Understand what s new and think differently...

Transcription

1 Understand what s new and think differently... Together, we can think differently about our new programs and benefit options that are designed to help you make wiser, healthier choices. Annual enrollment: October 14 25, 2013

2 2014 at-a-glance We are asking you to think differently about your health care benefits. For 2014, you ll have new medical options to consider, new ways to pay for your health care and new ways to maintain and improve your health. That s why it s more important than ever to consider your options and decide on the type of coverage you want. You will find more details on the following pages and in your 2014 online enrollment guide available September 30 at What s new You can choose between two new medical options (or opt for no coverage ): Active Health Option Standard Medical Option Aetna will be our sole health care carrier; UnitedHealthcare will no longer be available A Health Reimbursement Account, funded by New York Life, will be available if you participate in the Active Health Option We are offering health incentives if you, your spouse, or domestic partner participate in the Active Health Option and complete healthy activities (e.g., get an annual physical) We are increasing our focus on preventive care, starting with 100% in-network coverage of preventive services and clearer definitions of what s considered preventive and what s not We are enhancing our current health management programs and introducing new ones available no matter which option you choose to help you obtain the best possible care Prescription drug benefits will change next year A new debit card, called the PayFlex Card, will allow you to pay for eligible expenses from both the Flexible Spending Account (FSA) for Health Care and your HRA in the Active Health Option 2

3 Why we re making changes We re changing our health care options starting next year to offer sustainable health care benefits, help us manage rising health care costs, and provide programs that focus on your health. We needed to think differently about our health care coverage, and we re asking you to think differently, too. New York Life will continue to offer valuable benefit programs, resources, and tools but it s up to you to use them to your best advantage. Making informed decisions, using your benefits wisely, and participating in relevant health programs can help you enhance your overall health and well-being and also manage your health care costs. Our two new medical options are designed with these goals in mind. And, the Active Health Option can also help you be a better user of health care, and as a result, stay healthy or become healthier. 3

4 New medical options You have a choice between two new medical options for 2014: The Active Health Option with a Health Reimbursement Account works like a traditional Preferred Provider Organization (PPO), but has a Health Reimbursement Account (HRA) funded by New York Life. With this option, you can access the money in your HRA with a debit card and use it to pay your deductible and other medical expenses. The Standard Medical Option works like a traditional PPO with a network of doctors, hospitals, and other health care providers who have agreed to provide their services at reduced rates to members. Both options cover the same services and have the same Aetna network of providers, called Choice POS II. Both offer the same prescription drug coverage through Express Scripts. The tables below show in-network and out-ofnetwork benefits, so you can see the similarities and the differences between the two options. With both options, you can use in-network or out-ofnetwork providers. However, the plan pays more when you obtain care in-network. Summary of benefits Feature Active Health Option Standard Medical Option In-network Out-of-network In-network Out-of-network Annual deductible $1,600/individual $3,200/family $3,200/individual $6,400/family $1,250/individual $2,500/family $2,500/individual $5,000/family Annual out-ofpocket maximum (includes deductibles) $4,600/individual $9,200/family $9,200/individual $18,400/family $3,750/individual $7,500/family $7,500/individual $15,000/family Coinsurance Pays 90% after you meet your deductible Pays 50% after you meet your deductible Pays 80% after you meet your deductible Pays 60% after you meet your deductible 4

