ANNUAL ENROLLMENT GUIDE 2015

Transcription

1 ANNUAL ENROLLMENT GUIDE 2015 Choose the coverage that s right for you and your family Click here to get started

2 COVERAGE THAT S RIGHT FOR YOU As a part of our Total Rewards package, Farmers offers comprehensive and competitive benefits to our employees. When it comes to benefits, we understand that one size doesn t necessarily fit all. That s why we give you the flexibility to choose the combination of benefits that s best for you and your family. We also provide you with the tools to help you make the right choices. You can start by reading this guide, which walks you through the enrollment process and gives you details about your benefits. If you are looking for more information, this guide also directs you to other resources that can help answer your questions. MARK YOUR CALENDAR Annual Enrollment is from October 20 to November 3. Enrollment takes place only once a year, so take this opportunity to review your benefits and ensure they fit your needs. Choose wisely because you can t make changes outside of Annual Enrollment unless you experience a qualified life change event, such as a marriage or the birth of a child. Remember that you must enroll in order to have coverage next year. Your current medical, dental, vision, supplemental life insurance, and AD&D insurance elections do not carry forward into Even if you aren t changing your selections, you must enroll or you will lose these benefits at the end of

3 Annual Enrollment 2015 begins October 20 and ends November 3, 2014 Here s what you ll find inside (click on the below chapters) WHAT S NEW FOR MEDICAL... 7 SAVING TAXES THROUGH HEALTH SAVINGS AND FLEXIBLE SPENDING ACCOUNTS EMPLOYEES LIKE YOU UHC PLAN COST ESTIMATOR WELLNESS RESOURCES HEALTHFIRST PLUS VISION DENTAL LIFE AND DISABILITY WORK/LIFE BALANCE RETIREMENT RESOURCES TO HELP YOU Contact information Glossary IMPORTANT NOTICES Privacy notice of availablity MONTHLY EMPLOYEE PAYROLL DEDUCTIONS

4 EXTENDED HOURS FOR HR SERVICE CENTER The HR Service Center is staying open extra hours during Annual Enrollment to help answer your enrollment questions. 5 a.m. to 5 p.m. PST October 20 November 3 (888) hr.service.center@farmersinsurance.com WHAT S NEW FOR 2015 The amount you contribute through payroll deductions for some benefits has gone up you will find 2015 payroll deductions on page KEY MEDICAL PLAN CHANGES CONSIDERATIONS CHOICE PLUS HSA In-network deductibles and out-of-pocket maximums are increasing to: Employee Family Deductible $1,300* $2,600* Out-of-pocket maximum $2,600 $5,200 CHOICE PLUS PPO In-network deductibles and out-of-pocket maximums are increasing to: Contribute pre-tax dollars to your HSA so you have enough set aside to cover your deductible and out-of-pocket expenses. Employee Family Deductible $750 $1,500 Out-of-pocket maximum $1,500 $3,000 Prescription drug copays are increasing and will apply to the out-of-pocket maximum. 30 day retail 90 day mail-order Use the online UHC Plan Cost Estimator to make sure you select the most appropriate plan for you and your family. Generic $10 $25 Preferred brand $30 $75 Non-preferred brand $50 $125 ALL PLANS Certain services under the Farmers medical plan will require prior authorization services in 2015 to determine benefit coverage prior to certain service being rendered. If you utilize a UnitedHealthcare network provider they will facilitate this process for you, but when you seek services from a non-network provider you will be responsible for prior authorization. The 2015 Summary Plan Description will provide information on the services that require prior authorization. Use in-network providers as they will facilitate the prior authorization process for you. Out-of-network deductibles and out-of-pocket maximums are increasing in all four medical plans. Use in-network providers as the deductible and out-of-pocket maximum are lower. * Increase due to regulatory requirement in order to remain eligible to contribute to a Health Savings Account. 4

5 For detailed information on Farmers benefits, log in to GEMS and go to Employee Self-Service and select Benefits & Policies GET STARTED Choosing your benefits and maximizing the value of your Total Rewards package is important. Spend a little time now and reap the benefits in A Farmers Today Annual Enrollment web page has been set up as a one-stopshop to access your resources. Simply click on HR Connection and select the Annual Enrollment link. WHAT DO I NEED TO DO? Review this Annual Enrollment guide. Visit UnitedHealthcare s (UHC) pre-member website, where you can compare your estimated costs under each medical plan option by using the Plan Cost Estimator at You can also find medical plan highlights and compare all plans side by side. If you already have a Health Savings Account, consider the amount you expect to have available for eligible health care expenses next year. If your spouse or domestic partner has benefits available through his or her employer, be sure to consider those additional options as well. Visit Benefits and Policies through HR Connection on Farmers Today to learn more about your 2015 benefits. Once you log in to the GEMS portal: ENROLL Click on the Employee Self Service tab at the top of the screen. Then click on the Benefits and Policies tab located on the navigation bar below the Employee Self Service tab. Decide which plans best meet your needs and how much to contribute to your Health Savings Account and/or Flexible Spending Account. Enroll between October 20 and November 3. To enroll, go to Farmers Today and log in to GEMS under HR Connection. Then: Click on the Employee Self Service tab at the top; Click on Benefits on the left under Detailed Navigation; Click on Benefits Enrollment and follow the onscreen instructions; Save a copy of your benefits confirmation statement for your records. 5

