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2011 Open Enrollment Update & UPlan Changes
For Calendar Year 2012
What’s in this presentation? Benefit Changes for 2012
2012 Medical and Dental Plan Options Open Enrollment Basics Disability Program Changes Open Enrollment Resources Flexible Spending Accounts Other Open Enrollment Information HealthPartners Information Wellness Program Highlights for 2012
UPlan Benefit Changes for 2012
UPlan Cost Increases Change to Single Medical Plan Administrator
– Medica Changes for U Classic Plus by HealthPartners
members Medical and Pharmacy Changes University Contribution Changes Relief for Lower Paid Employees Disability Program Changes New Wellness Program Points Bank Program
What are the UPlan Benefit Changes for 2012?
4
UPlan cost increase requirement due to Minnesota State funding reductions for University: 5% of UPlan Medical Program expense $12.7 million first year, $11.4 million
ongoing, plus savings from the RFP process
Shift to employees necessary Premium/copays
Why are Changes Being Made to the UPlan for 2012?
5
Cost share for employee-only coverage 2011: Employee 10% / University 90% 2012: Employee 13% / University 87%
Cost share for family coverage 2011: Employee 15% / University 85% 2012: Employee 19.5% / University 80.5%
Medical trend (inflation) increase: 6.5% Premium increase due to University contribution shift +
trend: Insights by Medica – 25.0% Base Plans, National & HSA – 34.6%
How will the Medical Contribution Rates Change?
6
Cost share for employee-only coverage 2011: Employee 10% / University 90% 2012: Employee 12% / University 88%
Cost share for family coverage 2011: Employee 40% / University 60% 2012: Employee 48% / University 52%
Dental trend (inflation) increase: 2.9% Premium increase due to University contribution shift
+ trend: 19% for all plan options
What about the Dental Contributions?
7
Selecting a single administrator: MEDICA Saves more than $14 million over six years Gains uniformity of important variables across UPlan
offerings Streamlines internal administration
HealthPartners Medical Group (HPMG) clinics will continue to be available in UPlan All HPMG clinics are Tier 1 in Insights by Medica
Como, Riverside, etc. Limited HPMG clinics in Medica Elect/Essential, Medica
Choice and Medica HSA Other U Classic Plus by HealthPartners Providers (Allina,
Park Nicollet, Boynton, UMP, etc.) are available in other Medica Plans
Who will administer the UPlan medical plans for 2012?
8
Will our Copays Change? Copay / Deductible Changes
Increase in Pharmacy Copays (Generic Plus from $8 to $10; Formulary Brand from $25 to $30; Non-Formulary from $50 to $60)
Increase in Office Visit Copays (Base Plans from $11 to $15; Insights – No change; National from $25 to $30)
Increase in ER Copay ($75 to $90) Increase in Walk-In Clinic Copay ($5 to $10) Increase in MRI/CT Scan Copay ($25 to $30) Increase in Out-of-Network Deductible (Individual from $500
to $600; Family from $1,000 to $1,200).
Some benefit & contribution changes are subject to collective bargaining.9
What if I need help paying the increased premiums for
2012?• New, one-year grant program to help
lower income employees offset 2012 medical premium increases
• Premium relief amounts based on medical plan coverage tier & total household income
• Amounts available range from $200 to $450–Paid as bi-weekly credits on paycheck
• Employees apply by submitting application form & 2010 federal tax form to Employee Benefits
10
2012 Medical Plan Options
What Medical Plans are available in 2012?
Medica Elect/Essential – Twin Cities & Duluth (Base Plan in Twin Cities and Duluth)
Medica Choice Regional – Greater Minnesota(Base Plan for Greater MN)
Insights by Medica (tiered network) Medica Choice National (open network) Medica Health Savings Account Plan
(HSA) 12
How are rates determined for UPlan Medical options?
UPlan: self-insured program Actuarial consultant: helps set
rates Costs reflect actual cost of care:
for employees, early retirees, and dependents
Costs include: Medical and pharmacy claims, external administrative fees, special insurance for high claims, internal costs, FrontierMEDEX, wellness program
13
How is the Base Plan the Key to Employee Cost?
