Health Insurance Overview

Transcription

1 Spotsylvania County Open Enrollment August 10 to 28, 2015 Plan Year: October 1, 2015 to September 30, 2016 Health Insurance Overview All Full Time employees are eligible to participate in the County Health Insurance Plans. Current Health Plans are: Key Care 30 is the basic plan. Key Care 20 is the optional or buy-up plan. The Affordable Care Act (ACA) now requires prescription out-of-pocket co-pays to go towards any calendar year out-of-pocket maximums respective to your to plan choice. There is no increase to any co-pays, co-insurance, deductibles, etc. for either plan. The cost of premiums, co-payments, coinsurance and deductibles are the major difference between health plans. Key Care 30 has lower premiums withheld from your paycheck and a higher cost for some services. Please see the Side-by-Side comparison of plans at the end of this letter. Key Care 20 has higher premiums withheld from your paycheck and a lower cost for some services. Please see the Side-by-Side comparison of plans at the end of this letter. If you are eligible to enroll in another health plan, you may wish to compare the options available to you before electing to participate in one of the County health plans. If you and your spouse are employed full time by the County, you are not required to have the same policy. For example: If you have one child to cover, one of you may enroll as employee + 1 child and the other enroll as employee only. If you do not have 1 child to cover, each of you may enroll in employee only coverage rather than employee + spouse coverage. 1

2 Rates Key Care 30 Key Care 20 Coverage Level Total County Share EE Monthly EE Per Pay Total County Share EE Monthly EE Per Pay Employee Only Employee + 1 Child Employee + Spouse 1, , , , Employee + Family 1, , , , *Rates include Health, Dental, Vision and Prescription Drug benefit Premiums are pre-taxed and deducted over 24 pay periods beginning on the October 2, 2015 payday. Pre-tax deductions reduce your Social Security, Federal and State tax withholdings. If you are changing your coverage option, adding or dropping dependents and/or changing health plans, you are required to complete an Anthem enrollment form. This form can be found on the Human Resources intranet, select Forms. Health and Dental enrollments are now on one form. Return your completed Anthem enrollment form to Human Resources no later than 4:30pm on Friday, August 28, Anthem Enrollment Forms will not be accepted after 4:30 PM on Friday, August 28,

3 Beginning in 2016 (for tax year 2015), the Affordable Care Act (ACA) requires employers to provide information to their employees as to who is or was covered under their health insurance plan for the prior calendar year. This documentation will show name, social security number, date of birth and what months the dependent was covered under your health insurance policy. A similar report will also be sent to the Internal Revenue Service by employers. This information will be distributed to employees no later than January 31, Mandatory documents are available for your review on the Human Resources section of the intranet site or by contacting the Human Resources Department at Mandatory notices are: Summary of Benefits and Coverage (SBC) Medicare D Notice Newborns and Mothers Health Protection Act Mastectomy Benefits Loss of Medicaid or CHIP Eligibility HIPAA Qualifying Event Overview Some examples of a Qualifying Event are: marriage, divorce/legal separation, birth/adoption of a child, loss of coverage, and death. If you have any questions regarding Qualifying Events, please contact Beth Ann Reinhart at (540) or at breinhart@spotsylvania.va.us. If you experience a Qualifying Event, per IRS requirement you must complete a new application within 31 days of the Qualifying Event. For example: You marry or have a child born on August 15 th. To modify health coverage, a complete Health and Dental Enrollment Form is due to Human Resources no later than September 15 th. If you do not comply with the 31-day IRS requirement for a Qualifying Event, you will not be able to enroll or make changes to your existing health plan until the next Open Enrollment or when you experience another Qualifying Event. 3

4 County of Spotsylvania: Health Plan Summary Key Care 20 & Key Care 30 October 1, September 30, 2016 PLAN OPTION OPTIONAL PLAN KEYCARE 20 (patient liability) BASIC PLAN KEYCARE 30 (patient liability) CALENDAR YEAR DEDUCTIBLE (January 1 through December 31) $0 individual / $0 family $500 individual / $1,000 family OUTPATIENT OFFICE VISITS Primary Care Physician (PCP) Specialist $20 copayment $40 copayment DEDUCTIBLE DOES NOT APPLY $30 copayment $50 copayment PREVENTIVE CARE & WELL BABY CARE $0 copayment DEDUCTIBLE DOES NOT APPLY $0 copayment ANNUAL VISION EXAM $15 co-payment ($30 out of network allowance) DEDUCTIBLE DOES NOT APPLY $15 co-payment ($30 out of network allowance) DIAGNOSTIC TESTS THERAPIES: Physical, speech, occupational Physical and occupational therapy have a combined 30 visit limit per calendar year. Speech therapy has a 30 visit limit per calendar year. $40 copayment + OUTPATIENT SURGERY MATERNITY CARE $100 copayment + $400 copayment + PROFESSIONAL (global bill): MENTAL HEALTH and SUBSTANCE ABUSE OFFICE VISITS $20 copayment DEDUCTIBLE DOES NOT APPLY $30 copayment INPATIENT HOSPITAL SERVICES SKILLED NURSING FACILITY 100 day per stay limit $400 copayment + NO CO-PAY APPLIES 4

5 DURABLE MEDICAL EQUIPMENT AMBULANCE SERVICES EMERGENCY ROOM COMBINED MEDICAL and PRESCRIPTION DRUG CALENDAR YEAR OUT-OF-POCKET (in-network) $100 copayment + $3,000 individual / $6,000 family COPAYMENTS, and COINSURANCE ACCUMULATE TO ANNUAL OUT-OF-POCKET NO CO-PAY APPLIES $3,500 individual / $7,000 family DEDUCTIBLE, COPAYMENTS, and COINSURANCE ACCUMULATE TO ANNUAL OUT-OF-POCKET COMBINED MEDICAL and PRESCRIPTION DRUG CALENDAR YEAR (out-of-network) CALENDAR YEAR DEDUCTIBLE COINSURANCE OUT-OF-POCKET $500 individual / $1,000 family 30% coinsurance $4,500 individual / $9,000 family $1,500 individual / $3,000 family 40% coinsurance $5,250 individual / $10,500 family PRESCRIPTION DRUGS Retail (30 day supply) Mail Order (90 day supply) Tier 1 $10 / Tier 2 $20 / Tier 3 $35 Tier 1 $10 / Tier 2 $40 / Tier 3 $105 Tier 1 $10 / Tier 2 $30 / Tier 3 $50 Tier 1 $10 / Tier 2 $60 / Tier 3 $150 *Key Care 30 and Key Care 20 have identical dental, EAP and vision coverage.* Anthem Enrollment Forms will not be accepted after 4:30 PM on Friday, August 28,