2011 Open Enrollment

Transcription

1 2011 Open Enrollment TO: USI Faculty and Staff FROM: Brandyn Smith Benefits Manager DATE: October 26, 2010 RE: 2011 Open Enrollment Kick-off and Benefits Informational Fair During the Open Enrollment period you have the opportunity to evaluate your health insurance needs and make changes in your health plan coverage for the next plan year Open Enrollment will be October 26, 2010, to November 16 th, 2010.* At this time you may: Apply for health insurance coverage. Change your current health insurance coverage. NOTE: If you are in the Anthem Blue Access 1000 Plan, you will automatically be enrolled in the plan which replaces it (Lumenos CDHP/HSA) unless you enroll in another plan by filling out a form. Add dependents to your health insurance coverage. Drop dependents from your health insurance coverage. Enroll in the flexible benefit plan. Note: You must enroll in this plan annually. Enroll in, drop or change coverage in the voluntary supplemental life insurance program Enroll in the new optional vision plan with a new insurer. Note: If you currently have vision coverage, we will automatically enroll you for the same coverage with the new carrier unless you sign a form to opt out or change your coverage level. Enroll in the new voluntary short-term disability plan for partial income replacement when you have a disability. Note: You must enroll if you want this new benefit. Learn about and act on changes related to health reform including the option of covering dependents to age 26, the elimination of pre-existing condition exclusions for dependents up to age 19, and the elimination of lifetime maximums. In 2011, the University will offer four healthcare plans: Anthem Blue Access 300 Buy-Up Plan; Anthem Blue Access 500 Core Plan; a new Consumer-driven High Deductible Health plan (CDHP) with a Health Savings account (HSA) called Lumenos CDHP/HSA (which replaces the Anthem Blue Access 1000 High Deductible Plan); and Welborn HMO. Each of these options includes prescription drug coverage through the medical provider and dental coverage through Health Resources, Inc. (HRI). Attached is an Insurance Comparison Overview sheet for you to compare the benefits of the different health plans. It is very important that you take time to review the enclosed information closely as you make your health care choices for 2011, especially with regard to the New Benefit Offerings: Anthem Lumenos Consumer-Driven High Deductible Health Plan (CDHP) with Health Savings Account (HSA) Vision provider change from United Healthcare/Spectera to Anthem Voluntary Short-term Disability from The Standard

2 This year, to provide you with information on the new benefit offerings, we are creating an enhanced Human Resources website that contains additional information regarding all your benefits. Watch for the announcement of the new web page availability. Also, we are holding individual informational meetings this week on October 26, 27 and 28. Please feel free to attend as many sessions as you like. Please register for a meeting at or call (ext. 1989) to register. OPEN ENROLLMENT INFORMATION As always, the Open Enrollment Benefits Informational Fair will have representatives from Anthem Insurance Companies, Inc. (medical/rx), Welborn Health Plans (medical/rx), Health Resources, Inc. (dental), The Nyhart Company (flexible benefit plans),the Standard Insurance (short-term disability), Deaconess CONCERN Employee Assistance Program (EAP) with new Work- Life resources, TIAA CREF (retirement savings), PERF (retirement savings), and Prudential (Basic Life, AD&D & Supplemental Life Insurance) who will be available to discuss benefit options and decisions with you. The fair will be held on: Friday, November 5, :00 a.m. to 3:30 p.m. Carter Hall A benefit meeting for employees is also scheduled for Tuesday, November 9, at 10:00 p.m. in Human Resources Training Room, FA 164. If you are unable to attend the Open Enrollment Benefits Informational Fair, but are interested in talking with someone about your benefit coverage, please contact Amy Miller at or ajmiller3@usi.edu; Connie Schnarre at or csschnarre@usi.edu; or Brandyn Smith at or brsmith@usi.edu. If you are a current participant in one of the Anthem plans or the Welborn HMO, you may change your coverage without providing evidence of insurability. If you previously waived coverage for yourself and/or your dependents, Anthem requires submission of a Certificate of Health Coverage to waive the pre-existing condition waiting period. Enrollment forms will be available at the Open Enrollment Kick-Off and Benefits Informational Fair on November 5, 2010, or may be obtained from the Human Resources Department in the Wright Administration Building, Room FA 166. Open Enrollment will be your only opportunity to elect or change your medical, dental, vision, or related Section 125 Flexible Benefit Plan coverage elections and/or enroll or drop dependents or your own coverage on these plans for the 2011 calendar year. You may only make changes outside of the open enrollment period if you have a qualified family status change and notify the Human Resources benefit staff of that change within 30 days of the change. Enrollment forms must be completed by November 16, 2010,* to ensure coverage effective January 1, Your current health insurance coverage will be continued unless you complete a form to change your coverage. If you are in Anthem Blue Access 1000 plan, you will be automatically enrolled in the Lumenos CDHP/HSA plan unless you complete paperwork to waive coverage or to enroll in a different health plan. The 2011 insurance rates and open enrollment information for health and dental insurance coverage, the flexible benefit plan, the voluntary group term life insurance plan, and the optional vision insurance plan are included with this enrollment package.

