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2012 Open Enrollment. October 11 th -November 10 th New website Do NOT wait until the last minute...

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2012 Open Enrollment
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Page 1: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Open

Enrollment

Page 2: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Open Enrollment

• October 11th -November 10th

• New website www.myshbp.ga.gov

• Do NOT wait until the last minute

• You need to register every year.

• You can not use your password from last year

Page 3: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 SHBP Benefit and Plan Changes

• PeachCare FOR KIDS®

• TRICARE• Wellness vs. Standard Plans• HRA – prescription protocol• GaBreeze plan changes

Page 4: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesPeachCare FOR KIDS®

Federal law has changed.

SHBP members are now eligible to apply for the – PeachCare FOR KIDS® program

Page 5: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesPeachCare FOR KIDS®

• a link to the PeachCare website that includes an eligibility calculator to determine if your children may qualify

• Complete an application on-line or call and request a paper application

• Information is available at 1-877-GA-PEACH (1-877-427-3224) and www.peachcare.org

• Earliest an employee can apply is 10-03-2011

Page 6: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Frequently Asked Question

Q.Should an employee remove their child(ren) during Open Enrollment (O/E) in anticipation of PeachCare coverage acceptance?

R.No! You should not remove your child(ren) during O/E unless the child(ren) has been approved for enrollment into PeachCare for Kids. Once approved, you have 60 to remove your child(ren) from your State Health plan.

Page 7: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes New Tricare Supplement

Is anyone eligible for TRICARE?

Page 8: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes New Tricare Supplement

• SHBP will again offer the TRICARE Supplemental Insurance to SHBP eligible individuals who are also eligible for TRICARE (which is the military health benefit program).

• This coverage is an alternative to SHBP coverage. • This plan is voluntary and the member will pay all of

the costs for the TRICARE Supplemental Coverage• Coverage ends at age 65• Members must provide a Defense Enrollment Eligibility

Report System (DEERS) number when enrolling

Page 9: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes New Tricare Supplement (continued)

• Eligibility for Children – NOT THE SAME AS SHBP - Must be single - Age 19 - 23 must be a full-time student or if under age 26 if

enrolled in the TRICARE Young Adult Program

• Loss of eligibility for Tricare Supplement while actively working - Is a qualifying event to select another option if you make the request within 31 days

• COBRA - Members who lose eligibility for SHBP coverage while covered by Tricare supplement will not be offered COBRA

For additional information call 866-637-9911 or on the website at www.asicorporation.com

Page 10: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes New Tricare Supplement (continued)

• At Age 65 and RETIRED• SHBP will roll your coverage into the MA PPO Standard

Plan with your previous health care vendor prior to Tricare Supplement if we have your Medicare Part B information

• If we do not have Medicare Part B information we will put all family members in the Standard Plan of your previous option prior to the Tricare Supplement and will pay 100% of the premiums for coverage

Page 11: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness/Standard Plans

Wellness vs.

Standard

Page 12: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness/Standard Plans

Old Plans• HDHP • HRA• HMO

New Plans • Wellness HDHP• Wellness HRA• Wellness HMO• Standard HDHP • Standard HRA• Standard HMO

With these new Plan Options, all members will need to make a new election this year.

Page 13: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness/Standard Plans

Wellness Plans• Wellness Promise • Biometric Screening

Required • Lower Premiums• More HRA credit• Lower HMO copays

Standard Plans • No Wellness Promise• No Biometric

Screening Required • Higher Premiums • Less HRA credit • Higher HMP copays

Page 14: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness/Standard Plans

• Wellness Options are designed to help you (and your spouse, if covered) become a more active participant in your health and require you to take additional steps in engaging in better health.

• If you do not wish to participate in the Wellness Options, the Standard Options are available to you.

Page 15: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness Plans

Rewards received for Wellness Plan Options

• Lower premiums (only 11% increase)

• Lower out-of-pocket costs through co-payments, coinsurance, deductibles and out-of-pocket maximums

Page 16: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness Plans

Includes the HRA, HMO and HDHP Plan Options

• Wellness Plan Promise:

- Members and Covered Spouses (not children)

- Each MUST complete an Online Health Assessment

- Each MUST Obtain biometric screening* between July 1, 2011 and June 30, 2012

(*Body Mass Index, Blood Pressure, Blood Glucose, Cholesterol – considered preventive and covered at 100%)

- Biometric screening results MUST be received by your health care vendor by June 30, 2012

Page 17: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesNew Wellness Plans

Includes the HRA, HMO and HDHP Plan Options

• Wellness Plan Promise:If you or your spouse do not take the Health

Assessment, complete and have your physician submit the results of the required screening that includes all four measurements by the June 30, 2012 deadline, you will not be eligible to enroll in any of the Wellness Plan Options the following year.