For Medical, employees pay: 13% of Base Plan rates for Employee Only 19.5% of Base Plan rates for Family Coverage Everything above the U’s Base Plan rate
contribution for “buy-up” (higher cost) plans Costs vary by Employee/Family tier Rate Information:
U & Your Benefits Newsletter — October & November 2011
www.umn.edu/ohr/benefits/openenroll
14
2011 Dental Plan Options
Are the same Dental Plans available in 2012?
All Dental options remain the same for 2012
The base plan choices are: Delta Dental PPO for the Twin Cities and
Duluth Delta Dental Premier for Greater
Minnesota
www.umn.edu/ohr/benefits/openenroll
16
What other Dental Plan options are available in
2012? All other plans also remain the same:
Delta Dental Premier HealthPartners Dental HealthPartners Dental Choice University Choice
Check with Delta Dental or HealthPartners to see whether your dentist is in the plan you are considering
Note: HealthPartners Dental Plans will continue to be available!
17
2011 Open Enrollment Basics for January 1,
2012
What are the Dates for Open Enrollment?
Your annual opportunity to review your benefit elections: November 1–30, 2011
Employees make changes online at: http://hrss.umn.edu/
Additional information on Employee Benefits Website at: www.umn.edu/ohr/benefits/openenroll 19
What Changes Can I Make During Open
Enrollment? Add or cancel Medical and Dental
coverage or elect a different plan option
U Classic Plus by HealthPartners members must elect one of the Medica plans to have coverage in 2012
Add, change, or cancel your dependents
Elect to participate in the Health Care or Dependent Daycare Flexible Spending Accounts
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What Other Changes Can Be Made?
Enroll or increase the amount of Voluntary Short-term disability coverage without evidence of insurability
Elect to participate in Voluntary Long-term Disability coverage (Civil Service and Represented Staff employees), or
Increase or decrease your Long-term Disability benefit amount
21
Do I have to make changes during Open Enrollment ?
You need to go online and change your elections: If you are a U Classic Plus by HealthPartners
member and want to have medical coverage in 2012
If you are an FSA participant and want to have an account for 2012
If you want to change your Medical or Dental Plan, or coverage level
Otherwise, no changes are necessary To change your clinic election only, call Medica
health plan directly at 952-992-1814 or 1-877-252-5558 22
Who can I cover on my UPlan Medical & Dental Plans?
Yourself Your spouse or registered same-sex
domestic partner Your dependent child or children to age 26
Unmarried or married But not the spouse of a married child
Review detailed Dependent Eligibility Definition:
www.umn.edu/ohr/benefits/eligibility/index.html 23
Will I get new cards for 1/1/2012?
All members will receive a new card from Medica and from the HealthPartners Dental Plans
Only new enrollees will receive cards from the Prime Therapeutics Pharmacy Program and Delta Dental Plans
If you need a new or additional card any time during the year, contact the health plan directly and they will issue a new one 24
Will flu shots be available this year?
Seasonal Flu Shots will be available this year
Flu shots will be available at campus flu clinics and the Employee Health & Benefits Fairs
Seasonal Flu shots available at all Walk-in Clinics
No copay for flu shots at your own medical clinic
Flu shots at retail locations are full price and will often not be billed to your medical plan
On the Twin Cities campus: schedule appointment for flu shot online at: www.bhs.umn.edu/public-health/flu.htm
25
What is the Medication Therapy Management (MTM) Program? You are eligible for MTM if you take
Four or more medications for chronic conditions
UPlan-paid consultations with MTM Pharmacist
$10 copay reductions for all Generic Plus and Brand medications for six months
Note: HSA members pay full cost of MTM consultations www.umn.edu/ohr/benefits/
26
Disability Coverage
What are the Disability Program Changes?
New Disability Administrator - CIGNA During the 2011 Open Enrollment, for
plan year 2012 only, you can enroll in or increase your existing amount of short-term disability coverage without evidence of good health
Enroll or make your changes online in Employee Self-Service by November 30
In future years, open enrollment amounts will be limited
28
When Can I Enroll in Short-term Disability?