3 IMPORTANT NOTE: Benefits under the USI benefit plan(s) are provided pursuant to insurance contracts between USI and the insurance companies. If the terms of this enrollment document conflict with the terms of the insurance contract, the terms of the insurance contract will control, unless superseded by applicable law. PLEASE READ THIS IMPORTANT INFORMATION. OPEN ENROLLMENT WILL TAKE PLACE TUESDAY, OCTOBER 26, 2010, THROUGH TUESDAY, NOVEMBER 16, 2010.* HEALTH and DENTAL INSURANCE PLAN INFORMATION Attached is an Insurance Comparison Overview sheet that will allow you to compare the benefits of the different health plans briefly summarized below. ANTHEM BLUE ACCESS 300 BUY-UP PLAN Prescription Drug (Rx) Co-payments Only Plan Design Change for 2011 In-network deductible $300 individual and $600 family Non-network deductible $600 individual and $1,200 family In network out-of-pocket maximum $1,500 individual and $3,000 family Non network out-of-pocket maximum $3,000 individual and $6,000 family In-network co-insurance 80%/20% and non-network co-insurance 60%/40% Generic Rx co-payments are lowered. A fourth tier is added for high cost specialty drugs. Rx retail co-payments $10/24/40/70 / mail order co-payments $20/48/80/140 (90 day supply) ANTHEM BLUE ACCESS 500 CORE PLAN Prescription Drug (Rx) Co-payments Only Plan Design Change for 2011 In-network deductible $500 individual and $1,000 family Non-network deductible $1,000 individual and $2,000 family In-network out-of-pocket maximum $2,500 individual and $5,000 family Non-network out-of-pocket maximum $5,000 individual and $10,000 family In-network co-insurance 80%/20% and non-network co-insurance 60%/40% Generic Rx co-payments are lowered. A fourth tier is added for high cost specialty drugs. Rx retail co-payments $10/40/60/80/ mail order co-payments $20/80/120/160 (90 day supply) New CONSUMER-DRIVEN HIGH DEDUCTIBLE HEALTH PLAN WITH HEALTH SAVINGS ACCOUNT (CDHP/HSA) replaces the ANTHEM BLUE ACCESS 1000 HIGH DEDUCTIBLE PLAN beginning January 1, 2011 This plan offers 100% preventative care coverage Deductible $1,500 for single coverage and $3,000 for any level of family coverage (employee plus child; employee-spouse or family) in-network and out-of-network combined for this non-embedded deductible Out-of-pocket maximum $3,000 for single coverage and $6,000 for any level of family coverage (employee plus child; employee-spouse, or family); $6,000 for single coverage and $12,000 for any level of family coverage out-of-network Co-insurance after deductible, 90%/10% co-insurance in-network or 70%/30% coinsurance non-network, until maximum out-of-pocket is reached Prescription drugs subject to deductible and co-insurance: in-network Rx retail and mail order co-insurance is 10% after deductible; non-network Rx retail & mail order coinsurance is 30% after deductible Enhanced wellness incentives with rewards include: health risk assessments, MyHealth Coach, Healthy Lifestyles, ComplexCare, and Comprehensive Medical Management On-line consumer tools, including comparative prescription drug shopping