Page 18: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Includes the HRA, HMO and HDHP Plan

Covers the same services as the Wellness Plans

EXCEPT:• No Promise (no biometric requirements)• Higher premiums (17% increase)• Less credit on the HRA plan • No preventive incentive for the HRA ($125 credit)• Higher Copays under the HMO plan

2012 Benefit and Plan ChangesNew Standard Plans

Page 19: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard Plans

SHBP HRA Credit Comparison

Wellness HRA Credit Standard HRA Credit

You $ 500 You + Spouse $ 1,000You + Child(ren) $ 1,000You + Family $ 1,500

You $ 375You + Spouse $ 650You + Child(ren) $ 650You + Family $1,000

HRA Deductibles and Out of Pocket Maximums have not changed. They are the same for the Wellness and Standard options.

Page 20: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard Plans

Prescription Drug Coverage• The Pharmacy benefit - the same under the Wellness and

Standard HRA Plans

• Pharmacy costs will NO longer apply to the HRA deductible or out-of-pocket limit no matter how you pay for them.

• Starting day one member will pay a % (co-pay) amount

• HRA dollar credits may be used for prescription drug • The benefit will change to a 3 Tier structure with a minimum

and maximum out-of-pocket

Page 21: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard Plans

Prescription Drug Coverage is the same for the Wellness and

Standard Plans:A 3 tier structure with a minimum and maximum

amount, you will pay as follows:

• Tier 1 – 15% (min $20 – max $50)

• Tier 2 – 25% (Min $50 – max $80)

• Tier 3 – 25% (min $80 – max $125)

Page 22: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes

HRA Wellness and Standard PlansPrescription Drug Coverage - continued

Retail Pharmacy - 31 day Tier 1 – 15% ($20 min/$50 max)

Tier 2 – 25% ($50 min/$80 max)

Tier 3 – 25% ($80 min/$125 max)90-Day Retail Pharmacy Tier 1 – 15% ($60 min/$150 max)

Tier 2 – 25% ($150 min/$240 max)

Tier 3 – 25% ($240 min/$375 max)90-Day Voluntary Mail Order

Tier 1 – 15% ($50 min/$125 max)

Tier 2 – 25% ($125 min/$200 max)

Tier 3 – 25% ($200 min/$312.50 max)

Page 23: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard Plans

Prescription Coverage Examples–Drug A is Tier 1Cost of the drug is less than the minimum amount for Tier 1 drugs

– For a 31-day supply the usual and customary price (contracted rate) is $15

– The minimum for Tier 1 is $20– The SHBP Member pays only the $15 since the actual cost is less than

$20.

Cost of the drug when coinsurance applies for Tier 1 drugs

– For a 31-day supply the contracted price is $100– The Coinsurance is 15% and the minimum amount for Tier 1 is $20– 15% of $100 is $15– Since the actual cost is $100, The SHBP Member would pay the

minimum amount of $20

Note: The $4 generics from $4 Generic Programs offered by some pharmacies will still be only $4

Page 24: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard

Prescription Coverage Examples – Drug B is Tier 2

Cost of the drug is less than the minimum amount for Tier 2 drugs

– For a 31-day supply the usual and customary price is $35.79– The minimum for Tier 2 is $50– The SHBP Member would only pay $35.79 since the actual drug cost is

less than the minimum.

Cost of the drug when coinsurance applies for Tier 2 drugs– For a 31-day supply the contracted price is $350– The Coinsurance is 25% and the maximum amount for Tier 2 is $80

– 25% of $350 is $87.50– The SHBP Member pays $80

Page 25: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Frequently Ask Questions - FAQs

Q. What happens when I have used all of my HRA credit and I need to purchase prescriptions?

A. The cost would be the same as in the previous examples you would just pay out of pocket instead of using HRA credits.

Page 26: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard Plans

Prescription Drug Coverage• Please note: In addition to your insurance card,

United Healthcare (UHC) members will need to provide a separate Pharmacy Health Care Spending Card (PHCSC) to access HRA dollar credits for their pharmacy expenses. (This additional card is not connected to the HCSA you may elect through GaBreeze.)

• No separate card is required for CIGNA members at the pharmacy.

Page 27: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHRA Wellness and Standard Plans

United Healthcare Pharmacy Health Care Spending Card

– How does it work and what happens at the pharmacy? 

• Activate your card as soon as you receive it by calling the number on the back of your card.

