North Carolina State Health Plan for Teachers and State Employees. New Charter Schools

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1 North Carolina State Health Plan for Teachers and State Employees New Charter Schools May 13, 2013

2 Topics Legislation Group Set-up Electronic Enrollment Eligibility Rates Plans Benefit Updates 2014 New Plan Options Effective Dates Group Premiums 2

3 Legislation NCGS Charter School Board of Directors must make election in writing Election must be made no later than 30 days after charter signed Sent to the SHP Executive Administrator and the State Board of Education Election is irrevocable Shall notify each employee of the election in writing Each employee shall acknowledge receipt 3

4 New Group Set Up Complete group set-up form and submit to SHP Address Contact information including Order new employee kits requisition form State Health Plan website Electronic enrollment setup free (required) Benefitfocus electronic enrollment vendor 4

5 Electronic Enrollment The State Health Plan is paperless and enrollment is only available electronically. No paper applications are accepted Following receipt of Group Set-up form, a Benefitfocus Representative will be assigned to implement the new group onto the ebenefitsnow system. 5

6 Eligibility Full-time employees covered at 100% of premium on the 70/30 basic plan 30 or more hours per week Part-time employees covered at 50% of premium hours per week Dependents employees pay 100% of premium Legal spouse Natural, stepchild, adopted, foster and legal guardian up to age 26 6

7 Rates Current Employee-Only Rate - $ (Employing Unit currently pays 100% for 70/30 plan; employees pay $22.76 for the 80/20 plan) 4-Tiers (emp-only, emp-spouse, empchild(ren), emp-family) Rates for dependent coverage are based on tier and plan Current rate sheet attached 7

8 Plans Two PPO Plans offered benefits are the same, cost sharing varies 80/20 Standard Plan 20% coinsurance $30 office visit copay - primary $700 deductible Higher dependent premiums Employee pays $22.76 per month 70/30 Basic Plan 30% coinsurance $35 office visit copay primary $933 deductible Lower dependent premiums Employee pays $0 per month 8

9 Benefit Updates Effective July 1, 2013: The mid-tier office copay for mental health & substance abuse will be reduced to the primary care level. Standard 80/20 plan from $52 to $30 Basic 70/30 plan from $64 to $35 Members will be able to select a PCP for themselves and any covered dependents during enrollment. The selection will appear on member ID cards. With the addition of the PCP information, each family member will receive an individual ID card. In February of this year, the Board of Trustees approved moving the benefit period to a calendar year effective January 1, In order to transition to a calendar year benefit period, the upcoming Annual Enrollment will be for just a six-month benefit period: July 1, December 31, This means deductibles, coinsurance maximums, and pharmacy out-of-pocket will be reduced by half. (Reduction of the pharmacy out-of-pocket max applies to the Traditional Pharmacy Plan only and not the Express Scripts Medicare PDP.) 9

10 Benefit Updates July 1, 2013 December 31, 2013 Deductibles, Coinsurance and Out-of-Pocket Maximums 70/30 Basic Plan 80/20 Standard Plan In-Network Out-of-Network In-Network Out-of-Network Benefit Year Deductible Plan Coinsurance Coinsurance Maximum (does not include deductible) Pharmacy Outof-Pocket Maximum $466 Individual $1,399 Family 30% of eligible expenses after deductible $1,896 Individual $5,689 Family $933 Individual $2,799 Family 50% of eligible expenses after deductive and the difference between the allowed amount and the charge $3,793 Individual $11,379 Family $350 Individual $1,050 Family 20% of eligible expenses after deductible $1,605 Individual $4,815 Family $700 Individual $2,100 Family 40% of eligible expenses after deductive and the difference between the allowed amount and the charge $3,210 Individual $9,630 Family $1,250 (This does not apply to Medicare eligible members enrolled in the Express Scripts Medicare Prescription Drug Plan) 10

11 2014 New Plan Options On February 4 th, the North Carolina State Health Plan s Board of Trustees also approved a proposal to offer new health plan options for teachers and state employees. Beginning January 1, 2014, State Health Plan members will have new choices for their health care benefits. These new options will focus on helping members understand and improve their health and at the same time, lower their out-of pocket costs. 11

12 2014 Plans New Plan Options Active and Non-Medicare Retirees will have more options in They can choose to remain on the current premium-free 70/30 plan or select an Enhanced 80/20 plan option that comes with a premium, but allows members to reduce their premium and outof-pocket costs by completing healthy activities, for example: Choosing a primary care provider Completing a Health Assessment Not smoking or participating in a smoking cessation program Members will also have the option to select a Consumer Directed Health Plan (high-deductible plan) with a Health Reimbursement Account (HRA). 12

13 2014 Plans Medicare Advantage Products available in 2014 Medicare Advantage Plans will be offered for the 2014 benefit year. Contracts were awarded to Humana and United Healthcare. Medicare Advantage offers services to help Medicare-primary members effectively manage their health. No member premium (on base plans) Open Networks All plans will include Silver Sneakers All plans will include a prescription drug plan (PDP) No other decisions regarding the Medicare Advantage products have been made at this time but the benefits will be comparable if not better than the traditional benefit plans. Medicare primary members will still have the option to choose the Traditional 70/30 Basic plan. 13

14 Effective Dates Effective date is the first of the month or first of the second month following date of hire Dependents must be added at time of hire or due to a qualifying event Dependents must be enrolled within 30 days of the qualifying event or added at annual enrollment 14

15 Group Premiums Prepaid Plan Billed monthly for the next month i.e., June bill is for July Bills are generated in the middle of the month Premium is due by the 5 th of the next month and must be paid as billed If premium is not paid by the due date, claims are held Premiums not received by the fifteenth day of the month following the due date shall be charged 1 ½% interest of the amount due the Plan, per month beginning with the sixteenth day of the month following the due date. (NCGS ) 15

16 Thank You!