MASCRegional Meeting Overview

Employee Insurance Program803-734-0498

(Products, Legal, and Policy)

Disclaimer

BENEFITS ADMINISTRATORS AND OTHERS CHOSEN BY YOUR EMPLOYER WHO MAY ASSIST WITH INSURANCE ENROLLMENT, CHANGES, RETIREMENT OR TERMINATION AND RELATED ACTIVITIES ARE NOT AGENTS OF THE EMPLOYEE INSURANCE PROGRAM AND ARE NOT AUTHORIZED TO BIND THE EMPLOYEE INSURANCE PROGRAM.

THIS PRESENTATION CONTAINS AN ABBREVIATED DESCRIPTION OF INSURANCE BENEFITS PROVIDED BY OR THROUGH THE EMPLOYEE INSURANCE PROGRAM. THE PLAN OF BENEFITS DOCUMENTS AND BENEFITS CONTRACTS CONTAIN COMPLETE DESCRIPTIONS OF THE HEALTH AND DENTAL PLANS AND ALL OTHER INSURANCE BENEFITS. THEIR TERMS AND CONDITIONS GOVERN ALL BENEFITS OFFERED BY OR THROUGH THE EMPLOYEE INSURANCE PROGRAM. IF YOU WOULD LIKE TO REVIEW THESE DOCUMENTS, CONTACT YOUR BENEFITS ADMINISTRATOR OR THE EMPLOYEE INSURANCE PROGRAM.

THE LANGUAGE USED IN THIS PRESENTATION DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE AGENCY. THIS PRESENTATION DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS PRESENTATION, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.

MASC

Review of Informational Materials

Review of Informational Materials

• Insurance Benefits Guide• Local Subdivision Handbook• List of participating counties and

municipalities• Plan comparison matrices• Cafeteria plan matrix

MASC Orientation

Local Subdivision Handbook and

Application

Local Subdivision Handbook and Application

Eligibility• Established by statute

Section 1-11-720 of the 1976 S.C. Code of Laws, as amended

Local Subdivision Handbook and Application

Participation Requirements• Minimum of four years

participation

• 90 days notice of intent to withdraw

• Minimum of four years before returning

• Must offer all EIP benefits to all eligible employees

Local Subdivision Handbook and Application

Participation Requirements• Designate a Benefits Administrator

• Verify eligibility of employees

• Make good-faith effort to notify eligible retirees, terminated employees, and surviving dependents of deceased employees/retirees

Local Subdivision Handbook and Application

Funding Requirements•Make same contribution as the state for employees and their dependents

•$3 administrative fee per employee

• Initial experience ratings <100 covered lives: 1.2% 100-500 covered lives : 2.2% >500 covered lives: 4.3%

Local Subdivision Handbook and Application

Submission Deadline and Fees• Submission of application to EIP by

February 15

• $500 non-refundable application fee

MASC Orientation

Support Resources

MASC Orientation

Support Resources• On-site orientation and training

• Continuing training programs

• Employee Benefits Services (EBS) online inquiry/enrollment system

• Multi-media education materials

• Other web-based resources

MASC Orientation

Frequently Asked Questions and Important

Considerations

Frequently Asked Questions and Important Considerations

• Are HMO enrollees required to elect and disclose their PCP at time of enrollment? No

• How is the plan year determined? EIP’s plan year is always based upon the calendar year

• Does the State have an employee assistance program? No

• Does it cost extra for employers or employees to use the services of EIP’s Prevention Partners unit? There is no additional cost to the employer for Prevention Partners programs; however some workshops and programs may be offered at minimal fee to the employees and their dependents.

Frequently Asked Questions and Important Considerations

• What control does the employer have over which plans are offered? A participating employer must offer all EIP programs to employees and also must allow employees to elect any levels of coverage.

• Does the state administer its own COBRA? Employers are responsible for the day-to-day administration of COBRA continuation coverage. EIP offers many resources to support this function.

