Transcript Open Enrollment PowerPoint Presentation

Open Enrollment Overview
City of Clearwater
2016 Plan Year
Benefits Committee
• CWA: Steve Sarnoff, Steve Finney, Mike Head, Matt McCombs, Roberta
Gluski, Alternates: Phil Hughes & Todd Voigt
• FOP Officers: Jonathan Walser, Christopher Precious
• FOP Supervisors: Sgt. Joel Morley
• IAFF: Stephen Colbert; Matt Schad
• SAMP: Susan Chase; Sandy Clayton; Jim Donnelly; Jay Ravins (Mgt.)
• Retirees: Karen Dombrowski (contact info on www.myclearwater.com)
Are there any Benefit Committee Members present today?
What’s Driving Clearwater’s Health
Care Costs for 2016?
• Medical claim costs are down 6% with Local Plus
Network Implementation. Local Plus Network is
working! Amount of physician visits didn’t decrease,
but the costs associated with them did.
• Catastrophic claims rose by $25K from last year and
that accounted for 68% of our medical claims costs.
• Pharmacy claim costs are up 36% driven by specialty
medications. Example: Hep C curable meds
introduced in 4th Qtr of 2014 costs $1,000 per pill with
a 90 day treatment plan.
(Specialty meds for: Hepatitis C, Cancer, Multiple
Sclerosis, Arthritis)
• 2016 premiums increased by 7.7%.
OPEN ENROLLMENT 2016
Benefits Committee Voted To:
• Continue self-funding and remain with Cigna
• Continue with “Local Plus Network”
• Adopt Open Access Plus (OAP) “PHA Buy-Up” plan with
larger network
• PHA incentive: Local Plus PHA plan or Open Access Plus
(OAP) “Buy-up” Plan
OPEN ENROLLMENT 2016
• Open Enrollment Period – Wednesday October 28th - Friday,
November 20th at 11:59 P.M
•Benefit Plan Year: January 1 to December 31, 2016
• During Open Enrollment, you may change plans, add/drop
dependents, elect FSA, and enroll/drop other benefits
• Changes are not allowed outside Open Enrollment–unless
having Qualifying Event (Page 5)
• Effective date of changes made during open enrollment is
January 1, 2016
EMPLOYEE BENEFITS HIGHLIGHTS HANDBOOK
• Available in hardcopy as well as electronically on the City’s
Intranet site.
• Handbook contents:
o
Carrier and Benefits Administrator contact information
o
Qualifying event and dependent eligibility guidelines
o
Available benefits
o
Rates for premium payroll deductions
OPEN ENROLLMENT 2016
ALL EMPLOYEES ARE REQUIRED TO LOG INTO BENTEK THIS
YEAR (Even if you are not making changes)
• Acknowledge the Federal Healthcare Notices
• Review and/or make changes to benefit elections for 2016
• Enroll in the 2016 Flexible Spending Account if you would
like it for 2016. FSAs do not roll automatically roll over –
must enroll annually!
City Premium Payment Plan
• As an employee, you are automatically enrolled in the City IRS
Section 125 qualified Premium Payment Plan when you elect
eligible benefits such as medical, dental, vision and supplemental
insurance.
• Premiums are deducted pre-tax from your paycheck.
• Changes to elections may not be made outside of open
enrollment except for qualifying events. (30 days to notify HR of
Qualifying Event, per IRS Section 125)
Domestic Partners are a post tax deduction as they do not
qualify under the Section 125 plan.
Medical Insurance for 2016
Pages 7-11
Three Cigna Medical Plan Options
 Cigna Local Plus PHA Plan
 Cigna Local Plus Base Plan
 Cigna Open Access Plus (OAP) “Buy-Up” Plan
(New!)
3 Medical Options for 2016
1. PHA Local Plus Plan – Must have a Personal Health
Assessment (PHA) completed between January 1, 2015
and Friday, November 20, 2015.
2. Base Local Plus Plan – No PHA required.
The biweekly rates will be the same for both plan options, the
difference is in the schedule of benefits.
The PHA plan has lower office visit co-payments, co-insurance,
deductibles, and out-of-pocket limits.
