2016 Annual Enrollment. Human Resources Training

Transcription

1 2016 Annual Enrollment Human Resources Training

2 2016 Annual Enrollment KEY CHANGES This is a passive enrollment. Only members wishing to change plans or add/delete covered dependents need to complete the enrollment process either online or through human resources (Members enrolled in the HSA and/or FSA will need to update their contributions) Active employees will not be allowed to enroll through the paper annual enrollment form Members may add their same-sex spouse and/or eligible dependent(s) to their OGB health coverage.

3 HR Liaison s Responsibilities Human Resources representatives will have several responsibilities during this year s annual enrollment period: Assisting OGB in sharing information with your active employees Answering general questions related to plan options and annual enrollment Enrolling active employees who are making changes to their level of coverage, adding/dropping dependents or changing plans, as needed, through the current eenrollment system Collect appropriate forms and make changes in e-enrollment for new hires 3

4 Timeline Oct 1 OGB Annual Enrollment Begins Nov 15 OGB Annual Enrollment Ends Nov 22 Deadline for agencies to enter all plan changes made during Annual Enrollment in the eenrollment system (Late applications will not be accepted) Jan plan year begins

5 2016 Enrollment

6 Pelican HRA1000 How to Enroll OGB encourages members to use the online annual enrollment portal. However, if members are discontinuing OGB coverage, adding or removing dependents, or are new hires, they must visit HR. Annual Enrollment Portal Human Resources Department Enroll in a health plan with the same covered dependents as 2015 Enroll in a health plan with different or new covered dependents than 2015 Elect HSA or FSA contributions Discontinue OGB coverage Adding OGB Coverage New Hires

7 Member Annual Enrollment Portal Members wishing to change health plans with the same covered dependents as their 2015 plan are eligible to use the annual enrollment portal to make their 2016 selection. To enroll using the annual enrollment portal: Follow the links from the OGB homepage to the annual enrollment portal Enter your Member ID from your current medical ID card and the last four digits of your social security number Make your selection for the next plan year Enter your HSA and/or FSA contribution, if applicable Submit IMPORTANT! You must click on submit in order for your selection to be valid. Print/Save confirmation page

8 Pelican HRA1000 Meeting Schedule Active Employees and Retirees without Medicare DATE LOCATION START TIME October 1 October 6 October 6 October 7 October 13 October 13 October 15 October 19 October 20 R.W. Johnson Conference Center (Franklinton Primary School) 610 T.W. Barker Dr., Franklinton, LA BREC s Independence Park Theater 7800 Independence Blvd., Baton Rouge, LA Lake Charles Civic Center 900 Lakeshore Drive, Lake Charles, LA Bossier City Civic Center 620 Benton Road, Bossier City, LA West Monroe Civic Center 901 Ridge Ave., West Monroe, LA Greater Covington Center Fuhrmann Auditorium 317 N. Jefferson Ave., Covington, LA University of New Orleans (University Center Ballroom) 2000 Lakeshore Drive, New Orleans, LA Sai Hotel and Convention Center 2301 N. MacArthur Dr., Alexandria, LA Heymann Center 1373 South College Rd., Lafayette, LA October 20 Houma Civic Center (Rooms 1 and 2) 346 Civic Center Blvd., Houma, LA :00 AM 4:00 PM 9:00 AM* 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM

9 Pelican HRA1000 Meeting Schedule Retirees with Medicare DATE LOCATION START TIME October 2 October 7 October 7 October 8 October 14 October 14 October 16 October 20 October 21 October 21 R.W. Johnson Conference Center (Franklinton Primary School) 610 T.W. Barker Dr., Franklinton, LA BREC s Independence Park Theater 7800 Independence Blvd., Baton Rouge, LA Lake Charles Civic Center (Contraband Room) 900 Lakeshore Drive, Lake Charles, LA Bossier City Civic Center 620 Benton Road, Bossier City, LA West Monroe Civic Center 901 Ridge Ave., West Monroe, LA Greater Covington Center Fuhrmann Auditorium 317 N. Jefferson Ave., Covington, LA University of New Orleans (University Center Ballroom) 2000 Lakeshore Drive, New Orleans, LA Sai Hotel and Convention Center 2301 N. MacArthur Dr., Alexandria, LA Heymann Center 1373 South College Rd., Lafayette, LA Houma - Terrebonne Civic Center 346 Civic Center Blvd., Houma, LA :00 AM 4:00 PM 9:00 AM* 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM 9:00 AM 2:00 PM

10 2016 Plan Options

11 Pelican Plans OGB s Pelican benefit options offer low premiums, in combination with employer contributions, to create the most affordable options for enrollees in Pelican plans offer coverage within the Blue Cross and Blue Shield nationwide network, as well as out-of-network coverage.

