Medical & Prescription Drug Program Employee Informational Meetings

Transcription

1 Medical & Prescription Drug Program Employee Informational Meetings

2 Today s Discussion Review Medical Plan Design Options: Preferred Provider Organization (PPO) Plan Qualified High Deductible Health Plan (QHDHP) Common Terms Wellness Program Components New! MetLife Voluntary Product Offering Voluntary Supplemental Term Life/ADD Identity Theft Protection Dates to Remember 2

3 Medical Plan Design Options PPO: In-network deductible of $500 Individual/$1,000 Family This is exclusive of copayments. They do not accumulate toward the deductible 10% coinsurance after the deductible has been satisfied up to an In-Network Out-of-Pocket Maximum of $1,000 Individual/$2,000 Family Prescription Drug copays: Retail (31 day supply) - $10 Generic/$35 Formulary/$70 Non-Formulary Mail Order (90 day supply) - $20 Generic/$70 Formulary Brand / $140 Non-Formulary The Medical Flexible Spending Account (FSA) is offered with the PPO Qualified High Deductible Health Plan (QHDHP) + Health Savings Account (HSA) Combined In-Network & Out-of-Network deductible of $1,500 Individual/$3,000 Family 10% coinsurance after the deductible has been satisfied up to the In-Network Out-of-Pocket Maximum of $1,500 individual/$3,000 family Prescription drugs are subject to deductible and co-insurance May be coupled with a Health Savings Account (HSA) Both Allegheny College and employees may contribute Allegheny College will contribute to the HSA based on each employee s coverage tier $500 Single coverage $1,000 All other coverage tiers 2015 IRS annual pre-tax contribution limits are $3,350 Individual/$6,650 Family 3

4 Plan Designs PPO & QHDHP PPO QHDHP In Network Out of Network In Network Out of Network MEDICAL Deductible (Individual/Family) $500 / $1,000 $1,000 / $2,000 $1,500 / $3,000 Coinsurance 10% 30% 10% 30% Out-of-Pocket Maximum (Individual/Family) $1,000 / $2,000 $2,000 / $4,000 $1,500 / $3,000 $3,000 / $6,000 Total Out-of-Pocket Maximum (Individual/Family) $6,600/$13,200 Not Applicable Not applicable Not Applicable Office Visit / Specialist Coverage $20 / $30 30% after deductible 10% after deductible 30% after deductible Urgent Care $30 30% after deductible 10% after deductible 30% after deductible Preventive Care 0% no deductible Not Covered 0% no deductible Not Covered ER Coverage $100 copay 30% after deductible 10% after deductible 30% after deductible PRESCRIPTION DRUG Generic Formulary Non-Formulary 31 day supply $10 copay $35 copay $70 copay 31 day supply 10% after deductible 10% after deductible 10% after deductible 4

5 Wellness Program Components The program components are outlined below, each step must be completed to earn the $250 cash incentive at the end of the program which is June 30, 2016 Wellness Program Components 1. Obtain a Routine Physical Exam timeframe to complete July 1, 2015 June 30, 2016 A routine physical exam helps detect health problems in early stages when they can be easier and less costly to treat 2. Obtain a Biometric Screening timeframe to complete July 1, 2015 June 30, 2016 Biometric screenings are a quick & easy assessment tool to determine your current health status. Testing will include a finger stick blood draw followed by consultation with a health professional on the results. 3. Complete Wellness Profile timeframe to complete September 1, 2015 November 2015 The WebMD online profile is a confidential health risk assessment tool used to analyze your current health status and identify potential risk. 5

6 Wellness Program Components 4. Complete a Wellness Based Activity timeframe to complete July 1, 2015 June 30, 2016 Members are required to complete 1 of the following activities: Telephonic Coaching: A Blues On Call Health Coach can give you information about losing weight, managing stress or quitting tobacco. Learn about symptoms for diseases and the latest treatment options for chronic conditions. Find out about your medications or understand an upcoming test or procedure Online My Health Assistant: a WebMD digital health assistant simulates a health coaching experience by providing guidance, support, subject expertise and resources so that members remain motivated and achieve success. Programs include: Emotional Health, Exercise, Nutrition, Stress Management, Tobacco Cessation and Weight Management. Eating for Health: on-site pre-recorded presentation featuring Emily Fonnesbeck, a staff dietitian at the Biggest Loser Resort. 6

7 Dates To Remember Biometric Screenings will be held on campus: September 22, 2015 from 7:00 AM 11:00 AM September 23, 2015 from 7:00 AM 11:00 AM September 29, 2015 from 7:00 AM 11:00 AM September 30, 2015 from 7:00 AM 11:00 AM Wellness profile day will be held on campus on September 22, 2015 from 10:00 AM 5:00 PM Highmark s mobile unit will be available with laptops and representatives to help members complete the profile and answer questions An additional wellness profile day is scheduled on-campus tentatively in October 7

8 New!! Voluntary Product Offering MetLife - Voluntary Supplemental Term Life/ADD Employees will be able to purchase (post-tax) voluntary supplemental term life/add for you and/or your spouse or dependents through MetLife Employees can purchase supplemental term life/add coverage up to 5x their annual salary or $500,000 in increments of $10,000 with no age reduced benefit. Coverage is guarantee issue at $100,000 Employees can also purchase supplemental term life/add coverage for their spouse or child dependent This policy is portable and has a conversion benefit: Employee may convert this policy to an individual whole life policy. MetLife guarantees coverage (member can t be denied) but policy is individually underwritten Employee may port coverage to an individual term policy at retirement Example, how to calculate monthly premium Employee age 45 would like to purchase $100,000 of supplemental term life coverage 100,000 of coverage/$1,000 = 100 x.150 = $15.00 a month Employee age 60 would like to purchase $100,000 of supplemental term life coverage 100,000 of coverage/$1,000 = 100 x.563 = $56.30 a month 8

9 New!! Voluntary Product Offering Voluntary Supplemental Term Life Rates Age Bracket Employee Life Rate per $1,000 Spouse* Life Rate per $1, $0.049 $ $0.049 $ $0.049 $ $0.052 $ $0.064 $ $0.097 $ $0.150 $ $0.230 $ $0.378 $ $0.563 $ $0.904 $ $1.709 $1.709 Dependent Child Life** $0.240 per $1,000 Employee Supplemental AD&D $0.018 per $1,000 Spouse Supplemental AD&D $0.018 per $1,000 Child(ren) Supplemental AD&D** $0.051 per $1,000 9

10 New!! Voluntary Product Offering MetLife Defender - Identity Theft Protection Employees can now purchase identity theft protection through MetLife s Defender product MetLife s Defender product offers comprehensive coverage using 25 data points Example s of just a few benefits you will receive: Personally identifiable information protection Personal health information and medical data protection Medical insurance fraud protection Credit monitoring Online account protection File sharing privacy protection 10