Transcript Open Enrollment presentation

Benefits Overview
OPEN ENROLLMENT 2016 -2017
APRIL 18 TH – APRIL 29 TH
Health Care Benefits
MEDICAL PLANS
PRESCRIPTION COVERAGE
D E N TA L P L A N S
VISION PLANS
FLEXIBLE SPENDING ACCOUNTS
LIFE INSURANCE BENEFITS
H E A LT H A D V O C AT E
S TAY W E L L
AFFORD ABLE CARE ACT (AC A) INDIVIDUAL
M A N D AT E A N D 1 0 9 5 C
Benefits Eligibility
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Who is eligible for health coverage
• Your same-sex or opposite sex spouse
• A same-sex domestic partner who is on your plan on or before July
1, 2016. Same-sex domestic partners and dependent children
(under the age of 26) of a same-sex domestic partner enrolled in a
Penn health plan prior to July 1, 2016 may remain on the plan until
June 30, 2018.
• Your biological and adopted children, and stepchildren, up to the
end of the month in which they turn 26. Your spouse’s biological and
adopted children are eligible if they meet the age and dependent
criteria.
• Your children age 26 or older who are incapable of self-support due
to a mental or physical condition that existed prior to age 26 and
who were enrolled in your medical plan as dependents prior to age
26.
Active Medical plan design – effective 7/1/2016
Key features1
PennCare PPO
Aetna Choice
POS II
Keystone/
AmeriHealth HMO
Aetna HDHP
Penn Providers
Personal Choice
Deductible (Single/Family)2
$125/$375
$150/$450
$300/$900
$350/$1,050
$300/$900
$100/$200
$1,500/$3,000
HSA Seed (Single/Family)
N/A
N/A
N/A
N/A
$500/$1,000
OOPM – Overall
(Single/Family)
$1,000/$3,000
$2,500/$7,200
$1,200/$3,600
$1,200/$2,400
$3,000/$6,000
Primary/Specialist
$20/$30 copay
$25/$40 copay
$30/$40 copay
$25/$35 copay
90%/90%
10%
20%
20%
10%
10% after ded.
$0 copay
$0 copay
$30.00 copay
$0 copay
10% after ded.
10% after ded
20% after ded
$40 (routine)
$100 (complex)
$40 (routine)
$100 (complex)
10% after deductible
PBH
PBH
PBH
Magellan
Aetna
n/a
Tier 3 coverage
Emergency Care
Emergency Care
Emergency Care
Coinsurance (after deductible)
Lab/Pathology
X-rays/radiology
Behavioral Health Provider
International Coverage
Other Coverage
Emergency Room
IVF (2 cycles per
lifetime/per family
and only at HUP)
$100 copay
IVF (2 cycles per IVF (2 cycles per
IVF (2 cycles per
IVF (2 cycles per
lifetime/per family lifetime/per family lifetime/per family and lifetime/per family and
and only at HUP) and only at HUP)
only at HUP)
only at HUP)
SRS
$100 copay
$150 copay
$150 copay
10%
Retail Prescription Drugs
* Rx Coverage for Local 54
and 590 are separate from
Penn Medical Plan
Annual OOPM: $2,000/$6,000 (Individual/Family)
10% after deductible
applied to medical
OOP Max
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Prescription Coverage
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CVS/caremark
 Retail Network(short-term medications)
Use a participating retail pharmacy when filling short-term prescriptions for medications such as
antibiotics. Our network includes more than 64,000 pharmacies nationwide, including chain pharmacies,
20,000 independent pharmacies and 7,100 CVS/pharmacy stores. Target pharmacies are now CVS
pharmacies.
 Mail service pharmacy (long-term medications)
Use the CVS Caremark Mail Service Pharmacy to fill your long-term prescriptions. Mail service is a cost
effective choice for long-term medications because you can get up to a 90-day supply for less than what
you would pay for the same supply at retail. You may also fill a 90-day supply only at a CVS/pharmacy.
 Maintenance Choice®
You choose how to get 90-day supplies of your maintenance medications: through mail service or at a
CVS/pharmacy store. Either way, you pay mail service prices
 CVS Caremark Specialty Pharmacy
Designed for individuals who are taking medications for rare, complex or genetic conditions. CVS
specialty pharmacy offers convenient delivery of specialty medications, personalized service and
educational support for your specific treatment. It also offers 24-hour access to a clinical pharmacist for
any questions that may come up. Individuals will also have the ability to fill and pick up their
specialty medications at a CVS/pharmacy location. Effective 7-1, specialty medications will be
available at HUP pharmacies.
Prescription
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CVS/caremark Retail Pharmacy Network
Maintenance Choice
CVS Caremark Mail Service Pharmacy or
CVS/pharmacy
For short-term medications
(Up to a 30-day supply)
For long-term medications
(Up to a 90-day supply)
Generic Medications
Ask your doctor or other prescriber if
there is a generic available, as these
generally cost less.