You can enroll or increase your short-term disability coverage during this Open Enrollment period without proof of good health
You can elect coverage any time during the year but would be required to submit evidence of good health
You can elect an amount to replace up to 66-2/3 percent of your salary but no more than $5,000 per month (Calculation = Annual Salary times 66.67%; divided by 12; rounded down to nearest $100)
See website for details on how to apply: www.umn.edu/ohr/benefits/disability/shortterm
29
Who can enroll in Long-term Disability during Open Enrollment?
Civil Service and Represented Staff Employees May enroll in or change the amount of Long-
term Disability during Open Enrollment. Maximum Benefit: 60% of salary up to
$5,000 per month. (Calculation = Annual Salary times 60%; divided by 12; rounded down to nearest $100)
Pre-existing Condition Limit: Disabilities related to medical issues during previous 12 months will not be covered for 24 months.www.umn.edu/ohr/benefits/openenroll
30
Open Enrollment Resources
What if I need help with open enrollment?
Telephone: 612-624-9090 or 1-800-756-2363 Option 2 M General benefits questions Option 3 M FSA questions
E-mail: [email protected] Benefit Fairs: Computer help, Plan
representatives, and Employee Benefits staff available to answer questions
Computer Labs (Twin Cities): Room 315 Donhowe Bldg. November 23, 28, 29, and 30: 8 a.m. to 4:30
p.m.32
What if I want to talk to Employee Benefits?
Employee Benefits Service Center612-624-9090 or 1-800-756-2363 Option 2 M General benefits questions Option 3 M FSA questionsTelephone Language Interpretation service available through Employee Benefits
Employee Benefits Websitewww.umn.edu/ohr/benefits/openenroll
33
What if I want to talk to the Health Plans?
Medica: 952-992-1814 or 1-877-252-5558
Prime Therapeutics: 1-800-727-6181
Fairview Specialty Pharmacy: 1-877-509-5115 and 612-672-5289
HealthPartners Dental: 952-883-5000 or 1-800-883-2177
Delta Dental: 651-406-5916 or 1-800-448-3815
34
When are the Employee Health & Benefits Fairs?
Duluth: November 2: Kirby Student Center – Ballroom – 10 a.m. to 2:30 p.m.
Morris: November 4: Oyate Hall, UMM Student Center – 11 a.m. to 1 p.m.
St. Paul: November 8: St. Paul Student Center – North Star Ballroom – 10 a.m. to 4:30 p.m.
Minneapolis: November 9: Coffman Memorial Union – Great Hall – 10 a.m. to 4:30 p.m.
35
www.bhs.umn.edu/public-health/flu.htm (Slide 1, 13)
www.umn.edu/ohr/benefits/openenroll/ (Slide 6, 23, 34, 47, 51)
http://hrss.umn.edu (Slide 6, 54)
www.umn.edu/ohr/benefits/eligibility/index.html (Slide 10)
www.wellness.umn.edu (Slide 41)
[email protected] to e-mail Wellness (Slide 42)
www.umn.edu/ohr/benefits/ (Slide 45)
www.umn.edu/ohr/benefits/disability/shortterm/ (Slide 48)
[email protected] to e-mail Employee Benefits (Slide 50)
Links to U of M Resources
36
Flexible Spending Accounts
37
What are Flexible Spending Accounts?
The UPlan includes: Health Care Flexible Spending Account Dependent Daycare Flexible Spending
Account Your contributions to both accounts
are made with pre-tax dollars No Federal, state, or Social Security
taxes are taken
No FSA Enrollment = No FSA for 2012
38
How much can I contribute to a Flexible Spending Account?