6 WHO IS ELIGIBLE FOR BENEFITS? You can enroll yourself and your eligible dependents. Your eligible dependents include: Your legally married spouse or domestic partner, except when legally separated. Note: If you are adding a domestic partner for the first time, you will need to complete the appropriate documentation with the HRSC. Please log in to Farmers Today > HR Connection> GEMS > Employee Self Service > Benefit and Policies for more information or contact the HRSC directly at (888) Your children, including your eligible domestic partner s children, adopted children and children under your court-appointed legal guardianship, under age 26, regardless of the child s student or marital status. Note: Grandchildren can be covered only if you are the courtappointed legal guardian. Your single children of any age who are handicapped or totally disabled and who were enrolled in your benefits before age 26. BENEFIT DOLLARS Paying for benefits is a shared responsibility. For many benefits, you and Farmers both make contributions to pay for your coverage. To help pay for your benefits Farmers also provides Benefit Dollars. You receive a total of $375 per year equally divided into 24 semi-monthly paychecks. You can use these dollars to help offset your paycheck deductions for the benefits you choose. 6

7 If you can t find your answer in Benefits and Policies or call the HRSC, they re standing by. (888) a.m. - 5 p.m. PST Monday - Friday hr.service.center@farmersinsurance.com MEDICAL Farmers offers you a choice of four medical options so you can choose the plan that best fits your needs. The options for 2015, administered by UnitedHealthcare (UHC), include a choice of three High Deductible Health Plans and a PPO: High Deductible Health Plans: Choice Plus HSA Choice Max HSA Choice Premier HSA PPO Plan: Choice Plus PPO PRESCRIPTION DRUGS Your prescription drug benefit is managed by Express Scripts. The Express Scripts preferred drug list, sometimes called a formulary, is a list of brand-name and generic medications that are preferred by your plan. This list offers access to safe and effective medications in all therapy classes based upon guidance from an independent group of expert health professionals. Medications are selected because they can safely and effectively treat most medical conditions while helping to contain costs for you and your plan. Some medications may be removed from this list when safe and effective alternatives are available. The Express Scripts preferred drug list contains thousands of commonly prescribed drugs. For more information, please visit or call (800) This toll-free number also appears on your member ID card. WHAT MEDICAL PLANS HAVE IN COMMON The medical plan options have a lot in common, as well as some important differences (see page 8 to compare what s different). All four options: Cover the same services and give you access to the same network of health care providers and facilities. You re free to see any provider you want, but using providers in UHC s network will save you money because they have agreed to negotiated rates, the plan pays a higher level of reimbursement and the deductible and out-ofpocket maximums are higher when you go out-of-network. Cover preventive care services at 100 percent when you use in-network providers. Preventive care includes annual physical exams, routine immunizations and much more. Include prescription drug benefits managed by Express Scripts. To receive benefits, you must go to an in-network pharmacy. If you go to an out-of-network pharmacy, you ll pay the full cost of your prescription. 7

8 COMPARE YOUR MEDICAL OPTIONS HIGH DEDUCTIBLE HEALTH PLANS (HDHP) PPO Plan name Choice Plus HSA Choice Max HSA Choice Premier HSA Choice Plus PPO When the plan begins to pay Pay later through higher deductibles but require lower payroll contributions for coverage Pays sooner through a lower deductible but requires a higher payroll contribution for coverage How the plan covers prescription drugs Which taxadvantaged accounts can be used Subject to the deductible and coinsurance like any other eligible medical expense Can be used with a Health Savings Account (HSA), which allows you to save tax-free money for health care expenses now or in the future and Farmers helps by contributing to your HSA if you contribute a minimum amount (see page 11 for more details) Can be used with a Dental and Vision FSA (see page 13 for more details) to pay for dental and vision expenses during the plan year you will be able to rollover up to $500 of your unused Dental and Vision FSA balance remaining at the end of the plan year. Any carry over amounts that exceed $500 will be forfeited Subject to copays, which do not count toward your deductible, but do count towards your out-ofpocket maximum Can be used with the Health Care FSA, which allows you to save taxfree money for medical, dental and vision expenses during the plan year. You will be able to rollover up to $500 of your unused Health Care FSA balance remaining at the end of the plan year. Any carry over amounts that exceed $500 will be forfeited. (see page 13 for more details) 8 8