10% ($7.50 min / $20 max) for a generic
prescription
10% ($15 min / $40 max) for a generic
prescription
Brand-Name Medications With
Generic Available
10% ($15 min / $100 max) for a
brand-name prescription
10% ($30 min / $200 max) for a
brand-name prescription
Brand-Name Medications Without
Generic Available
30% ($15 min / $100 max) for a
brand-name prescription
20% ($20 min / $100 max) for brand-name
prescription
Specialty Medications
Refill Limit
Maximum Out-of-Pocket
10% ($15 min/$100 max) for a brand-name
medication (only available at a CVS
pharmacy)
One initial fill plus two refills for long-term
medications
20% ($20 min/$100 max) for brand name
prescripton
None
$2,000 per individual / $6,000 per family
Please Note: When a generic is available, but the pharmacy dispenses the brand-name medication for any reason, you will pay the difference between
the brand-name medication and the generic plus the brand copayment. The cost difference between brand name and generic does not count toward
the minimums and maximums
Prescription Coverage for HDHP Plan
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CVS/caremark
 Deductible applies to High Deductible Health Plan (combined with medical expenses)
•
No deductible for preventive generics, coinsurance 10%
•
Maximum out-of-pocket: $3,000 individual; $6,000 family (combined with medical expenses)
•
All other prescriptions have coinsurance of 10% once your deductible is met
 Maintenance medication – 90-day retail pick-up available at CVS pharmacies or CVS Mail
Service
 Specialty medication – available at a CVS pharmacy or through CVS Specialty Pharmacy
1-844-833-6390
www.caremark.com
Current Rates vs. 2016-2017 Rates
CURRENT FULL-TIME WEEKLY PAID (per pay period)
CURRENT FULL-TIME MONTHLY PAID (per pay period)
Employee
Employee +
Child(ren)
Employee +
Spouse/
Partner
Employee +
Family
Employee
Employee +
Child(ren)
PennCare/
Personal
Choice
$43.38
$73.62
$107.08
$134.08
$188.00
$319.00
$464.00
$581.00
Aetna Choice
POS II
$29.77
$50.77
$74.77
$93.46
$129.00
$220.00
$324.00
$405.00
Keystone/
AmeriHealth
HMO
$18.92
$32.08
$51.69
$60.46
$82.00
$139.00
$224.00
$262.00
Aetna HDHP
$16.62
$28.15
$42.69
$53.54
$72.00
$122.00
$185.00
$232.00
Employee + Employee +
Spouse/Partner
Family
2016-2017 FULL-TIME WEEKLY PAID (per pay period) 2016-2017 FULL-TIME MONTHLY PAID (per pay period)
Employee +
Employee +
Employee +
Employee +
Employee +
Employee +
Employee
Spouse/
Employee
Child(ren)
Family
Child(ren)
Spouse/Partner
Family
Partner
PennCare/
Personal
Choice
$44.54
$74.77
$111.00
$138.00
$193.00
$324.00
$481.00
$598.00
Aetna Choice
POS II
$30.23
$51.23
$77.77
$96.69
$131.00
$222.00
$337.00
$419.00
Keystone/
AmeriHealth
HMO
$20.54
$34.62
$55.15
$68.31
$89.00
$150.00
$239.00
$296.00
Aetna HDHP
$18.23
$30.69
$48.00
$60.00
$79.00
$133.00
$208.00
$260.00
MERCER
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Dental Plans
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MetLife Preferred Dentist
Program (PDP)
Penn Dental Plan
Networks
1. Preferred (negotiated fee)
2. Non-preferred (R&C fee)
Penn Faculty Practice (Three
locations)
Deductible
$50 per individual
None
Coinsurance
Based on treatment type
Based on treatment type
Annual Maximum (the plan
pays)
$2,000 per individual
$3,000 per individual
Preventive / Diagnostic
$0 copay
$0 copay
Orthodontics
50% ($1500 lifetime max per
child/adult) after deductible
Implants
Cosmetics
50% Coverage for a restoration
(bridge, crown, removable denture or
implant) of a tooth or teeth missing or
extracted prior to enrollment in a
University Plan is not covered
Not covered
40%, ($2000 individual lifetime max
per child/adult
50% Coverage for a restoration
(bridge, crown, removable denture or
implant) of a tooth or teeth missing or
extracted prior to enrollment in the
Penn Dental or MetLife Plan is
subject to the approval of the Clinical
Director or may be denied.
