Transcript 2011 Group Renewal Bulletin (Cont.)

2011 Open Enrollment
Carleton College
Open Enrollment Period
Our 2011 Open Enrollment period begins October 11, 2010 and
concludes November 15, 2011.
Employees will access the on-line tool (benefitsCONNECT) on
the Human Resources website.
Be sure to review the refresher regarding your username and
password; passwords will remain the same for 2011 as they are
in 2010.
This is a “passive” enrollment year, which means that unless
you request a plan change, your current plans in 2010 (along
with your corresponding dependents) will remain active for
2010.
2
The Hartford: Voluntary Life Insurance
Carleton College is pleased to announce that effective January 1, 2011, The Hartford will offer a
guaranteed life insurance increase to those non-union employees with existing voluntary group
term life coverage. The new amount of this guaranteed issue is $150,000, which is an increase
from the $90,000 offered since 2007. Please note: For those employees with amounts in excess
of this, no change will be possible.
Employees with current Voluntary Life coverage of any amount can increase their election to
$150,000 without completing medical underwriting.
Employees who do not have current VL coverage can enroll in up to $80,000 with out completing
medical underwriting.
In order to increase your coverage, you will need to indicate the change on benefitsCONNECT.
For specifics regarding the Voluntary Group-Term Life Insurance plan, please visit the Human
Resources website.
3
Flex Spending
• Starting Jan. 1, 2011, you can no longer be
reimbursed from an FSA for over-the-counter
(OTC) drugs or medicines without a prescription.
–
Many OTC supplies, such as bandages, will still be
eligible for FSA reimbursement without a prescription.
• We expect to have a new Third Party
Administrator for our Flex plans by January 1,
2011. In order to reduce confusion, we
encourage employees to exhaust their 2010
accounts by the end of the year.
• The new provider will offer a VISA debit card
which will reduce errors. Additionally, they offer
daily claims processing.
4
Dental Coverage
Dental Insurance
Total Annual Premium
Monthly Premium
Bi-Weekly Premium
Employee
$400.80
$33.40
$15.42
Employee + Spouse
$804.60
$67.05
$30.95
Employee + Child(ren)
$757.20
$63.10
$29.12
$1,301.40
$108.45
$50.05
$508.80
$42.40
$19.57
$1,022.40
$85.20
$39.32
$961.20
$80.10
$36.97
$1,651.80
$137.65
$63.53
Value
Family
Comprehensive Premier
Employee
Employee + Spouse
Employee + Child(ren)
Family
2011 Medical Insurance Options
• Options Blue (Aware)
• Aware PPO
• Accord HRA
Medical Premiums
Medical Insurance
Monthly Premium
Bi-Weekly Premium
Employee
$122.59
$56.58
Employee +1
$259.02
$119.55
Family
$408.93
$188.74
Employee
$84.23
$38.88
Employee +1
$172.39
$79.56
Family
$260.63
$120.29
Employee
$74.69
$34.47
Employee +1
$152.39
$70.33
Family
$230.06
$106.18
Aware PPO
Options Blue (Aware Network)
Accord HRA
2011 Plan Design Changes
Options Blue & Accord HRA:
• Unlimited Preventive services
(previously capped at $500)
• No lifetime maximum
(previously 5MM)
PPO
• No lifetime maximum (previously 5MM)
• Lab, x-ray, and allergy related
services now covered at 80% after
deductible (previously covered at 100%)
8
Options Blue (Aware)
HEALTH PLAN
In-network
Out-of-network
Individual
$1,000
$1,000
2-Party/Family
$1,500/$2,000
$1,500/$2,000
Individual
$1,900
$1,900
2-Party/Family
$2,550/$3,800
$2,550/$3,800
Coinsurance
80%
80%
Lifetime maximum
Unlimited
Unlimited
HRA
$500 Individual,
$750 2-Party,
$1000 Family
$500 Individual,
$750 2-Party,
$1000 Family
Health Plan
Eligible
Expenses
Health Plan
Eligible
Expenses
Deductible
Out-of-pocket
maximum
Contribution
Rollover
Covered
expenses
Options Blue (Aware) Cont’d.
Preventive
care
Routine cancer
screening
100%
100%
Routine physical
exams
100%
100%
Well-child care
(up to age 6)
100%
80% after
deductible
Immunizations
(up to age 18)
100%
80% after
deductible
Routine hearing
exams
Lab and x-ray
services
Immunizations
Routine vision
exams
Options Blue (Aware) Cont’d.
Covered services
Services received
In-network
Out-of-network
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
Professional
services