12 Pelican HRA1000 The Pelican HRA1000 includes $1,000 in annual employer contributions for employee-only plans and $2,000 for family plans in a health reimbursement arrangement that can be used to offset deductibles and other out-of-pocket medical, not pharmacy, costs throughout the year. The HRA funds are available as long as you remain employed by an OGB-participating employer. Any unused funds roll up to the in-network, out-of-pocket maximum (see following chart), allowing members to build up balances that cover eligible medical expenses.

13 Pelican HRA1000 Pelican HRA1000 Employer Contribution to HRA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children Family $1,000 $2,000 $2,000 $2,000 Deductible (in-network) $2,000 $4,000 $4,000 $4,000 Deductible (out-ofnetwork) Out-of-pocket max (innetwork) Out-of-pocket max (outof-network) $4,000 $8,000 $8,000 $8,000 $5,000 $10,000 $10,000 $10,000 $10,000 $20,000 $20,000 $20,000 Coinsurance (in-network) 20% 20% 20% 20% Coinsurance (out-ofnetwork) * 40% 40% 40% 40% Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Generic Preferred Non-Preferred Specialty Once you pay $1,500: $0 co-pay $20 co-pay $40 co-pay $40 co-pay *Once a member s deductible for allowable is met, he or she will pay 40% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount.

14 Pelican HSA775 The Pelican HSA775 offers our lowest premium in addition to a health savings account funded by both employers and employees. Employers contribute $200, then match any employee contributions up to $575. Employees can contribute additional funds on a pre-tax basis, up to $3,350 for an individual and $6,750 for a family, to cover out-of-pocket medical and pharmacy costs. Unused funds are rolled over every year with no limit. Unlike the HRA option, the money in an HSA follows the member even if he or she changes jobs or retires. This plan is available to Active Employees only.

15 Pelican HSA775 (Active Employees only) Medical Coverage Prescription Coverage Employee- Only Employee + 1 (Spouse or child) Employee + Children Family Tier Member Responsibility* Employer Contribution to HSA $200, plus up to $575 more dollar-for-dollar match of employee contributions Generic $10 co-pay Deductible (in-network) $2,000 $4,000 $4,000 $4,000 Deductible (out-ofnetwork) Out-of-pocket max (innetwork) Out-of-pocket max (outof-network) $4,000 $8,000 $8,000 $8,000 $5,000 $10,000 $10,000 $10,000 $10,000 $20,000 $20,000 $20,000 Coinsurance (in-network) 20% 20% 20% 20% Coinsurance (out-ofnetwork)** 40% 40% 40% 40% Preferred Non-Preferred Specialty $25 co-pay $50 co-pay $50 co-pay *Subject to deductible and applicable copayment (except maintenance medications) **Once a member s deductible for allowable charges is met, he or she will pay 40% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount.

16 HRA vs. HSA HRA vs. HSA Health Reimbursement Arrangement (HRA) Employer funds HRA Funds stay with the employer if an employee leaves an OGB-participating employer Contributions are not taxable Only employers may contribute Employer selects maximum contribution Funding Flexibility Health Savings Account (HSA) Employer and employee fund HSA Funds go with the employee when he/she leaves an OGBparticipating employer Contributions are made on a pre-tax basis Employers or employees may contribute IRS determines maximum contribution Must be paired with the Pelican HRA1000 Must be paired with the Pelican HSA 775 Contributions are the same for each employee May be used with a General-Purpose FSA HRA claims processed by the claims administrator IRS regulations and the Pelican HRA 1000 plan document govern expenses, funding and participation Can be used for medical expenses only Simplicity Eligible expenses Contributions are determined by employee and employer May be used only with a Limited-Purpose FSA Employee manages account and submits expenses to the HSA trustee for reimbursement IRS regulations govern expenses, funding and participation Can be used for pharmacy and medical expenses

17 Magnolia Local Plus (Nationwide In-Network Providers) The Magnolia Local Plus option offers the benefit of nationwide in-network providers. The Local Plus plan provides the predictability of co-payments rather than using employer funding to offset out-of-pocket costs. This plan provides care in the Blue Cross and Blue Shield nationwide network. Out-of-network coverage is provided in emergencies only and may be subject to balance billing.

