Open Enrollment September 1, 2012

Transcription

1 Open Enrllment September 1, 2012

2 Open Enrllment Agenda What s SWOOSH? What is Open Enrllment? What Frms D I Need t Cmplete? New Medical Plans and Rates UHC Resurces FSA Infrmatin Cverage fr Overage Dependents: Age 26 and Age 28 Questins & Answers

3 The SWOOSH Cnsrtium Frest Hills has decided t partner with SWOOSH (the Suth West Ohi Organizatin f Schl Health) cnsrtium n September 1, The SWOOSH cnsrtium was created t: negtiate better insurance rates fr districts and their emplyees prmte wellness and healthy lifestyles All SWOOSH plans run n a calendar year. We will change ur medical and FSA plan years t calendar year. UnitedHealthcare is the carrier SWOOSH selected t administer the medical plan. The SWOOSH cnsrtium is currently cmprised f 7 schl districts: Frest Hills, Indian Hill Lebann, Milfrd, Nrthwest Suthwest, Wintn Wds

4 What s Open Enrllment? Yur pprtunity t make benefit changes fr Yu can add r drp dependents r change tiers Enrll in the plan fr the first time Open Enrllment is frm September 1 t 30, 2012 The next time t make changes: January 1, 2013 Open enrllment perid will be held in Nvember Outside f pen enrllment yu r yur spuse must have a qualifying event t enrll in the insurance plans Birth r Adptin Death f a Spuse Lss f Cverage Marriage, Divrce r Legal Separatin Yu must ntify Treasurer s ffice within 30 days f the qualifying event.

5 What frms d I need t cmplete? Medical: Only emplyees making a change in medical plan electin r enrlling fr the first time must cmplete a medical enrllment frm FSA: Must cmplete a frm t enrll fr the shrt plan year regardless f prir enrllment Frms are psted n the Staff Intranet: UHC medical enrllment frm/applicatin and an FSA enrllment frm Cntact HR fr questins regarding frms

6 New Medical Rates and Plan Changes effective September 1, 2012: New Medical Rates: Rates are guaranteed fr 16 mnths September 1, 2012 thrugh December 31, Yu will receive a credit fr in-netwrk deductible and ut f pcket (OOP) Credit is applied until New Plan Year restarts n , Deductible, ut f pcket and plan limits will restart n New Medical Plan: Netwrk is UHC Chice Plus (when searching fr a prvider select this netwrk) Netwrk ffers natinal netwrk f prviders UHC s netwrk f dctrs is a 99.48% match t Humana s There is an increase in deductible, ut f pcket and prescriptin cpays Increases nt due t jining SWOOSH, but t ffset premium increases due t claims experience, plan changes were negtiated Cpays will still apply t ut f pcket (except fr prescriptin)

7 Benefit Terms Cpays Is a set dllar amunt, e.g. ffice visits, ER visits and Urgent Care Cpays d nt apply t deductible, but Cpays d apply t ut f pcket (except prescriptin cpays) Deductible Is the amunt a member pays fr services befre UHC pays Deductible applies t inpatient and utpatient services Deductible des nt apply t ut f pcket Cinsurance Is the percentage (10%, in-netwrk) members pay after the deductible is met Out f Pcket Maximum Is the ttal amunt a member will pay in a calendar year, nce deductible has been met An Example: Inpatient r Outpatient Surgery csting $4000: $500 Deductible, $350 Cinsurance (10% f $4000-$500=$3500) Ttal cst t emplyee: $850

8 In-Netwrk Benefits Chice Plus Netwrk Medical Plan Summaries 9/1/12 12/31/13 9/1/11 8/31/12 UHC Humana Plan Chice Plus Plan Deductible: $250/$500 $500/$1000 Out f Pcket Max: $1500/$3000 $2000/$4000 Preventive: Cvered at 100% Cvered at 100% Office Visit PCP/Specialist OBGYN=Primary Care w/uhc $25/$40 $25/$40 Inpatient Services: Outpatient Services: $400 Cpay, Deductible, 10% Cinsurance $200 Cpay, Deductible, 10% Cinsurance N Cpay, Deductible, 10% Cinsurance N Cpay, Deductible, 10% Cinsurance Urgent Care / ER: $40/$200 $40/$200 Prescriptin - Retail $10/$25/$40 $15 / $30 / $60 Prescriptin Mail Order Must submit 90 day RX t UHC $20/$50/$80 (90 day supply) $30 / $60 /$120

9 Medical Premiums September 1, 2012 December 31, 2013 Emplyee Mnthly Cst Certified Emplyee Only Certified Half-Time Supprt 6,7,8 hurs Supprt 5 hurs Single $76.46 $ $76.46 $98.40 Family $ $ $ $436.14

10 Medical Benefit Enhancements: Medical Plan Enhancements Inpatient Hspital and Outpatient Surgery n lnger have a cpay. (Prir cverage had $400/$200 cpays.) The Chice Plus Netwrk is a natinal netwrk. Yu can access a natinal netwrk f dctrs and facilities acrss the entire natin. (N mre HMO netwrk restrictins.) Physical, Occupatinal, Speech and Cgnitive Therapy limits are 60 visits each. (Prir cverage limit was 60 visits cmbined.) Hearing Aids will be cvered (within supprted ranges) up t $2500 per ear, every three years. (Prir cverage limit was $0.) Preventive Care will nt have age-based schedule. (Prir cverage had age restrictins.) Visin Exam, with refractin, will be cvered nce a year. (Prir cverage included a screening and nt full exam.) Wigs will have a $500 per calendar year allwance fr all medically necessary reasns (Prir cverage limit was $250).