Lab and x-ray
services
Physician’s office
80% after deductible
80% after deductible
80% after deductible
80% after deductible

80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
Inpatient care

Facility services

Professional
services
Outpatient care

Facility services





Office visits for
illness
In-office surgery
Allergy-related
services
Urgent care
Lab and x-ray
services
Emergency room care

Emergency room 80% after deductible

Physician services 80% after deductible
• Ambulance services 80% after deductible
80% after deductible
80% after deductible
80% after deductible
Options Blue (Aware)
$2000
deductible
$1,500
deductible
$1,000
deductible
Two-party and family plans are
subject to individual deductibles and
out-of-pocket maximums. An
individual can meet their own
deductible and out-of-pocket
maximum before other family
members . Individuals within the
family may have claims processed at
different levels of coverage. Total
expenses will not exceed plan
deductibles and out-of-pocket
maximums.
Aware PPO
Covered services
In-network benefits
Out-of-network
benefits
Individual
$500
$1,000
Family
$1,000
$2,000
Individual
$2,000
$4,000
Family
$4,000
$8,000
Lifetime maximum
Unlimited
Unlimited
Coinsurance
80%
60%
Deductible
Out-of-pocket maximum
Aware PPO cont’d.
Covered
services
In-network
benefits
Out-ofnetwork
benefits
Routine physical exams
100%
60% after deductible
Routine cancer screening
100%
60% after deductible
Routine hearing exams
100%
60% after deductible
Lab and x-ray services
100%
60% after deductible
Immunizations
100%
60% after deductible
Routine vision exams
100%
60% after deductible
Well-child care (up to age
6)
100%
60% after deductible
Immunizations (up to age
18)
100%
60% after deductible
Preventive care
Aware PPO cont’d.
Covered services
Services received
In-network
benefits
Out-of-network
benefits
Inpatient care

Facility services
80% after deductible
60% after deductible

Professional services
80% after deductible
60% after deductible
Outpatient care

Facility services
80% after deductible
60% after deductible

Professional services
80% after deductible
60% after deductible
Lab and x-ray
services
Physician’s office
80% after deductible
60% after deductible

Office visits for
illness
In-office surgery
100% after $35 copay
60% after deductible
80% after deductible
60% after deductible
Allergy-related
services
Urgent care
80% after deductible
60% after deductible
100% after $35 copay
60% after deductible
Lab and x-ray
services
Emergency room care
80% after deductible
60% after deductible

Emergency room
100% after $75 copay
100% after $75 copay

Physician services
100%
100%
80% after deductible
80% after deductible





Ambulance services
The highlighted areas reflect plan coverage changes effective January 1, 2011.
Aware PPO
Accord HRA
Summary of Providers not included in Accord:
• Mayo Clinic Providers
–
–
–
–
–
Mayo Clinic
St. Mary’s Rochester
Rochester Methodist
Kasson Mayo Family Practice (contracted under Mayo Clinic)
Kenyon Mayo Family Practice (contracted under Mayo Clinic)
• Hazelden Providers
–
–
–
–
Hazelden
Hazelden OP CD Treatment
Youth and Family & extended residential CD treatment
Mental health clinics
Note: All Mayo Health System clinics (Faribault,
Northfield, Owatonna, etc.) are in the Accord
network
Accord HRA cont’d.
HEALTH PLAN
In-network
Out-of-network
Deductible
Individual
$1,000
$1,000
2-Party/Family
$1,500/$2,000
$1,500/$2,000
Individual
Out-ofpocket
2-Party/Family
maximum
Coinsurance
$1,900
$5,000
$2,550/$3,800
$7,500/$10,000
80%
60%
Lifetime maximum
Unlimited
Unlimited
HRA
$500 Individual,
$750 2-Party,
$1000 Family
$500 Individual,
$750 2-Party,
$1000 Family
Contribution
Rollover
Covered expenses
Health Plan Eligible Health Plan
Expenses
Eligible Expenses
Accord HRA cont’d.
Covered
HEALTHservices
PLAN
In-network
In-network
Preventiv Routine cancer 100%
e care
screening
Routine physical 100%
exams
Routine hearing
exams
Lab and x-ray
services
Immunizations
Routine vision
exams
Well-child care
(up to age 6)
Immunizations
(up to age 18)
100%
100%
Out-of-network
Out-of-network
100%
100%
60% after
deductible
60% after
deductible
Accord HRA cont’d.
HEALTH PLAN
In-network
Services
Inpatient care
Covered services
received
In-network
Out-of-network
Out-of-network