18 Magnolia Local Plus Active Employees and non-medicare retirees retirement date on or AFTER Employer Contribution to HRA/HSA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children $0 $0 $0 $0 Deductible (in-network) $400 $800 $1,200 $1,200 Family Deductible (out-of-network) No coverage No coverage No coverage No coverage Out-of-pocket max (in-network) $2,500 $5,000 $7,500 $7,500 Out-of-pocket max (out-ofnetwork) No coverage No coverage No coverage No coverage Co-Payment (in-network) $25 / $50 $25 / $50 $25/$50 $25/$50 Co-Payment (out-of-network) No coverage No coverage No coverage No coverage Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Once you pay $1,500: Generic Preferred Non-Preferred Specialty $0 co-pay $20 co-pay $40 co-pay $40 co-pay

19 Magnolia Local Plus non-medicare retirees retirement date BEFORE Employer Contribution to HRA/HSA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children $0 $0 $0 $0 Deductible (in-network) $0 $0 $0 $0 Family Deductible (out-of-network) No coverage No coverage No coverage No coverage Out-of-pocket max (in-network) $1,000 $2,000 $3,000 $3,000 Out-of-pocket max (out-ofnetwork) No coverage No coverage No coverage No coverage Co-Payment (in-network) $25 / $50 $25 / $50 $25/$50 $25/$50 Co-Payment (out-of-network) No coverage No coverage No coverage No coverage Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Once you pay $1,500: Generic Preferred Non-Preferred Specialty $0 co-pay $20 co-pay $40 co-pay $40 co-pay

20 Magnolia Open Access (Nationwide Providers) The Magnolia Open Access Plan offers coverage both inside and outside of Blue Cross s nationwide network. It differs from the other Magnolia plans in that members enrolled in the open access plan will not pay co-payments at physician visits. Instead, once a member s deductible for allowable charges is met, he or she will pay 10% of the allowable amount for in-network care and 30% of the allowable amount for out-of-network care. Out-of-network care may be balance billed. Though the premiums for the open access plan are higher than OGB s other plans, its moderate deductibles combined with a nationwide network make it an attractive plan for members who live out of state or travel regularly.

21 Magnolia Open Access Active Employees and non-medicare retirees retirement date on or AFTER Employer Contribution to HRA/HSA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children Family $0 $0 $0 $0 Deductible (in-network) $900 $1,800 $2,700 $2,700 Deductible (out-of-network) $900 $1,800 $2,700 $2,700 Out-of-pocket max (in-network) $2,500 $5,000 $7,500 $7,500 Out-of-pocket max (out-ofnetwork) $3,700 $7,500 $11,250 $11,250 Coinsurance(in-network) 10% 10% 10% 10% Coinsurance (out-of-network) 30%* 30%* 30%* 30%* Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Once you pay $1,500: Generic Preferred Non-Preferred Specialty $0 co-pay $20 co-pay $40 co-pay $40 co-pay *Once a member s deductible for allowable charges is met, he or she will pay 30% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount for out-ofnetwork care.

22 Magnolia Open Access non-medicare retirees retirement date BEFORE Employer Contribution to HRA/HSA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children Family $0 $0 $0 $0 Deductible (in & out-of-network) $300 $600 $900 $900 $1,300 individual; plus $1,300 per additional person up Out-of-pocket max (in-network) to 2; plus $1,00 per additional person up to 10 people; $12,700 for a family of 12+ Out-of-pocket max (out-ofnetwork) $3,300 individual; plus $3,000 per additional person up to 2;$12,700 for a family of 4+ Coinsurance(in-network) 10% 10% 10% 10% Coinsurance (out-of-network) 30%* 30%* 30%* 30%* Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Once you pay $1,500: Generic Preferred Non-Preferred Specialty $0 co-pay $20 co-pay $40 co-pay $40 co-pay *Once a member s deductible for allowable charges is met, he or she will pay 30% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount for out-ofnetwork care.

23 Magnolia Local (Limited In-Network Provider Only Plan) The Magnolia Local plan is a limited provider in-network only plan for members who live in specific coverage areas. Out-ofnetwork coverage is provided in emergencies only and may be subject to balance billing. o Community Blue Community Blue is a select, local network designed for members who live in the parishes of East Baton Rouge, West Baton Rouge, Ascension, Caddo and Bossier. o BlueConnect BlueConnect is a select, local network designed for members who live in the parishes of Jefferson, Orleans and St. Tammany. You must stay in your network when receiving care. Your residence determines which Magnolia Local network you are in.