• Your card must be activated 1 business day prior to use. • When you use your card, payment is transferred directly from your

card to the pharmacy.• Once HRA funds are no longer available transactions will be

denied.• This card can only be used for covered prescription expenses (not

for medical or dental). • Unauthorized transactions will be denied.

Page 28: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHMO Wellness and Standard

HMO Plan Changes

The $200 annual vision benefit for glasses and contacts will

no longer be offered.

Page 29: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHMO Wellness and Standard

Type of Service Wellness HMO

Co-payment

Standard HMO

Co-payment

Primary Care Physician $35 – no change $45

Specialist $45 – no change $55

Prescription Co-pays, Deductibles and Out of Pocket Maximums

have not changed.Pharmacy 90- day Voluntary Mail Order

Tier 1- $ 50Tier 2- $125Tier 3- $225

HMO Plan Changes

Page 30: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHigh Deductible Health Plan

Wellness and Standard

Deductible Wellness HDHP

(In/Out of Network)

Standard HDHP

(In/Out of Network)

You

You + Spouse

You + Child(ren)

You + Family

$1500/$3000$3000/$6000$3000/$6000$3000/$6000

$1750/$3500$3500/$7000$3500/$7000$3500/$7000

Out-of-Pocket Wellness HDHP

(In/Out-of-Network)

Standard HDHP

(In/Out-of-Network)

You

You + Spouse

You + Child(ren)

You + Family

$2400/$5300$4100/$9800$4100/$9800$4100/$9800

$2650/$5800$4600/$10800$4600/$10800$4600/$10800

HDHP Deductible and Out-of-Pocket Comparison

Page 31: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan ChangesHigh Deductible Health Plan (HDHP)

Wellness and Standard

HDHP Co-Insurance and Pharmacy Comparison

Type of Service Wellness HDHP Standard HDHP

Co-Insurance 90% IN or 60% OON 80% IN or 60% OON

Pharmacy 90-Day Voluntary Mail Order

(this is not a change)

80% ($25 min/ $250 max)

IN = In Network

OON = Out of Network

Page 32: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes

All Plan Options

– Certain Tobacco Cessation Medications

• Covered when prescribed as part of a Tobacco Cessation Program

• Contact each vendor for specifics

– Bariatric Surgery

• Bariatric (weight loss) surgery will no longer be covered under any plan options

Page 33: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Making Your 2012 Benefit Election - Considerations

• Determine if healthcare provider is in-network

• Carefully review the 2012 Decision Guide available at www.myshbp.ga.gov

• Compare the benefits in relation to the premiums

• Check the Preferred Drug Lists for each plan and healthcare vendor as the formulary varies between plans and vendors

Page 34: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Making Your 2012 Benefit Election – Did You?

Remember to: •Make sure you have selected the correct option

•Confirm you have added all eligible dependents you wish to be covered

•Confirm you have answered the surcharge questions correctly

•Click “Confirm” and always Print your Confirmation (this WILL include a confirmation number)

Page 35: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Making Your 2012 Benefit Election – If You Don’t

If you don’t go online and make a 2012 election

Your coverage will default to:

• To the Standard HRA, HMO or HDHP Option with your current vendor

• The tobacco and spousal surcharges (if you cover your spouse) will apply for the 2012 Plan Year

Page 36: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes Eligibility Changes

• Surviving Spouse/Adding New Born– 90 days to request to continue coverage/add

newborn

• Election Error Reporting– Active employees will have until December 31 to

report an election error made during the Open Enrollment Period to their Payroll Location

– Office closure for the holidays will not extend the deadline

– Once coverage goes into effect, SHBP will not allow a change

Page 37: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

2012 Benefit and Plan Changes Eligibility Changes

– Spousal Surcharge Verification• it is important that you answer the Spousal Surcharge

questions accurately to avoid disruption of coverage.

• SHBP will be requesting from you documentation or an affidavit from your spouse’s employer verifying the spouse is not eligible for health insurance.

• You do not need to take any additional action until documentation is requested.

Page 38: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Important Notice

• The information provided in this presentation is a summary of changes for the 2012 Plan Year.

• It is intended only to highlight principal benefits

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

• TTT, rates, decision guides and other information will be available soon at www.dch.georgia.gov/shbp and www.myshbp.ga.gov

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Page 39: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Questions or Additional Information

36

Page 40: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Frequently Ask Questions - FAQs

Q. If I complete my Health Assessment and obtain my biometric screening but my spouse doesn’t, will I be able to enroll in a Wellness Option in 2013? - A. No.

Q. Can I still earn $125 for taking my online health assessment and obtaining my annual physical? A. Yes but only if you are enrolled in the Wellness HRA Plan.

