mychoices 2013 Annual Enrollment Decision Guide For Johns Hopkins University Faculty and Staff Explore Compare Choose

Transcription

1 2013 mychoices 2013 Annual Enrollment Decision Guide For Johns Hopkins University Faculty and Staff October 19 November 12, 2012 Explore Compare Choose

2 Table of Contents INTRODUCTION 1 Welcome to mychoices 2013 EXPLORE 2 What s Changing for A New Approach to Paying for Benefits 3 New Critical Illness Insurance 3 New Accident Insurance 4 How the Medical Plans are Changing COMPARE 5 Your 2013 Medical Plan Options 6 New Tools To Help You Understand and Compare Your Medical Plan Options 8 Things to Consider When Making Your Choice 9 Employee Examples CHOOSE 10 Enrollment Checklist Money-Saving Tips With the cost of health care increasing for everyone, it s important to keep in mind these money-saving tips during Annual Enrollment and throughout the year. Throughout this guide, look for this icon to learn about money saving tips.

3 INTRODUCTION Welcome to mychoices 2013 Welcome to 2013 Annual Enrollment. This is your once-a-year opportunity to review the benefit choices available to you and select what s best for you and your family. There are some significant changes this year to your medical plans and contribution costs, so it s important that you review this Decision Guide carefully. Even if you re not planning to make changes to your current benefit choices, you should make time now to understand the plan changes, as they will impact both your coverage and your costs for This year, Annual Enrollment will run from October 19 to November 12, giving you more time to consider your choices and to make the best decisions for you and your family. You ll have access to tools and resources online, and in-person meetings will be offered through a series of campus-wide town hall sessions. Use the Benefits website at benefits.jhu.edu as your key resource for learning more about 2013 enrollment, including the new medical plan rates. This Decision Guide provides an overview of the 2013 benefit changes, tips to help you choose, and important enrollment information. Use this guide to: Explore what s changing for 2013, even if you intend to re-enroll in the same medical and prescription drug plans. Compare the medical plan options available, so you understand how they work and how each would impact your family and your costs. Choose the best plan for you and your family during Annual Enrollment, and continue to make good health care choices throughout the year. TIP: Consider your 2012 health care expenses when estimating for Considering your past expenses will help you plan for the future; whether it s which plan to choose or how much to contribute to your Health Care Flexible Spending Account (FSA). See page 7 for information on the new Medical Plan Cost Estimator tool, which helps you estimate your health care expenses. This enrollment guide provides highlights of the Johns Hopkins University Health and Welfare Plans for faculty and staff. The university has made every effort to ensure that this guide accurately reflects the plan documents and contracts. If there is a discrepancy between this guide and those documents or contracts, the documents, summary of benefits and coverages, summary plan descriptions, or contracts will take precedence. Johns Hopkins University mychoices 2013 Decision Guide 1

4 EXPLORE What s Changing for 2013 We re making some significant changes to how your plans work and to how you pay for coverage. Take the time to explore these changes, so you can understand how they will impact you. Change Salary-based health insurance premiums are being introduced Employees share of health insurance premium costs are increasing from 22% to 25%, on average in 2013 and 2014 Dependents eligible up to the end of the year in which they turn age 26, regardless of coverage availability What This Will Mean for You If you re enrolled in the CareFirst BlueCross BlueShield or EHP Classic plans, your premium cost will vary depending upon your salary. This will help make premiums more affordable for lower paid employees. Depending on your salary, your health insurance premium (the amount you pay out of your paycheck) could increase for 2013 and 2014 to be consistent with premium costs at peer institutions. You can enroll your eligible dependent for medical coverage up until the end of the year in which he/she turns age 26, even if he/she has coverage available from his/her employer. Benefit dollars are being retired Deductibles and out-of-pocket limits are increasing for nonpreventive care. A new coverage level, Adult and Child(ren), is being introduced for the CareFirst BlueCross BlueShield and EHP Classic plans Copayments for the HMO Plans are increasing Copayments for prescription drugs are increasing Health care flexible spending accounts capped at $2,500 (as a result of Health Care Reform) New Critical Illness Insurance and Accident Insurance You will no longer receive benefit dollars, but some of the cost savings will be used to mitigate increases in your health insurance premiums. Note: You will continue to receive a medical waiver credit if you decline medical coverage through the university. The medical waiver credit is $800, if your salary is $40,000 or less and $500 if your salary is more than $40,000. This is the amount you pay out of your pocket before your cost sharing begins. Your out-of-pocket limit will also increase. This is the amount you need to spend before the plan pays 100% of the cost. The new coverage level makes it easier for single parents to afford coverage. This level replaces Parent and Child coverage level and increases the number of dependents that may be covered. Copayments are being increased for 2013, and will continue to track with market trends in the coming years. As a reminder, it is more cost-effective to use a generic drug and mail order because they will have lower copayments. You will not be able to contribute any more than $2,500 to a Health Care Flexible Spending Account annually. The maximum for the Dependent Care Flexible Spending Account is still $5,000 annually. You will have the opportunity to enroll in two, new voluntary benefits Critical Illness Insurance and Accident Insurance. They offer low-cost coverage that pays you a benefit in the event you become critically ill or injured in a non-work related accident. 2 Johns Hopkins University mychoices 2013 Decision Guide