24 Magnolia Local Active Employees and non-medicare retirees retirement date on or AFTER Employer Contribution to HRA/HSA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children $0 $0 $0 $0 Family Deductible (in-network) $400 $800 $1,200 $1,200 Deductible (out-of-network) No coverage No coverage No coverage No coverage Out-of-pocket max (in-network) $2,500 $5,000 $7,500 $7,500 Out-of-pocket max (out-ofnetwork) No coverage No coverage No coverage No coverage Co-Payment (in-network) $25 / $50 $25 / $50 $25/$50 $25/$50 Co-Payment (out-of-network) No coverage No coverage No coverage No coverage Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Once you pay $1,500: Generic Preferred Non-Preferred Specialty $0 co-pay $20 co-pay $40 co-pay $40 co-pay

25 Magnolia Local non-medicare retirees retirement date BEFORE Employer Contribution to HRA/HSA Medical Coverage Employee- Only Employee + 1 (Spouse or Child) Employee + Children $0 $0 $0 $0 Deductible (in-network) $0 $0 $0 $0 Deductible (out-of-network) No coverage No coverage No coverage Family No coverage Out-of-pocket max (in-network) $1,000 $2,000 $3,000 $3,000 Out-of-pocket max (out-ofnetwork) No coverage No coverage No coverage No coverage Co-Payment (in-network) $25 / $50 $25 / $50 $25/$50 $25/$50 Co-Payment (out-of-network) No coverage No coverage No coverage No coverage Prescription Coverage Tier Member Responsibility Generic 50% up to $30 Preferred 50% up to $55 Non-Preferred 65% up to $80 Specialty 50% up to $80 Once you pay $1,500: Generic Preferred Non-Preferred Specialty $0 co-pay $20 co-pay $40 co-pay $40 co-pay

26 Vantage Medical Home HMO Vantage Medical Home HMO is a patient-centered approach to providing cost-effective and comprehensive primary health care for children, youth and adults. This plan creates partnerships between the individual patient and his or her personal physician and, when appropriate, the patient s family. This plan includes a preferred provider network, Affinity Health Network (AHN), which has lower co-payments for certain covered services as indicated by AHN. This plan also includes Out-of-Network coverage.

27 Vantage Medical Home HMO Medical Coverage Employee- Only Employee +1 (Spouse or child) Employee + Children Deductible (Tier I) $400 $800 $1,200 $1,200 Deductible (Tier II & Out-of-Network) $1,500 $3,000 $4,500 $4,500 Out-of-pocket max (Tier I) $2,500 $5,000 $5,000 $7,500 Out-of-pocket max (Tier II & Out-of-Network) Unlimited Unlimited Unlimited Unlimited Family Co-Payment PCP (Tier I) $10 AHN/$20 $10 AHN/$20 $10 AHN/$20 $10 AHN/$20 Co-Payment Specialist (Tier I) $35 AHN/$45 $35 AHN/$45 $35 AHN/$45 $35 AHN/$45 Coinsurance PCP (Out-of-Network) Coinsurance Specialist (Out-of-Network) 50% coverage; subject to out-of-network deductible 50% coverage; subject to out-of-network deductible Prescription Coverage Tier Member Responsibility Tier 1 Preferred Generics $5 Tier 2 Non-Preferred Generics $20 Tier 3 Preferred Brand $50 Tier 4 Non-Preferred Brand $80 Tier 5 Specialty $150 Tier I Providers Members seeing Tier I providers pay the Tier I co-pays, co-insurance and deductibles as listed in the Certificate of Coverage and Cost Share Schedule. Tier I consists of two networks: A preferred provider network, Affinity Health Network (AHN), which has lower co-payments for certain covered services; and A standard provider network Tier II Providers Members who chose to see these providers will have to pay an additional 20% coinsurance in addition to their Tier I cost share, after the applicable deductible is met.

28 Retiree Plans OGB retirees with Medicare have several additional options available to them. Retirees who have Medicare Part A and Part B coverage can select from four-ogb sponsored Medicare Advantage plans: the Peoples Health HMO-POS; the Vantage Premium HMO-POS; the Vantage HMO-POS; and the Vantage Zero-Premium HMO-POS. They can also choose a Medicare Advantage plan through OneExchange (formerly Extend Health) and be enrolled in a health reimbursement arrangement (HRA) receiving HRA credits of $200 to $300 per month. Retirees can also select from five OGB plans during annual enrollment: the Pelican HRA1000 and the Magnolia plans, administered by Blue Cross and Blue Shield of Louisiana, and the Vantage Medical Home HMO plan. These plans will be secondary to Medicare.