3 Medical Options for 2016
3. Open Access Plus (OAP) “Buy-Up” Plan (New!)
• To be eligible, must have a PHA completed between
January 1, 2015 and November 20, 2015.
• Larger network of physicians.
• Schedule of benefits same as the Local Plus Base
Plan.
Medical Insurance 2016
Personal Health Assessment (PHA) is a requirement to
participate in either:
• Local Plus PHA Plan with the better schedule of benefits
• New Open Access Plus (OAP) “Buy Up” Plan with the larger
network.
• Police and Fire personnel who have completed their Lifescan
prior to November 20, 2015 can use that result as their PHA
credit.
The Local Plus Base Plan is an option for those employees who
do not want to complete a personal health assessment.
(Base plan has higher co-pays, deductible, out of pocket
maximum.)
How to Complete a Personal Health Assessment
• Personal Health Assessments must be completed between January
1, 2015 – November 20, 2015 (Friday before Thanksgiving)
• Employee Health Center re-opened on November 2nd
• Call 727-298-1788 to make an appointment
• Remember to fast eight (8) hours prior to your appointment
• If you are unsure when you had your last PHA, log into the Care
ATC patient portal at patients.careatc.com. If you do not have
your username or password, please call the Patient Access Center
at 800-993-8244
Medical Insurance 2016
Summary of Differences
Local Plus PHA Plan
Deductible
$2,000/$4,000
Out-of-pocket limit $3,500/$7,000
Co-Insurance
10%
PCP Copayment
$40
Specialist Copayment
$60
Local Plus Base and
Open Access Plus Buy-Up Plan
$3,000/$6,000
$4,000/$8,000
20%
$50
$75
Biweekly deductions are the same for the Local Plus PHA and Base Plans.
Biweekly deductions are higher for Open Access Plus Buy Up Plan.
Medical Insurance 2016
No changes to the current schedule of benefits:
• $500 inpatient ($300 outpatient) hospital admission charge,
then subject to deductible and applicable co-insurance.
• $150 co-payment per visit for emergency room services and
$75 co-payment per visit for urgent care services.
Medical Insurance 2016
No changes to the current schedule of benefits:
• Prescription co-payments of $30 for generic, $40 for preferred
brand, and $60 for non-preferred brand (30 day retail); mail
order (90-day supply) at 2X the 30-day co-payment.
• Advanced imaging services (MRI, CAT/PET scans) at hospitalaffiliated facilities subject to deductible and applicable coinsurance; no charge for advanced imaging at freestanding
facilities (West Coast, Rose, etc.)
Preventive Care
Take Care of Yourself with Preventive Care.
Preventive exams and other routine health
screenings can help keep you healthy by
detecting early warning signs of a more
serious issue. These exams are covered at
100% without a co-pay applying.
Preventive Care
Cigna participants can have the following services done as well
care/preventive care at no cost:
• Well Exam
• Well Woman Exam
• Mammogram
• Pap Test
• Colonoscopy – initial physician’s visit co-pay applies & the
actual procedure will be done at no cost
• PSA Test
Medical Insurance 2016
How Deductible and Co-Insurance Works (refer to page 9)
•
•
•
•
For services requiring a co-payment, you pay only the amount of the
co-payment each time you receive the service.
For services requiring co-insurance, (anything with a % listed), you
pay the full cost of services up to the deductible amount, and you
then pay a percentage of the remaining cost of services up to your
out-of-pocket limit.
Once you reach your out-of-pocket limit, the plan pays the full cost
of any services.
Only services requiring co-insurance go toward satisfying the
deductible. All services, including co-payments and co-insurance,
will go toward satisfying the out-of-pocket limit. Prescription Drugs
now go towards the out-of-pocket limit.