9 AT A GLANCE: YOUR MEDICAL OPTIONS For detailed information on Farmers benefits, log in to GEMS and go to HIGH DEDUCTIBLE HEALTH PLANS Employee PPO Self-Service and select Benefits & Policies Choice Plus HSA Choice MAX HSA Choice Premier HSA Choice Plus In-Network Out-of- Network In-Network Out-of- Network In-Network Out-of- Network In-Network Out-of- Network Annual deductible* (employee only/family) $1,300/ $2,600 $1,950/ $3,900 $2,000/ $4,000 $3,000/ $6,000 $2,800/ $5,600 $4,200/ $8,400 The individual deductible and out-of-pocket maximum does NOT apply if any dependents are covered. In these cases, the family deductible must be met before the plan pays a benefit. $750/ $1,500 $1,125/ $2,250 Out-of-pocket maximum* (employee only/family) $2,600/ $5,200 $3,900/ $7,800 $4,000/ $8,000 $6,000/ $12,000 $5,600/ $11,200 $8,400/ $16,800 $1,500/ $3,000 $2,250/ $4,500 Preventive care Plan pays 100% Plan pays 60%** Plan pays 100% Plan pays 60%** Plan pays 100% Plan pays 60%** Plan pays 100% Plan pays 60%** Most other eligible healthcare expenses Plan pays 80%** Plan pays 60%** Plan pays 80%** Plan pays 60%** Plan pays 80%** Plan pays 60%** Plan pays 80%** Plan pays 60%** Prescription drugs (generic, preferred, non-preferred brandname)*** Retail and mail order: Plan pays 80% after annual deductible is met Not covered Retail and mail order: Plan pays 80% after annual deductible is met Not covered Retail and mail order: Plan pays 80% after annual deductible is met Not covered Retail: $10/$30/$50 Mail order: $25/$75/$125 Not covered SAVINGS TIP: USE THE MAIL-ORDER SERVICE If you take a medication on an ongoing basis, ordering your prescriptions by mail can save you time and hassle by delivering your maintenance medication right to your home. In addition, if you elect the Choice Plus plan, ordering your prescriptions by mail can save you time and money. That s because you ll be responsible for the full mail-order copay after your third refill of a maintenance medication at a retail pharmacy. That means you ll be paying for a 90-day supply but only receiving a 30-day supply. Start saving by signing up at *** The annual deductibles and out-of-pocket maximums include expenses for in-network and out-of-network services combined. However, in 2015 the out of network deductibles and out of pocket maximums will be higher than the in network deductibles and out of pocket maximums. For example, if an employee sees an in-network doctor and pays $200 for the service, and later sees an out-of-network doctor and pays $500 for services, the combined amount of $700 will apply to the employee s annual deductible and out-of-pocket maximum. UHC refers to this as cross application. *** Percentage of negotiated fee for in-network or reasonable and customary charges for out-of-network, which the plan covers after you meet your deductible. The out-of-area option will provide an in-network benefit of 80 percent of reasonable and customary charges. *** Under Choice Plus, when a generic drug is available and a prescription is filled with a brand-name drug, you ll pay the difference in the cost between the generic drug and the brand-name drug, in addition to the generic copay. This will apply regardless of whether you or your physician requests the brand-name drug. 9

10 AVAILABILITY OF SUMMARY HEALTH INFORMATION Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option to help you compare across options. The SBC, along with the Summary Plan Description (SPD) is available on the intranet at: Farmers Today > HR Connection > GEMS > Benefits and Policies. A paper copy is also available, free of charge, by contacting the HR Service Center at (888) or at hr.service.center@farmersinsurance.com. Out-of-area coverage is available If you live in an area where the UHC network is not available, there is an out-of-area plan for each of the medical options. The benefits under these plans are the same as in the in-network plan. Because the UHC network is not available in your area, you can go to any doctor or hospital. If you are eligible for out-of-area coverage, it will be listed on your benefit enrollment screen. Important note: UHC s in-network providers request an explanation of benefits (EOB) for the services provided to determine your out-of-pocket responsibility. However, the provider has the right to request payment at the time of the visit. If this happens, you are responsible only for the negotiated fee between UHC and the provider. SAVINGS TIP: CHOOSE IN-NETWORK PROVIDERS Since the out-of-network deductibles and out-of-pocket maximums will be higher, using in-network providers you can save even more money, so take a few minutes to use the UHC Online Provider Directory. This tool lets you search for innetwork providers and facilities by geographical area or by name. You also can designate a medical specialty and other criteria, such as a second language, to further refine your search. To use the directory, go to and click Find Physician or Facility. The directory changes as information is updated so it s a good idea to check the status of your doctors during Annual Enrollment and throughout the year as you schedule appointments. 10

11 If you can t find your answer in Benefits and Policies or call the HRSC, they re standing by. (888) a.m. - 5 p.m. PST Monday - Friday hr.service.center@farmersinsurance.com SAVING TAXES THROUGH HEALTH SAVINGS AND FLEXIBLE SPENDING ACCOUNTS Want to save on taxes? You can with a Health Savings Account (HSA) or Flexible Spending Account (FSA). These tax-advantaged accounts let you pay for your outof-pocket health care costs with tax-free dollars. With easy payroll deductions and convenient debit cards, these accounts may be easier to use than you think. They sound similar, but they re very different it s important for you to understand the difference. HEALTH SAVINGS ACCOUNTS If you enroll in one of our three High Deductible Health Plans (Choice Plus HSA, Choice Max HSA or Choice Premier HSA), you can use an HSA to pay for eligible health care expenses including medical, prescription drug, dental and vision expenses. How you use your HSA is up to you. You can: Set aside money to cover your expected health care bills for the year while making the most of the tax advantages. Build up enough savings to cover your deductible and out-of-pocket maximum so that you re protected from the costs of a serious illness or injury. Make contributions and invest your balance to save for your health care expenses in retirement. No matter how you choose to use your HSA, be sure to keep your receipts with your other tax records. You ll need them at tax time, and the IRS may ask you to substantiate your eligible health care expenses. Paying for dependent medical expenses from your HSA THERE S MORE ONLINE To learn more about HSAs, visit the Annual Enrollment Web page ( farmersinsurance.com/humanresources/pages/annualenrollment.aspx). To learn more about eligible expenses, visit gov and enter Health Savings Accounts in the search bar. Family situations can vary. Generally, contributions limits to an HSA determined by the type of coverage individual or family. Even if your spouse or dependents are not covered by your High Deductible Health Plan, you may use your HSA dollars to pay for qualified medical expenses for them. If you have adult children under your health plan, you may not use your HSA to pay or reimburse yourself for their qualified medical expenses if they are not your tax dependents. However, single adult children who have coverage under a parent s family HDHP can open their own HSAs and contribute up the yearly family maximum. Visit or for answers to frequently asked questions on these topics. Consult your tax advisor for guidance on your specific situation. 11