29 Individual Medicare Plans through OneExchange OneExchange: Customize your insurance Towers Watson's OneExchange is an Individual Medicare Market Exchange offered to OGB retirees and spouses who have Medicare Parts A and B. OneExchange offers a variety medical, prescription drug, and dental plans based on an individual's provider preferences, prescription drug needs, geographic location and medical conditions. These plans may include Medicare Advantage, Medicare Supplement (or Medigap) and Medicare Part D Prescription Drug coverage. Plan Advice and Enrollment Assistance OneExchange gives you access to licensed benefit advisors and online tools combined with comprehensive knowledge of the Medicare market. Licensed benefit advisors are available to assist you before, during and after enrollment. You can contact benefit advisors at (855) , Monday through Friday from 8:00 a.m. until 8:00 p.m. central standard time. OneExchange Health Reimbursement Arrangement (HRA) Retirees enrolled in a medical plan through OneExchange receive a Health Reimbursement Arrangement. The OneExchange HRA allows for tax-free reimbursement of qualifying medical expenses to the extent that funds are available in the HRA account. A single retiree will receive HRA credits of $200 per month and a retiree plus spouse will receive HRA credits of $300 per month from the agency you retired. Compare Plans OneExchange offers a variety of tools to help you compare insurance plans and premiums. They also offer a Prescription Profiler that uses your current and projected medication expenses to determine which plans will have the lowest estimated annual out-of-pocket cost. For a complete list of plans and providers visit: medicare.oneexchange.com/ogb or call OneExchange at Sampling of plans available through OneExchange

30 Peoples Health Medicare Advantage The Peoples Health Medicare Advantage plan offers much more than Medicare, with extra benefits like vision and dental coverage, free health club membership and prescription drug coverage. As a Peoples Health Group Medicare member, retirees pay a premium in addition to paying their Medicare Part B premium; retirees receive 100 percent coverage for many services with NO Medicare deductibles. COVERED BENEFIT PEOPLES HEALTH HMO-POS PLAN YEAR DEDUCTIBLE $0 MAXIMUM OUT-OF-POCKET EXPENSE (IN-NETWORK) $2,500 MAXIMUM OUT-OF-POCKET EXPENSE (OUT-OF-NETWORK) 20% OFFICE VISIT - PRIMARY CARE / SPECIALIST EMERGENCY ROOM $5 / $10 co-pay per visit $50 ER co-pay per visit INPATIENT HOSPITAL $50 per day (days 1-10) PRESCRIPTION DRUGS (PART D) Preferred Generics $0 co-pay Non-Preferred Generics $0 co-pay Preferred Brand $20 co-pay (30-day supply) Non-Preferred Brand $40 co-pay (30-day supply) Specialty 20%

31 Vantage Health Plan Medicare Advantage For retirees who are 65 and over, Vantage offers several great Medicare Advantage plans as an alternative to Medicare. One benefit to Vantage s Medicare Advantage plans is that a network of providers is already contracted with the plan throughout Louisiana. These physicians, hospitals and specialty medical facilities have already agreed to provide health care services to treat Medicare Advantage members. COVERED BENEFIT Vantage Premium HMO-POS VANTAGE POS PLAN VANTAGE ZERO-PREMIUM HMO-POS PLAN YEAR DEDUCTIBLE N/A N/A N/A MAXIMUM OUT-OF-POCKET EXPENSE $2,000 $3,000 $6,700 OFFICE VISIT PRIMARY CARE / SPECIALIST EMERGENCY ROOM $5/$20 co-pay per visit or $0/$10 AHN co-pay per visit $50 co-pay per visit; worldwide coverage $10/$40 co-pay per visit or $0/$30 AHN co-pay per visit $75 ER co-pay per visit - worldwide coverage $15/$50 co-pay per visit or $5/$40 AHN co-pay per visit $75 ER co-pay per visit - worldwide coverage INPATIENT HOSPITAL $50/per day (days 1-10) $300/day (days 1-5) $345/day (days 1-5) PRESCRIPTION DRUGS (PART D) Tier 1 Preferred Generics Tier 2 Non-Preferred Generics Tier 3 Preferred Brand Tier 4 Non-Preferred Brand Tier 5 Specialty $5 co-pay $10 co-pay $25 co-pay $50 co-pay 20% coinsurance $4 co-pay $10 co-pay $47 co-pay $100 co-pay 33% coinsurance $4 co-pay $10 co-pay $47 co-pay $100 co-pay (after $125 deductible) 25% coinsurance (after $125 deductible)

32 We encourage you to make sure you choose a doctor or hospital in your provider network when you need healthcare. By choosing network providers, you avoid the possibility of having your provider bill you for amounts in addition to applicable co-payments, coinsurance, deductibles and non-covered services. (Often referred to as balance billing.)

