State Health Plan Benefits North Carolina Retired Governmental Employees Association April 2015

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1 State Health Plan Benefits North Carolina Retired Governmental Employees Association April 2015

2 Presentation Overview Medicare Eligible Plan Options 2015 Annual Enrollment Results Outreach Events Enrollment Distribution Aging into Medicare Disability Other Insurance/TRICARE Re-employment and State Health Plan 2016 Benefit Changes Transition of Services 2

3 State Health Plan Options for Non-Medicare Retirees Traditional 70/30 PPO Plan Enhanced 80/20 PPO Plan Consumer-Directed Health Plan (CDHP) with a Health Reimbursement Account 3

4 State Health Plan Options for Medicare Retirees Humana Group Medicare Advantage (PPO) Base Plan Humana Group Medicare Advantage (PPO) Enhanced Plan UnitedHealthcare Group Medicare Advantage (PPO) Base Plan UnitedHealthcare Group Medicare Advantage (PPO) Enhanced Plan Traditional 70/30 Plan Traditional 70/30 Plan premium free for Medicare Primary members; monthly premium for Medicare eligible spouses and/or dependents. Base Plan premium free for primary member; monthly premium for Medicare eligible spouse and/or dependents. Enhanced Plan monthly premium for primary member ($33) and Medicare eligible spouse and/or dependents 4

5 Medicare Primary Retiree Outreach Events During Sept-Oct 2014 prior to Annual Enrollment: 67 Medicare Primary Outreach Events were conducted in 38 counties. 3,419 individuals attended Outreach Events 53% of attendees completed a survey 97% were pleased that the State Health Plan has multiple choices for Medicare primary retirees. 98% agreed that the information presented was helpful and easy to understand. 99% agreed that the presenters were clear and knowledgeable. 95% agreed that the location was convenient. 87% heard about Annual Enrollment through the 1 st mailer this year; 5% through a friend/family member; 8% through other means, such as SHIIP or the Internet. 5

6 Plan Distribution Post Enrollment-Active/Non-Medicare Retirees 9,972, 3% 198,589, 55% 154,355, 42% Subscriber counts only. Traditional 70/30 Enhanced 80/20 CDHP 6

7 Plan Distribution Post Enrollment-Medicare Primary Retirees 31,147, 23% 33,395, 25% 36,181, 27% 27,976, 21% 6,253, 4% Humana Base Plan Humana Enhanced Plan UHC Base UHC Enhanced Traditional 70/30 Traditional 70/30 results do not include dependent counts. Dependents are included in the MAPDP results. 7

8 Aging Into Medicare Retirees aging into Medicare are automatically enrolled into either Humana or UnitedHealthcare s Group Medicare Advantage Base Plan. 50/50 split between the two companies If you wish to select a different plan option other than the one to which you are assigned, you will need to call the Eligibility and Enrollment Support Center at or log into ORBIT and change your plan through the eenroll system. You will not be able to change plans again until the next Annual Enrollment period. 8

9 Disability If you become eligible for Medicare due to disability, it is very important for you to enroll in both Medicare Part A and Medicare Part B. Do not overlook accepting Medicare Part B. Many people fail to accept the offer to retroactively purchase Medicare Part B. State Health Plan becomes SECONDARY to Medicare as of the Medicare eligibility date. Claims will be reprocessed back to Medicare eligibility date. The State Health Plan will reduce your claims by the amount that would have been paid under Medicare, paying the remaining claim amount under the terms of the health benefit plan. As a result, if you do not enroll in Medicare Part B, you will be responsible for the amount that would have been paid by Medicare Part B. 9

10 Medicare Advantage & Other Insurance Enrollment in other insurance coverage may result in disenrollment from our group Medicare Advantage Prescription Drug plans. If disenrollment occurs subscriber or dependent (if applicable) would be placed automatically in the Traditional 70/30 plan. Enrollment in another Part D prescription drug plan (PDP) or Medicare Advantage plan can also cause you to be disenrolled from your SHP plan. When enrolled in a MAPDP, you can not purchase a Medicare Supplement or Medigap plan without terminating the MAPDP. If already enrolled in an individual Medicare Advantage or Part D prescription drug plan, your coverage will terminate when autoenrolled unless you opt out of these Group Medicare Advantage plans. 10

11 TRICARE & Other Insurance TRICARE for Life (TRICARE + Medicare) TRICARE for Life beneficiaries can enroll in Medicare Advantage plans and TRICARE will reimburse your copayments for services covered by TRICARE. TRICARE pays secondary to the Medicare Advantage plan. You cannot use Medicare or Medicare Advantage in a Military Treatment Facility, like a VA Hospital. TRICARE beneficiaries have a robust pharmacy benefit and typically don t need additional prescription drug coverage. If covered by another Employer Group Health Plan, it is important to check with them before enrolling in one of these Medicare Advantage plans. Federal Employee Health Benefit Plans (FEHBP) Other former employer retiree group health plans 11

12 Re-employment and State Health Plan General Assembly passed legislation to create a new eligibility category for non-permanent full-time employees to comply with the Affordable Care Act (ACA). Directed State Health Plan to offer a health benefit for newly eligible employees that is not greater than the bronze level as defined under ACA. High Deductible Health Plan (HDHP) created which meets the bronze level requirements. Employing units are responsible for determining eligibility for this plan. Includes non-permanent employees who work at least 30 hours per week. Employing units are required to cover re-hired State retirees as active employees if they are determined to meet definition of full-time employee. Eligible re-hired retirees are NOT eligible for retiree health benefit coverage. Retiree are not required to enroll in HDHP but no longer eligible for State Health Plan under Retirement Systems. State Health Plan will terminate the retiree from retiree group coverage under Retirement Systems. 12