12 HOW THE HSA WORKS When you contribute to an HSA, so does Farmers. As long as you make the minimum contribution with company payroll deductions through Optum Bank, Farmers will make a contribution to your HSA: If you have employee only coverage and contribute at least $100 to the HSA, Farmers will contribute $500. If you cover any dependents and contribute at least $200 to the HSA, Farmers will contribute $1,000. Your HSA contributions and those you may receive from Farmers are not subject to federal income tax, and in most cases, state income tax. Currently, the states of California, New Jersey and Alabama do not allow pre-tax HSA contributions and they are subject to state tax. You also don t pay taxes when you spend your HSA money on qualified medical expenses. MEDICARE AND THE HSA If you are enrolled in Medicare Part A or B in 2014, or will be enrolled in 2015, federal regulations don t allow you to open and contribute to an HSA. So, if you already have an HSA you can keep your account and use the funds for eligible health care expenses but you cannot continue to contribute to it, and you may not open a new HSA. Although you make contributions evenly over the course of the year, the company contribution will appear as a lump-sum deposit into your HSA in conjunction with the January 15, 2015 pay period. As soon as the company contribution is in your HSA, it s yours to save or spend on qualified health care expenses. Both your contributions and the company contribution count toward the HSA annual maximum, as shown in the chart: 2015 HSA Annual Maximum Contributions (All HSA Plans) Coverage Level Maximum Employee Contribution + Company Contribution = Annual Maximum HSA Contribution Employee only $2,850 + $500 = $3,350 Family $5,650 + $1,000 = $6,650 If you ll be age 55 or older in 2015 and not enrolled in Medicare, you can contribute up to an additional $1,000 to your HSA in catch-up contributions. That means your maximum annual HSA contribution is $4,350 for employee only medical coverage and $7,650 for employee plus family medical coverage. Your account also can earn tax-free interest. Optum Bank charges monthly maintenance fees if minimum balances are not maintained. In addition, other fees may be associated with the Optum Bank HSA options. Three bank account options are available to you. Refer to Benefits and Policies or call Optum Bank Customer Service at (800) for details. 12

13 For detailed information on Farmers benefits, log in to GEMS and go to Employee Self-Service and select Benefits & Policies FLEXIBLE SPENDING ACCOUNTS How the Health Care FSA works If you enroll in Choice Plus PPO, you can use a Health Care FSA to pay for eligible health care expenses including medical, dental and vision expenses with tax-free dollars. You can contribute up to $2,500 per year into your FSA. You can contribute from a minimum of $10 per pay period to a total of $2,500 in The company does not contribute to your FSA (unlike an HSA). If you choose to use an FSA, remember to plan your contributions carefully. Due to IRS rules, and unlike a Health Savings Account, your expenses need to be incurred during the plan year to be reimbursed from your FSA, but you can submit claims for your qualifying expenses through April 30 of the following year. Also you will be able to rollover up to $500 of your unused Health Care or Dental and Vision FSA balance remaining at the end of the plan year. Any carry over amounts that exceed $500 will be forfeited. How the Dental and Vision FSA works If you enroll in one of the High Deductible Health Plans, the IRS does not allow you to use a Health Care FSA in combination with your HSA, but you can set aside taxfree money in a Dental and Vision FSA. You can contribute up to $2,500 per year into your Dental and Vision FSA. Just like the name says, this FSA can be used for dental and vision expenses only. Expenses subject to your medical deductible, including prescription drugs, must be paid with money from your HSA. You can pay for your dental and vision expenses with money from either your Dental and Vision FSA or from your HSA but not both. The Dental and Vision FSA is subject to the same rules as the Health Care FSA, including the use it or lose it rule, so you ll want to set aside just enough money to cover your 2015 eligible dental and vision expenses. THERE S MORE ONLINE For a complete list of qualified health care and dependent care expenses, visit click on Forms and Publications and then select IRS Publication 502 for health care expenses and IRS Publication 503 for dependent care expenses. 13

14 COMPARING AN HSA TO AN FSA Questions Health Savings Account (HSA) Flexible Spending Account (FSA) With which medical plan can I have this account? High Deductible Plans: Choice Plus HSA, Choice Max HSA or Choice Premier HSA Who funds the account? You and Farmers You Choice Plus PPO or if you are not enrolled in a Farmers medical plan If you contribute to an HSA, you can also contribute to the Dental and Vision FSA, which is for dental and vision expenses only How much can you contribute? $2,850 for employee only (plus $500 Farmers contribution) $5,650 for family (plus $1,000 Farmers contribution) Employees age 55 or older can contribute an additional $1,000 You may contribute up to $2,500 Does the money in the account earn interest? What happens to any money left in my account at the end of the year? What happens to any money left in my account if I leave or retire? Am I eligible to contribute? Yes, it grows tax-free with interest and can be withdrawn tax-free to pay for eligible health care expenses Your unused money rolls over from year to year can be used anytime, even in retirement The money is yours to take with you Yes, if you are enrolled in a high deductible plan No, if you are enrolled in Medicare Part A or B No, but it can be withdrawn tax-free to pay for eligible health care expenses If you don t spend it within the calendar year, it s forfeited except you can rollover up to $500 to the following year Your account balance must be used for expenses incurred up to the end of the month following your date of termination, but you can submit claims through April 30 of the following year Yes. If you contribute to an HSA, you can only contribute to the Dental and Vision FSA, which is for dental and vision expenses only How the Dependent Care FSA works If you have child care or elder care expenses, be sure to consider taking advantage of the Dependent Care FSA. In the same way that a Health Care FSA lets you set aside before-tax money for eligible health care expenses, you can use the Dependent Care FSA to set aside a minimum of $10 per pay period, up to $5,000 per year, in before-tax money for child care expenses while you and your spouse/domestic partner work or attend school full time. Examples of eligible dependent care expenses include: Charges for day care centers for children or adults Before- and after-school programs Babysitters Summer day camps Nursery school Important tax rules apply to the Dependent Care FSA. You can t be reimbursed from your FSA for any expense that s also covered by a tax credit on your federal tax return. Talk to your tax advisor to decide whether enrolling in a Dependent Care FSA or taking the Child Care Tax Credit is better for your financial situation. 14