• Are elected members of participating county and city councils eligible to participate? Those elected members who contribute to the South Carolina Retirement Systems are considered full-time employees and are eligible

MASC Orientation

Overview of EIP Plans of Benefits

Overview

EIP Benefit Programs• Health Plans• Dental Plans• Vision Plan• Life Insurance• Long Term Disability• Long Term Care• MoneyPlu$ (Pre-tax programs)

Overview

Eligibility

Eligibility

Active Employee• Must be employed in permanent,

full-time position

• Work at least 30 hours per week unless Employed as a part-time teacher (only

eligible for health, dental, vision and MoneyPlu$)

Employed by employer who allows coverage for 20-hour employees

Retired Employee• Must meet certain

requirements to continue coverage in retirement

• EIP will accept Benefits Administrator certification of eligibility

Eligibility

Eligible Spouse• Spouse or former spouse* if

coverage is court-ordered

• Cannot cover spouse who is eligible for benefits through EIP as active employee or funded retiree

Eligibility

* Documentation required to cover a former spouse

Eligibility

Eligible Children• Under age 26*• No access to insurance

through employer of child or child’s spouse

• Approved for incapacitation*

* To be eligible for Dependent Life-Child, a child age 19-24 must be a full-time student or certified incapacitated

Overview

Enrollment Periods

Enrollment

October Enrollment Periods• Annual Enrollment (Every year)

Change health plans Enroll in or drop State Vision Plan Enroll or re-enroll in MoneyPlu$

programs• Open Enrollment (Odd-numbered years, i.e., 2011, 2013)

Enroll in or drop health, dental or Dental Plus

Add or drop eligible dependents

Overview

Health Plans

Overview

Health Plan Options• State Health Plan

Standard Plan

Savings Plan

• HMO BlueChoice HealthPlan HMO

CIGNA HMO

State Health Plan(SHP)

Administered by BlueCross BlueShield of South Carolina

State Health Plan

Common to Both• Worldwide coverage

• In- and out-of-network benefits

• Pharmacy network

• Online access available www.SouthCarolinaBlues.com

State Health Plan Standard Plan and Savings Plan

Limited Preventive Benefits*

• Routine mammogram

• Pap test

• Well child care

• Routine colonoscopy

State Health Plan Standard Plan and Savings Plan

* Refer to the 2011 Insurance Benefits Guide for plan guidelines

Preauthorization• Medi-Call

Required for specific services, including maternity care

If pre-authorization is not obtained, penalties apply

$200 per inpatient admission Related charges do not satisfy any

portion of the annual coinsurance maximum

State Health Plan Standard Plan and Savings Plan

State Health Plan Standard Plan

SHP Standard Plan

Standard Plan

Annual Deductible $350 individual $700 family

Out-of-network Coinsurance Plan pays

60%

Subscriber pays 40%

Coinsurance Maximum $4,000 individual

$8,000 family

In-network Coinsurance Plan pays 80%

Subscriber pays 20%

Coinsurance Maximum $2,000 individual

$4,000 family

Deductibles and Coinsurance

Standard Plan

Per-occurrence Deductibles $10 Office visit

$75 Outpatient facility service

$125 Emergency room visit

Network Retail

Pharmacy*

(up to 31-day supply)

$ 9 Tier 1 $ 30 Tier 2 $ 50 Tier 3

MedcoMail Order*

(up to 90-day supply)

$ 22 Tier 1 $ 75 Tier 2 $125 Tier 3

Retail Maintenance Network

Prescription Drug Benefits

$2,500 maximum copayment per person

Standard Plan

*”Pay the Difference” applies

State Health Plan Savings Plan

SHP Savings Plan

Annual Deductible

$3,000 individual

$6,000 family

Out-of-network Coinsurance Plan pays

60%

Subscriber pays 40%

Coinsurance Maximum $4,000 individual

$8,000 family

In-network Coinsurance Plan pays 80%

Subscriber pays 20%

Coinsurance Maximum $2,000 individual

$4,000 family

Deductibles and Coinsurance

Savings Plan

Savings Plan

Rules• Subscriber pays 100% of

Allowable charges in-network

Actual charges out-of-network

Allowable charges at network pharmacies

• After deductible is met, Plan will reimburse subscriber 80% of allowable charges

Savings Plan

Added benefits• Annual flu shot

• Annual physical that includes specific services

• Eligibility to contribute to Health Savings Account (HSA)

HMOs

Health Maintenance Organizations

(HMOs)

HMOs

Requirements• Must live or work in HMO

service area

• Must choose Primary Care Physician (PCP) in network and receive referrals before seeing specialist