Facility services
80% after deductible
60% after deductible

Professional services 80% after deductible
60% after deductible
Outpatient care

Facility services
80% after deductible
60% after deductible

Professional services 80% after deductible
60% after deductible

Lab and x-ray
services
Physician’s office
80% after deductible
60% after deductible

Office visits for
illness
In-office surgery
80% after deductible
60% after deductible
80% after deductible
60% after deductible
Allergy-related
services
Urgent care
80% after deductible
60% after deductible
80% after deductible
60% after deductible
Lab and x-ray
services
Emergency room care
80% after deductible
60% after deductible

Emergency room
80% after deductible
60% after deductible

Physician services
80% after deductible
60% after deductible
80% after deductible
60% after deductible




Ambulance services
Accord HRA
$2000
deductible
$1,500
deductible
$1,000
deductible
Two-party and family plans are
subject to individual deductibles
and out-of-pocket maximums.
An individual can meet their own
deductible and out-of-pocket
maximum before other family
members . Individuals within
the family may have claims
processed at different levels of
coverage. Total expenses will
not exceed plan deductibles and
out-of-pocket maximums.
Prescription Drugs
Prescription drugs

Generic Feature:
If a brand name is selected
when a generic is
available, the member will
pay the higher copay plus
the difference between the
cost of the brand and the
generic. The difference
amount does not
accumulate toward the
OOPM.