33 Affordable Care Act (ACA)

34 IRS Reporting Employer Shared Responsibility Provisions Effective January 1, 2015 o Must offer health coverage to all ACA full-time employees (30+ hours per week) o Must provide IRS Forms to employees and the IRS Agency MUST assure accuracy of data Agency MUST maintain documentation

35 IRS Reporting Data required to populate IRS Form 1095-C: o Employee s/plan member s name, SSN, address o Employer Information o Months Minimum Essential Coverage (MEC) was offered that provided minimum value o Employee share of lowest cost monthly premium for self-only minimum value coverage o Employer safe harbor and transition relief code(s) o Covered individuals and months covered

36 IRS Reporting OGB will provide data on covered individuals * and their dependents Data provided by OGB will include: o Plan member s name, SSN, address o Months of the year the individual was covered o Lowest cost monthly premium for self-only coverage o Listing of covered individuals and months they were covered Agencies will be responsible for capturing additional data required for these forms including: o Offer of Coverage Code - Type of coverage that was offered. o Coverage Code Whether the plan member was covered or the reason that they were not covered. *Covered individuals include active employees, retirees, COBRA participants and survivors

37 IRS Reporting OGB Data File o File is on the OGB website ( under Agencies o File will be housed under Misc. Documents > Affordable Care Act (ACA) Files o File is a complete enrollment file and will be updated on a regular basis A sample layout can be found at acacompliance.groupbenefits.org under the downloads sidebar

38 Eligibility

39 Dependents The following people can be enrolled as dependents: Legal spouse Children until they reach age 26 Children are defined as: Natural child of plan member or Spouse Legally adopted child or child placed for adoption Child under court ordered custody or court ordered legal guardianship (two participating plan members cannot cover the same dependent)

40 Dependents To add a newborn as a dependent, the member must provide human resources with a birth certificate or a copy of the birth letter within 30 days of the child s birth date. The birth letter will suffice as proof of parentage only if it contains the relationship of the child and the employee. If the birth certificate or birth letter is not received within 30 days, enrollment cannot take place until the next annual enrollment period*. * Subject to Plan exceptions

41 Dependent Verification Members must provide human resources with proof of the legal relationship of each newly eligible dependent. Without that documentation, enrollment cannot be completed. Acceptable documents include: Marriage Certificate Birth letter or birth certificate Legal adoption or placement for adoption papers, court ordered custody papers or court ordered legal guardianship papers, if applicable. Human Resources must verify the eligibility of newly eligible dependents.

42 Plan Recognized Qualified Life Events The Office of Group Benefits (OGB) will be providing a chart advising agencies of Plan Recognized Qualified Life Events that allow for mid-year plan benefit changes by members. It will also include ACA recognized events. The life events on this chart will be effective January 1, Agencies will be provided instruction on how to use this chart in the coming months. Be sure to check your for an invitation to a training session.

43 Retirees OGB coverage must be in effect immediately prior to a member s retirement to be eligible for retiree coverage. If the member started participation or rejoined state service on or after January 1, 2002, the state contribution of their premium is based on the number of participation years in an OGB health plan. This also applies to surviving spouse who started coverage after July 1, The participation schedule below shows the number of years a member must participate in an OGB health plan to receive a specified state contribution. Retiree Participation Schedule Years of OGB Plan Participation State s Share of Total Monthly Premium 20 years or more 75 percent 15 years but less than 20 years 56 percent 10 years but less than 15 years 38 percent less than 10 years 19 percent

44 Agency Checklist Verify applicable participation rate with OGB Verify life insurance amount check accuracy of salary shown in e-enrollment Verify actual retirement date with retirement system Verify life insurance beneficiary Collect 2 to 3 months of health and/or life insurance premiums Verify employee s contact information, including mailing address, address and phone number

45 Retirees Medicare Eligibility If a retiree or the covered spouse of a retiree is eligible for premium-free Medicare Part A (hospitalization insurance), he or she MUST ALSO enroll in Medicare Part B (medical insurance) to receive OGB benefits on Medicare Part B claims If the above applies to the member or covered spouse, he or she should visit the local Social Security office to enroll for Medicare Part B coverage at least 3 months before his or her 65 th birthday. This does not apply to anyone who reached age 65 before July 1, 2005 If the plan member is retired but has not yet reached age 65, this will apply to the member when he or she reaches age 65. If the member reached age 65 on or after July 1, 2005, but has not retired, this will apply to the member when he or she retires. This applies to the member and covered spouse regardless of whether each has individual Medicare eligibility (under his/her own Social Security number) or one person is eligible as the dependent of another person. Retirees should bring the name(s) and social security number(s) of previous spouses (divorced or deceased spouse) so that Social Security can determine which spouse they may qualify under.