5 Comparing the options Feature Active Health Option Standard Medical Option Health Reimbursement Account (HRA) Has an HRA funded by New York Life, with annual rollover of unused funds* Does NOT have an HRA HRA funding Provides contributions and health incentives to encourage healthy behaviors (see tables on pages 6 and 7) Not applicable Preventive care Covers in-network preventive care and immunizations at 100% Deductibles Separate deductibles for in-network and out-of-network services Out-of-pocket maximums Out-of-pocket maximums include all deductibles and coinsurance for both medical expenses and in-network prescription drugs. After you reach this amount, the plan will pay 100% of covered services for the rest of the year Separate out-of-pocket maximums for in-network and out-of-network benefits *Employees who plan to leave the company should check with a Benefits Center representative about the HRA. Separate out-of-pocket maximums: an example Out-of-pocket maximum amount (individual coverage) $4,600 $2,500 spent out-of-pocket In-network $9,200 $1,000 spent out-of-pocket Out-of-network In both of the new medical options, the out-of-pocket maximums for in-network and out-of-network expenses are separate. So in-network expenses you pay out-ofpocket count toward the in-network maximum, and out-of-network expenses you pay out-of-pocket count toward the out-of-network maximum. They are not combined, as shown in this example for an individual covered under the Active Health Option. 5

6 With the Active Health Option, you have a Health Reimbursement Account to help you pay for health care If you participate in the Active Health Option, you will receive contributions from New York Life to an HRA. In 2014, there will be three types of contributions: transition dollars, consumer dollars, and health incentive dollars. Plus, if you cover your spouse or domestic partner, you will receive additional HRA contributions for them. Note that the HRA is a notional account, not a bank account. Three types of HRA contributions in 2014 HRA contributions Features Amounts Transition dollars One-time contribution for 2014 only $200 if you cover yourself only $400 if you cover your spouse or domestic partner Consumer dollars Amount based on benefits salary Helps pay for current medical expenses or save for future expenses Up to $600 if you cover yourself only Up to $1,200 if you cover your spouse or domestic partner Health incentive dollars Earn additional dollars by completing healthy activities (see table on page 7) Encourages healthy behaviors Up to $400 if you cover yourself only Up to $800 if you cover your spouse or domestic partner Benefits salary Consumer dollars New York Life gives you If you cover yourself only If you cover your spouse or domestic partner Less than $50,000 $600 $1,200 $50,000 - $99,999 $400 $800 $100,000 - $149,999 $200 $400 $150,000 or more $0 $0 What is a Health Reimbursement Account? A Health Reimbursement Account, or HRA, is set up so that you can pay for current or future eligible medical expenses. New York Life makes contributions on your behalf, and you decide when to use them. In addition to these contributions, any health incentives you earn are deposited in your account to help you pay for health care. Any money remaining in your account at the end of the year will roll over to the next year, as long as you work at New York Life. 6

7 How health incentives work In 2014, you can earn health incentive dollars for your HRA simply by completing the following healthy activities. The more you engage in healthy behaviors, the more you will receive. Keep in mind, the health incentives may change from year to year, aligning with the health needs of our workforce. The table below shows just some of the activities for which you can receive health incentive dollars in Activity Health incentive dollars Complete the Walk Me Through tool on the Personal Health Record on $50 Get an annual physical from your primary doctor or a well-woman exam from your OB/GYN $100 Take the online health assessment questionnaire that is part of the Simple Steps to a Healthier Life program; you ll receive a summary of your results and suggestions for programs or activities that can improve your health When applicable, respond to a confidential call from a Care Advocate Nurse from Aetna who will work with you to create a personalized care plan $100 $75 When applicable, complete the personalized care plan $75 Keep in mind you can earn incentives only after your coverage under the Active Health Option begins in All health coverage available through Aetna Beginning January 1, 2014, Aetna will provide all health care coverage. We made the decision to consolidate our coverage with a single carrier after conducting a careful analysis of many factors, including which providers are used by our employees and their families. Most doctors participate in multiple networks. This means if you currently have coverage through UnitedHealthcare, you will not necessarily have to change doctors. However, you should check to see if your health care providers are in the Aetna network before receiving care. You can visit our microsite at to see if your doctor is in the network or find a new one, if needed. If you currently use UnitedHealthcare, you will receive more information on how to transition your care to Aetna, including preauthorizations, prescriptions, ID cards, and more. Log onto the microsite at and go to DocFind ( a user-friendly tool to help you find doctors near you. DocFind is available now, so you can check to see if your current doctors are in the Aetna network. 7