50%
Dental Rates: 2016-2017
Cost Per Pay Period
Penn Dental Plan
Full-time weekly paid
Employee
Employee + Child(ren)
Employee + Spouse/Partner
Employee + Family
Full-time monthly paid
Employee
Employee + Child(ren)
Employee + Spouse/Partner
Employee + Family
MERCER
MetLife Dental
$8.39
$18.56
$16.46
$26.18
$5.98
$13.16
$11.95
$17.94
$36.35
$80.41
$71.32
$113.43
$25.91
$57.02
$51.80
$77.74
Vision Plans
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Davis Vision
VSP
Networks
1. Scheie Eye – top tier
2. Davis Vision Network
3. Out-of-Network
1. Choice Network – includes Scheie
Eye
2. Out-of-Network
Deductible
None
None
Copay
Based on treatment type
Based on treatment type
Frames
1. $100 retail, $0 from collection
2. $65 retail, $0 from collection
3. Reimbursed up to $30
1. $150 retail + 20% off excess
2. $150 retail
3. Reimbursed up to $70
Laser Vision
Correction
1. For discounts, call Davis Vision
or Scheie Eye
1. For discounts, call VSP or Scheie
Eye
Disposable
Contact Lenses
1. $80 allowance
2. $75 allowance
3. Reimbursed up to $75
1. $150 allowance
2. $150 allowance
3. Reimbursed up to $150
Vision Plans Rates: 2016-2017
WEEKLY PAID (per pay period)
Employee +
Employee
Child(ren)
Davis
Vision
Plan
Employee +
Employee +
Spouse/
Family
Partner
MONTHLY PAID (per pay period)
Employee
Employee +
Child(ren)
Employee +
Spouse/Partner
Employee
+ Family
$1.05
$1.70
$2.27
$2.89
$4.55
$7.36
$9.83
$12.52
VSP Plan $1.45
$2.36
$3.13
$3.99
$6.28
$10.21
$13.57
$17.31
MERCER
Flexible Spending Accounts
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Health Care Spending Account
• Pre tax account where you deduct a small amount from your weekly
pay to use to reimburse yourself for medical expenses that you are
responsible for.
• $2,550 Annual Limit – Full Time Employees
• $1,000 Annual Limit – Part Time Employees (2 year waiting period)
• For current plan year, claims must be incurred by June 30, 2016;
Submitted by September 30, 2016
• Can carry over up to $500, unused amounts over $500 you lose
• Debit Card for both current and carry over funds- but must save
receipts in case substantiation is required!
• Cannot change goal amount outside window (Open Enrollment only or
qualifying event)
Save your receipts!
Flexible Spending Accounts
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 Dependent Care Spending Account –
• Pre-tax account where you set aside a small amount
weekly/monthly to reimburse yourself for daycare or other child
care expenses for dependent child(ren) up to age 13
• $5,000 calendar-year limit ($1,800 for Highly Compensated
employees)
• For current year, claims must be incurred by September 15,
2016 and submitted by September 30, 2016; “Use it or lose it”
IRS rule
• Cannot change goal amount outside window (Open Enrollment
only or qualifying event)
Life Insurance Benefits
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 Carrier: Aetna Group Insurance
 Basic
•
•
Coverage amount equals 1x “benefits base salary” (up to $300,000)
Coverage over $50,000 is imputed income
 Supplemental
•
•
•
•
•
Can select max of five times during new hire window
Can only increase by 1 times per o/e period (if not already at 5x max)
Combined basic and supplemental maximum of $1,000,000
If supplemental exceeds $500,000, you must provide Evidence of Insurability
(EOI)
Supplemental rates per $1000 decrease for the 2016-2017 plan year
 Dependent Life Insurance
• Spouse/partner $20,000
• Child(ren) $10,000 (up to age 26)
 Beneficiary designation: online through the Benefits portal
Health Advocate
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Find qualified doctors
Navigate insurance plan
Expedite appointments
Explain conditions
Provide cost estimates
Assist with the transfer of
medical records
Straighten out claims
 Locate eldercare
services
Secure second opinions
1-866-799-2329
StayWell Wellness Partner and Portal
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Penn Wellness Campaign
Biometric Screenings throughout year
Earn Points towards Cash Incentives
Health Assessment
Health Coaches
Smoking Cessation
Online Wellness Programs
Wellness information
Tools
1-855-428-6324
penn.staywell.com
Affordable Care Act
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 Effective January 1, 2014 under the Patient Protection and
Affordable Care Act (ACA) all individuals and their family
members are required to obtain health insurance or they
may be subject to a tax penalty.
 If you waive your University coverage, you are still
responsible for obtaining coverage through some other
source, such as a spouse or domestic partner’s plan or
your parent’s plan (if you are under age 26); or you can
obtain coverage via the Health Insurance Marketplace.
 For the 2015 tax year, the University has provided you
with the required form (1095-C). Not needed for tax filing
this year. To request an additional copy or for questions,
contact Equifax at 1-855-823-3728.and their family
members are required to obtain health insurance or they
may be subject to a tax penalty.
Changing Your Coverage
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Open Enrollment
• Annual opportunity to make changes
• April 18-April 29
• Changes effective July 1
After Open Enrollment???
Life or status change events
• Examples: marriage, divorce (up to 60 days), birth of
a child, relocating out of your insurance carriers
service area, a move from full-time to part-time status
• Must make changes within 30 days of date of event
Penn Benefits Center
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1-888-PENN-BEN
1-888-736-6236
Monday-Friday
8:00am-6:00pm EST
For information on your benefit packet, benefit
plans, general questions and to enroll
Visit: www.hr.upenn.edu/myhr
Email: [email protected]