2011 State Health Open Enrollment

Presentation

Introduction

Open Enrollment dates are

October 12 – November 10, 2010

Agenda

•SHBP Options for 2011

•2011 Plan Changes

•2011 Benefit Overview

•2011 Retiree Changes

2011 Benefit Options• Healthcare vendors remain - CIGNA and United

Healthcare • Active members and retirees under age 65 have the

following options for 2011:• Health Reimbursement Arrangement (HRA)• Health Maintenance Organization (HMO)• High Deductible Health Plan (HDHP)

2011 Plan Changes• There will be a number of changes to the

Plan effective January 1, 2011• It is important that you read the 2011 Active

Employee Decision Guide, so you will know what is changing, and what affect the changes will have on your benefits, options, rates, etc. before making your election for the 2011 Plan Year

Changes for all SHBP Members

• The Open Access Plan (OAP) option will no longer be offered

• The Tobacco Surcharge increases to $80 per month• The Spousal Surcharge is increasing to $50 per month • The Pre-existing clause will no longer apply to any

SHBP option • Social Security Numbers (SSN) must be collected for all

dependents

Changes for all SHBP Members

• All premiums will increase. • Some tiers will see a higher increase in order to

accommodate the addition of dependents previously not eligible for coverage (health care reform)

• Changes to co-pays, deductibles, out-of-pocket limits • Life-time maximum benefits limit will be removed• All SHBP members will receive new ID cards before

January 1, 2011

Changes for all SHBP Members

• Children who were not eligible to be in the Plan last year, may be eligible this year

• Children can be covered until the end of the month of their 26th birthday– OK to be married– Does not have to be FT Student– Does not have to live at home (includes step-

children)

Current OAP Members• Effective January 1, 2011 the OAP Option will no longer

be offered• Members currently in the OAP Option will need to make

another benefit selection during the Open Enrollment for the 2011 Plan Year. If you do not go online and make another election, coverage will roll over into the HRA with their current healthcare vendor and the Tobacco surcharge and Spousal Surcharge (if applicable) will apply. Members will remain in the HRA option for the 2011 Plan Year

Tobacco and Spousal Surcharges

• Tobacco Surcharge will increase to $80 • Spousal surcharge will increase to $50• Employees MUST answer the Surcharge questions when

making their 2011 benefit selection• Failure to answer the Surcharge Questions will result in

paying the applicable surcharge(s) for the entire plan year unless you experience a qualifying event that will allow the removal of the surcharge

• Information on steps to take to remove the surcharges is available at www.dch.georgia.gov/shbp

HMO Deductible Changes

TIER FROM TO

You $600 $1000You + Spouse $900 $1500

You + Child(ren) $900 $1500

You+ Family $1200 $2000

Your specialist office visit co-pay will change from $35 to $45

HMO Maximum Out-of-Pocket Changes

TIER FROM TO

You $2000 $3000

You + Spouse $3000 $4500

You + Child(ren) $3000 $4500

You+ Family $4000 $6000

HMO Prescription Drug Co-Pay Changes

TIER FROM TO

Tier 1 – Generic $15 $20

Tier 2 – Preferred Brand

$40 $50

Tier 3 – Non Preferred Brand

$75 $90

HRA Deductible Changes

TIER FROM TO

You $1100 $1300

You + Spouse $1900 $2250

You + Child(ren) $1900 $2250

You+ Family $2750 $3250

HRA Maximum Out-of-Pocket Changes

TIER FROM TO

You $2500 $3000

You + Spouse $4100 $5000

You + Child(ren) $4100 $5000

You+ Family $5700 $7000

HRA Plan Design– Health Reimbursement Account (HRA) Credits– $ 500 – You– $1,000 – You + Spouse– $1,000 – You + Child(ren)– $1,500 – You + Spouse + Child(ren)

– Plus $125 for annual physical and completing a health assessment. Employee and spouse can each earn this. (Cigna is also offering additional incentives.)

– SHBP credits the HRA account each year to help pay covered medical expenses

Features of the HRA Plan• Low employee premiums• HRA credits each year that pay for covered initial charges, whether

medical or pharmacy expenses. These dollars also reduce your deductible and maximum out-of-pocket expenses

• You do not pay co-pays under this plan but co-insurance whether it is for your prescription drugs, office visits or surgery

• Any dollars not used at the end of the year roll over to the next year

• 100 percent coverage for preventive care and the cost of these services do not come out of your HRA credits

HDHP Deductible Changes

Deductibles

FROM 2010 In-Network

FROM 2010 Out-of-Network

TO 2011 In-Network

TO 2011 Out-

of-Network

You $1200 $2400 $1500 $3000You + Spouse $2400 $4800 $3000 $6000You + Child(ren) $2400 $4800 $3000 $6000You + Family $2400 $4800 $3000 $6000

HDHP Out-of-Pocket Maximum Changes

Out-of-Pocket

FROM 2010 In-Network

FROM 2010 Out-of-Network

TO 2011 In-Network

TO 2011 Out-

of-Network

You $1800 $4000 $2400 $5300You + Spouse $3100 $7400 $4100 $9800You + Child(ren) $3100 $7400 $4100 $9800You + Family $3100 $7400 $4100 $9800