8 New or enhanced health management programs We recognize the health care system is complicated and that treatment decisions can be hard to make. To help you navigate the system and manage your health, New York Life is providing a range of resources through Aetna. The primary resource is the Aetna Care Advocate Program. Here s how it works. You and your family will have a personal Care Advocate Nurse available to you from Aetna. He or she can answer health care questions and identify the services and resources that might be helpful for you. Your nurse can provide support if: You have a health issue that requires surgery or hospitalization. The nurse can help you understand what to expect and suggest the questions you should ask your doctor beforehand You have a chronic condition, such as diabetes, asthma, or heart disease. The nurse can help you manage your condition and stay well You need information about treatment alternatives, for example, if your doctor recommends back surgery, hip replacement, or a hysterectomy You need to consider post-surgery home care The nurse will coordinate all the resources Aetna provides, so you don t have to you just have to focus on getting well. The Aetna Care Advocate Program is voluntary and confidential Your health information is protected by federal privacy laws, just as your health care claims are confidential. New York Life does not have access to your personal health information. In addition,we will also re-launch or introduce the following programs starting January These include: Aetna Resources for Living offers access to short-term support for a variety of issues, including mental health, marital, and child/elder care issues Surgery Decision Support Tool guides you through the process of making decisions about surgery WellMatch helps you see the range of choices available for obtaining care for both providers and costs Best Doctors provides a second opinion by a panel of independent physicians on a treatment your doctor is recommending. Visit and to learn more about how these programs work. Aetna Concierge As a member, you ll be able to take advantage of Aetna s concierge service starting January 1, If you have a question about a diagnosis, are looking for a doctor, or want to check your coverage or look up a claim, you can contact Aetna Concierge online at or by calling the number on your member ID card at any time between 8:00 a.m. and 6:00 p.m. 8

9 New prescription drug coverage Your prescription drug coverage will change next year. Coverage is provided through Express Scripts and is the same for both medical options. When you fill your prescriptions at a retail pharmacy, you need to use an Express Scripts network pharmacy to receive benefits from the plan. You also receive benefits and save money when you use the mail order service for maintenance medications. Go to for a list of in-network pharmacies and to learn more. What you pay for prescriptions Retail pharmacy You pay In-network Out-of-network Generic 20% (no less than $10, no more than $20) Formulary 30% (no less than $30, no more than $80) No coverage Non-formulary 50% (no less than $50, no more than $120) If you take maintenance medications, ask your doctor for a prescription for a 90-day supply of your drugs. The mail order program will save you money, since you can purchase a 90-day supply of your medication through the mail for less than it would cost you at a retail pharmacy. Mail order You pay Generic 20% (no less than $25, no more than $50) Formulary 30% (no less than $75, no more than $200) Non-formulary 50% (no less than $125, no more than $300) No matter which medical option you choose, you can elect to contribute to a Flexible Spending Account (FSA) for Health Care and pay for certain out-of-pocket health care expenses on a pre-tax basis. You can use the money in your FSA for eligible medical, prescription drug, dental, vision, and hearing care expenses for you and your family members. 9

10 Accessing funds in your FSA for Health Care and your HRA If you are in the Active Health Option, you will be able to access balances in both your FSA for Health Care and your HRA using the PayFlex Card, a debit card that enables you to use the money in both accounts to pay for eligible expenses. The money from your FSA will automatically be used before your HRA funds. This is different from the way the current HRA and FSA coordinate now. In addition, you can use the FSA to reimburse yourself for that portion of your deductible the HRA does not cover. If you are in the Standard Medical Option, you can use the PayFlex Card for eligible expenses for your FSA for Health Care. Health Care Reform updates Beginning January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) requires most Americans to have health insurance this is called the Individual Mandate. Without health insurance, a tax penalty may apply. All Americans will have the option to purchase health care coverage through a health insurance marketplace, also known as an exchange. To help you evaluate all your options, New York Life will provide a notice that features information about the new public insurance marketplace. However, if you are benefits-eligible, the New York Life medical options will likely be the more cost-effective choice for you. Our medical options provide our employees with comprehensive and affordable coverage. Managing your health is in your best interest The two new medical options available in 2014 offer a new way to think about how you use and pay for your health care and will require you to think differently than you have in the past. Here are a few simple tips: Take advantage of preventive care services Manage any chronic conditions you may have Understand alternatives before obtaining treatment Consider the cost of services Keep in mind, with the Active Health Option you have the opportunity to be rewarded for your efforts to engage in healthy activities and manage costs. 10