Health Care FSA Minimum: $100 Maximum: $5,000
Dependent Daycare FSA $5,000 maximum per family
www.umn.edu/ohr/benefits/openenroll
39
What else do I need to know about Flexible Spending Accounts for
2012? 2012 contributions are made during
the calendar year 2012 claims can be incurred between
January 1, 2012, and March 15, 2013 “Use it or lose it”
Any amount remaining after March 15, 2013, is forfeited
Note: 2011 claims can be incurred through March 15, 2012
40
Are there any recent changes for Flexible Spending Accounts?
Reminder: Section 9003 of the Affordable Care Act has a new uniform definition of qualified medical expenses
Reimbursement will be made only if the medicine or drug (1) requires a prescription, (2) is available over the counter (OTC) and individual obtains prescription, or (3) is insulin
Note: Insulin does not require a prescription 41
What else do I need to know about Flexible Spending Accounts for
2012? Over the Counter (OTC) supplies and devices
(such as contact lenses and lens cleaning solutions), eyeglasses, Rx and office copays, bandages, blood sugar test kits, and out-of-pocket dental charges continue to be eligible for reimbursement.
Be conservative in estimating your health care account contributions for 2012: do not include amounts for OTC medications unless you will have a prescription from your physician
RFP in process for outsourced FSA services Debit card option 42
Other UPlan Information
Enrolling Online
If hired before December 1, new employees may make two elections to participate in FSA for 2011 and 2012 Multiple elections can be made online, but
not at the same time; wait a day between enrollments
Benefits will send an e-mail to affected employees
Employees with appointments ending prior to January 1, 2012, cannot enroll online - they are not anticipated to be active employees in 2012 44
Open Enrollment Communications
Employees with enrolled same-sex domestic partners will receive a letter and instructions for Open Enrollment. Elections can be made online if currently enrolled, or on paper, if not.
Materials are sent to employees on LOA & to those without computer access
An e-mail will be sent in November to announce the start of Open Enrollment
A final reminder will be sent near the end of November
45
Benefit Materials for 2012
U & Your Benefits newsletters Guide for UPlan Benefits Open Enrollment
Online for all employees Paper copies for new employees, retirees, other
former employees, and those without computer access
COBRA instructions & rates Benefit summaries for prospective
employees Summary of Benefits for Medical & Dental
Plans Managers Toolkit on OHR website
http://www.umn.edu/ohr/debcp/index.html
46
Applying for the Medical Premium Relief Program
Application on Employee Benefits website UPlan participants submit application & 2010 tax
forms to Employee Benefits Premium relief amounts range from $200 to $450
annually Paid as biweekly Medical Premium credits Applications received by December 15, 2011
Full year of Medical premium credit Applications received during 2012
Amounts are pro-rated Must be covered on January 1, 2012
47
Applying for the Medical Premium Relief Program Employee Benefits will contact those with incomplete
applications Costs are considered taxable income Per University budget office, costs will be charged to
departments, since income to the employee First payment on January 25, 2012 paycheck; last
payment on December 26, 2012 paycheck
48
Information for Current Members of U Classic Plus by HealthPartners
What are the Guidelines for Current U Classic Plus by HealthPartners
Members?
All U Classic Plus by HealthPartners members will need to re-enroll in a Medica plan option during Open Enrollment
Elections are made online in Employee Self-Service
A new election must be made in order to have coverage for 2012
50
Will HPMG Clinics be Available in Medica for 2012? All HealthPartners Medical Group Clinics
(HPMG) will be available in Tier 1 of Medica Insights Lowest cost tier - $15 copay Includes Como & Riverside Clinics &
Regions Hospital Tiers for Specialists and Hospitals can vary
Example: University of MN Physicians (UMP) is in Tier 3 of Medica Insights
Limited HPMG clinics are available in Medica Elect/ Essential and Medica Choice & Medica HSA
51
How does Insights by Medica work?
Providers submit bids to Medica Providers are placed in three tiers based on
cost/quality Insights Copays also vary by tier
Tier 1 - $15 copay Tier 2 - $30 copay Tier 3 - $50 copay
HealthPartners Medical Group clinics & Regions Hospital are in Tier 1 of Insights by Medica
Specialists and hospitals are also tiered. Example: UMP is in Tier 3
52
How does Insights by Medica work?