46 Rehired Retirees If an agency hires a retiree who did not carry coverage into retirement, the rehired retiree may now enroll in a health plan with the following provisions: The retiree is hired as a full-time employee The retiree s participation level at retirement will still apply The employee s rate will be RN (retired, no Medicare) CMS rules state that OGB will be primary over Medicare The employee s coverage will be terminated once he or she separates from the agency. If an agency hires a retiree who has health coverage through OGB: Offer coverage Submit GB-01 to let OGB know to move the rehired retiree to 92 invoice

47 Using eenrollment for HSA

48 Pelican HSA 775 Enrollment Enrollment must be done in eenrollment DO NOT send paper application to Bancorp Current HSA participants must re-enroll every year Monthly deductions must be entered in eenrollment Agency and plan member contribution will only be sent to Bancorp after the account has been opened NOTE: Once Bancorp opens the account, the employee s name will appear in the HSA Opened Accounts folder under the Miscellaneous Documents link. Monthly deductions can only be entered after Bancorp opens the account.

49 Invoicing

50 Invoicing HSA Billing Information IMPORTANT! HSA funds will NOT be transferred to Bancorp until they have been first received by the Office of Finance and Support Services (OFSS).

51 Invoicing HSA Billing LaGov paid agencies(formerly ISIS), PeopleSoft, LCTCS payroll systems: Deduction file is sent to OFSS once per month Once received, amounts are verified and funds are transferred to Bancorp Process takes up to 5 days once file is received Members should see contributions a few days after this transfer IMPORTANT! Contributions deducted during the month will not be submitted until after that month has passed. Example: April deductions are received on a deduction file dated May 4. Funds will begin being processed at that time, not as soon as they are deducted.

52 Invoicing HSA Billing LaGov non-paid agencies (formerly Non-ISIS): Funds will be transferred once OFSS has received invoice payment for that month AND the HSA Contribution Spreadsheet upload Once both items have been received, amounts are verified and funds are transferred to Bancorp Process takes up to 5 days once file is received Members should see contributions a few days after this transfer

53 Invoicing HSA Billing Non-ISIS (Non-LaGov)continued: Agency upload must be done monthly HSA Contribution Spreadsheet is located on the OGB website under Forms-Agencies Please only submit one upload per month, per agency Do Not alter the HSA Contribution Spreadsheet doing so will result in it being rejected or delayed Make sure all SSNs are correct Incorrect SSNs will be rejected and a new upload will be needed for members with incorrect SSNs Once the initial $200 employer contribution has been funded, the employer can only match the employee contribution each month, up to the additional $575. The employer portion can never exceed the employee portion

54 Other Benefit Offerings

55 COBRA Following a qualified event that causes a covered employee (or spouse or child of a covered employee) to lose health insurance coverage, the employee s Human Resources Department or Agency Benefits Coordinator will update the member s information in the e-enrollment system. OGB generates a data report weekly that identifies the qualifying events and submits it to Discovery Benefits. Discovery Benefits then mails out COBRA enrollment information, as well as information about access to their Discovery Marketplace, where COBRA-eligible members can choose from several affordable option(s) for individual insurance coverage, Qualifying events for a covered employee: Termination of the covered employee's employment for any reason other than "gross misconduct"; or Reduction in the covered employee's hours of employment. Qualifying events for a spouse and dependent child of a covered employee: Termination of the covered employee's employment for any reason other than "gross misconduct"; Reduction in hours worked by the covered employee; Covered employee becomes entitled to Medicare; Divorce, legal separation or annulment of marriage of the spouse from the covered employee; Death of the covered employee; or Loss of "dependent child" status under the plan rules. For more information regarding COBRA, please refer to the U.S. Department of Labor publication An Employer's Guide to Group Health Continuation Coverage Under COBRA, located online at

56 COBRA Members that experience a qualifying event and become eligible for and elect COBRA will be invoiced by Discovery Benefits, Inc. (DBI). Members will remit payment directly to DBI, either by mail, by ACH drafts from their bank accounts, or by credit card online, or online through Discovery Benefits Participant COBRA web portal (online payments are subject to a $20 processing fee). Payment processing center address: Discovery Benefits Inc. PO Box 2079 Omaha, NE COBRA participant services click option 1, click option 2 when prompted (fax) cobraadmin@discoverybenefits.com Participant COBRA web portal:

57 Flexible Benefits What are Flexible Benefits? Flexible Benefits are tax-saving benefits They enable employees to save both state and federal income taxes on eligible payroll deductions for health care and dependent care

58 Flexible Spending Arrangement Options There are four Flexible Spending Arrangement options available to eligible OGB members: Premium Conversion General-Purpose FSA (GPFSA) Limited-Purpose FSA (LPFSA) Dependent Care FSA (DCFSA)

59 Flexible Benefits Enrollment Opportunities New Hires & Rehired Retirees (Full-Time/ACA Full-Time) 30 day window for: General-Purpose or Limited-Purpose FSA Dependent Care FSA Employees who experience an IRS-recognized qualifying event Plan members have a 30-day window to submit their paperwork to Human Resources after the qualifying event happens Annual Enrollment: October 1 November 15

60 Premium Conversion Automatic Enrollment Employees of agencies that participate in the OGB administered Flexible Benefits Plan will automatically be enrolled in the Premium Conversion option for all OGB products and eligible miscellaneous products Once enrolled in the Premium Conversion option, enrollment will automatically continue from year to year unless the employee chooses to end participation in all coverage during annual enrollment or due to experiencing an IRS-recognized qualifying event. See the Flex Plan document for additional information.