Step Therapy Classes:
Antidepressants,
Cholesterol Lowering,
Diabetic Monitors &
Strips, Proton Pump
Inhibitors.
Retail pharmacy
(31-day supply)
90dayRx
(retail or mail)
$15 Generic Drugs
$35 Brand Name Formulary Drugs
$55 Brand Name Non-formulary
Drugs
$15 Generic Drugs
$35 Brand Name Formulary
Drugs
$55 Brand Name Non-formulary
Drugs
Prescription Drug Out of pocket
maximum:
$750 Individual
$1,000 Family
Prescription Drug Out of pocket
maximum:
$750 Individual
$1,000 Family
$30 Generic Drugs
$70 Brand Name Formulary Drugs
$110 Brand Name Non-formulary
Drugs
$30 Generic Drugs
$70 Brand Name Formulary
Drugs
$110 Brand Name Non-formulary
Drugs
Prescription Drug Out of pocket
maximum:
$750 Individual
$1,000 Family
Prescription Drug Out of pocket
maximum:
$750 Individual
$1,000 Family
Prescription Drug Out of pocket maximum:
Options Blue
(Aware)
$750
Individual
$1,000 Family
Accord HRA
$750
Individual
$1,000 Family
Aware PPO
$500 per
person
2011 Group Renewal Bulletin
• The 2011 Group Renewal Bulletin outlines benefit
clarifications, process modifications and other
recommended health plan changes that may affect
members. As we embark on a new era of health care
reform, it’s important to know that this bulletin
includes the first wave of changes required by new
federal health care reform legislation – including both
the Patient Protection and Affordability Act signed in
March and the second reconciliation bill that followed.
• As health care reform continues, you can count on
Blue Cross Blue Shield of Minnesota to be your trusted
guide in navigating the changing health care
landscape, providing you the information and
guidance you need to effectively manage your health
care benefits.
2011 Group Renewal Bulletin (Cont.)
The Group Renewal Bulletin provides a summary of changes
that will be implemented with our health plan renewal
effective January 1, 2011.
The summary of changes involve:
• Blue Distinction Centers® for spine surgery and for knee and
hip replacement
• Creditable coverage disclosure for pharmacy benefits
• Emergency Care
• Medical equipment, prosthetics and supplies
• Notification requirements
• Skilled nursing facility language update
• Legislative update: Federal health care reform, Mental
Health Parity, and state of Minnesota legislative mandates.
2011 Group Renewal Bulletin (Cont.)
Blue Distinction Centers for Spine Surgery and for Knee and Hip Replacement
Customer service representatives will encourage all members to use the new Blue Distinction Centers. These
Blue Distinction specialty care facilities have been selected after a rigorous evaluation of clinical data that
provided insight into the facility’s structures, processes and outcomes of care. Members must use a Blue
Distinction provider to obtain the highest level of benefits. The Blue Distinction benefit design is as follows:
• Highest level for Blue Distinction Centers
• Reduced benefit for non Blue Distinction participating providers
• No coverage for nonparticipating providers
*Note: The benefit differential option and soft steerage for Blue Distinction Centers are NOT available for
groups on the Accord, Value, BluePlus or other alternative networks.
Creditable coverage disclosure for pharmacy benefits
There are two disclosures relating to creditable coverage: 1) disclosure to Medicare-eligible members; and
2) disclosure to Centers for Medicare and Medicaid Services (CMS).
Member notification of creditable coverage status is due each year on November 14, upon member request,
upon plan design change, or upon termination of coverage. Member notification is the employer’s
responsibility.
Employers must also disclose creditable coverage status to CMS, which includes information relating to the
prior disclosure to members. The CMS disclosure must be provided within 60 days after the beginning date
of the plan year for which the entity is providing the disclosure to CMS.
Emergency Care
Fully insured groups who previously elected copayments on outpatient facility fees will now process as
follows:
–
–
Outpatient hospital/facility charges will be paid at 100% after copayment.
Outpatient professional charges will be paid at 100% and are NOT subject to copayment or a deductible.
Health plans with coverage for emergency services subject to the deductible and overall coinsurance will not
be impacted by this change.
2011 Group Renewal Bulletin (Cont.)
Medical equipment, prosthetics and supplies
Durable medical equipment and supplies (DME) on the Aware PPO or CMM product now process according to
plan’s overall deductible and coinsurance.
the benefit
Notification requirements
Effective January 1, 2011, for all renewing fully-insured groups, notification requirements have been revised. The language
has changed from “Recommended” to “Required” for an approved prior authorization, preadmission notification,
preadmission certification, and/or emergency admission notification.
This revision aligns contract language with Blue Cross’ review of inpatient services and health care industry standards. Blue
Cross reviews services to verify that they are medically necessary and that the treatment provided is the proper level of
care.
Skilled nursing facility language update
The fully insured certificate of coverage (COC) description for skilled nursing facility (SNF) have been updated. The following
