OPEN ENROLLMENT PLAN YEAR 2013
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1 OPEN ENROLLMENT PLAN YEAR 2013
2 HR PERSONNEL HIPAA (protects your private health information) Sydney Covey ext Melissa Spence ext Benefit Explanations Claim Questions Family Status Changes Katherine McGuire ext Retirement Questions Retirement Planning Retiree Benefits Retirement Processing
3 HEALTH CARE REFORM March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act March 30, 2010, President Obama signed into law the Health Care and Education Reconciliation Act These two Acts will require sweeping health care reform which will impact : Insurance Companies Health care providers Employers (City of Plano) Individuals (You)
4 HEALTH CARE REFORM Changes are coming Final Federal Regulations (Rulings) have not been released Between 2012 and 2018 Changes in plan offerings and cost Changes in options for where you may obtain coverage State Exchanges Mandate for individual coverage or YOU pay penalty; begins Cost to provide benefits Increase Cost to the City through benefit mandates and taxes/fees/additional reporting requirements Employers NOT required to provide coverage, but may be taxed if they do not Increase Cost to You through increasing medical costs, premiums and taxes
5 HEALTH CARE REFORM City of Plano will continue to provide you information Health Care Reform will change both the Cost and the Plan Offerings How it impacts the City future decisions How it impacts you individually What are your options and responsibilities How it will impact you financially So you can make an informed decision that best fits your family s needs
6 Health Care Reform 2013 Changes New 6 page Summary of Benefits and Coverage (SBC) will be placed on Benefits Website New fee on health plan coverage for outcomebased research ($2/yr./participant; $1 fee in first year). Fee will adjust thru 2019 based on average U.S. health care expenditures W-2 reporting (on statement January 2013) Medical plan benefit cost (for informational purposes only and NOT considered taxable income)
7 Health Care Reform-2013 Changes (cont.) Medical Flexible Spending Account (FSA) limit reduced to $2500. (Dependent Care FSA no change still $5,000)
8 Medical Plan No Plan Design Changes CURRENT PLAN COVERAGE (IN-NETWORK) Annual Wellness Physical covered at 100% (NO $25 Office Visit co-pay) Labs 100% Mammograms 100% Vaccinations 100% Wellness Colonoscopy 100% unless removal of polyps, then deductible and co-insurance apply
9 Medical Rates 2013 No Increase in Premium MONTHLY EMPLOYEE CITY Employee only $50 $448 Employee + Spouse $248 $1040 Employee + Children $156 $765 Family $390 $1466
10 Network Matters Stay In Network What do you need to do? Check myuhc.com to verify In-Network Call UHC Customer Service number on the back of your card Be a Good Consumer of your medical benefit to keep costs down now and in the future
11 Employee Assistance Program (EAP) Expert Counseling professional counselors, over the phone or face to face Job Stress Marital or relationship problems Depression Parenting issues Legal Assistance free 30 minute over the phone or in person. 25% discount with network attorneys and mediators Legal disputes Drafting a will Mediation services
12 Employee Assistance Program (EAP) Financial Services free, unlimited phone consultation with credentialed financial counselors for Budgeting Debt management Retirement planning Referrals to financial professional and planning resources for complex financial matters
13 Pharmacy CVS / Caremark NO CHANGES TO PHARMACY BENEFIT NO CHANGES IN YOUR COPAYS OR LIMITS Mandatory Mail Order for Maintenance Drugs Maintenance Choice (CVS Retail at Mail Order prices) Tier 4 for Specialty Drugs - $120 Co-pay with limit of 30 days Specialty Drug Program implemented Specialty Guideline Management $100 Family Deductible Maximum Out of Pocket $2500 per person Mandatory Generics Copay plus the difference between the brand and generic alternative up to a maximum total copay of $360 for a 90 day supply
14 Expiring Drug Patents The next 3 years will bring GENERIC versions of the world s best-selling drugs Opportunity to save money Switch to Generic Q4, 2012 Rank Drug Name 1 Singulair #4 COP # in Cost 2 Lexapro #12 3 Plavix #20 4 Tricor #22 5 Actos # Rank Drug Name 1 Cymbalta #11 2 Niaspan 3 Actoplus Met 4 Oxycontin 5 Lamictal XR COP # in cost 2014 Rank Drug Name COP # in Cost 1 Nexium #3 2 Copaxone #2 3 Loestrin 24FE 4 Celebrex 5 Novolog #10
15 Pharmacy CVS /Caremark