4 A Health Savings Account (HSA) that allows both employer and employee to make tax-free contributions for use toward qualified healthcare expenses in 2011 and beyond University Contributions to your HSA as follows: o For single members, one-time, new participant funding of $200 and a regular contribution of $500 over the year, for a total of $700 in annual funding in 2011 o For all levels of family membership, one-time, new participant funding of $400 and a regular contribution of $1,000 over the year for a total of $1,400 in annual funding in 2011 o One-time employer contributions are only provided to those participating as of January 1. Newly eligible participants entering after January 1 will receive only prorated annual employer contributions Wellness Initiatives for the Anthem Plans Wellness initiatives will continue with the Anthem Blue Access Plans as steps toward controlling claims expense. These items include: 24/7 NurseLine: Access to a 24/7 NurseLine in which experienced registered nurses provide information concerning general health questions and guidance with critical health issues; Future Moms: Support from trained obstetrical nurses to provide maternity management to help expectant parents have a healthy pregnancy and delivery; ConditionCare: Assistance from registered nurses for members to better manage and improve chronic health conditions; MyHealthAdvantage: Utilizes integrated information systems and data analytics to enhance early detection of potential health issues for participants. MyHealth Advantage provides members and their doctors with information about evidence-based standards that can facilitate better health care choices. WELBORN HMO PLAN No Plan Design Changes for 2011 Must use WHP provider (Deaconess Only); no out-of-network benefits. Deductible $250 individual and $500 family Out-of-pocket maximum $1,500 Individual and $3,000 family In-network co-insurance 80%/20% and non-network co-insurance 60%/40% Rx retail co-payments $15/35/50 / mail order co-payments $30/70/100 (90 day supply) HEALTH REFORM CHANGES IMPLEMENTED FOR 2011 AFFECT ALL USI HEALTH PLANS Dependent child coverage has been extended to age 26. Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are now eligible to enroll in USI s health plans. Individuals may request enrollment for such children for 30 days from the date of this notice. Coverage will be effective January 1, Children will be covered until the end of their birth month in which they turn age 26. No pre-existing conditions for children under age 19 in the Anthem plans; Welborn already has no pre-existing condition exclusions for any members, including children. 100% preventative coverage for all conditions identified as nationally recommended preventative services No lifetime plan maximums or annual limits on essential benefits. The lifetime limit on the dollar value of benefits under USI s Anthem and Welborn health plans no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment for coverage effective January 1, No referrals required for OB/GYN services for the Welborn plan; Anthem already had a noreferral plan design

5 Emergency services coverage will not require preauthorization, be limited to in-network providers or impose higher cost sharing for out-of-network services in the Welborn plan; Anthem already had this feature. Both Anthem and Welborn will continue to conduct appeals processes for these insured plans; and the insurers will adapt those processes to conform to all requirements of health reform. USI health plans will not retroactively terminate coverage, except in limited situations, such as when the covered individual commits fraud against the plan or makes intentional misrepresentations. When rescission is permitted for other reasons, USI s health plans will provide the required prior notice of 30 days. HEALTH RESOURCES, INC. DENTAL PLAN No Plan Design Changes for % for preventive and 50% for restorative services Must use a Health Resources, Inc., provider Dependent limiting age extended to age 26 to match medical plans. POST RETIREMENT The University and its insured employees continue to contribute to a fund for future retiree health benefits (VEBA Trust) Employees continue to pay 25% or $2.12 for single coverage and $5.50 for all other coverage MONTHLY INSURANCE RATES: Health, Dental and Post-Retirement Blue Access 2010 Monthly Rates Blue Access 300 Buy-Up Blue Access 500 Core Lumenos CDHP/HSA Welborn HMO Employee $ $79.68 $46.54 $ EE + Child(ren) $ $ $83.88 $ EE + Spouse $ $ $ $ Family $ $ $ $ FLEXIBLE BENEFIT SPENDING ACCOUNTS Flexible Benefit Spending Accounts allow you to set aside pre-tax dollars to pay for certain unreimbursed medical and dental expenses, and dependent care expenses. The spending account limit for the un-reimbursed medical and dental expense reimbursement plan remains at $6,000 per year. The dependent care plan remains at the federal maximum allowance of $5,000 per year. Summary plan descriptions are available in the Human Resources Department. For 2011, the IRS ruled that over-the-counter (OTC) drugs are NO LONGER an allowable expense. Some OTC items can be claimed like vitamins and certain medication if you obtain a prescription from your doctor stating these are medically necessary. Please keep this in mind when determining the annual election for Examples of reimbursable medical expenses include eyeglasses, contact lenses, co-payments for doctor s visits, deductibles, and other costs (health, dental, or vision) not covered by co-insurance. A partial list of Eligible Expenses can be obtained at please disregard the over-the-counter items on this list since those will not be eligible in 2011 except for the limited exception described above. Employees may use 2010 funds remaining in their flexible spending accounts at the calendar year end for purchases through March 15, Any remaining 2010 balances not exhausted by March 15, 2011 will be lost. Additionally, employees may use 2011 funds remaining in their flexible spending accounts at the calendar year end for purchases through March 15, The grace period/carry-over of account balances will only apply to un-reimbursed medical and dental expenses. The dependent care flexible spending account must be exhausted within the particular calendar year for which those expenses were elected.