11 Important reminders If you do not actively enroll: If you are currently enrolled in a New York Life medical option, you will default to the Active Health Option and cover the same eligible dependents you cover now. If you are not currently enrolled in a New York Life medical option, you will default to no coverage. Preventive care exams Preventive care and immunizations are covered at 100% when you receive care from an in-network doctor. You generally do not need to meet your deductible first. Preventive care includes annual physicals for men and women, well-woman or well-child visits, and most related lab work. It also includes many age-appropriate screenings such as mammograms and colonoscopies. Keep in mind that the services considered preventive are determined by federal guidelines (for example, an annual GYN exam is considered preventive, but a screening for skin cancer is not). Be sure to check and see if a doctor s visit or procedure is considered preventive before you receive services. As a reminder, if you are in the Active Health Option, in 2014 you can earn a $100 health incentive simply by getting an annual physical or annual well-woman exam. For more information on preventive care, including age- and gender-specific health screenings, visit Flexible Spending Accounts Flexible Spending Accounts (FSAs) for Health Care and Dependent Care do not roll over from year to year. The limited purpose FSA for Health Care will be discontinued for those who currently have an HSA. If you want to participate in either or both accounts next year, you must enroll during annual enrollment. In 2014, your FSAs can be used to cover eligible out-of-pocket expenses incurred until March 15, You will have until March 31, 2015 to submit your claims. You cannot combine FSAs for Health Care and Dependent Care. You can claim your dependents out-of-pocket health care expenses from your FSA for Health Care, NOT your FSA for Dependent Care. Use the tools on the Your Benefits Resources (YBR) website to help you determine the most appropriate amount to contribute to the FSAs. Calculate carefully, as the FSAs are use it or lose it. FSA for Health Care The FSA for Health Care can be used for all eligible outof-pocket medical, prescription drug, dental, vision, and hearing care expenses for you and your eligible dependents. Visit the FSA section of for information about eligible expenses. The IRS contribution limit for 2014 is $2,500. FSA for Dependent Care The FSA for Dependent Care can be used for caretaker services for children, disabled dependents, or elderly relatives whom you list as dependents on your federal income tax return. It cannot be used for expenses for overnight camp or for children age 13 or older for any reason. This FSA cannot be used for medical expenses. The IRS contribution limit for 2014 is $5,000 (per household). 11

12 Dependent eligibility As you decide on your benefit elections for you and your family, make sure your dependents are eligible for coverage under the New York Life plans. Eligible dependents include: Your spouse Your children under age 26 Domestic partners and their children Refer to your Summary Plan Description (SPD) for a complete list of eligible dependents. Please be aware that in 2014, we will require both new and existing employees to provide documentation to support the eligibility of all dependents. For example, you will need to provide marriage and birth certificates for your spouse and children, respectively, or certification of your domestic partnership. We will provide more information about these requirements in Updating your address and contact information It s important to make sure your address is correct on YBR, as it is used for benefits and claims correspondence. If you have moved, use Employee Self Service from the company Intranet (home page>work & Life>Change Address under Life Events ). Enter your Universal ID and password, select the Employee tab at the bottom of the screen and then Address from the left navigation bar, then select change. You can also update your phone number on the address screen. 12