Medical Insurance 2016
The City continues to subsidize employee & dependent
coverage for the Local Plus plans as follows:
 Employee Only Coverage - City pays 100 % of the cost
 Employee + One dependent - City pays 75% of the cost
 Employee + Family – City pays 68% of the cost
Local Plus Plans 2016
Employee Only
Employee Plus One
Dependent
Employee
Pays
City
Pays
Total
monthly
Premium
Increase from
2015
$0
$661.78/
month
100% of
Premium
$ 661.78
$0
$141.74
biweekly
$850.45/
month
75% of
Premium
$1,133.93
$10.15
increase
Per Pay from
2015
$297.70
biweekly
($595.40/
month)
$1,265.23/
month
68% of
Premium
$1,860.63
$21.31
increase
Per Pay from
2015
$0
$1,860.53
100% of
Premium
$1,860.63
$0
($283.48/
month)
Employee + Family
Dual Coverage
Cigna Open Access Plus (OAP) Buy-Up Plan 2016
Employee
Pays
City
Pays
Total
monthly
Premium
Increase from
2015
Employee Only
$25.48
biweekly
($50.96/
month)
$661.78/
month
93% of
Premium
$ 712.74
$25.48
Per Pay
Employee Plus One
Dependent
$185.40
biweekly
$1,221.24
($370.80/
month)
$850.45
/month
70% of
Premium
$53.81 per pay
increase from
2015 LP +1
coverage
Employee + Family
$369.34
biweekly
($738.68/
month)
$1,265.21
/month
63% of
Premium
$2,003.89
$92.95 per pay
increase from
2015 LP Family
coverage
Dual Coverage
$71.63
biweekly
($143.26/
month)
$1,860.63
/month
93% of
Premium
$2003.89
$71.63 per pay
increase
Cigna Open Access Plus (OAP) Buy-Up Plan 2016
Consider benefit versus cost
Benefit: Larger network
Cost: $611.52 annually for employee only
How many times will you use the physician that is in
the OAP network? Is it worth the biweekly deduction?
Medical Insurance 2016
Retiree Premiums, no City subsidy
Local Plus PHA or Local Plus Base Plans
• Retiree only $661.78 ($47.31 increase per month)
• Retiree + One $1,133.93 ($81.07 increase per month)
• Retiree + family $1,860.63 ($133.03 increase per month)
Medical Insurance 2016
Retiree Premiums, no City subsidy
New PHA “Buy-up” Plan
• Retiree Only $712.74 ($50.96 increase per month)
• Retiree + One $1,221.24 ($107.62 increase per month)
• Retiree + Family $2,003.89 ($185.89 increase per month)
Cigna On-Site Representative
Stacy Lambert
[email protected]
Municipal Services Building
Third Floor
• Hours:
Monday and Wednesday 8:30 a.m. – 5:00 p.m.
Tuesday, Thursday & Friday 8:00 a.m. – 4:30 p.m.
• Direct phone: (727) 562-4503
City Employee Health Center (page 6)
• Must be enrolled in the City’s Medical Insurance to be eligible - No
other requirement
• Reopened November 2nd and managed by Cigna On-Site Health
• Staffed with 1 Physician, 1 Nurse Practitioner, 1 Health Coach, and 2
Medical Assistants
• No cost for ANY services:
o Primary and urgent care office visit
o Labs
o Radiology
o Prescription drugs
• All services must be authorized by the EHC physician.
Employee Assistance Program (pg 12)
• Effective January 1, falls under medical insurance: Cigna Behavioral
Health - EAP and Mental Health/Chemical Dependency provider.
• Entitled to five free EAP visits annually per issue, $10 per visit co-pay
after five visits or if diagnosed during 5 free visits, the copay applies.
• National network of providers and no limit to the number of visits.
• Co-pays for services go toward satisfying Cigna Out-of-Pocket
Maximum.
•
Completely Confidential!
EAP can help to resolve issues with family, personal,
financial, marital, job, and substance abuse.
Dental Insurance 2016 (pages 13-14)
Assurant and Humana remain as 2016 Dental Providers.
