2007 Open Enrollment

For Health and Flexible Benefits

It’s the time you can…

• Enroll in or change your health plan

• Add or remove family members, or

• Enroll in a flexible reimbursement account

Changes you make during Open Enrollment are effective

July 1, 2007 – June 30, 2008

What do I need to do?

• Take no action to continue your current health plan and membership level

• Take action to enroll or make changes to your health plan and membership level

• Take action to enroll in or continue a Medical or Dependent Care Flexible Reimbursement Account

How can I find out what benefits I have currently?

• You may visit EmployeeDirect to review your current benefit elections and you can even enroll or make changes online

• You may also call or e-mail a member of the Employee Benefits team:– Barbara Tonovitz (employees last name beginning

A-J)– Angela Vann (employees last name beginning K-Z)– Beth Lunde

EmployeeDirect

https://edirect.virginia.gov/Application.aspx

Available 24 hours a day

Step 1: Verify your registered e-mail address and date of birthContact a member of the Employee Benefits team if your information is incorrect. It will need to be corrected before you can use EmployeeDirect

Step 2: Create a passwordStep 3: Sign-up or loginStep 4: Click and follow promptsStep 5: Ask questions if you need help

COVA Care changes effective July 1, 2007

• Routine wellness benefit enhanced– $500 cap on lab work, shots, and x-rays removed

for routine wellness

• Outpatient prescription drug benefit covers diabetic blood glucose test strips and glucometers– 20% of product cost, no deductible– Prescription needed

• Medical benefit covers diabetic equipment and education

Anthem’s new 24/7 NurseLine

• Available to COVA Care and COVA HDHP members

• 365 days a year/24 hours a day

• 1-800-337-4770

• Registered nurse trained to answer your medical questions

Flexible Reimbursement Account changes effective July 1, 2007

• New medical flexible reimbursement account reimbursement card– EZ REIMBURSE Mastercard– You present the card for payment when purchasing eligible

medical services, prescription or over-the-counter drugs– The expense may not exceed your account balance– You may be required to provide documentation for certain

expenses. Failure to provide requested documentation may result in suspension of your card until the next plan year

– Must complete an EZ REIMBURSE card request by June 1st if you wish to receive the card

• Account statements for both Medical and Dependent Care FRA will change from quarterly to monthly

Health Insurance Premium Increase

• 4.5% premium increase on COVA Care ranges from $2 per month to $10 per month depending on plan and membership level

• 2.75% of the 4.5% increase is to cover the wellness benefit enhancements

• 1.75% of the 4.5% increase covers other post employment benefits – new accounting rules in 2008 require a special

trust fund for early retiree coverage• HDHP continues to have $0 premium

Health Insurance – Full-Time Employee Monthly Premiums 7/1/07 – 6/30/08

Plan Single Dual Family

HDHP $0 $0 $0

COVA Care $42 $103 $147

COVA Care + Out-of-Network $52 $117 $166

COVA Care + Expanded Dental $55 $128 $185

COVA Care + Out-of-Network + Expanded Dental

$65 $142 $203

COVA Care + Expanded Dental + Vision & Hearing

$64 $145 $207

COVA Care + Out-of-Network + Expanded Dental + Vision & Hearing

$74 $158 $224

When will the new premiums go into effect?

• Look for new health plan premiums and FRA contributions on your paycheck on July 16, 2007

• 9 month faculty on 18 pay option will not see changes until the September 1, 2007 paycheck

Health Insurance

• Premium Conversion– Health insurance premiums are

automatically deducted pre-tax

Review of Plans

Health Insurance – Membership Levels

• Single – Employee Only

• Dual – Employee and one dependent (spouse or child)

• Family – Employee and two or more eligible dependents

Health Insurance – Eligible Dependents

• Legally married spouse• Unmarried biological and legally adopted children

– Living with the employee– Employee provides over ½ support– May be covered until the end of the year they turn age 23

• Unmarried stepchildren– Living full-time with employee– Parent-child relationship– Eligible to be claimed on tax return

• Children of whom you have permanent sole custody• Adult Disabled Children

Health Insurance – Ineligible Dependents

• Siblings• Grandchildren (unless you have shared custody with a

minor child living in your home)

• Nieces/Nephews• Parents• Grandparents• Aunts• Uncles• Domestic Partners

Health Insurance – Plan Options

• COVA Care

• COVA HDHP

Health Insurance – COVA Care

• No PCP requirement

• No referrals

• Blue Card PPO Network

• Out-of-network defined by providers not a geographical region

• Out-of network coverage for true emergencies

Health Insurance – COVA Care

• Co-payments– PCP - $25– Specialist - $35– Inpatient hospital - $300– Outpatient hospital and ER - $100

