Post on 24-Dec-2015
transcript
Open Enrollment Presentation
October, 2012
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Filice Insurance AgencyNina Gardner, Joyce Manansala
• Nina Gardner, J.D. – Your Employee Benefits Consultant – strategic benefit planning
• Joyce Manansala – Your Account Manager – day-to-day administration – questions, plan design inquiries, claims and coverage issues, billing questions, etc.
• Serena & Lily’s Customized Website – Your Own Intranet
www.filice.com/benefits/serenaandlily
What is Open Enrollment?
Once-per-year opportunity for employees to: Enroll or drop coverage Add or delete dependents
When Can I Change My Election?
OPEN ENROLLMENT OR A STATUS CHANGE…Marriage
Divorce or legal separation
Birth or adoption of a child
Death of a spouse or child
Change in your spouse’s employment
You or your spouse change from full-time to part-time,
You or your spouse experience an unpaid leave of absence
Major changes to your spouse’s benefit program
YOU MUST NOTIFY HR AND ENROLL WITHIN 30 DAYS
OF THE EVENT.
Challenges in Health Care
Drivers of Increased Health Care Cost: Aging population Medical inflation – driving 51% of the growth in healthcare spending New expensive technology and drugs Cost of expanding and improving health care facilities Less competition in the market place Increased utilization and demand for services Providers adjust prices charged to insurers to offset losses from non-
payers Government regulations:
Health Care Reform Mandated Benefits
Health Care Costs Controlled by You
Lifestyle Choices: Smoking Obesity Exercise (lack of) Stress Accessing preventive care Taking medications as prescribed Seeking care at the appropriate level (urgent care clinics and
physical office visits instead of emergency room care) Fraud prevention
Check your claims. If you need help, contact Joyce.
How can you help control costs?
Wellness: Eat, sleep and exercise appropriately. Check out your new wellness website with Filice. Monthly newsletters.
Utilize appropriate level of care: Call the 24-hour nurse line, only go to the emergency room for true emergencies, use urgent care as necessary, and schedule annual check-ups.
Engage: Manage your health and your health-related expenses. Always stay inside the network whenever possible.
Ways to Save on RX
Ask your doctor for generic alternatives Use mail order for long-term and maintenance
drugs Use over-the-counter medications instead of
prescription drugs when possible Ask physician for free samples Annually review your medications with your doctor
Benefits Overview Blue Shield – New plan names but similar to last year. Blue Shield
changed its small group portfolio.
Premier PPO 35 – Base Plan
Access HMO Enhanced 25 – Buy-up Option
Premier PPO 25 – Buy-up Option - New
Dental – Direct Dental (Assurant Network) - Enhanced
Vision – VSP – New Benefit
Life and disability – Mutual of Omaha
EAP
Travel Assistance
FSA – New Provider on 1/1/2013
401(k) – New Provider on 1/1/2013
Company Contribution Medical: Serena & Lily pays 100% of premium for employees and
50% of the premium for dependents for the Blue Shield Premier PPO 35 plan. If you choose the Access HMO Enhanced 25 or Premier PPO 25, you will pay the difference.
Dental: Serena & Lily pays 100% of premium for employees and 50% for dependents for your Direct Dental plan.
Vision: Serena & Lily pays 100% of premium for employees and 50% for dependents for your VSP vision plan.
To calculate your cost per paycheck, please multiply monthly cost by 12 and divide by 26.