15 If you can t find your answer in Benefits and Policies or call the HRSC, they re standing by. (888) a.m. - 5 p.m. PST Monday - Friday hr.service.center@farmersinsurance.com EMPLOYEES LIKE YOU How do you pick the right medical plan? There s a lot to consider: your monthly payroll deductions, deductibles, coinsurance, tax savings opportunities and more. Take a look at these examples of fictional Farmers employees to learn from their thought processes and their math. It s important to understand what you expect to spend for health care. It s also important to plan for the unexpected when selecting a medical plan. Make sure that you re aware of your out-of-pocket maximum and that you are able to cover this potential expense. Take full advantage of an HSA if you re enrolled in the one of the High Deductible Health Plans. In 2015 the out-of-network deductible and out-of-pocket maximums will be higher than the in-network deductible and out-of-pocket maximums. So using in-network providers can save you money. In the following examples, you will see how to calculate your total estimated healthcare costs, but don t worry; you don t need to pull out the calculator and do this by hand. UHC s Plan Cost Estimator does it for you and makes it easy to determine which medical plan makes the most sense and can save you the most money. See page 21 for more information. Note: Only in-network services have been used under each of these examples. 15

16 MEET MARK Age: 49 Status: Looking for employee plus family coverage Health snapshot: Healthy but his son s asthma requires regular care Mark, his wife and teenage son have predictable health care expenses. As a family, they lead healthy lives by eating well and exercising often. Outside of regular checkups, Mark and his wife use minimal health care. However, their teenage son was born with a chronic condition and needs regular care. Mark also expects there may be a couple of unplanned trips to the doctor or emergency room in the year. To help cover their out-of-pocket costs, they use an HSA. For 2015, Mark estimates his family s medical expenses will come to $1,800 (the plan pays preventive care 100%). Mark also contributes $1,500 to his HSA. He can use the money to offset his deductible or save for future use. Based on Mark s expected health care needs, the Choice Premier HSA is the least expensive plan, but he ll need to be sure he has enough money set aside in his HSA or personal savings if he incurs unexpected medical costs he could be responsible for up to $11,200 (in-network). Because of his lower medical contributions, he can afford to contribute more money into this tax-advantaged account. Here s what his math looks like for each of the plans: HIGH DEDUCTIBLE HEALTH PLANS PPO Considerations Choice Plus HSA Choice Max HSA Choice Premier HSA Choice Plus* Mark s 2015 payroll deductions for employee plus family coverage $4,788 $2,520 $936 $9,600 Pays toward deductible (in-nework) $1,800 of the $2,600 deductible $1,800 of the $4,000 deductible $1,800 of the $5,600 deductible $1,500 of the $1,500 deductible Dollars in excess of deductible paid through coinsurance (Mark pays 20% and the plan pays 80%, up to the out-of-pocket maximum) $0 $0 $0 $60 (20% of his remaining $300 in expenses) HSA dollars** (Farmers contribution) $1,000 $1,000 $1,000 N/A Total Cost for Mark: $5,588 $3,320 $1,736 $11,160 Maximum exposure for out-ofpocket (in-network) medical expenses (does not include payroll deductions) $5,200 $8,000 $11,200 $3,000 **Under Choice Plus, prescription drugs are covered with copays and are not subject to the deductible. To simplify these examples, no prescription drug expenses were included. ** If Mark elects Choice Plus HSA, Choice Max HSA or Choice Premier HSA and contributes at least $200 to an Optum Bank HSA through payroll deductions, Farmers will contribute $1,000 to his HSA. Mark can contribute the money he s saving on his monthly contributions to further increase his HSA savings. 16