• Only out-of-network benefit is emergency care

BlueChoice HealthPlan (Available in all South Carolina counties)

BlueChoice HealthPlan HMOAvailable in all South Carolina Counties

Coinsurance Maximum

$2,000 individual

$4,000 family

Annual Deductible

$250 individual

$500 family

Network Coinsurance Plan pays 85%

Subscriber pays 15%

Deductibles and Coinsurance

BlueChoice HealthPlan(Available in all South Carolina counties)

Annual Benefits Maximum $2,000,000

BlueChoice HealthPlan(Available in all South Carolina counties)

Provider:

$15 PCP $15 OB-GYN $40 specialist $35 urgent care

Plan pays 100% after copay

Facility:

$100 outpatient $125 ER $200 inpatient

Plan pays 85% after copay

Copays

Network Retail Pharmacy

(up to 31-day supply)

$ 8 Lower-cost generic

$ 15 Higher-cost generic

$ 35 Preferred brand

$ 55 Non-preferred brand

$ 80 Preferred brand specialty

pharmaceuticals

$125 Specialty pharmaceuticals

Mail Order (up to 90-day supply)

$ 20.00 Lower-cost generic

$ 37.50 Higher-cost generic

$ 87.50 Preferred brand

$137.50 Non-preferred brand

BlueChoice HealthPlan (Available in all South Carolina counties)

CIGNA HMO

CIGNA HMOAvailable in all South Carolina counties except Abbeville,

Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Coinsurance Maximum $2,000 individual $4,000 family

Annual Deductible

None

In-network Coinsurance Plan pays

80% Subscriber pays 20%

Deductibles and Coinsurance

CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Copays

Provider

$15 PCP $15 OB-GYN $30 specialist $100 ER

Plan pays 100%after copay

Hospital

$250 outpatient $500 inpatient

Plan pays 80%after copay

CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Mail-Order (up to 90-day supply)

$ 14 generic $ 50 preferred brand $100 non-preferred brand

Network Retail Pharmacy (up to 30-day supply)

$ 7 generic $25 preferred brand $50 non-preferred brand

CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Tobacco Surcharge• $40 per month for subscribers• $60 per month for subscribers who

cover at least one dependent

• Automatically charged unless certify no one uses tobacco

• May certify by completing paper Certification Regarding Tobacco Use form

Tobacco Surcharge

Overview

State Dental PlanAdministered by BlueCross BlueShield of South Carolina

State Dental Plan

Features• Free to choose dentist

• No pre-existing condition exclusions

• Two year plan – may not drop or change until next open enrollment

• $1,000 maximum benefit per year

* $25 Combined Deductible for Classes II and III

Classes of Services Class I Preventive

services 100% of fee

schedule

Class III*

Prosthodontics 50% of fee schedule

Class IV Orthodontics (only

children younger than 19; $1,000 lifetime maximum)

Class II*

Basic services 80% of fee

schedule

State Dental Plan

Overview

Dental PlusAdministered by BlueCross BlueShield of South Carolina

Dental Plus

Features• Supplement to Basic Dental

• Higher allowance for Class I, II and III services

• Combined maximum benefit of $2,000

• May enroll in or cancel coverage during open enrollment

Overview

State Vision PlanAdministered by EyeMed Vision Care

State Vision Plan

Vision Care Services• Eye exams

• Frames

• Lenses

• Contact lens services and materials

• Discounts on LASIK and PRK vision correction

State Vision Plan

Providers• In-network

No claims to file Pay copayment and charges above the

plan’s allowance

• Out-of-network Pay provider for service EyeMed will reimburse you for a

portion of expenses for certain services* Locate a provider on EIP’s web site or by calling EyeMed at 877-735-9314

State Vision Plan

Eye Exams• $10 copayment

• Standard contact lens fitting No copayment

• Premium contact lens fitting 10% discount and

$55 allowance toward discounted price

State Vision Plan

Eyeglasses• Frames every 2 years

$140 allowance*

20% discount off balance

• Lenses every year $10 copayment for single vision,

bifocal, trifocal and lenticular plastic lenses

$45 copayment for standard progressive lenses

*Cannot be combined with any other promotion or discount

State Vision Plan

Contact Lenses*

• Every 12 months

• Conventional lenses $130 allowance 15% discount off balance

• Disposable lenses $130 allowance

• Declining balance* Subscriber may choose either eyeglass lenses or contact lenses, but not both in the same plan year.

