Benefits Presentation Open Enrollment November 1, 2013

Transcription

1 Benefits Presentation Open Enrollment November 1, 2013

2 Welcome To Open Enrollment! Rock Church and Academy understands the health and welfare benefit package is a core necessity to many of our employees and families and we are pleased to continue to offer a robust benefit plan to our employees. Benefit costs continue to rise and medical trend is averaging between 15%- 18%. Health Care Reform (HCR) fees (taxes) are adding an additional 4% - 7% to the medical rates this year. Rock Church and Academy was blessed to receive very competitive renewals this year, despite the added HCR taxes, so the employees payroll deductions will not be changing this year! Looking to the future, HCR virtually requires all Americans to carry some form of qualified health insurance by Individuals who do not comply with this mandate will be faced with a penalty from the Federal Government - most likely via the IRS. Please review your options carefully from Rock and the Marketplace Exchange. 1

3 What is Open Enrollment! Open Enrollment is the one time a year to make any plan changes without a qualified life event. During Open Enrollment, you can add or delete dependents or switch from one plan to another with no questions asked! Any other changes (including cancelling coverage) made mid year can only be completed if you have a qualified family status change. All Open Enrollment changes and enrollment forms are due back to Nancy Hawley, Benefits Coordinator, by October 9th. All plan changes and enrollments will be effective November 1,

4 Qualified Family Status Changes Throughout the course of a plan year, certain qualifying events may occur which allow employees to add, change or terminate health or dental plan elections. The following are examples of qualifying events: Marriage, legal separation, or divorce Birth or adoption of a child Death of a spouse or dependent Court Order which results in the employee gaining or losing custody of a dependent An over-age dependent who is no longer eligible You must contact Nancy Hawley, Benefits Coordinator, within 31 days of the qualifying event to make any changes to your enrollment. 3

5 This Year s Plans Medical Plans renewing with Aetna and Kaiser! (small change on the Aetna prescription program) Vision still offered from MES! Dental is renewing with Principal! EAP is remaining with Holman Group! Life Insurance and Long Term Disability through Assurant! New This Year: We will be adding Voluntary Life Insurance through Assurant! 4

6 This Year s Plans But there is one pretty important change: Rock Church and Academy will be moving to a January 1 st renewal date starting next year so our renewal this year will run from November 1, 2013 to December 31, This allows our medical plans to renew January 1, 2015 and align with the calendar year. This should offer our employees an easier experience since our plan year will now coincide with the calendar year. We will renew with the carriers November 1 st and then all our deductibles and out-of-pocket maximums will reset for the January 1 st cycle going forward. 5

7 Eligibility As a reminder, the following individuals are eligible for the benefits plans: Regular employees who were hired to work a schedule of 35 hours or more per week are eligible to enroll in the Rock's insurance plans. Employees, who are enrolled in the Rock's insurance plans, may also insure their legal spouse and dependent children up to their child s 26th birthday. Dependents do not need to be enrolled in school to be covered. 6

8 Medical

9 Medical Plans The medical plans currently offered by Aetna and Kaiser will remain with no plan changes: Aetna offers a choice of: HMO Aetna Value Network (excludes Scripps Clinic and other selected providers) No cost for employee only coverage HMO Full network Open Access Managed Choice POS The Kaiser offers: HMO Kaiser network No cost for employee only coverage 8

10 Aetna HMO Networks MEDICAL GROUPS Aetna Limited HMO Plan (Value Network) HMO Plan (Full Network) Network Arch Health Partners Yes Yes Children's Physicians Medical Group, Inc. Yes Yes Children's Specialists of San Diego Yes Yes Encompass Medical Group No No Greater Tri-Cities IPA Yes Yes Mercy Physicians Medical Group Yes Yes Mid-County Physicians Medical Group No No Multicultural Primary Care Medical Group Yes Yes Noble AMA IPA No No Primary Care Associates Medical Group Yes Yes Rady Children's Specialists of San Diego, A Medical Foundation Yes Yes San Diego Physicians Medical Group Yes Yes Scripps Clinic No Yes Scripps Coastal Medical Center No Yes Sharp Community Medical Group - Graybill Yes Yes Sharp Community Medical Group at San Diego Yes Yes Sharp Community Medical Group - Inland North Yes Yes Sharp Rees-Stealy Medical Group Yes Yes UCSD Healthcare Network Yes Yes 9