6 Please note that if you enroll in the Lumenos CDHP/HSA you are NOT eligible to participate in the Health Care Flexible Spending Account. Instead, you may defer tax-free funds into your Health Savings Account. CURRENT FLEXIBLE SPENDING ACCOUNT PARTICIPANTS Employees currently enrolled in flexible benefit spending accounts need to complete a new Section 125 Plan Enrollment Form, even if allocation amounts remain unchanged for calendar year These enrollment forms should be completed and returned to the Human Resources Department, FA166, by November 16, Benefit elections for current participants in the Flexible Benefit Premium Only Plan for pre-tax premium contributions will continue, unless you choose to change your election. NEW FLEXIBLE SPENDING ACCOUNT ENROLLEES Employees interested in establishing a Flexible Benefit Spending Account for 2011 will need to complete a Section 125 Plan Enrollment Form. Enrollment forms should be completed and returned to the Human Resources Department, Wright Administration Building, FA166, by November 16, The election form for the flexible benefit plan is attached. A Health Care Expense Reimbursement Worksheet also is attached. This form allows you to estimate the amount of out-of-pocket health care expenses for The election form also can be found on the USI Human Resources Benefits website. Watch for the announcement of our new website coming soon. NEW VOLUNTARY SHORT-TERM DISABILITY (STD) INSURANCE OFFERING Short Term Disability insurance helps provide a partial income replacement for temporarily disabled faculty and staff. From October 26, 2010, through November 16, 2010, you have the opportunity to enroll in this coverage at the employee meetings we are holding or you can enroll online at any time during the enrollment period. This benefit is a supplement to the University s sick pay benefit that will be of special interest to those (like short-service faculty and staff) with limited sick banks. To take full advantage of this plan, you should enroll at this first eligibility opportunity since late enrollees have a reduced benefit during the first 12 months after enrollment. Additional information, including rates, will be available shortly on the Human Resources website. VOLUNTARY GROUP TERM LIFE INSURANCE Voluntary Group Term Life Insurance offers you the option to purchase additional term life insurance at group rates on a payroll deduction basis for yourself, your spouse, and/or dependent children. You may purchase up to $500,000 or eight times annual earnings, whichever is less, for yourself and up to half that amount for your spouse. There are four levels of coverage for dependent children. The life insurance program is offered through Prudential Life Insurance Company. Please note that this insurance plan is strictly voluntary and is offered as a supplement to the University-provided life insurance. An Evidence of Insurability (EOI) form must be completed when applying at any other time than upon hire.

7 OPTIONAL VISION COVERAGE Effective January 1, 2011, Anthem Blue View Vision replaces our current vision plan with United Healthcare/Spectera. This is a stand-alone vision plan that is separate from your medical coverage. There are no significant changes to the plan design in 2011, but the benefits are slightly higher under the Anthem Blue View Vision Plan as compared to United Healthcare/Spectera. Additionally, Anthem s vision plan offers increased network size with retail chain access to top four national chains, eliminates frame restrictions and contact lens formulary, and provides 40% discounts on complete pairs of eyeglasses after funded benefits are used. While the plan allows participant choice of facility/provider in or outside the network, and retail and private practices are both included, there are maximum limitations on reimbursement. The maximum benefit is received by going to a network facility/provider to ensure contracted discounts. You do not have to participate in the University medical insurance plan to enroll in the optional vision plan. VISION INSURANCE MONTHLY RATES Employee $7.42 Employee + Child(ren) $14.08 Employee + Spouse $12.98 Family $21.50 You can access the vision provider network at by selecting Find a Doctor, then View National Vision Provider Directory, and then selecting the plan Blue View Vision. OPEN ENROLLMENT INFORMATION ON-LINE COMING SOON Open enrollment information is attached and can soon be found on the new USI Human Resource Benefits website. Watch for the upcoming website announcement. HUMAN RESOURCES BENEFITS CONTACTS Employees should contact the benefit representatives in the Human Resources Department with any questions concerning the 2011 Open Enrollment. The Human Resources Department is in the Wright Administration Building, Room FA166. Amy Miller ajmiller3@usi.edu Connie Schnarre csschnarre@usi.edu Brandyn Smith brsmith@usi.edu PLEASE REMEMBER THAT ALL OPEN ENROLLMENT FORMS MUST BE COMPLETED AND RECEIVED IN HUMAN RESOURCES NO LATER THAN NOVEMBER 16, 2010,* TO BE EFFECTIVE JANUARY 1, *NOTE: For certain medical changes that require a 30-day open enrollment under health reform regulations, such as the addition of dependents to age 26 and the addition of children up to age 19 with pre-existing conditions, this Open Enrollment is available until November 25, However, such late submissions are not encouraged as they will result in employee inconvenience due to double deductions on biweekly paychecks December 17, 2010, and the risk of delayed availability of insurance cards and insurance coverage confirmation.

8 Attachments: Insurance Comparison Overview Anthem Medical Enrollment Application Anthem Employee Change Form Welborn Enrollment Application/Change Form HRI Enrollment Application The Nyhart Flexible Spending Account Enrollment Form The Nyhart Flexible Spending Account Information Packet Short-term Disability (STD) Online Enrollment Information