• Deductible– $200 – individual– $400 - family

• Co-insurance• Out-of-pocket expense limit

– $1,500 per person– $3,000 per family

• Wellness visits covered at 100% - no co-pay

Health Insurance – COVA Care

• Prescription Drug Program– Mandatory generic– Tier System– Mail Order for Maintenance Rx– Co-pays

• Retail pharmacy – up to 34 day supply– $15 – Tier 1– $20 – Tier 2– $35 – Tier 3

• Mail order – 90 day supply– $30 – Tier 1– $40 – Tier 2– $70 – Tier 3

Health Insurance – COVA Care

• Dental Basic Services– Diagnostic and preventive services

• Twice a year• Paid at 100%

– Primary services• Paid at 80%• Includes fillings, periodontal, and root canals

– Dental Maximum• $1,200 annually

Health Insurance – COVA Care

• Options– Out-of Network

• Access to providers outside Anthem or Blue Card PPO network• Plan pays 75% - you pay 25%

– Expanded Dental• Adds complex restorative service coverage at 50% (crowns, dentures, and

bridgework)• Adds orthodontic services coverage at 50% up to a $1,200 lifetime maximum• Provides $1,500 dental maximum annually

– Vision and Hearing• 1 eye exam every 24 months - $35 co-pay• Provides allowance for lenses, frames, and contacts every 24 months ($50, $75,

or $100)• 1 hearing exam every 48 months - $35 co-pay• Provides hearing aids and other hearing aid related services up to $1,200 every

48 months

Health Insurance – COVA Care

• Vendors– Anthem– Delta Dental of Virginia– Medco Health– ValueOptions

Health Insurance - HDHP

• $1,200/$2,400 Deductible• 80/20% Coinsurance• $5,000/$10,000 Out-of-pocket expense limit• 100% wellness coverage• Deductible and co-insurance for prescription drugs• Out-of-network – not available• Blue Card PPO Network• Dental Benefits

– $25/$75 Deductible– 100/80/50% Coinsurance– $1,500 Plan year maximum– $1,500 orthodontic lifetime maximum

• Claims administrator for all services – Anthem• $0 premium does not mean $0 out-of-pocket expense

Flexible Reimbursement Accounts (FRA)

• Allows employees to use pre-tax dollars to pay for certain medical and dependent care expenses

• Cannot claim these expenses on your taxes and utilize the FRA

• Medical Reimbursement Account – may claim expenses not covered by your health benefits plan

• Dependent Care Reimbursement Account – may claim expenses for the care of your eligible dependent

Flexible Reimbursement Accounts (FRA)

• Funds cannot be transferred between the accounts• “Use it or Lose it” rule• May claim reimbursement for expenses incurred during the plan

year (July 1 – June 30)• Must submit all claims for reimbursement by September 30th of

each year• Must re-enroll in FRAs each year – your election does not roll

over from one plan year to another• Availability Rule

– Medical – entire election amount available at the beginning of the plan year

– Dependent Care – funds must be posted to the account in order to be claimed (available after payroll deductions)

Flexible Reimbursement Accounts (FRA)

• Minimum contribution - $10 per pay period• Maximum contribution

– $5,000 per plan year– IRS has a calendar year limit for Dependent Care

FRA for the plan year beginning July 1 – see the Flexible Benefits Program Sourcebook for more information

• Contributions must be made in whole dollar increments

Flexible Reimbursement Accounts (FRA)

• Fringe Benefits Management Company (FBMC) is the claims administrator

• Fax claims accepted• 5 day processing guarantee• Daily reimbursements• Direct bank deposit available• EZ REIMBURSE Mastercard available• Online account access at www.myfbmc.com

Qualifying Mid-Year Events

• Within 31 days of qualifying event• Allows for consistent changes• Events include

– Marriage– Birth/Adoption– Divorce– Termination or commencement of spouse’s employment– Death of a dependent– Dependent loses eligibility– Going on or returning from an unpaid leave of absence– Spouse’s open enrollment period

Enrollment Options

• Employee Direct– Quick, easy, and available 24 hours a day

from any computer with internet access– Permits review and changes to health

benefits, flexible reimbursement accounts, and personal information in the Commonwealth’s Benefits Eligibility System

• Enrollment Form

Confirmation of Changes

• FRA confirmations will be sent to employees before July 1

• Please check the confirmation carefully and report errors immediately

• Health insurance selections can be confirmed via EmployeeDirect

Links to Open Enrollment information and forms can be accessed on the TCC Benefits webpage

http://www.tcc.edu//welcome/collegeadmin/administrative/hr/benefits/index.htm

Open Enrollment ends May 16, 2007