17 For detailed information on Farmers benefits, log in to GEMS and go to Employee Self-Service and select Benefits & Policies MEET JANET Age: 26 Status: Looking for employee coverage Health snapshot: Healthy uses minimal health care Janet takes good care of herself. She eats a balanced diet and exercises regularly. She does not have any chronic conditions and does not take any regular medication. Aside from her annual physical and lab work, she rarely goes to the doctor. Because she doesn t need a lot of health care, she doesn t want to pay for coverage she s not going to use. Janet keeps a tight budget and wants to keep her payroll contributions as low as possible. But she also wants to protect herself in case something unexpected happens. She could consider putting the money she saves from lower contributions into her HSA, which she can use as a health emergency fund if she needs it in the future. For 2015, Janet estimates her medical expenses will be no more than $200 (plan pays for preventive care at 100%). Janet also makes a $500 contribution to her HSA. She can use this money to offset her deductible or save for future use. Based on Janet s expected health care needs, the Choice Premier HSA is the least expensive plan. Still, she needs to be able to pay $5,600 (out-of-pocket maximum in-network), and/or $8,400 (out-of-network) in the event she has an unexpected illness or injury and plan accordingly. Here s what her math looks like for each of the plans: HIGH DEDUCTIBLE HEALTH PLANS PPO Considerations Choice Plus HSA Choice Max HSA Choice Premier HSA Choice Plus* Janet s 2015 payroll deductions for employee coverage $1,572 $828 $312 $3,144 Pays toward deductible $200 of the $1,300 deductible $200 of the $2,000 deductible $200 of the $2,800 deductible $200 of the $750 deductible Dollars in excess of deductible paid through coinsurance (Janet pays 20% and the plan pays 80%, up to the out-of-pocket maximum) HSA dollars** (Farmers contribution) $0 $0 $0 $0 $500 $500 $500 N/A Total Cost for Janet $1,272 $528 $12 $3,344 Maximum exposure for out-ofpocket medical expenses (does not include payroll deductions) $2,600 $4,000 $5,600 $1,500 **Under Choice Plus, prescription drugs are covered with copays and are not subject to the deductible. To simplify these examples, no prescription drug expenses were included. ** If Janet elects Choice Plus HSA, Choice Max HSA or Choice Premier HSA and contributes at least $100 to an Optum Bank HSA through payroll deductions, Farmers will contribute $500 to her HSA. Janet can contribute the money she s saving on her monthly contributions to further increase her HSA savings. 17

18 MEET DENISE Age: 38 Status: Looking for employee plus child(ren) coverage Health snapshot: Uses health care frequently for family needs Denise and her husband know that in a family of five, health care expenses can be hard to predict. Her husband has coverage through his employer but Denise covers the children under Farmers plan. Having three active children under the age of 12 means injuries are not uncommon. Additionally, Denise has minor surgery planned for the coming year. To help cover expected and unexpected costs, they use an HSA. Because of their lower medical contributions, they can afford to contribute money into this tax-advantaged account. For 2015, Denise thinks her family s health care costs may reach $20,000. Denise also contributes $3,000 to her HSA. She can use the money to offset her deductible or save for future use. Based on Denise s expected health care needs, the Choice Plus HSA is the least expensive plan. Here s what her math looks like for each of the plans: HIGH DEDUCTIBLE HEALTH PLANS PPO Considerations Choice Plus HSA Choice Max HSA Choice Premier HSA Choice Plus* Denise s 2015 payroll deductions for employee plus child(ren) coverage $2,664 $1,404 $456 $5,352 Pays toward deductible $2,600 of the $2,600 deductible $4,000 of the $4,000 deductible $5,600 of the $5,600 deductible $1,500 of the $1,500 deductible Dollars in excess of deductible paid through coinsurance (Denise pays 20% and the plan pays 80%, up to the out-of-pocket maximum) $2,600 (hits out-of-pocket maximum) $3,200 (20% of her remaining $16,000 in expenses) $2,880 (20% of her remaining $14,400 in expenses) $1,500 (hits out-of-pocket maximum) HSA dollars** (Farmers contribution) $1000 $1000 $1000 N/A Total Cost for Denise $6,864 $7,604 $7,936 $8,352 Maximum exposure for out-ofpocket (In-network) medical expenses (does not include payroll deductions) $5,200 $8,000 $11,200 $3,000 *Under Choice Plus, prescription drugs are covered with copays and are not subject to the deductible. To simplify these examples, no prescription drug expenses were included. ** If Denise elects Choice Plus HSA, Choice Max HSA or Choice Premier HSA and contributes at least $200 to an Optum Bank HSA through payroll deductions, Farmers will contribute $1,000 to her HSA. Denise can contribute the money she s saving on her monthly contributions to further increase her HSA savings. 18

19 If you can t find your answer in Benefits and Policies or call the HRSC, they re standing by. (888) a.m. - 5 p.m. PST Monday - Friday hr.service.center@farmersinsurance.com MEET LARRY Age: 61 Status: Looking for employee plus spouse coverage Health snapshot: Fairly healthy, uses health care moderately Larry and his wife are just a few years away from retirement, so he s been preparing by contributing as much as possible to his HSA. He likes the pre-tax savings opportunity available with the HSA, and he knows that these funds will be useful in his retirement years to help pay for his eligible expenses. Larry and his wife are generally healthy. He has high blood pressure, but he takes medication and receives regular care so his condition is well-managed. On top of his regular care, Larry thinks there might be only one or two trips to the doctor s office for allergies or other minor illnesses. For 2015, Larry expects his medical expenses will come to $2,700 (beyond preventive care). Larry also contributes $6,650 to his HSA (because he is over 55, he takes advantage of the additional $1,000 catch-up contribution). He can use this money to offset his deductible and coinsurance or save for future use. Here s what his math looks like for each. Based upon Larry s expected health care costs, the Choice Premier HSA looks like the best option. Larry knows this plan has an in-network out-of-pocket maximum of $11,200; the most he ll have to pay if he incurs unexpected medical costs. Turn the page to see what happens. HIGH DEDUCTIBLE HEALTH PLANS PPO Considerations Choice Plus HSA Choice Max HSA Choice Premier HSA Choice Plus* Larry s 2015 payroll deductions for employee plus spouse coverage $3,612 $1,896 $708 $7,236 Pays toward deductible $2,600 of the $2,600 deductible $2,700 of the $4,000 deductible $2,700 of the $5,600 deductible $1,500 of the $1,500 deductible Dollars in excess of (in-network) deductible paid through coinsurance (Larry pays 20% and the plan pays 80%, up to the out-ofpocket maximum) $240 (20% of his remaining $100 in expenses) $0 $0 $240 (20% of his remaining $1,200 in expenses) HSA dollars** (Farmers contribution) $1000 $1000 $1000 N/A Total Cost for Larry $5,232 $3,596 $2,408 $8,976 Maximum exposure for out-ofpocket in-network medical expenses (does not include payroll deductions) $5,200 $8,000 $11,200 $3,000 *Under Choice Plus, prescription drugs are covered with copays and are not subject to the deductible. To simplify these examples, no prescription drug expenses were included. ** If Larry elects Choice Plus HSA, Choice Max HSA or Choice Premier HSA and contributes at least $200 to an Optum Bank HSA through payroll deductions, Farmers will contribute $1,000 to his HSA. Larry can contribute the money he s saving on his monthly contributions to further increase his HSA savings. 19