Members do not need to elect a Primary Care Clinic
No referrals required Copays are based on the tier for the clinic /
hospital from which you receive services If you want to stay with
HealthPartners Medical Group clinics, they are all available only in Insights by Medica
53
What if I use a different provider within U Classic Plus? Other U Classic Plus by HealthPartners Clinics (Example:
Park Nicollet, Allina, UMP) are available in other Medica products Medica Elect/Essential (base plan for Twin Cities &
Duluth – lowest copays at $15) Insights by Medica (plan with tiered providers &
copays) Medica Choice National (broad network plan with $30
copays) Medica HSA (high deductible plan with an HSA
account) Use Medica’s Find a Physician/Hospital feature to
locate the plan with your providers
http://www.medica.com/uofm 54
What if I choose to change my plan and providers?
You can change your Medical plan and providers, if you elect to do so.
If you are in the midst of care for a serious medical condition (care received in the past 90 days) A short-term continuation of care with your current provider may
be available. Medica’s care coordinators will work with you if you have
An acute or life-threatening, A disabling, or chronic condition in an acute phase A confirmed pregnancy A physical or mental disability Culturally appropriate care or care in a certain language that Medica
doesn’t have available
Use the transition of care form to submit your request
http://www.medica.com/uofm
55
Will I need a referral to see a specialist with Medica?
You may want to have a recommendation from your primary care doctor before you see a specialist
However, these Medica Plans do not require referrals to see an in-network specialist: Insights by Medica (the plan with tiered providers & copays) Medica Choice National (the broad network plan) Medica HSA (the high deductible plan with an HSA account)
There are special guidelines for Medica Elect/Essential (the base plan) You do not need a referral to see a specialist in your care system You will need a referral approved by your care system’s referral
coordinator to see an in-network provider who is not in your care system
For all plans, you’ll need a referral from your care system and Medica to receive in-network benefits from an out-of-network provider
56
Will I still have access to my online HPMG medical record?
If you remain a HealthPartners Medical Group patient, you will still have access to your online medical record
This is a clinic/patient record, not a health plan record
57
If I decide to change to a new provider, can I ask my old provider
to transfer my medical records?
Yes, contact your new clinic’s Medical Records Department
They will give you a form to use Send that to your old provider The old provider will transfer your
records
58
2012 Wellness Program
What Wellness Programs will continue in 2012?
Wellness Assessment: January through March 2012 Earn $65 Wellness Reward for Employee &
Spouse/SSDP Health Improvement Programs
Phone-based Health Coaching In-person Health Coaching – Twin Cities, Duluth, and
Morris Online Healthy Living Programs and Step It Up!®
walking program Earn $65 Wellness Reward for Employee &
Spouse/SSDP Fit Choices Program
$20 monthly subsidy for health club participants Farmers Market: Minneapolis and Duluth
60
What’s new in the Wellness Program in 2012?
New Wellness Points Bank program UPlan Members & Spouse/SSDPs can earn
wellness points in 2012 to reduce their UPlan Medical Program premiums in 2013 through the new Wellness Points Bank program
Wellness points are earned by participating in a wide range of Wellness Program-sponsored wellness activities
Spouse participation completely voluntary Also includes Early Retirees, COBRA, etc.
61
How Does the New Wellness Points Bank Work? Employee-Only and Employee Plus Child(ren)
coverage levels must earn 300 points by August 31, 2012, to qualify for a $300 premium reduction in 2013
Employee Plus Spouse/SSDP and Employee Plus Family coverage levels must earn 400 points by August 31, 2012, to qualify for a $400 premium reduction in 2013
$65 Wellness Rewards continue for 2012 but stop in 2013
62
What points can I earn for my Wellness Points Bank?
63
Wellness Program Option Reward Points
Preventive Care Wellness Assessment Annual flu shot Tobacco-free pledge Biometric Health Screening participation
1002525
100
Health Improvement Programs On campus Weight Management Program Tobacco-cessation Program NextSteps Telephonic Health Coaching On-site Health Coaching Fit Choices if Credits Earned in 5 Months Healthy Pregnancy Program Disease Management Telephonic Health Coaching
1501501501505050
150
Health Action Campaigns Step It Up! Walking & Pedometer Program (available April 1, 2012) Online Healthy Living Program Bike Commuter Program
505050
What Weight Management Programs are offered for 2012?