Q. If I smoke, will I be able to enroll in a Wellness Option? A. Yes

Page 41: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Frequently Ask Questions - FAQs

Q. Can I submit my biometric screening results to my healthcare vendor? A. No. Your physician must fax to your vendor by June 30, 2012. (This physician fax form will be available January 1, 2012)

Q. In year two, what happens if my biometric numbers don’t improve? A. You may continue in the Wellness Plan. You will need to show that you are taking steps to improve your health unless you have a medical condition that does not allow you to take steps to improve your biometric numbers.

Page 42: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

Questions or Additional Information

• CIGNA - HMO, HRA, HDHP 800-633-8519

www.mycigna.com/shbp

• UnitedHealthcare - HMO, HDHP - 877-246-4189

HRA - 800-396-6515www.welcometouhc.com/shbp

• Refer to www.myshbp.ga.gov to access additional information

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Page 43: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 43APRIL 2010

Changes to Flexible Benefits

for 2012

Page 44: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 44APRIL 2010

Dental Plans

Regular and PPO Dental

– Increase in premiums*

–No changes to the plan design

DHMO – CIGNA

– Increase in premiums*

–No changes to the plan design

Plan Design/Premium Changes for 2012

*Premium amounts will be listed on the 2012 Rate Sheet

Page 45: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 45APRIL 2010

Employee, Spouse, Child Life and AD&D Plans – Minnesota Life

All life insurance options will deducted as after-tax options.

Plan Enhancements

– Child Life

> Removed the limitation for 0 - 6 months ($6,000 cap)

> Child coverage can begin at live birth

• Automatic coverage of $3,000 for a newborn child if the child dies within 30 days of birth but prior to the employee enrolling for child life coverage

– Employee/Spouse Life

> Legacy Planning Services: End-of-life planning and resources

Plan Design/Premium Changes for 2012

Page 46: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 46APRIL 2010

Short-Term Disability Plans –

The Standard

5% Rate decrease in STD premiums

Plan Design/Premium Changes for 2012

Page 47: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 47APRIL 2010

Critical Illness Plan – CAIC

Plan enhancement–Additional covered illness: Coverage for Alzheimer’s disease (25% of the benefit amount)

Plan Design/Premium Changes for 2012

Also, if you have the critical/specified illness plan for this year, and went for your wellness check, don’t forget to send them a claim from to receive your $100. You can find the link to the claim form on our website.

Page 48: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 48APRIL 2010

Legal Plans – Hyatt

Plan enhancements

– Additional covered services for Both plans (Select & Select Plus)

> Elder law matters

> Home equity loans assistance

– Additional covered services for Select Plus plan

> Civil litigation defense

> Incompetency defense

Plan Design/Premium Changes for 2012

Page 49: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 49APRIL 2010

No Plan Changes

Vision

Long Term Care (contact Unum directly to enroll)

Long Term Disability

Health Care/Dependent Care Spending Accounts

Plan Design/Premium Changes for 2012

Page 50: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 50APRIL 2010

GaBreeze Confirmation Number

Employees will receive a Confirmation Number upon successful completion of their online Annual Enrollment on the completed successfully page on the GaBreeze Website

Additional changes will be permitted online during the remainder of the Annual Enrollment period.

– Employees will retain the same Confirmation Number

– Date/Time Stamp will update to reflect the most recent completion

Employees should print a copy of the Confirmation Number page for their records

GaBreeze Enhancements for 2012

Page 51: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 51APRIL 2010

Reminders for 2012

Benefits Call Center

1-877-3GBreez or 1-877-342-7339

Monday – Friday, 8:00 am – 5:00 pm ETexcluding holidays

Website

www.GaBreeze.ga.gov

Link on Team Georgia Flexible Benefits tabhttp://www.gms.state.ga.us/employees/flexible_benefits.asp

Page 52: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 52APRIL 2010

• Direct deposit of all payroll checks will be required with the January 15, 2012 payroll. 

• For those employees that do not already have direct deposit, we ask that you have an account with a financial institution and transmit your account information to the payroll office by January 1, 2012. 

• You must notify payroll at least 10 days before a pay date in order to have your funds transferred to the right account.

Direct Deposit

Page 53: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 53APRIL 2010

• Compare your paycheck statements with your Confirmation Statement.

• It is your responsibility to notify your personnel/ payroll office immediately if there is an error.

• Deductions should match the confirmed choices.

Confirmations

Page 54: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 54APRIL 2010

Page 55: 2012 Open Enrollment. October 11 th -November 10 th New website  Do NOT wait until the last minute You need to register.

February 2010 55APRIL 2010

????? Questions ??

???


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