20 AS IT TURNS OUT Larry s wife needed multiple surgeries and physical therapy after she fell and broke her leg. This caused their 2015 health care expenses to rise to $68,000. The out-of-pocket maximum under all four medical options protected them from paying the full cost of their large claims from their own pocket. Based on Larry s expectations, the Choice Premier HSA originally looked like the best option. However, Larry s plan met with the unexpected. If Larry could have forseen the future, the Choice Plus HSA plan would have been the best choice. However, since he s been putting money into his HSA, he has the funds to pay for his portion of the medical expenses, which are capped by out-of-pocket maximums. Here s what their 2015 costs actually look like. HIGH DEDUCTIBLE HEALTH PLANS PLAN FOR THE UNEXPECTED: Make sure you know the out-ofpocket maximum for the medical plan you select and that you are able to cover this potential expense. Take full advantage of an HSA if you re enrolled in one of the High Deductible Health plans. PPO Considerations Choice Plus HSA Choice Max HSA Choice Premier HSA Choice Plus* Larry s 2015 payroll deductions for employee plus spouse coverage $3,612 $1,896 $708 $7,236 Pays toward deductible (in-network) $2,600 of the $2,600 deductible $4,000 of the $4,000 deductible $5,600 of the $5,600 deductible $1,500 of the $1,500 deductible Dollars in excess of deductible paid through coinsurance (Larry pays 20% and the plan pays 80%, up to the out-of-pocket maximum) $ 2,600 in coinsurance, plus her deductible, puts Larry at the $5,200 out-ofpocket maximum $4,000 in coinsurance, plus her deductible, puts Larry at the $8,000 out-of-pocket maximum $5,600 in coinsurance, plus her deductible, puts Larry at the $11,200 out-ofpocket maximum $1,500 in coinsurance, plus her deductible, puts Larry at the $3,000 out- ofpocket maximum HSA dollars** (Farmers contribution) $1000 $1000 $1000 N/A Total Cost for Larry $7,812 $8,896 $10,908 $10,236 Maximum exposure for out-ofpocket medical expenses (in-network) $5,200 $8,000 $11,200 $3,000 *Under Choice Plus, prescription drugs are covered with copays and are not subject to the deductible. To simplify these examples, no prescription drug expenses were included. ** If Larry elects Choice Plus HSA, Choice Max HSA or Choice Premier HSA and contributes at least $200 to an Optum Bank HSA through payroll deductions, Farmers will contribute $1,000 to his HSA. Larry can contribute the money he s saving on his monthly contributions to further increase his HSA savings. 20

21 For detailed information on Farmers benefits, log in to GEMS and go to Employee Self-Service and select Benefits & Policies MAKE A SMART CHOICE VISIT UHC S PRE-MEMBER WEBSITE When you consider which medical option is right for you, remember that the monthly employee contribution is only a part of your health care costs. Your total health care expenses include your payroll contributions and your out-ofpocket health care expenses. The UHC Plan Cost Estimator can help you add up all of these considerations. The UHC Plan Cost Estimator analyzes your unique needs like your prescription drug costs, treatment for chronic conditions and any planned procedures and compares what your health care expenses could be under each of the medical plan options. You can use the UHC Plan Cost Estimator to model contributions to your HSA and Health Care FSA to maximize your tax savings and manage your total outof-pocket costs. When using the Plan Cost Estimator, remember to plan for the unexpected and consider what you have and what you can contribute to your HSA when making your medical plan decisions. The Plan Cost Estimator is located within United Healthcare s pre-member website where you can also find medical plan highlights, a link to find a network doctor or hospital near you and you can also learn about Optum Bank and eligibility requirements to open an HSA, as well as access to other tools and resources. REMEMBER: As you consider your health care costs for 2015, remember to take into account your Benefit Dollars and HSA Dollars, which further offset the cost of your Farmers benefits. 21