Create your Weight — offered through Fairview on Twin Cities Campus and Weight Watchers at Work — offered on The Twin Cities and coordinate campuses You pay up front, Wellness Program will reimburse
you in full if you attend 80% of sessions (Costs: $186 to $235)
You can be reimbursed for up to three sessions per year; six total lifetime reimbursements
New this year: Complete a weight management session by August 31, 2012, and earn 150 points in your Wellness Points Bank
HIP (Health Improvement Program) available at UMD - no cost-Weight Management Focused Program
Details available at: www.wellness.umn.edu64
Would you like to be a Wellness Advocate for your Department?
Wellness Advocates Program:
Looking for Wellness Advocates from each College, Department
Lead departmental Wellness initiatives Wellness Program to provide support,
materials, and training Plus special programs for wellness
advocates Interested? Email to [email protected]
65
Wellness Program Metrics
Return on Investment Analysis
Annual Return on investment (ROI) analysis assesses effectiveness of wellness programs in helping to control health care costs Overall study led by Professor John
Nyman (School of Public Health), and research assistant Nathan Barleen
Study on ROI for Fitness Rewards led by Jean Abraham 67
Programs Evaluated for Savings
Evaluated Phone-based Disease & Lifestyle
Management, Wellness Assessment, 10000 Steps
Not Evaluated Nurseline, flu shot clinics, Farmers
Market, Health Action Programs, Online Healthy Living Programs
68
Costs Evaluated for Savings De-identified costs evaluated for
changes based on:– Health care claims costs from U of
M claims data warehouse– Sick leave use by civil service and
bargaining unit employees as a proxy for absenteeism
69
Brief Methodology Statement Tracked “difference in differences” in costs
between participants and those eligible to participate who did not.
Used claims and absence data from 2004 – 2007 to reflect pre- and post-implementation data
Evaluated wellness program participation as one of many factors (age, gender, etc.) that could influence health care cost changes to isolate just the difference associated with participation. 70
2006-2008 ROI Analysis
Disease management shows positive, statistically significant return on investment. Continued smaller return on absenteeism. Claims: $8,064,960 Absenteeism: $480,988 Total Savings - $8,545,948 Total Program Costs - $7,809,984
Disease Management Claims Savings covered $1.09 for every $1.00 of program costs –
First positive ROI71
2006-2008 ROI Analysis Also evaluated participation by year
since many Wellness Program analyses indicate 3 years necessary for positive return DM participation in any one year
generated savings of $960 over all three years
DM participation in 2006 and 2007 or 2008 generated savings of $1,200 per year
Participation in all three years didn’t add significant savings
72
2006-2008 ROI Analysis No significant return on Lifestyle
Management or 10,000 Steps Did not put dollar impact on participant
health and include that in calculations – have included improved measure of participant health in most recent Wellness Assessments to make that calculation possible
Portion of the effectiveness is durable. Study does not include gains that would occur if program were stopped but effectiveness continued 73
Fitness Rewards ROI Analysis
“Fragile Evidence” Persistent Exercisers show Some Evidence of
Medical Claims Savings Exercise 5-9 of 12 Months 923 people – each saved $1,032 per year
Estimated Return on Investment $952,536 Total Savings $406,246 Incentives & Administrative
Expense $2.34 for Each $1 spent
74
Weight Management Programs
Metric Create Your Weight
Weight Watchers at Work
Totals
Participants 391 550 per session 941
Total Weight Lost 2,665.4 lbs. 12,555 lbs. 15,220.4 lbs.
Average Loss Per ParticipantPer Session
6.8 lbs. 10.8 lbs. 9.8 lbs.
Weight Loss Range 1-35 lbs. 1-70 lbs. 1-70 lbs.
75