5 A New Approach to Paying for Benefits For 2013, your health care costs will depend upon three important factors: your salary, the medical plan you select and the number of family members you choose to cover. Be sure to check our online Health Care Premium Net Impact tool to see how each of these factors impacts your 2013 health care plan premium. 1Your salary as of January 1, 2013 Salary-based premiums are being introduced for the CareFirst BlueCross BlueShield and EHP Classic medical plans; benefit dollars are being retired and will no longer be available to you. Your health care premium will vary depending on your salary. Premiums are based on six salary tiers, which are: 2 $40,000 or less $80, ,000 $40,001-60,000 $120, ,000 $60,001-80,000 $200,001+ The medical plan you select Health care premium costs also vary depending upon which plan you choose. The plan features also differ by plan, so review your potential out-ofpocket costs carefully. The Medical Plan Coverage Comparison tool (MPCC), which is available at benefits.jhu.edu will help you compare plan features. 3 The number of family members you choose to cover We have slightly modified our coverage levels to make coverage more affordable for single parents. The chart to the right explains these changes. Your costs will vary depending upon the coverage level you choose. LEVEL Individual Adult and Child(ren) NEW Now Covers More Than One Child 2 Adults 2 Adults 2 Adults and Child(ren) NEW Name For Family Coverage Coverage Levels NUMBER OF PARTICIPANTS 1 Adult 1 Adult; any number of children 2 Adults; any number of children New Critical Illness Insurance Critical Illness Insurance provides additional financial protection to you during treatment for illnesses such as cancer and Alzheimer s disease. You receive a lump-sum benefit* to help you pay some of your additional expenses. You have three options for coverage: $10,000 $15,000 $20,000 If you enroll for coverage during this year s Annual Enrollment, you will not need to complete a medical questionnaire to qualify for coverage. You can find more information on *Payable one time per illness. New Accident Insurance Accident Insurance allows you to purchase low-cost coverage that pays benefits if you are involved in an accident off the job. This coverage supplements your Personal Accident Insurance. If you enroll for coverage during this year s Annual Enrollment, you will not need to complete a medical questionnaire to qualify for coverage. You can find more information on Johns Hopkins University mychoices 2013 Decision Guide 3

6 How the Medical Plans are Changing The chart below details the changes to the medical plans. We continue to offer three medical plan options. FEATURE Deductible (individual/2+) CAREFIRST BLUECROSS BLUESHIELD EHP CLASSIC 2012 $250/$750 $0 (in-network) $250/$750 (out-of-network) 2013 $500/$1,500 $250/$750 (in-network) $500/$1,500 (out-of-network) Out-of-Pocket Maximum (individual/2+) 2012 $1,500/$4,500 $1,500/$4,500 (in-network) $3,000/$9,000 (out-of-network) 2013 $2,000/$6,000 $2,000/$6,000 (in-network) $4,000/$12,000 (out-of-network) Emergency Room Copay 2012 $75 (waived if admitted) $75 (waived if admitted) $ $100 (waived if admitted) $100 (waived if admitted) $100 Urgent Care Copay 2012 You pay 20% You pay 20% $20 (after deductible, in-network) You pay 30% (after deductible, out-of-network) 2013 $50 $50 (in- and out-of-network) $50 Prescription Drugs Retail (up to 30-day supply) 2012 Generic Formulary Brand Non-Formulary Brand 2013 Generic Formulary Brand Non-Formulary Brand $10 $20 $35 $10 20% coinsurance ($30 min, $45 max) 25% coinsurance ($60 min, $100 max) $10 $20 $35 $10 20% coinsurance ($30 min, $45 max) 25% coinsurance ($60 min, $100 max) KAISER AND BLUECHOICE HMOS $0 n/a $3,500/$9,400 (Kaiser) $0 (BlueChoice) $3,500/$9,400 (Kaiser) $0 (BlueChoice) KAISER* Kaiser Pharmacy/Retail $10/$20 $20/$40 $35/$55 Kaiser Pharmacy/Retail $15/$20 $25/$45 $40/$60 *Note: BlueChoice pricing for 2013 is $10 Generic; 20% coinsurance ($30 min, $45 max) for Formulary Brand and 25% coinsurance ($60 min, $100 max) for Non-Formulary Brand Prescription Drugs Mail (up to 90-day supply) KAISER** 2012 Generic Formulary Brand Non-Formulary Brand 2013 Generic Formulary Brand Non-Formulary Brand $20 $40 $70 $25 $75 $150 $20 $40 $70 $25 $75 $150 Up to 90-day supply for one copay $30 $50 $80 **Note: BlueChoice pricing for 2013 is $25 Generic; $75 for Formulary Brand and $150 for Non-Formulary Brand 4 Johns Hopkins University mychoices 2013 Decision Guide