language has been removed, as access to skilled nursing facilities locally and nationally is no longer an issue.
"If you are unable to obtain a bed in an in-network skilled nursing facility within a 50-mile radius of your home due to full
capacity, you may be eligible to receive services at an out-of-network skilled nursing facility at the in-network level of
coverage.“
Legislative Update: Federal Health Care Reform
All group health plans must implement a number of rules. This is true regardless if their plan(s) was in existence prior to
the enactment of the law, their funding type (self or fully-insured), and/or if their plan is subject to a collectively bargained
agreement. There are no exceptions or special provisions in the enactment. All group plans must include:
•No lifetime limits on coverage for essential benefits for all plans. Plus an enrollment period for those who have met the
plan’s LTM and are still otherwise eligible for enrollment. Note: Interim Final Rules on “essential benefits” are still pending.
• Extension of parents’ coverage to young adults under 26 years old regardless of residence, student status, marital status,
financial dependency, or employment status (grandfathered plans may exclude children who have other employment-based
coverage until 2014). Plus an enrollment period for those eligible to enroll who lost coverage or were ineligible but are now
under age 26.
• No coverage exclusions for enrollees (under age 19) with pre-existing conditions
•No annual limits may be applied to essential benefits.
27
2011 Group Renewal Bulletin (Cont.)
Preventive Care
For groups that have followed our recommended preventive care benefits, services covered will not
significantly change with Health Care Reform as the majority of the recommendations are already
included. New preventive care services have been added. Examples of these are:
• Screening, counseling and behavioral interventions for obesity in adults
• Screening for major depressive disorders in adolescents
• Counseling for tobacco use
To comply with Health Care Reform and to ensure the preventive care benefit is easy to understand, Blue
Cross has consolidated preventive care, prenatal and well-child services into one Preventive Care
Package. Detailed information on what is included in our Preventive Care Package is available
for review at www.employers.bluecrossmn.com
Update to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act
(the Act)
On February 2, 2010, the Internal Revenue Service and the U.S. Departments of Labor and Health and
Human Services issued interim final regulations (IFR) that expand the criteria to determine if health
plans meet mental health and substance use disorder parity standards. The IFR applies to health plans
offered by employers with 51 or more employees and takes effect generally with plan years that begin
on or after July 1, 2010. (Alternate effective dates may apply for health plans subject to collectively
bargained agreements.)
Blue Cross and Blue Shield of Minnesota (“Blue Cross”) has done extensive parity assessments on the
benefit plans we administer. Additionally, Blue Cross contracted with an independent actuarial evaluation,
and they largely confirmed our results.
28
2011 Group Renewal Bulletin (Cont.)
State of Minnesota Legislative Mandates
Oral Oncology Parity
Effective August 1, 2010 the Minnesota State Legislative requires that fully insured health plans provide oral
chemotherapy to members at a cost sharing that is at parity with cost sharing for intravenous and injected
chemotherapy.
Private Duty Nursing
Effective July 1, 2010 the Minnesota State Legislature requires fully-insured health plans to provide private
duty nursing to certain individuals who are also covered under Medical Assistance (MA).
Coordination of Benefits (COB) Primacy Rules
Blue Cross and Blue Shield of Minnesota administers coordination of benefits (COB) primacy rules based on the
National Association of Insurance Commissioner's (NAIC) guidelines. Minnesota's previous regulations allowed
an individual non-group health plan to always be the secondary payer if the other insurance was a group health
plan. Minnesota recently amended the law to coincide with the current NAIC model in which a non-group health
plan is now regarded in the same way as a group health plan for primacy purposes. This allows group health
plans the possibility to benefit from coordination of benefits savings as the group health plan will no longer
automatically be made to pay as the primary plan. Effective immediately, Blue Cross is administering the new
COB rules for all groups. We anticipate that only a minimal number of our members will be directly affected by
this change.
Provider Collection of Deductibles and Coinsurance
Effective 08/01/2010 a new state law allows providers to collect a patient's anticipated deductible and
coinsurance amount prior to the claims submission. This applies to Minnesota providers and their patients,
regardless of where the patient resides and regardless of the participation status of the provider. Providers
may not withhold a service for a member based on a patient's failure to pay a deductible or coinsurance at or
