High Plains Educational Cooperative

10/1/2015Open Enrollment

August 5th & 6th, 2015

Open Enrollment Agenda1. Medical Plan Overview2. Claims Administrator3. Preferred Provider Network4. Dental Plan Overview5. Health Reimbursement Account6. Medical ID Cards7. Group Life/AD&D Overview 8. Open Enrollment & Next Steps

Note: This presentation and information will be posted to the HPEC website for future reference.

What’s Happening on 10/1/2015?• Healthcare Reform regulations apply to HPEC

• Expanded eligibility to Para Educators

• Expanded benefit coverage (i.e. Prescription, Mental Health, etc.)

• Annual Open Enrollment

• New Medical Plan – effective 10/1/15

• Claims Administrator – EBMS (www.ebms.com)

• Case Management – EBMS

• New Pharmacy Administrator – Navitus

• Preferred Provider Network - ProviDRs

• Termination of the Health Reimbursement Arrangement (HRA)

• New waiting period – First of the month following 60 days. Eligible employees working 30+ hours per week including Para Educators.

Important Contact Numbers• Medical & Dental Claims Administrator

• EBMS – www.ebms.com

• Toll-Free: 800-777-3575

• Care Management• EBMS Care Link

• Toll-Free: 866-894-1505

• Preferred Provider Network • WPPA ProviDRs Care Network – www.providercare.net

• Toll Free: 800-801-9772

• Pharmacy Benefit Administrator • Navitus Customer Care – www.navitus.com

Toll-Free: Will be listed on your pharmacy benefit member ID cardTTY user call 711Hours: 24 hours a day, 7 days a week(Closed Thanksgiving and Christmas Day)

Claims ProcessThe claims submission process is much easier for you when you use

network providers because they submit the claim on your behalf.

Find a Network Provider

• Access www.providerscare.net

• Search for a Network Provider

Provider Submits Claim(s)

• Network provider sends claim(s) directly to EBMS

• EBMS processes claim based on plan specifications

• EBMS notifies member and provider of claim(s) outcome

Care Managemen

t Services

10/2015 Medical Plan OverviewIn-Network Shown Medical Plan

Plan Deductible$800 per person

$1,200 family maximum

Out of Pocket Maximum(Includes Deductible & Copays)

$1,600 per person$2,800 family maximum

Preventive Care(Well Care)

$0 – no cost to participant

Office Visits(Per person)

30% coinsurance

Prescriptions(mail order 90 day supply 3x)

Navitus Formulary Applies

Tier 1 Generic – $10 copayTier 2 Preferred Brand – 40% copayTier 3 Non-Preferred Brand – 50%

copay

Diagnostic Tests & Imaging (CT/PET/MRI) 30% coinsurance

Out Patient Surgery 30% coinsurance

In Patient Surgery 30% coinsurance

Emergency Room 30% coinsurance

All other covered care 30% coinsurance

Deductible & Out of Pocket Maximum Reminder

• As of 10/1/15 your deductible and out of pocket amounts will increase to:

• Deductible: $800 per person; $1,200 family maximum

• Out of Pocket: $1,600 per person; $2,800 family maximum

• If you had met your deductible prior to 10/1/15; the new additional amount will apply for care incurred from 10/1/15 to 12/31/15.

• Reminder: All deductible and out of pocket maximums restart on 1/1/16.

Medical Plan – Your monthly cost:

• Single enrollment (total cost) - $453.00

• Family enrollment (total cost) - $890.00

• HPEC will cover 100% of the single rate:

• Your cost for single enrollment - $0

• Your cost for family enrollment - $477.00

10/2015 Dental Plan OverviewIn-Network Shown Dental Plan

Plan Deductible(Does not apply to Class 1 Dental Expenses)

$25 per individual $75 family maximum

Calendar Year Maximum $1,500 per person

Class 1 – Preventive Services 100%

Class 2 – Basic Services 85% after deductible

Class 3 – Major Services 50% after deductible

Orthodontia Not Covered by Plan

- Refer to Dental Plan Document for limitation and benefit frequency.

Powered by EBMS

MEMBER ACCESS

HRA Termination Effective 10/1/15 the HPEC Health Reimbursement Account (HRA) will be

terminated.

All eligible claims incurred prior to 10/1/15 will be eligible for reimbursement through 12/31/15. Any claims after this date will be denied and not paid by the HRA plan.

Submit all claims to EBMS for processing and payment.

ID Cards Effective 10/1/2015 – ALL participants will

receive a new EBMS Medical/Dental ID card.

Please discard your prior EBMS ID card as it will NOT contain the appropriate information to process medical and prescription claims after 10/1/15.

Life/AD&D OverviewEligible: Board Officers and All Full-Time Certified Teachers

Personal Life Insurance: $10,000 AD&D Insurance: $10,000 Personal Life and AD&D Insurance will be reduced as

follows: At age 65, benefits will reduce by 35% of the original

amount; At age 70, benefits will reduce an additional 25% of the

original amount; At age 75, benefits will reduce an additional 15% of the

original amount. Benefits will terminate when you retire.

REMINDER: Update your Beneficiary if you have experienced any life changes.

Open Enrollment ChecklistIMPORTANT NOTICE: Your election to participate in the Company’s Medical & Dental plan, is made for the ENTIRE PLAN YEAR & will remain in effect from 10/1/15 to 9/30/16. Benefit Plan election changes may be made mid-Plan Year and at other times during the year ONLY if the changes:

1) Affect eligibility to participate in these plans,

2) Are allowed under IRS Code, AND

3) Because of, and consistent with, a qualifying event (i.e. marital status, number of dependents, employment status, dependent ceasing to satisfy eligibility requirements, entitlement to Medicare, etc.). Change-in-status requests must be submitted to Chrissie Mangels, in writing, within 31 days of the change-in-status event.

Open Enrollment ChecklistOpen Enrollment is being held from August 5th through August 20th. All forms are due to Chrissie by Noon, August 20th 2015. No exceptions!

Medical/Dental for Full-Time and Certified Teachers – If you are wanting to make changes (enroll, drop or add dependents) to your enrollment, now is the time to do so. You must complete an EBMS enrollment/change form to make the changes. If you wish to keep your enrollment the same as the 10/2014 plan year – no form is necessary your prior elections will rollover to the 10/2015 plan year.