Changes for Medicare Eligible Retirees

• The Medicare Advantage Private Fee (MA PFFS) for Service Plans will be replaced by the Medicare Advantage Preferred Provider Organization (PPO) Plans

• This change is due to the requirement by the Centers for Medicare & Medicaid Services (CMS) that all national and private MA PFFS plans offer a PPO network

• Medicare-eligible retirees may still elect any other option (HMO, HRA, or HDHP) but will pay the full cost

CIGNA-Humana Alliance• CIGNA’s Medicare Advantage Private Fee-for-Service

Plan will be replaced by the Humana Group Medicare Advantage PPO due to a newly formed alliance between CIGNA and Humana and the information receive will show the Humana name

• Since retirees may also receive information from other MA Plans, including Humana, retirees should only be concerned with mail that says for SHBP Retirees on the envelope

Medicare Advantage PPO Plans

• The Four Medicare Advantage PPO options offered in 2011 are:

– Humana Group Medicare Advantage PPO Standard

– Humana Group Medicare Advantage PPO Premium

– United Healthcare Medicare Advantage PPO Standard

– United Healthcare Medicare Advantage PPO Premium

Medicare Advantage PPO Plans

• The MA PPO Standard and Premium plans include prescription drug coverage as with the current MA PFFS plans

• Retirees will be able to choose from a large national provider network

• Benefits and co-payments and/or coinsurance will be the same whether the provider is in-network or out-of-network

Medicare Advantage PPO Plans

• Retirees can seek care from any provider that accepts Medicare (regardless if they have a signed contract with the health care vendor)

• If the retiree sees a provider who does not accept Medicare assignment, the retiree will be balance billed

Important Reminders-Retirees

• If eligible and the retiree selects any option other than one of the MA PPO Options, they will pay the entire cost of the premium

• If the retiree is enrolled in a SHBP MA PPO option they should NOT enroll in an individual Medicare Part D or Medicare Advantage Plan as doing so will cause the retiree to lose their SHBP coverage

Important Reminders-Retirees

• Retirees enrolled in one of the CIGNA or United Healthcare (UHC) Medicare Advantage (MA PFFS) Plans will receive a cancellation notice from their health care vendor advising them that their current MA PFFS option will end December 31, 2010

• Retirees should not be alarmed-This notice is a requirement of CMS.

• Their new coverage under the MA PPO Option will take effect January 1, 2011

Important Reminders-Retirees

• Medicare Advantage enrollment is optional for retirees under age 65. Enrollment in the MA PPO plan must be approved by CMS

• Pre 65 retirees may enroll in the HRA, HDHP or HMO and will pay the same rate as active employees

• If the retiree is under age 65 they must answer the surcharge questions

Open EnrollmentOctober 12 – November 10, 2010

• Employees will make their health election at www.oe2011.ga.gov

• Web site will open at 4 a.m. on October 12 and close at 4:30 p.m. on November 10, 2010

• The Active Employee Health Plan Decision Guide will be available on the Web site at www.oe2011.ga.gov and www.dch.georgia.gov/shbp (no printed hardcopies)

Open EnrollmentOctober 12 – November 10, 2010

• You MUST go online to make your benefit selection. If you do not go online and you are – In the OAP, you will be enrolled in the HRA with your

current healthcare vendor and tier and the Tobacco surcharge and Spousal surcharge (if applicable) will be applied

– In the HMO, HRA or HDHP, you will rollover into the same coverage and tier and the Tobacco surcharge and Spousal surcharge (if applicable) will be applied

Open EnrollmentOctober 12 – November 10, 2010

• If you do not make an Open Enrollment election coverage will roll over and the tobacco surcharge and spousal surcharge (if applicable) will apply.

• You will not be allowed to make a change to coverage until the next Open Enrollment unless you experience a qualifying event that allows a change.

Open EnrollmentOctober 12 – November 10, 2010

• When making your benefit election, you should make sure you have selected the correct option

• Confirm you have added all eligible dependents you wish to be included in their coverage

• Confirm you have answered the surcharge questions correctly

• Click “Confirm” and Print their Confirmation

Reminders• You may go online and make changes anytime

during Open Enrollment (4 a.m. on October 12 until the Web-site closes at 4:30 p.m. on November 10, 2010)

• You must answer the surcharge questions each time they log on to the web site

• The last selection made when the web site closes at 4:30 p.m. will be the option members are placed in for the 2011 Plan Year

Questionsor Additional Information

CIGNA – HMO, HRA, HDHP - 800-633-8519www.mycigna.com/shbp

United Healthcare – HMO, HDHP - 877-246-4189 Definity HRA - 800-396-6515www.welcometouhc.com/shbp

Important Notice• The information provided in this presentation is a

summary of changes for the 2011 Plan Year. It is intended only to highlight principal benefits

• Please refer to the Active Employee Decision Guide for more details

THANK YOU