7 COMPARE TIP: See a side-by-side comparison of your options with the Medical Plan Coverage Comparison tool. The Medical Plan Coverage Comparison tool allows you to see a side-by-side comparison of your medical plan options. Use it to compare your options and make the best choice for you and your family. You can access the tool at benefits.jhu.edu. Your 2013 Medical Plan Options The medical plan options available to you have some key differences that are important for you to understand when making an informed choice. What you need to know about: CareFirst BlueCross BlueShield Plan When you enroll in the CareFirst BlueCross BlueShield Plan, you may see any provider. You pay less for care when you use JHU s special Preferred Physician Network. When you need care that is not covered as preventive care, you pay the determined cost of service until you meet the annual deductible. Once you meet the deductible, the plan kicks in to pay a high percentage of the cost of the service, called the coinsurance, and you pay the rest until you reach the out-of-pocket maximum. EHP Classic Plan With the EHP Classic Plan, you have the flexibility to see any provider in- or out-of-network. Your out-of-pocket costs are lower if you use providers who participate in the EHP network. New this year, this plan has a deductible for non-preventive care, even if you see an in-network provider. When you need care that is not covered as preventive care, you pay the determined cost of service until you meet the annual deductible. Once you meet the deductible, the plan kicks in to pay a high percentage of the cost of the service, called the coinsurance, and you pay the rest until you reach the out-of-pocket maximum. Kaiser Permanente HMO Plan This plan is an HMO, which only pays benefits when you see a provider who is a member of Kaiser s network. You choose a Primary Care Physician (PCP), who coordinates your in-network care. For most services, you pay a flat copayment. BlueChoice HMO Plan The BlueChoice HMO Plan is a managed health care plan consisting of a network of physicians and other medical providers. If you enroll in BlueChoice, all of your health care must be coordinated and approved by your PCP and received in network. Note: The BlueChoice HMO Plan is available only to current participants. TIP: Use the Medical Plan Cost Estimator Tool. This online tool estimates what your costs would be under each plan, allowing you to make an informed decision as to which plan will save you and your family the most money. Johns Hopkins University mychoices 2013 Decision Guide 5