13 What happens next In the coming weeks, you ll have various tools and resources available to help you understand the changes to our benefit plans. Microsite where you ll find all your enrollment information, including videos that explain features of the Active Health Option, and be able to link directly to YBR Interactive, online enrollment guide available on our new benefits microsite starting September 30 Health Care AnswerLine staffed by representatives who will be able to answer questions about changes to your medical benefits and about the enrollment process Webinars and live seminars that will explain how the new options work YBR website and InfoLine that will provide various tools to help you determine the level of coverage you need (for example, the Life Insurance Estimator and the Medical Expense Estimator) 13

14 Enrollment resources Resources Where to find it Why to contact Microsite Visit the microsite for information about your benefits for 2014 Link to resources and tools, including the YBR enrollment site Your online enrollment guide Health Care AnswerLine Webinars and live seminars (866) (866) Review detailed information about all your 2014 benefit options Available September 30 on the microsite Call with questions about changes to your medical benefits and the enrollment process Register to attend a webinar or live seminar to help you understand your medical options Your Benefits Resources (YBR) website and InfoLine hewitt.com/newyorklife (888) Enroll in your 2014 benefits View your elections and make changes Access comparison charts and other helpful enrollment tools Remember to... Enroll between October 14 and October 25 Enroll for both 2013 and 2014 if you were hired on or after October 1 Review the dependents you cover under your New York Life benefits and make sure they are eligible for coverage Update your address and contact information if needed 14

15 Important Note: The information presented in these materials is intended to assist you in electing benefits, benefits options, and coverages under the Group Plan for New York Life Employees ( Group Plan ), the New York Life Insurance Company Flexible Benefits Plan ( Flexible Benefits Plan ), and if applicable, the New York Life Insurance Company Executive Officer Life Plan ( Executive Officer Life Plan ) or the New York Life Insurance Company Officer Life Plan ( Officer Life Plan ) (collectively, the Plans ). It is necessarily brief and provides only a general description. You should refer to the applicable Summary Plan Descriptions for more information. This information also discusses changes to benefits options for Please keep this information with your Summary Plan Descriptions and other important benefits materials. Specific benefits, options, requirements, and exclusions will be determined only by the terms and conditions contained in the relevant plan documents. In the event of any conflict between (1) the plan documents and (2) this information, the provisions of the plan documents will govern. New York Life reserves the right to change or terminate all or part of the program, or all or any of the Plans, at any time without notice to, or consent of, employees, retired employees, or their dependents or beneficiaries. Specifically, the Company may at any time terminate or modify any coverage for any or all employees and retired employees, including, those not yet covered or receiving benefits, and those already covered or receiving benefits. No attempt is made to offer tax or other advice with respect to the choices available under the program or offer solutions to individual problems. For that advice, you should consult your own professional advisers. Important Note about HRAs: The use of terms such as contribution, dollars, funds, rollover and funding in these materials is for illustrative purposes only. The HRA is a notional, bookkeeping account. No actual funds are set aside in an account for you or otherwise segregated for purposes of the HRA, and all HRA payments come from the general assets of the Company. HRAs do not earn interest, and New York Life is not permitted to refund to you, and you are not permitted to withdraw, any part of the HRA. HRA amounts may never be used for anything but reimbursements for qualified medical expenses. Amounts remaining in your HRA account can generally be carried over to the next year, except in certain circumstances. If you leave New York Life and are not eligible for retiree medical coverage, your unused HRA balance will generally no longer be available for qualified medical expenses incurred following your termination of employment. However, if you elect COBRA coverage following your termination of employment, you should contact the Benefits Center regarding the availability of any unused HRA balance. New York Life reserves the right to amend or terminate the options and coverages available under the Group Plan at any time, including HRAs. In the event New York Life does not offer or discontinues HRAs, any HRA balances may revert to the Company and no longer made available to you. The Health Care AnswerLine is provided by The Ayco Company L.P. 15

16 What s New Employee Version Sept 2013