacy Benefit
Catalyst Rx
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Formulary Advantage Program
 Complete Formulary Listing
Price and Save Program - www.catalystrx.com
 You can price and compare co-payments at local
pharmacies
 Helps you choose lower cost prescription drug
options
Diabetic Sense Program
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Catalyst Rx offers the Diabetic Sense program at no
charge
Injectable insulin and syringes at no charge
Home delivery of testing supplies
Access to Diabetes Educators, Nutritionists and
Pharmacists
To access this benefit, you must enroll
To enroll call Liberty Medical at 1-866-896-7303
Health Plan of Nevada
• HMO Health Plan
• Required to have PCP
• Must stay in-network
• No Annual Deductible
and Out of Pocket
Max
• Co Pays for various
services
• Co Pay for Rx
• No Out of Network
benefit
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2012 Sierra PPO Plan
Prescription Co-Pay
Generic
Preferred Brand
Non Prefer. Brand
Deductible
Employee
Employee + 1
Family
OPM
Employee
Employee +1
Family
$15.00
$40.00
$60.00
In-Network
$500
$1000
$1000
In-Network
$3000
$6000
$6000
Out-of-Network
$1000
$2000
$2000
Out of Network
$6000
$12000
$12000
Please refer to medical plan comparison chart in the 2012 open
enrollment for more plan details.
Did you know?
– Annual dental and vision exams are as
important as an annual physical
– Dental and Vision exams can detect over 120
disease signs (usually at very early stages)
including:
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Heart disease/Heart attacks
Diabetes
Respiratory disease
A weakened immune system that can slow healing of wounds and
reduce a person’s response to hepatitis B and flu vaccines.
Cancers
Stroke
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CONFIDENTIAL
Dental and Vision Benefits
Dental
Preferred Dental Network
Increase in annual benefit to $2,500
Vision
Vision Service Plan Network
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Section 125
Flexible Spending Accounts
• Two types of funds (you must enroll annually)
• Health Care FSA – contribute up to $4,000 to pay for
unreimbursed medical costs
• Dependent Care FSA – contribute up to $5,000 to pay
for eligible day care expenses for child or dependent adult
• Contributions to your FSA are pre-tax
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Your taxable income is decreased
Fewer taxes are withheld
Increase monthly cash flow
Use the money when you need it
• You must budget carefully, governed by IRS use-it –or-loseit rule.
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CONFIDENTIAL
Voluntary Life
• For employees currently participating in
The Standard’s Voluntary Life plan, you
can increase your benefit level:
– $60,000 for employee, up to guaranteed issue
amount of $150,000
– $10,000 for your spouse, up to guaranteed
issue amount of $50,000
Please update or complete your beneficiary
designation.
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CONFIDENTIAL
• 457 plan
– Pre tax employee contribution
• Reduces federal taxes
• Provides savings for retirement
Hartford
ICMA
Nationwide
Voluntary Programs
•
Discounts on Auto and Home Insurance
– F. Hayden Ray
702-736-8611 Ext. 58082
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Consult with Board Certified doctors on the telephone or via email
regarding commonly treated short-term illnesses, such as: flu,
allergies, colds, etc.
Available 24 hours a day, 7 days a week
Can prescribe medications and refill recurring prescriptions
For information, contact Lori Wilkerson at 702.877.1177
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• Pat Johnson or Amy Bechtel
• Phone - 702-877-6388
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CONFIDENTIAL
Stage 1 –
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Planning, Prevention and Identification
Wellness
Engagement – Behavior Change - EAP
Lifesigns
Primary Care Physician – Use available preventative care
services, Dental & Vision annual exams
• Virtually no cost
Stage 2 Maintenance, Treatment and Management
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Wellness
Primary Care Physician
Specialists
Dental, Vision, FSA
Bridge/Deductible/Out of Pocket/Co-Insurance
Stage 3 – Health, Prosperity, Well Being
• Enjoying a long healthy happy life
• HEALTH 31= WEALTH
CONFIDENTIAL
Information
CLV Intranet Site
Benefits tab
Summary Plan Descriptions
Claim Forms
Change and Enrollment Forms
Provider contacts & web sites
Resources
Insurance Services
Dan Rigato
Sandy Ray
Mandee Bowler
Candace Mbaye
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CONFIDENTIAL