8 New Tools To Help You Understand and Compare Your Medical Plan Options With so many things to consider paycheck contributions, copayments, deductibles, provider networks you could spend a lot of time comparing alternatives and still be unsure about which medical plan option to choose. To help you select the best and most cost-effective plan for you and your family, we re offering three new tools: a Health Care Premium Net Impact tool, a Medical Plan Cost Estimator tool and a Medical Plan Coverage Comparison tool. Use these tools to feel confident that the plan you select is the most cost-effective choice for you and your family. You can use these tools as a three-step process to help you understand how the changes for 2013 impact you. STEP Use the Health Care Premium Net Impact Tool to help you understand how the change in health care premiums and the retiring of the benefit dollars 1 impact you (for the CareFirst BlueCross BlueShield and EHP Classic Plans, or if you waive coverage). STEP Use the Medical Plan Cost Estimator Tool to determine the medical plan and coverage option that may provide the best value for your money, factoring in payroll deductions 2 and the cost of your anticipated health care needs for the year. You can also estimate how much you should contribute to a Health Care Flexible Spending Account (FSA). STEP Use the Medical Plan Coverage Comparison Tool to see a side-by-side comparison of your medical plan options. 3 HOW TO ACCESS THE TOOLS You may access all of these tools by visiting the mychoices tab on the Benefits website at benefits.jhu.edu. STEP 1: HEALTH CARE PREMIUM NET IMPACT TOOL 2013 Faculty/Staff Health Care Premium Net Impact Tool For the CareFirst BlueCross BlueShield Plan, EHP Classic Plan and Waiving Coverage How You Pay for Benefits Health care premiums are generally increasing in 2013 for a variety of reasons: medical inflation, our claims experience, and the Benefits Advisory Committee s study and recommendations. While not all 2013 health care premiums will increase, there are noticeable differences you need to be aware of. For 2013, the amount that you pay (your individual health care premium) will depend on three factors: 1. Your salary as of January 1, 2013: There are six salary tiers as shown below 2. The medical plan you select: CareFirst BlueCross BlueShield, EHP Classic, or waive coverage 3. The number of individuals you choose to cover: Individual, Adult & Child(ren), 2 Adults, or 2 Adults & Child(ren) Our new, salary-based contribution approach is a deliberate attempt to share health care costs equitably while keeping affordability in mind. This Document is Clickable! Find the information you need in just a few clicks. Click on the buttons below to go directly to the information you want. You can also scroll through the document pageby-page by clicking the Next Page arrow at the bottom of each page. Let s Start With Your Salary Level Pricing by salary tiers applies to the CareFirst BlueCross BlueShield Plan and the EHP Classic Plan only. Click a salary tier below to narrow down how your costs are changing: $40,000 or less $40,001 $60,000 $60,001 $80,000 $80,001 $120,000 $120,001 $200,000 $200,001+ If Your Salary is: $60,001 - $80,000 My Plan and Coverage Options Use the examples below to explore what you will pay under each plan and coverage level. To see an example, simply select the plan and coverage option that applies to you. CareFirst BlueCross BlueShield Plan Click the links below to see examples of how your 2013 premium costs for enrolling in the CareFirst BlueCross BlueShield Plan compare to your 2012 costs. Adult and 2 Adults and Individual 2 Adults Child(ren) Child(ren) EHP Classic Plan Click the links below to see examples of how your 2013 premium costs for enrolling in the EHP Classic Plan compare to your 2012 costs. Individual Adult and Child(ren) 2 Adults 2 Adults and Child(ren) Waive Coverage You are not immune from these changes if you waive medical coverage. You will receive a medical waiver credit ($800 if your salary is $40,000 or less and $500 if salary is greater than $40,000). The balance of your benefit dollars ($400) will no longer be available to you. Click the link to the right to see an example of your costs if you elect to waive coverage. Want to learn more about your medical plan options? Try our other new tools: The Medical Plan Cost Estimator tool (MPCE) a modeling tool that allows you to compare plan costs across all of the plans and estimate what your 2013 costs might be. This tool even allows you to model contributions to a flexible spending account. The Medical Plan Coverage Comparison tool (MPCC) an online tool that allows you to compare plan features across all of the medical plan options. These tools can be found under the mychoices tab at benefits.jhu.edu. How to Use It Select your salary level, current plan and coverage level. You ll see how your 2013 health care premiums compare to what you paid in Johns Hopkins University mychoices 2013 Decision Guide

9 STEP 2: MEDICAL PLAN COST ESTIMATOR TOOL View It On The Go! The Medical Plan Cost Estimator tool is available on your ios, Android or Blackberry devices. Just type in Helpful Hints Choose the Reset button to clear the results of the Medical Plan Cost Estimator. Click the Print button to view your results on paper. After you review your results, you also should carefully consider each plan, keeping in mind your unique situation and tolerance for risk. The bar charts on the right show the relative costs in each of the medical plans You can also model contributions to a health care flexible spending account How to Use It Indicate if you are full- or part-time and who is covered by the plan (spouse, children, etc.) Use the slide rules to indicate if your medical plan usage is low, medium or high (or you may input the actual number of services you expect to use) You input your number of dependents and typical medical plan usage, the modeling tool compares your total cost under each of the JHU plans The bar charts on the right show the relative costs in each of the medical plans You can also model contributions to a health care flexible spending account STEP 3: MEDICAL PLAN COVERAGE COMPARISON TOOL Helps you compare specific plan features for each of your plan options You select the number of features you wish to compare The tool displays only these features and how they compare across all of your medical plan options Johns Hopkins University mychoices 2013 Decision Guide 7