11 HMO Medical Plans VALUE NETWORK HMO CA AVN HMO Preferred 1 10/10 100% (excludes Scripps Clinic) AETNA FULL NETWORK HMO CA HMO Preferred 2 15/ BENEFIT HIGHLIGHTS CALENDAR YEAR DEDUCTIBLE HMO AVN Netw ork HMO FULL Netw ork Individual None None Family None None CALENDAR YEAR OUT OF POCKET MAXIMUM Individual $1,500 $1,500 Family $3,000 $3,000 LIFETIME MAXIMUM Unlimited Unlimited PROFESSIONAL SERVICES Office Visit $10 Copay $15 Copay Routine Preventive Visit No Charge No Charge Specialist Visit $10 Copay $20 Copay DIAGNOSTIC PROCEDURES Diagnostic Laboratory No Charge No Charge Diagnostic X-ray No Charge No Charge CT or CAT Scan, MRI and PET Scan $100 Copay $100 Copay 10

12 HMO Medical Plans VALUE NETWORK HMO CA AVN HMO Preferred 1 10/10 100% (excludes Scripps Clinic) AETNA FULL NETWORK HMO CA HMO Preferred 2 15/ BENEFIT HIGHLIGHTS HOSPITALIZATION Inpatient No Charge $250 / Admit Outpatient Surgery No Charge $100 Copay EMERGENCY Emergency Room Visit $100 Copay $100 Copay Urgent Care $35 Copay $35 Copay $10 Copay $15 Copay CHIROPRACTIC SERVICES 20 Visits / Cal. Year 20 Visits / Cal. Year 11

13 HMO Medical Plans VALUE NETWORK HMO CA AVN HMO Preferred 1 10/10 100% (excludes Scripps Clinic) AETNA FULL NETWORK HMO CA HMO Preferred 2 15/ BENEFIT HIGHLIGHTS PRESCRIPTION DRUGS Participating Pharmacy Participating Pharmacy Generic $10 Copay $10 Copay Brand Name $20 Copay* $20 Copay* Non-Formulary $35 Copay* $35 Copay* Mail Order - 90 day supply 2 copays 2 copays * If a generic is available, the member would pay the copay + the Choose Generics Plan difference in the cost of the drug. 12

14 Open Access Managed Choice POS Medical Plan AETNA OPEN ACCESS MANAGED CHOICE Preferred 3 BENEFIT HIGHLIGHTS 20/ / CALENDAR YEAR DEDUCTIBLE Preferred Provider Non-Preferred Provider Individual $250 $500 Family $500 $1,000 CALENDAR YEAR OUT OF POCKET MAXIMUM Individual $2,500 $5,000 Family $5,000 $10,000 LIFETIME MAXIMUM Unlimited PROFESSIONAL SERVICES Office Visit $20 Copay 40% after Deductible Routine Preventive Visit No Charge 40% after Deductible Specialist Visit $25 Copay 40% after Deductible DIAGNOSTIC PROCEDURES Diagnostic Laboratory 20% after Deductible 40% after Deductible Diagnostic X-ray 20% after Deductible 40% after Deductible CT or CAT Scan, MRI and PET Scan 30% after Deductible 50% after Deductible 13

15 Open Access Managed Choice POS Medical Plan AETNA BENEFIT HIGHLIGHTS HOSPITALIZATION Inpatient OPEN ACCESS MANAGED CHOICE Preferred 3 20/ / $150 Copay, then 20% after Deductible $300 Copay, then 40% after Deductible Outpatient Surgery 20% after Deductible 40% after Deductible EMERGENCY Emergency Room Visit $100 Copay, then 20% (Deductible Waived) Urgent Care CHIROPRACTIC SERVICES $25 Copay (Deductible Waived) 12 Visits / Cal. Year $35 Copay Not covered 14

16 Open Access Managed Choice POS Medical Plan AETNA OPEN ACCESS MANAGED CHOICE Preferred 3 20/ / BENEFIT HIGHLIGHTS PRESCRIPTION DRUGS Participating Pharmacy Non-Participating Pharmacy Generic $10 Copay $10 Copay + 50% of Submitted Cost Brand Name $20 Copay* $20 Copay + 50% of Submitted Cost Non-Formulary $35 Copay* $35 Copay + 50% of Submitted Cost Mail Order - 90 day supply 2 copays NA * If a generic is available, the member would pay the copay + the difference Choose Generics Plan in the cost of the drug. 15

17 Carrier Site: Find a provider Use to find providers in your area. Print ID cards Access health information Find discounts on alternative medicine providers Take an on line Health Risk Assessment Healthy eating and weight tips 16