prior to the time of service. Overpayments by patients to providers must be returned to the patient by the
provider by check or electronic payment within 30 days of the date in which the claim adjudication is received
by the provider.
Please visit the Human Resources to access the 2011 Group Renewal Bulletin
and more information on Health Care Reform in detail.
29
Health Care Reform
Highlights of Health Care Reform include:
•Breaks for Nursing Mothers: Adequate, non-bathroom space is
provided to nursing mothers to express breast milk.
•Whistleblower Protections: Employees who exercise rights
granted by, report alleged violation of, or participate in legal
proceedings related to health care reform cannot be subject to
discrimination in employment.
•Report Value of Employer-Provided Health Coverage on W2
•No OTC (Over-the-Counter) Drug Reimbursements for Health
FSAs/HRAs.
30
Health Care Reform (Cont.)
•All group health plans must implement a number of rules
including:
1.
No lifetime limits on coverage for essential benefits for all plans
2.
No rescissions of coverage except for fraud or intentional
misrepresentation.
Extension of parents’ coverage to young adults under 26 years of age
regardless of residence, student status, marital status, financial
dependency, or employment status. This change will also allow
employees to reimburse medical expenses of their adult children from the
Health FSA/HRA account.
3.
31
(e.g.
ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental
health and substance abuse disorder services including behavioral health treatments, prescription drugs,
rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services
and chronic disease management, pediatric services including oral and vision care) .
Health Care Reform (Cont.)
4.
5.
6.
32
No coverage exclusions for children (under age 19) with pre-existing
conditions.
No “restricted” annual limits (e.g. annual dollar-amount limits on coverage
for essential benefits below $750,000 in 2011).
Additional benefits:
**Guaranteed access to pediatricians and OB-GYNs
**Emergency Services must be provided without prior
authorization
requirements and non-participating providers must be covered at the same
benefit and cost-sharing level as services provided for participating
providers.
Medical/Dependent Care Flexible Spending
• Medical Flex Spending Limit=
$5,000
• Dependent Care Flex Spending Limit =
$5,000
Both accounts have risk of forfeiture.
Please be conservative when making your
election.
OTC Medicines, FSAs & Health Care Reform
Health care reform legislation passed by Congress and signed by
President Obama in March, 2010 changed the rules for health
care flexible spending account (FSA) benefit plans.
Starting Jan. 1, 2011, you can no longer be reimbursed from an
FSA for over-the-counter (OTC) drugs or medicines without a
prescription.
Many OTC supplies, such as bandages, will still be eligible for
FSA reimbursement without a prescription.
34
OTC Medicines, FSAs & Health Care Reform (Cont.)
What this means to you?
•Decide how much to contribute to your health care FSA
with the new law in mind.
• If you use OTC drugs or medicines recommended by
your doctor to treat a medical condition, you may want to
ask your doctor for a prescription.
• You will purchase these drugs or medicines by paying
for them yourself. Then, you can submit a claim, a receipt
and a copy of the prescription to OptumHealth Financial
Services to be reimbursed from your FSA.
35
OTC Medicines, FSAs & Health Care Reform (Cont.)
Following are examples of OTC items that will require a
prescription for FSA reimbursement as of Jan. 1, 2011:
Acid controllers
Acne medicine
Aids for
indigestion
Allergy and sinus
medicine
Anti-diarrheal
medicine
36
Baby rash ointment
Cold and flu
medicine
Eye drops
Feminine anti-fungal
or anti-itch products
Hemorrhoid
treatment
Laxatives or stool
softeners
Lice treatments
Motion sickness
medicines
Nasal sprays or
drops
Ointments for cuts,
burns or rashes
Pain relievers,
such as aspirin or
ibuprofen
Sleep aids
Stomach remedies
OTC Medicines, FSAs & Health Care Reform (Cont.)
Examples of OTC items that may continue to be reimbursed from
an FSA without a prescription:
Bandages
Birth control
Braces and supports
Catheters
37
Contact lens
solution
and supplies
Crutches
Denture cleaners
and adhesives
Diagnostic tests
and monitors
(such as blood
glucose monitors)
Elastic bandages
and wraps
First-aid supplies
Insulin
Ostomy products
Reading glasses
Walkers, wheelchairs
and canes
OTC Medicines, FSAs & Health Care Reform (Cont.)
Grace Periods:
The rule covering OTC drugs and medicine applies to all
purchases that take place on or after January 1, 2011. If
you file claims for eligible 2010 FSA expenses after
January 1, 2011 (during the “Grace Period”), you will not
have to provide prescriptions for purchases of eligible
OTC medicines that happened in 2010.
If you want to use your FSA dollars for OTC medicine,
you will need to pay out-of-pocket and submit a
prescription with your claims.
38
Resources
• Enrollment resources are available
on HR web site
• BlueCross and BlueShield web site –
http://www.bluecrossmn.org
• BlueCross and BlueShield Customer
Service – (866) 870-0348
• One-on-one appointments can be
scheduled with Kerstin or Andrea
during the open enrollment period.