10 Things to Consider When Making Your Choice Choosing the right plan may seem challenging. Here are some important questions to ask yourself when making your enrollment elections: Things to Consider CareFirst BlueCross BlueShield might be better if EHP might be better if Kaiser Permanente or an HMO might be better if Health Care Premiums You prefer to pay lower health care premiums and higher out-ofpocket costs You prefer to pay lower health care premiums and higher out-ofpocket costs You prefer to pay higher health care premiums and lower out-of-pocket costs Out-of-Pocket Costs You prefer to pay the same percentage for coverage, no matter which non-jhu provider you use You prefer to pay less for in-network providers, but accept that you may pay a greater cost for using out-of-network providers You prefer to pay a flat copayment for services Freedom and Flexibility You prefer to see any provider You prefer to use innetwork providers, but would like the flexibility to go outside the network You prefer using in-network doctors only and selecting a Primary Care Physician Out-of-Network Coverage You have dependents who need access to coverage outside of your local area You are comfortable paying more for coverage for emergency care when outside your local area You are comfortable having coverage for emergency care only when outside your local area International Coverage You expect to travel internationally and may need care. BlueCard Worldwide covers you internationally You do not expect to need care abroad. If you were to need international care, you would need to file an out-of-network claim for reimbursement You expect to travel internationally and may need care. Kaiser Permanente will cover sudden and serious medical conditions internationally Be sure to take the time to consider the needs of you and your family. While this list is not exhaustive, it can help you to focus on factors that will help you make the right choice. TIP: To learn more ways to save money, check out the GET SMART benefits education webinars, designed to provide you with more information on your benefits, posted on benefits.jhu.edu. 8 Johns Hopkins University mychoices 2013 Decision Guide

11 Employee Examples Meet Stella, 41 Adult and Child(ren) Stella s child has a medical condition that requires ongoing visits to multiple specialists. These specialists have been treating Stella s child for the past 3 years. It is important for Stella to maintain relationships with these doctors. One of them is currently an out-of-network provider for all of the health plan options available to Stella. As such, she is looking for a plan where she will have access to out-of-network physicians and will pay the same percentage of medical costs for those services. Stella chooses the CareFirst BlueCross BlueShield Plan. Stella Meet Andrew, 29 Individual Andrew doesn t have any ongoing medical conditions and wants to minimize his payroll deductions for medical coverage. He lives very close to work and wants to make sure he can access physician care nearby, if needs arise. He would prefer to go to a Johns Hopkins physician. Andrew chooses the EHP Classic Plan. Andrew Meet Darlene, 52 2 Adults and 3 Children Darlene has been a Kaiser HMO member for the past five years. She likes the convenience of Kaiser clinics where her family is able to see multiple physicians, get lab work done, and fill their prescription medications under one roof. She also likes the convenience of ing her physician to avoid unnecessary visits to the clinic. Copay-based payment structure allows Darlene to easily budget for her family s medical expenses. Darlene chooses the Kaiser Permanente HMO Plan. Darlene Johns Hopkins University mychoices 2013 Decision Guide 9

12 CHOOSE Enrollment Checklist q Do Your Homework Be informed. Make the right choice. Review this Decision Guide and explore the mychoices tab on the benefits website at benefits.jhu.edu. You should also consider if you have coverage available to you through your spouse or same-sex domestic partner (if applicable). q Tools and Resources to Help Use the following tools and resources to help you choose the right medical plan for you and your family: mychoices tab on the Benefits website at benefits.jhu.edu Health Care Premium Net Impact tool Medical Plan Cost Estimator tool Medical Plan Coverage Comparison tool Benefits Town Halls (visit the mychoices tab on benefits.jhu.edu for schedule) Benefits Fairs October 2 and October 4 GET SMART Benefits Education Webinars beginning October 9 q Make Your Choices Consider cost, quality, and your family s health care needs. Decide whether to participate in an FSA and how much to contribute. q Enroll Online October 19 - November 12 Enroll online at benefits.jhu.edu and click the mychoices tab. Have the Social Security number and dates of birth for all your eligible dependents and life insurance beneficiaries ready when you enroll. Resources Benefits Department Contacts If you have any questions about the benefits available to you, the Benefits Service Center at benefits@jhu.edu or call Johns Hopkins University mychoices 2013 Decision Guide