18 Aetna Navigator Visit Aetna Navigator to view your personal information Secure registration process Phone support to assist with login or registration questions Easy access to information from menus, quick links, related shortcuts and Site Map Request a new ID card, print a temporary ID card 17

19 Navigator Highlights You can register online 24 hours a day, 7 days a week - from anywhere you have Internet access! Price-A-Drug Compare drugs based on their tier and see the cost savings with mail order. SmartSource, Aetna InteliHealth & Healthwise Knowledgebase Helpful, online tools to search for additional information on medical conditions Member Services Member Services with a plan or claim question and get a response within 48 hours Simple Steps to a Healthier Lifestyle Take Simple Steps to a Healthier Lifestyle Health Risk Assessment Enroll in an online Healthy Lifestyle wellness program 18

20 What is DocFind? Aetna s premier online provider directory; replacement to paper provider directories. Provider data refreshed six times per week. Supports searches for preferred providers: Primary Care Physician Specialist Facility Pharmacy 19

21 Aetna Informed Health Line Talk to a registered nurse. The nurses encourage informed health care decision-making and improved patient/provider relationships through information and support. Access to the Informed Health Line is limited to 24-hour nurse line for your health questions It s toll-free You can call as many times as you need at no extra cost Visit your Navigator secure member website at Or call 1 (800)

22 Member Tools Aetna Mobile With Aetna s mobile web and mobile app, you can better manage your health and benefits. Simply use the secure member log in and get access to: DocFind Claim search Member ID card information Price-a-Drug Personal health record Contact Us Capabilities Forgot user name and password Registration Mobile Web is optimized for over 5,000 devices Mobile applications available for Apple ios devices (iphone, ipod touch, ipad), BlackBerry Curve TM models and now Androids. 21

23 HMO Medical Plans KAISER BENEFIT HIGHLIGHTS Kaiser HMO CALENDAR YEAR DEDUCTIBLE HMO Netw ork Individual None Family None CALENDAR YEAR OUT OF POCKET MAXIMUM Individual $1,500 Family $3,000 LIFETIME MAXIMUM Unlimited PROFESSIONAL SERVICES Office Visit $15 Copay Routine Preventive Visit No Charge Specialist Visit $15 Copay DIAGNOSTIC PROCEDURES Diagnostic Laboratory $10 Copay Diagnostic X-ray $10 Copay CT or CAT Scan, MRI and PET Scan $50 Copay 22

24 HMO Medical Plans KAISER BENEFIT HIGHLIGHTS HOSPITALIZATION Inpatient Outpatient Surgery EMERGENCY Emergency Room Visit Kaiser HMO No Charge $15 Copay $100 Copay Urgent Care CHIROPRACTIC SERVICES $15 Copay $15 Copay 20 Visits per Year 23

25 HMO Medical Plans KAISER BENEFIT HIGHLIGHTS PRESCRIPTION DRUGS Kaiser HMO Kaiser Pharmacy Generic Brand Name Non-Formulary Mail Order day supply $15 Copay $35 Copay Not Covered 2 Copays 24

26 Your electronic health record With My Health Manager, you can: your doctor s office with routine questions. Refill prescriptions online, and have most mailed to your home at no extra charge. Schedule routine appointments. View lab test results. Act on behalf of a family member, like a child or parent. 25

27 There s an app for that! Go mobile with kp.org and use My Health Manager while you re on the go to schedule appointments, your doctor, order prescriptions and more! Just bookmark kp.org on your smartphone. Or download the Kaiser Permanente app for the iphone or Android from the App Store SM or Google Play. Apple and iphone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Android is a trademark of Google Inc. 26

28 Health tools and programs Start a free online healthy lifestyle program and get a customized action plan for making healthy changes. Join a health class at a Kaiser Permanente facility near you, and get the extra help you need to feel your best. (Some classes may require a fee.) Or call a wellness coach to get personalized help for improving your health habits at no cost. 27

29 Positive choice wellness center Services available to all employees (KP and non-kp members) which includes: Medical weight management programs Nutrition counseling Fitness testing and instruction Personal training Exercise classes Biofeedback 28

30 Discount Programs As a KP member, you can access a complementary health and fitness program provided by ChooseHealthy to help you stay well. Acupuncture Massage therapy Chiropractic care Fitness facilities Herbs, Vitamins, Supplements 29

31 Dental

32 Dental Plans The dental plans currently offered by Principal will remain with no plan changes: Principal offers a choice of: EPO You must receive treatment from a provider participating in the Exclusive Providers Organization No cost for employee only coverage POS Point Of Service Plan that allows members to receive treatment from EPO providers, PPO providers or a noncontracted providers. 31