11 Medical Plan Reductins Medical Benefit Reductins: Skilled Nursing limit will be 180 days per benefit year. (Prir cverage was unlimited) Oral Surgery, fr remval f impacted teeth will nt be cvered. Medical Frmula fr treatment f PKU, an inherited metablic disease, will nt be cvered.

12 Tips n Hw t Utilize My Plan Verify that yur prvider is in-netwrk prir t receiving services Yu shuld have received yur ID card in the mail; Please g t t register t see FH plan infrmatin and yur claims histry Verify with dctr that in netwrk lab is utilized LabCrp is the preferred natinal lab, ther labs are cvered in netwrk Quest Diagnstic is NOT cvered in netwrk with UHC ffice setting lab wrk is the member s respnsibility, must direct physician t use an in-netwrk lab, inpatient lab wrk nt member s respnsibility Sme prescriptin drugs have changed tiers Yu can call custmer service (# n ID card) r g t If tier has changed, yu r yur pharmacist shuld check with yur dctr t see if an alternative prescriptin may be available Member s respnsibility t ntify UHC and receive prir authrizatin fr these services: Dental Services (cverage is fr accident nly) Nn Emergency Ambulance Service Transplant Services Mst Out f Netwrk Services Clinical Trials

13 Preventive Services and Wellness Preventive Care is cvered at 100% Nt subject t cpays r deductible Prviders must bill UHC as preventive If service is billed with diagnsis cde, then visit will prcess as a regular claim UHC has dedicated a Nurse Liaisn (Terry Winker) fr the SWOOSH cnsrtium-- t help emplyees with: Persnal fitness r wellness gals Manage chrnic diseases illnesses and diseases- fr example: asthma, heart, diabetes, back pain, Utilize all UHC prgrams, including healthy pregnancy prgram Claim issues that cannt be reslved by custmer service

14 UnitedHealthcare Other Benefits MyUHC.cm Netwrk dctrs / hspitals Estimate csts, Track claims status, Review plan details Health imprvement prgram, Persnal Health Recrd Health prduct discunts, take the Health Assessment Health Statements- Eliminates explanatin f benefit (EOB) fr every service. Cmbines services in a mnthly statement; EOB s fr individual services are available n myuhc.cm Care 24 NurseLine: 24 hurs a day/7 days a week access Emplyee Assistance Prgram (EAP) includes: Mental Health Specialist:, 3 face-t-face visits Legal Cunsel, Free 30 minute Cnsultatin

15 Flexible Spending Accunt (FSA) New Frm Must be cmpleted fr each plan year! FSA Shrt Plan Year, t Each participant can cntribute up t $800 tax-free, there is n minimum Annual fee is $5 per mnth r $20 fr the shrt plan year Can be used fr eligible medical, dental r visin expenses Over the cunter drugs are eligible expenses-- nly with a dctr s prescriptin Use it r lse it accunt Can enrll in FSA plan nly, but must be full-time emplyee Dependent Care Accunt Shrt Plan Year, t Can be used fr eligible dependent care expenses tax-free Fr Shrt Plan Year: $1675 maximum cntributin, if married, filing jintly

16 Full FSA Plan Year 12 mnth FSA plan year will start n t Must cmplete new enrllment frm in Nvember Infrmatin will be sent ut Annual fee is $5 per mnth r $60 fr plan year FSA Limit: $2400 will be the maximum cntributin fr 2013 ($400 minimum) Dependent Limit: $5,000 maximum cntributin fr 2013

17 Health Care Refrm Reminders Federal Extensin f Dependent Cverage t Age 26: Dependent Cverage is available regardless f: student status, residency, marital status, financial dependency, emplyment State f Ohi Dependent Age Extensin t Age 28: Must be full-time student r Ohi resident Cannt be married and n emplyer insurance available Dependents cvered until the end f the mnth f 26 th r 28 th Birthday

18 What s the Deadline? FORMS MUST BE RECEIVED BY TREASURER S OFFICE NO LATER THAN SEPTEMBER 28, 2012 Please submit cmpleted frms t: Missy Mink in Treasurer s Office, missymink@fresthills.edu

19 What If I have questins? If yu have any questins, please cntact: UHC Custmer Service, Ellen Chamberlain, Frest Hills HR extensin 2959 ellenchamberlain@fresthills.edu Terry Winker (UHC Nurse Liaisn) t_winker@uhc.cm Alisn Bristl, HORAN direct line alisnb@hranassc.cm

20 ANY QUESTIONS?