13 2016 Benefit Changes (Actives & Non-Medicare Retirees) Consumer-Directed Health Plan (CDHP) with HRA Enhanced 80/20 Plan Traditional 70/30 Plan Increase premium approximately $40 with the opportunity to earn it down to $0 Modify healthy activities to earn premium credits Increase HRA contribution by $100 to help offset member cost share Increase out-of-pocket max by $500 Establish Health Engagement Program to earn additional contributions to HRA: Increase credits for PCP visits and use of Blue Options Designated Providers Engage members with chronic conditions Healthy lifestyle program for all members Increase premium approximately $40 with the opportunity to earn it down to approximately $15 Modify healthy activities to earn premium credits Increase Tier 5 (non-preferred specialty medications) pharmacy coinsurance maximum Active Employees Only Establish a $40 premium with the opportunity to earn it down to $0 Establish healthy activity to earn premium credit: Tobacco attestation Active Employees and Retirees Increase member cost share copays, deductible, coinsurance max, and pharmacy out-of-pocket max Premium amounts referenced on this slide are estimates and requires legislation and Board approval 13

14 2016 Plan Design Changes (Actives & Non-Medicare Retirees) Current CDHP 2016 CDHP Current 2016/80/20 Current 70/ /30 Annual Contribution to Health Reimbursement Account (HRA) $500 Individual $1,500 Family $600 Individual $1,800 Family N/A N/A N/A Annual Deductible $1,500 Individual $4,500 Family $1,500 Individual $4,500 Family $700 Individual $2,100 Family $933 Individual $2,799 Family $1,054 Individual $3,162 Family Coinsurance Maximum N/A N/A $3,210 Individual $9,630 Family $3,793 Individual $11,379 Family $4,282 Individual $12,846 Family Out-of-Pocket (OOP) Maximum Pharmacy Out-of- Pocket Maximum $3,000 Individual $9,000 Family $3,500 Individual $10,500 Family N/A N/A N/A Included in OOP Included in OOP $2,500 $2,500 $3,294 Preventive Care $0 ACA Services $0 ACA Services $0 ACA Services PCP Visit Specialist Visit 15% after deductible; $15 added to HRA if you use PCP on ID 15% after deductible; $10 added to HRA if you use Blue Options Designated specialist 15% after deductible; $25 added to HRA if you use PCP on ID 15% after deductible; $20 added to HRA if you use Blue Options Designated specialist $30 for primary doctor; $15 if you use PCP on ID card $70 for specialist; $60 if you use Blue Options Designated specialist $35 PCP $81 Specialist $39 PCP $92 Specialist $35 $39 $81 $92 Urgent Care 15% after deductible 15% after deductible $87 $87 $98 Chiro/PT/OT 15% after deductible 15% after deductible $52 $64 $72 Emergency Care 15% after deductible 15% after deductible $233, then 20% after deductible $291, then 30% after deductible $329, then 30% after deductible Inpatient Hospital 15% after deductible; $50 added to HRA if you use Blue Options Designated hospital 15% after deductible; $200 added to HRA if you use Blue Options Designated hospital $233 copay, then 20% after deductible; copay not applied if you use Blue Options Designated hospital $291, then 30% after deductible $329, then 30% after deductible

15 2016 Plan Design Pharmacy Changes Pharmacy Benefit Current CDHP 2016 CDHP Current 80/ /20 Current 70/ /30 Tier 1 15% after 15% after $12 $12 $12 $15 Tier 2 deducible for in deducible for $40 $40 $40 $46 Tier 3 network benefits, 35% in network benefits, 35% $64 $64 $64 $72 Tier 4 after deductible after out of network deductible out 25% up to $100 25% up to $100 25% up to $100 25% up to $100 Tier 5 of network 25% up to $125 25% up to $132 25% up to $125 25% up to $132 OOP Integrated with Medical Integrated with Medical $2,500 Rx Only $2,500 Rx Only $2,500 Rx Only $3,294 Rx Only ACA Preventive Medications Covered 100% Covered 100% Covered 100% Covered 100% No No CDHP Preventive Medications Waive deductible, 15% coinsurance only Waive deductible, 15% coinsurance only N/A N/A N/A N/A 15

16 2015 Transition to Aon Hewitt Effective June 1, 2015, services currently performed by BenefitFocus will transition to Aon Hewitt. This transition will be seamless to members. Same phone number for support Access enrollment system via ORBIT System name will remain eenroll Online enrollment will have a new look and feel for retirees that will hopefully be easier to navigate. Telephonic enrollment and navigational support remains available by calling

17 2015 Outreach Pre-retiree/Pre-65 meetings - explains State Health Plan Options when retiring - will be held in April and May Retiree Annual Enrollment Meetings review of the Medicare eligible plan options available to Medicare eligible retirees will be held in September and October. Annual Enrollment mailings will occur in August and September. The Annual Enrollment Period for 2016 plan year will be during the month of October 2015 READ all mail from the State Health Plan completely. 17

18 Important Numbers ELIGIBILITY AND ENROLLMENT SUPPORT CENTER HUMANA UNITEDHEALTHCARE BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and HRA) EXPRESS SCRIPTS (PHARMACY QUESTIONS for Active/Non- Medicare Retirees) If you have questions about Medicare enrollment, you may contact the Seniors Health Insurance Information Program (SHIIP) at

19 Thank You! Questions?