61 Flexible Spending Arrangement Participation Money deducted from an employee s pay into a FSA is not subject to payroll taxes, resulting in substantial tax savings. Available FSAs: General-Purpose Health Care FSA Limited-Purpose Dental/Vision FSA Dependent Care FSA Employees can participate in any Flexible Spending Arrangement even if they are not enrolled in an OGB health plan. Enrollment Process: Current covered employees can enroll in FSAs on-line at the same time they enroll in their new OGB health plan through the annual enrollment portal; or Re-enroll Through their HR Department.

62 FSA Eligibility and Enrollment General-Purpose FSA, Limited-Purpose FSA and Dependent Care FSA: Must be an active, full-time employee in a participating payroll system Can enroll during Annual Enrollment or after experiencing an IRS-recognized qualifying event Must re-enroll each year to continue participation and agree to pay the $36 annual administrative fee New hires must enroll within their first thirty (30) days of full-time employment; your participation will be effective the first of the following month after your first full calendar month of employment. For example: if your Date of Hire is August 20 th, your Effective Date is October 1 st. General-Purpose FSA & Limited-Purpose FSA Amounts Maximum and Minimum amounts have not been determined.

63 Dependent Care FSA For eligible dependent care expenses while you work Submission of dependent care expenses can be reduced by signing up for DCFSA recurring Expense Service Reimbursement is limited to current amount in account Minimum annual amount is $600 Must re-enroll each year to continue participation Must file IRS form 2441

64 Dependent Care FSA PLAN YEAR MAXIMUM AMOUNTS EMPLOYEE TAX STATUS SINGLE OR MARRIED FILING SEPARATELY SINGLE HEAD OF HOUSEHOLD MAXIMUM AMOUNT $2,500 $5,000 ALLOWED DEPENDENT Child under age 13; Older dependent incapable of self care Child under age 13; Older dependent incapable of self care MARRIED FILING JOINTLY $5,000 Child under age 13; Older dependent incapable of self-care; Spouse incapable of self care

65 Discovery Benefits VISA Benefits Debit Card Discovery Benefits Contact Information: o Phone: o customerservice@discoverybenefits.com o Website: o Fax: Can be used to pay providers who accept VISA for eligible expenses for GPFSA, LPFSA and DCFSA Full amount of General-Purpose FSA and Limited-Purpose FSA funds are available immediately Dependent Care FSA funds are available upon deposit Card is reloadable each year as long as the employee reenrolls Card is replaced before expiration date

66 Mid-Year FSA Termination Notice Agency must send a termination notice to both contacts below on or before the retirement date or the termination date of an employee who is participating in an FSA The notice should include the first and last name, last four digits of SSN, date of termination, and the agency number of the termed/retired employee Discovery Benefits(FSA Administrator) Fax Number: customerservices@discoverybenefits.com OGB Flexible Benefits Administration Fax Number: flexiblebenefitsgroup@la.gov

67 Agency Checklist New hires Offer General-Purpose Health Care or Limited-Purpose Dental/Vision FSA Offer Dependent-Care FSA Enroll within 30 days of employee hire date Transfers Pick up same deductions no increase allowed Pick up same annual elected amount for the remainder of the plan year *Non-Medicare rehired retirees who are employed as active full-time employees are eligible for all options

68 Live Better Louisiana

69 Sponsored by Blue Cross and Blue Shield of Louisiana Provides resources to help monitor health, understand risk factors, make educated choices that can prevent illness & manage health conditions Complete two steps to qualify for annual premium discount: 1. Schedule a wellness checkup through Catapult Health or see your MD for wellness visit and submit completed Primary Care Provider form 2. Fill out Personal Health Assessment online survey at Participation information on the 2016 plan year will be forthcoming

70 Contact Information

71 OGB Agency Help Desk Toll Free: (844) Baton Rouge Area: (225) Website:

72 Contact Information Blue Cross Blue Shield of Louisiana Peoples Health MedImpact/Medicare Generations Rx Vantage Health Plan OneExchange medicare.oneexchange.com/ogb Discovery Benefits