Long-Term Disability: Paid by Serena & Lily Life Insurance: Paid by Serena & Lily EAP program: Paid by Serena & Lily Travel Assistance: Paid by Serena & Lily
Medical Plan Designs Blue Shield Premier PPO 35
Deductible: $750/member; $1,500/family ($500/$1,000 last year)
Office Visit Co-Pay: $35 (deductible waived) ($40 last year)
Preventive Care: No Charge
Hospitalization: 35% after deductible ($500/admit + 30% last year)
Surgery: 35% after deductible
($250/surgery + 30% last year)
Emergency Room: $100/visit (waived if admitted) + 35% after deductible ($100/visit + 30% last year)
Prescriptions: $10/$30/$50/30% up to $100 per fill ($250 deductible - last year)
Mail: $20/$60/$100/30% (90 day supply)
Annual OOP Max: $4,000 /member; $8,000/family (excludes deductible)
Medical Plan Designs Blue Shield Premier PPO 25
Deductible: $500/member; $1,000/family
Office Visit Co-Pay: $25 (deductible waived)
Preventive Care: No Charge
Hospitalization: 25% after deductible
Surgery: 25% after deductible
Emergency Room: $100/visit (waived if admitted) + 25% after deductible
Prescriptions: $10/$30/$50/30% up to $100 per fill
Mail: $20/$60/$100/30% (90 day supply)
Annual OOP Max: $3,000 /member; $6,000/family (excludes deductible)
Medical Plan Designs
Blue Shield Access Enhanced HMO 25 Deductible: None
Office Visit Co-Pay: $25/ $35 specialist
Preventive Care: No Charge
Hospitalization: 25% of allowed charges
Surgery: 25% of allowed charges
Emergency Room: $150 (waived if admitted)
Prescriptions: $10/$30/$50/ 20% up to $100 per fill ($300 Tier 2 & 3 Rx deductible)
($15/Generic; $30 Brand after $250 Rx deductible – last year)
Mail: $20/$60/$100 ($300 Tier 2 & 3 Rx deductible) – 90 day supply
Annual OOP Max: $3,000/member; $6,000/family ($3,500member; $7,000/family – last year)
Dental Plan Overview Direct Dental (Assurant Network)
$1,500 annual (plan year) maximum benefit
$50/individual (plan year) deductible
Ortho: $1,000 lifetime max for children and adults ($500 per year)
Plan design co-insurance levels
In Out
Preventative 100% 100%
Basic 90% 80%
Major 60% 50%
Ortho 50% 50%
Vision Plan Overview
VSP
Co-Pay: $10/$25
Exams: Every 12 months
Lenses: Every 12 months
Frames: Every 12 months (up to $130 + 20% off)
OR
Contact Lens Care: Every 12 months (up to $130)
Life, AD&D and Disability Overview
Life and AD&D Insurance – Mutual of Omaha Benefit: 1 x salary to a maximum of
$250,000
Long Term Disability – Mutual of Omaha Benefit: 60% of salary – maximum benefit of
$10,000/month
Elimination: 90 days
Voluntary and AD&D Term Life Insurance
Minimum Maximum Guaranteed
For You $10,000 $250,000 $100,000
For Your Spouse $5,000 $50,000 $25,000
For Your Children 2,000 $10,000 $10,000
• Employee can elect up to 5 times their salary to a maximum of $250,000.
• Guarantee issue amount is 5 times salary up to $100,000. • Spouse can elect up to 50% of employee’s benefit to
$50,000. • Children can elect up to 50% of employee’s benefit to
$10,000.
EAP Program – Mutual of Omaha
24/7 online resources and confidential telephonic consultation with licensed EAP consultants who provide assistance and guidance on:• Family, relationship and parenting issues• Emotional and stress-related issues• Conflicts at home or work• Alcohol and drug dependencies• Financial issues• Depression• Parenting• On-line resources and tools
Up to 3 in-person counseling sessions each year with a licensed mental health professional.
The need for emergency travel assistance is growing.
■ Whether your travel is for business or personal reasons, our worldwide
emergency travel assistance program goes with you when you travel to a foreign country or just
100 miles or more from home.
■ If you, your spouse or your dependent children need immediate assistance anywhere in the world.
Worldwide emergency travel assistance services
FSA Vendor Change 1/1/2013 Provided by Benefit Resource, Inc., starting 1/1/2013 This move will enhance your current services with the following:
Online access to your account Phone app to submit claims and to check your balance Professional customer service via phone, email, and live chat Faster reimbursement process including direct deposit Just one debit card that holds both your medical FSA and your
commuter and parking elections
More details at the November enrollment meeting
New Benefit 1/1/13Pre-Tax Commuter and Parking
• Pay $125 of your monthly eligible commuter expenses and $240 of your monthly eligible parking expenses pre-tax.
• More details at the November enrollment meeting
Flex Plan Benefits
Insurance Premiums
Health Flexible Spending Account(Health FSA)
Dependent Care Assistance Account (DCAP)
Serena & Lily is also introducing a new-look 401(k) plan.
Enhancements will include:
- A lower cost, higher quality investment menu- A higher-touch servicing approach- One-on-one, customized advice
& Much More.
Our new retirement plan will be provided by Portico Wealth Advisors and Verisight
Will be meeting with you to determine how to best position your 401(k) account
Will be providing the website and all of the backend support for your account
401(k) Retirement Plan
More details will follow over the next few months.
Enrollment InstructionsFor Blue Shield, if you are staying on the most similar
plan to last year’s plan, you don’t need to do anything. If you are moving to a new plan, please fill out a change form. For dental, you only need to fill out the form if you are new or making changes. Please complete the VSP enrollment form. Please fill out the Mutual of Omaha form as well as the beneficiary form. No forms to fill out for group life, disability, EAP and travel assistance. Everyone must turn in rate sheet.
Forms, applications, plan designs, etc. can be found at www.filice.com/benefits/serenaandlily under the Forms section.
For questions, please call Joyce Manansala at 925-299-7203 or email at joyce@filice.com.
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Q & A
Open Enrollment for your plans is the month of September, 2012. Please return all forms to the
office by Monday, September 24, 2012.
• Go to www.filice.com/benefits/serenaandlily to access all your benefit information