33 Dental PRINCIPAL FINANCIAL GROUP DUAL CHOICE BENEFIT HIGHLIGHTS EPO POS Calendar Year Deductible EPO EPO In Network Out of Network (Deductible Waived for Preventive) Yes Yes Yes No Individual $50 $25 $50 $50 Family $150 $75 $150 $150 Calendar Year Maximum $1,500 $2,000 $2,000 $1,000 Diagnostic & Preventive Office Visit 0120 Oral Evaluation 1110 Cleaning 0210 X-Rays Basic Procedures 2140 Amalgam Filling 3310 Endodontics 4210 Periodontics Major Services 2740 Porcelain/Ceramic Crown 5110 Complete Denture Implant Services 100% 100% 100% 100% 80% 80% 80% 50% 50% Not Covered 100% 100% 100% 100% 90% 90% 90% 60% 60% Not Covered 100% 100% 100% 100% 80% 80% 80% 50% 50% Not Covered 80% 80% 80% 80% 80% 80% 80% 50% 50% Not Covered Orthodontics 8080 Child (to age 19) 50% up to $1,500 Lifetime Max 50% up to $1,500 Lifetime Max 50% up to 50% up to 8090 Adult (Age 19 and older) $1,500 Lifetime Max $1,500 Lifetime Max REIMBURSEMENT SCHEDULE N/A N/A N/A UCR 80th NETWORK First Dental Health First Dental Health (+Principal Providers on In-Network Tier) To find a provider: Choose network First Dental Health PPO Plan 32

34 Dental As a reminder: please seek a Predetermination of Benefits before treatment begins for major services such as inlays, onlays, crowns, periodontics or oral surgery. Principal will provide a written response indicating benefits that may be payable for the proposed treatment and what your potential out of pocket costs will be. The Principal Dental plans includes a Maximum Accumulation Rollover: This allows for a portion of unused maximum benefit to carry over to the next year s maximum benefit amount. To qualify, you must have has a dental service performed within the Calendar year and used less than the maximum threshold. The threshold is equal to the lesser of 50% of the maximum benefit or $1,000. If qualification is met, 50% of the threshold is carried over to the next year s maximum benefit. You can accumulate no more than four times the carry over amount. 33

35 Dental Maximum Accumulation Rollover example: Year one: Member receives services = Cleaning and X-rays (claim submitted to Principal) Plan year maximum (in network) = $2,000 Threshold amount (the lower of 50% of the annual maximum or $1,000)= $1,000 Rollover amount = ½ the threshold amount = $500 Year two: Member receives services = Cleanings and X rays (claim submitted to Principal) Plan year maximum (in network) = $2,000 plus $500 in rollover Threshold amount = $1,000 Rollover amount = ½ the threshold amount $500 Year three: Member does not receive services Plan year maximum (in network) = $2,000 No rollover available since no services were received To find a provider: Choose network First Dental Health PPO Plan 34

36 Dental 35

37 Dental Principal does have waiting periods if you are a late entrant on the benefit plan. The Definition of late entrant is: If the member requests member or dependent insurance more than 31 days after the date the person is eligible, or the member elects to terminate insurance and more than 31 days later request to be insured again, during the first 12 months in which the insurance is in force, benefits will be limited to the following units: First 12 months: Second 12 months After 24 months Unit 1 (preventive procedures) only Unit 1 (preventive procedures) and Unit 2 (basic procedures) only Full coverage including: Unit 1, Unit 2 and Unit 3 (Major procedures) and Unit 4 (orthodontia services) 36

38 Vision

39 Vision Plan The vision plan currently offered by MES will remain with no plan changes: MES offers a plan that allows members to received services and treatment from a MES participating provider or a non-contracted provider No cost for employee only coverage The MES network includes many individual doctors and also retail chains such as Target Optical, Costco Optical, Lenscrafters, Sears Optical, and Wal-Mart Vision Center (to name just a few!) 38