• Assurant Dental Plan: No plan changes or increases in premiums
• Humana CS150 Dental Plan: No plan changes but will have slight
increases in premiums
– Employee Only: $9.25 per pay ($.49 cent increase from 2015)
– Employee + 1: $17.21 per pay ($.90 cent increase from 2015)
– Employee + Family: $22.40 per pay ($1.17 increase from 2015)
Dental Insurance 2016 (page 13-14)
• Humana Advantage Dental Plan- No plan changes but slight
increase in 2016 premiums
– Employee Only: $13.93 per pay ($.70 cent increase from 2015)
– Employee + 1: $25.95 per pay ($1.36 increase from 2015)
– Employee + Family: $33.78 per pay ($1.77 increase from 2015)
• Humana Elite Preferred Dental Plan - No changes
Vision Insurance (page 15)
• Offered by Humana Vision
• No changes to benefits
• No changes to premiums
Supplemental Insurance (pages 16-17)
• Administered by
Aflac
•
•
•
•
•
•
Accident Advantage
Short Term Disability
Hospital Advantage
Cancer Care Plan
Critical Care & Recovery
Dental
You must meet
with an Aflac
representative to
add, drop, or
make changes to
Aflac insurance
elections.
Flexible Spending Accounts (page 18)
• Administered by Aflac through WageWorks.
• Flexible Spending Account limits will be $2,550 for
unreimbursed medical and $5,000 for dependent care.
• A debit card will be issued for FSAs – no need to submit
forms for reimbursement. If you did not keep your FSA debit
card, you can request a new one online through the EBC.
• FSA requires a new online enrollment each year, it does
not roll over!!
Dependent Eligibility (page 3)
• An eligible dependent is defined as your legal spouse, domestic
partner or dependent child of you or your spouse/domestic
partner:
o Natural child, stepchild, legally adopted child, foster child, or a
child for whom legal guardianship has been awarded to you or
your spouse/domestic partner.
• Documentation verifying dependent eligibility will be required
from all employees covering a dependent that was not covered
in 2015.
• Documentation examples include marriage certificate, affidavit
for domestic partnership, birth certificate,
guardianship court order.
Dependent Eligibility
• Medical coverage for eligible dependents is provided to the
end of the calendar year in which the child turns age 26.
Dental and vision coverage is provided through the end of the
month in which the child turns age 26.
• Dependent children may continue to be covered for Medical
only from age 27 to the end of the calendar year in which the
child reaches age 30 if they meet the following criteria:
o Unmarried with no dependents
AND
o A Florida resident OR full-time or part-time student
AND
o Otherwise uninsured and not entitled to Medicare
BENTEK-Employee Benefits Center
Mandatory This Year!
• Open enrollment is available 24 hours/7 days a week through
the online Employee Benefits Center – no forms.
• Go to www.mybentek.com/clearwater (link on page 1 of EBH
and also on Intranet)
• Enter your username and password. (forgot username/forgot
password links available).
• In BenTek you can:
• Make changes to current benefits
• Add or remove dependents
• Enroll or re-enroll in FSA
• Update beneficiaries
Tips for a Successful Online Open Enrollment
Mandatory ALL EMPLOYEES MUST LOG INTO BENTEK!
• Review and/or make changes to benefit elections for 2016
• Acknowledge the Federal Healthcare Notices
• Enroll in the 2016 Flexible Spending Account (if you would
like it for 2016)
• If waiving medical insurance coverage, you must provide
proof of other coverage for yourself only and complete a
waiver form.
Tips for a Successful Online Open Enrollment
• You must meet with an Aflac representative if you are adding,
dropping, or making changes to your supplemental insurance
elections.
• You must click on “I Agree” and then hit “submit” on the final
page. Hitting submit acknowledges that the received the
federal healthcare notices through Bentek and can access
them in Bentek at any time. It also saves your elections. If you
exit before clicking “SUBMIT,” your changes will not be saved.
• You can print a confirmation statement or HR will provide
confirmation statements in December.
Thank You!
Don’t Forget ….
All election changes must be completed online no later than
11:59pm on November 20, 2015 (Friday before Thanksgiving).
www.mybentek.com/clearwater
PHAs must have been completed between
January 1, 2015 and November 20, 2015
to qualify for the Local Plus PHA Plan or Open Access Plus Buy-Up Plan.
Contact the Employee Health Center
727-298-1788 to make an appointment for a PHA