16 Dental Rates 2013 No increases in Dental premium No changes to Dental benefit Coverage for Children to age 26 Monthly Employee City Employee only $13.44 $20.16 Employee + Spouse $33.60 $33.60 Employee + Children $44.52 $40.32 Family $71.16 $57.80
17 Vision UHC Rates 2013 No increase in Vision premium No changes in Vision benefit
18 Flexible Spending Accounts You can help offset increases in your cost by participating in FSA You can set aside money in Pre-Tax Dollars for: Health Care Premiums automatic Health Care Reimbursement Plan Eligible health care expenses Dependent Care Reimbursement Plan (day care) Eligible dependent day care expenses Administered by United Healthcare
19 FSA Health Care Reimbursement Set aside up to $2,500 Pre-Tax Dollars Minimum $12.50 per pay period, before taxes from your salary per year in an account to reimburse for eligible health care expenses that the medical, dental, vision or Rx plan doesn t cover: Deductibles Coinsurance Copays Over the counter medications with prescriptions only More information on the Planonet under Benefit Information/FSA 24 Pay Periods
20 FSA Dependent Care Contribute up to $5,000 per year ($2,500 if married and filing separately) Obtain reimbursement for eligible dependent day care expenses Proof of expense and Tax ID of care provider required on claim form Eligible care includes expenses subject to taxation for: Day care for children or adults Care in or out of your home 24 Pay Periods
21 FSA Dependent Care Reimbursement Expenses to allow both spouses to work Eligible dependents include Children under age 13 Spouse, parent or child over age 13 who live with you and cannot care for self Reimbursement Claim forms can be found at or on Planonet
22 Long Term Disability Buy Up City provides LTD up to 40% of pre-disability income Buy Up additional 10% or 20% of pre-disability income Plan premiums are based on salary so you will see an increase in premiums due to recent increases If you are increasing the amount of coverage, you are required to complete the Standard s Medical History Statement at: Group Name: City of Plano Policy # By 4:00 p.m. on Wednesday, October 17, 2012
23 Hospital Gap No increase in Gap premium No changes in Gap benefit Reimburses: 5 office visit co-pays ($125) per family per year $200 for outpatient treatment Inpatient hospital stay up to the plan level enrolled in ($500, $1000, $1500) See premiums listed in Open Enrollment Workbook
24 Hospital Gap Paper Enrollment Form Requires Paper Enrollment Form in addition to On-Line Enrollment If NEW enrollment If making a CHANGE to current coverage Form Located on Open Enrollment website Not making a change? NO FORM NEEDED COMPLETED FORMS DUE IN HR NO LATER THAN 4:00 PM, WEDNESDAY, OCTOBER 17, 2012
25 On-Line Enrollment
26 On-Line Enrollment Your current year elections (except FSA) will automatically carry forward if you do not participate in Open Enrollment If you are making ANY changes to your benefit elections, you MUST make changes online through PeopleSoft.
27 Dependent Eligibility Documentation On-Line ALERT Message Appears only if documentation has not been received Adding new dependent During the Enrollment process in PeopleSoft: ALERT: Human Resources Department still needs documentation from you concerning this dependent. Dependent eligibility documentation for the dependent (i.e. Marriage license, birth certificate, etc.) must be submitted to the Human Resources Department no later than October 17, Failure to provide the requested information by the deadline will result in NO COVERAGE for this dependent for the Plan Year 2013.
28 Dependent Eligibility Documentation Refer to page 87 in your Summary Plan Document: Definition of Dependent Typical Documents: Marriage license Birth certificate Court Order
29 Beneficiary Update Update your Beneficiaries when event occurs: Marriage Divorce Death Data not maintained in PeopleSoft Forms on Planonet at the HR homepage or on Employee Benefits Website
30 Confirmation Statements Confirmation Statements will be sent out the end of October CHANGES Only send to HR by November 7 Check on-line through PeopleSoft at Employee Self Service to review your elections/benefits at any time
31 Important Dates Open Enrollment begins October 1, 2012 Open Enrollment ends October 17, 2012 Elections must be entered by 4:00 p.m. Coverage begins January 1, 2013 Payroll deductions begin December 6, 2012
32 Websites Open Enrollment Website Employee Benefits Website available to you 24/7 from home or work location
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