40 Vision BENEFIT HIGHLIGHTS COPAYMENT EXAM SCHEDULE Exam Allowance/Reimbursement LENS SCHEDULE Single Vision Allowance/Reimbursement Bifocal Allowance/Reimbursement Trifocal Allowance/Reimbursement FRAME SCHEDULE Frame Allowance/Reimbursement CONTACT LENS SCHEDULE Elective Allowance PARTICIPATION REQUIREMENTS NETWORK CONTRACTS In Network MES Vision Out-of-Network $10 Copay Exam / $25 Copay 12 Months Covered in Full Up to $40 Allowance 12 Months Covered in Full Up to $30 Allowance Covered in Full Up to $50 Allowance Covered in Full Up to $65 Allowance 24 Months Up to $130 Allowance Up to $75 Allowance 12 Months Up to $130 Allowance Up to $130 Allowance 100% Individual Providers & Retail Providers To find a provider or check your eligibility or claims status, please visit: 39

41 Life/AD&D and Long Term Disability

42 Basic Life/AD&D and LTD Basic Life/AD&D 100% Paid for by Rock Church and Academy Life = $50,000 AD&D = $50,000 Long -Term Disability -100% Paid for by Rock Church and Academy 60% of earnings to a maximum benefit of $12,000/month, up to age 65 Benefits begin on the 91st day of disability You may be eligible for CA State Disability Insurance (SDI) benefits after the 7-day waiting period 41

43 New Voluntary Life & AD&D BENEFITS Employee Assurant Increments of $10,000 Lesser of 5x Annual Salary or $500,000 Age Reduction Schedule: Spouse Reduced by 33% at age 70; Additional 33% of inforce at age 75 Not lesser than $20,000 Guaranteed Issue: $130,000 Increments of $5,000 Age Reduction Schedule: Child Lesser of 50% of Employee amount or $250,000 Maximum Reduced by 33% at age 70; Additional 33% of inforce at age 75 Not lesser than $20,000 Guaranteed Issue: $50,000 $1,000 to $5,000 or $10,000 Maximum Not to exceed 50% of Employee Amount Guarantee Issue: $10,000 Guarantee issue will only apply for the first offering of this plan. We will also need at least 39 employees to elect this plan at the November 1, 2013 open enrollment in order to bind this coverage

44 New Voluntary Life & AD&D Rates RATES (per $1,000) Age Non Smoker EE/SP Smoker EE/SP < 25 $0.057$0.057 $0.057/$ $0.086/$0.086 $0.086/$ $0.114/$0.114 $0.114/$ $0.114/$0.114 $0.143/$ $0.114/$0.114 $0.200/$ $0.200/$0.229 $0.343/$ $0.372/$0.400 $0.629/$ $0.715/$0.744 $1.173/$ $1.087/$1.144 $1.687/$ $1.888/$1.973 $2.746/$ $2.889/$3.003 $3.890/$ $5.777/$6.006 $7.808/$8.094 Child Rate $0.182 per $1,000 AD&D Rate* -AD&D can be waived -Amount elected will equal the amount elected for life insurance -AD&D may not be purchased wihout life insurance. EMPLOYEE / SPOUSE* Employee $0.026 per $1,000 Spouse $0.026 per $1,000 Child $0.026 per $1,000 43

45 New Voluntary Life Voluntary Life calculation example: Voluntary Life / AD&D Example Age 40 Non Smoker Current Salary $40k Life Desired Amount $100,000 Rate per $1,000 of Coverage $0.114 Formula =(100,000/1,000) x = $11.40 AD&D (must match Life amount) $100,000 Formula =(100,000/1,000) x = $2.60 Total Monthly Cost Paid by Employee $14.00 Voluntary Life / AD&D Example Age 40 Smoker Current Salary $40k Life Desired Amount $100,000 Rate per $1,000 of Coverage $0.200 Formula =(100,000/1,000) x = $20.00 AD&D (must match Life amount) $100,000 Formula =(100,000/1,000) x = $2.60 Total Monthly Cost Paid by Employee $

46 Employee Assistance Program (EAP) The company pays for this confidential program for you and your eligible dependents. Benefits include: 24 hour toll free access 6 face-to-face sessions per incident per year Elder care and child care referrals Legal referrals Financial referrals Call Today! Log on: 45

47 Reminder / Next Steps

48 Important Reminders All plan changes are effective November 1, 2013 All Open enrollment changes and enrollment forms must be turned in to Nancy Hawley, Benefits Coordinator, by October 9 th! All plan elections remain in place until our next renewal, January 1, 2015, unless you experience a family status change or a qualified event 47

49 What Next? Everyone must complete an enrollment form to confirm your plan elections or to waive coverage for this plan year. Please see Nancy Hawley if you need to confirm your current enrollment selections. Assistance completing forms will be available after the presentation Turn in completed forms to Nancy Hawley, Benefits Coordinator, by October 9 th! 48

50 Questions? Thank you!