22 HEALTHFIRST PLUS We re in this together! Your health care is a shared responsibility your health care costs reflect our actual claims experience. Taking care of yourself and getting the right care at the right time benefits you and Farmers. With a single call to HealthFirst, you can start living a healthier life. Call anytime and speak with a health specialist, wellness coach or nurse, who will provide assistance and help you find the health program or service that best meets your needs. Consider this your personal health care concierge service to help you: Find a doctor (they ll even schedule your appointment) Compare treatment options and costs Work with a nurse who can provide support and help you live better with an ongoing condition such as back pain, diabetes, or heart disease Better understand your medications, tests and procedures Create a personalized fitness plan Enroll in the diabetes prevention and control program Understand your symptoms and decide if you should see a doctor Connect with the Employee Assistance Program (EAP) USE HEALTHFIRST PLUS HealthFirst Plus makes your life easier and healthier. Learn more about all the HealthFirst Plus services available to you by calling (866) HealthFirst Plus makes your life easier and healthier. Learn more about all the HealthFirst Plus services available to you by calling (866) So, whether you have a short-term health situation or a long-term health condition, HealthFirst Plus has health specialists, wellness coaches, and registered nurses available to provide specialized support. In certain situations, you may be contacted directly by a HealthFirst nurse or health specialist. If that happens, take advantage of it. The service is private and confidential, and is available at no additional cost to you as part of your Farmers benefits. Some services are available to all employees, while for others you must be covered under a Farmers medical plan. 22

23 If you can t find your answer in Benefits and Policies or call the HRSC, they re standing by. (888) a.m. - 5 p.m. PST Monday - Friday hr.service.center@farmersinsurance.com VISION Take care of your eyes with vision coverage through Farmers. Our vision plan offers the convenience of being able to use any vision care provider, but a lower out-of-pocket expense for you if you choose an EyeMed provider. To find an EyeMed provider near you, visit At a glance: Your vision coverage Coverage In-network Out-of-network Exams $10 copay, once every calendar year $50 allowance Lenses $25 copay, once every calendar year $50 to $75 allowance Frames $0 copay with a $150 retail allowance, once every two calendar years $70 allowance Contact lenses $0 copay with a $150 retail allowance, once every calendar year instead of lenses $105 allowance for elective contact lenses $210 allowance for necessary contact lenses THE EYEMED PLAN OFFERS YOU THESE EXTRA DISCOUNTS: Save 40 percent on all additional complete eyeglasses pair purchases (unlimited use) Save an average of 15 percent on regular price services through Laser Vision Correction or 5 percent off promotional prices through the U.S. Laser Network Going to an in-network provider provides a higher benefit and lower, discounted rates. To receive in-network benefits in 2015, you will need to select an EyeMed provider. For more information, visit Click on the drop-down menu in the Locate a Provider box and choose the Select network. 23

24 DENTAL Good dental care plays an important part in your overall health. Take care of your teeth and gums with dental coverage through Farmers. You have a choice of two Aetna dental plan options: the Dental PPO and the Dental DMO. You can also enroll in the MetLife DMO (formerly known as Safeguard DMO) if you live in California, Texas or Florida. The plans generally cover the same types of services, but how you access care and share costs differ. How the Dental PPO works The Dental PPO offers coverage for a broad range of services with a low deductible, and your preventive dental care is covered at 100 percent. For other dental services, you ll share the cost with the plan by paying coinsurance. You can see any provider but you ll maximize your benefits when you see in-network providers. How the Dental DMO and MetLife DMO work The Dental DMO administered by Aetna is available in most areas and the MetLife DMO is available to you if you live in the DMO service areas in California, Texas or Florida. Both offer coverage for a broad range of services with no deductibles or annual maximums, and you ll pay a fixed copay for services other than diagnostic and some preventive dental care. If you re eligible for either DMO, it will be listed as an available option on your benefit enrollment screen. Under the DMO options, you and each of your covered family members must choose a participating primary care dentist (PCD) for coverage (generally there are no out of network benefits). If you do not choose a PCD by contacting Aetna or MetLife before the beginning of the year, you will not be able to obtain dental services until a provider is selected. You can find an Aetna PCD by calling Aetna Customer Service at (877) or using the DocFind tool at To find a MetLife PCD, visit or call (800)

25 For detailed information on Farmers benefits, log in to GEMS and go to Employee Self-Service and select Benefits & Policies At a glance: Your dental options You can find the schedule of dental benefits for each dental plan and for specifics on how procedures are paid for the dental plans on Benefits & Policies. Dental PPO Dental DMO (if available in your area) MetLife DMO (California, Florida and Texas only) Deductible $50 per person, up to $100 per family None None Annual plan maximum $1,500 None None Preventive services, such as cleanings and oral exams (up to two per calendar year) Plan pays 100% (not subject to deductible) $3 to $50 copay depending on the type of procedure $3 to $35 copay depending on the type of procedure Basic services, such as extractions and fillings Plan pays 80% after deductible $5 office copay for all office visits plus fixed copay per service, ranging from $3 to $50 depending on the type of procedure $5 to $80 copay, depending on the type of procedure*** Major services, such as crowns and bridges Plan pays 50% after deductible $5 office copay for all office visits plus fixed copay per service, ranging from $5 to $350 depending on the type of procedure $10 to $300 copay, depending on the type of procedure*** Orthodontia* Plan pays 50% after deductible, up to a lifetime maximum of $1,500** (children only) Screening exam: $30 Diagnostic records: $150 Adolescent and adult: $1,845 Orthodontic retention: $275 Treatment of adolescent/ adult dentition: $725 Orthodontic treatment adolescent and adult: $1,695 Orthodontic treatment plan and records: $250 * To be eligible for the orthodontia benefits in any of the dental options, the treatment must begin after the first day your dental coverage takes effect. This means if orthodontia treatment began in 2014 and you are initially enrolling for dental coverage as of January 1, 2015, the orthodontia benefit is excluded. **The Dental PPO option provides orthodontia coverage only for eligible dependent children under the age of 26. ***Refer to the schedule of benefits that can be found on Benefits & Policies. 25