Overview

Vision CareDiscount Program

Vision CareDiscount Program

Features

• No enrollment or premium

• Discount program

• Participating providers only $60 for routine eye exam – excludes

contact lens exam

20% discount on eyewear except disposable contact lenses

Overview

Life InsuranceAdministered by MetLife

Basic Life

Basic Life

• $3,000 term life insurance to all eligible employees under age 70

• Premium paid by employer

• Employees enrolled in any health plan are covered

• Accidental death and dismemberment benefits

Optional Life

Optional Life• Premium based on amount of

coverage and employee’s age• Coverage up to three times salary if

enrolled within 31 days of employment

• Medical evidence required for additional coverage

• Maximum coverage level of $500,000

Dependent Life

Child coverage• $15,000 per child

• Premiums ─ $1.24 per month, regardless of number of children covered

• Can enroll eligible children throughout the year without medical evidence of good health

Dependent Life

Spouse coverage• New hire can enroll spouse for

$10,000 or $20,000 without medical evidence of good health

• Premiums based on employee’s age and amount of coverage

• Employee is beneficiary • May enroll in up to 50% of

employee’s Optional Life coverage with medical evidence

Overview

Long TermDisability InsuranceAdministered by Standard Insurance Company

Basic Long TermDisability Insurance

Basic Long Term Disability (BLTD)

• Premiums paid by employer

• Employee automatically enrolled with selection of a health plan

• 62.5 percent benefit, up to $800 per month

• 90-day waiting period

Supplemental Long TermDisability Insurance

Supplemental Long TermDisability (SLTD)

• Provides protection for employee if annual salary exceeds $15,360

• Benefit – 65% of monthly salary up to $8,000 per month

• Choice of two plans 90-day waiting period

180-day waiting period

Supplemental Long TermDisability Insurance

Enrollment in SLTD• New hire may enroll without

providing medical evidence of good health

• Late entrant must provide medical evidence of good health to enroll

• Employee pays premium – based on monthly salary, plan chosen and age

Overview

Long Term CareAdministered by Prudential

Long Term Care

Features

• Benefits paid when subscriber, for at least 90 days: Is unable to perform at least two

activities of daily living (ADL) or

Has severe cognitive impairment requiring ongoing help or supervision

Long Term Care

Eligible Participants• Active full-time permanent

employees and their Spouse, parents, parents-in-law,

grandparents, grandparents-in-law, siblings, adult children (and their spouses)

• Retirees and their spouse

• Surviving spouses

Long Term Care

Premiums• Based on

Age at time of purchase Selected plan

• Paid directly to Prudential -- subscriber may continue coverage upon retirement or leaving employment

Overview

MoneyPlu$Administered by

Fringe Benefits Management Company (FBMC)

MoneyPlu$

Features• Pretax premiums

• Medical Spending Account (MSA)

• Dependent Care Spending Account (DCSA)

• Health Savings Account (HSA)

MoneyPlu$Pre-tax Premium

Pretax Premiums• Health• Dental and Dental Plus• State Vision Plan• First $50,000 of Optional Life • Tobacco Surcharge• $0.28 monthly administrative fee

MoneyPlu$Medical Spending Account

Medical Spending Account (MSA)

• Employed for one year before participating

• $5,000 maximum annual contribution

• $3.50 monthly administrative fee

• “Use it or lose it” account

MoneyPlu$Medical Spending Account

Eligible expenses include• Deductibles, coinsurance

and copayments

• Medically necessary expenses

• Prescribed medications, approved OTC medications with prescription, approved OTC items

MoneyPlu$Dependent Care Spending Account

Dependent Care Spending

Account (DCSA)

• $5,000 maximum contribution

• $3.50 monthly administrative fee

MoneyPlu$Dependent Care Spending Account

Eligible expenses• Day care fees

• Care for qualified individuals in your home or someone else’s home

• Summer day camps

MoneyPlu$Health Savings Account

Health Savings Account (HSA)• Employee must be enrolled in the

SHP Savings Plan

• Money deposited into account carries forward from year to year

• Account is portable

• Fees $1 per month to FBMC $1 per month ($10/year) to NBSC

Health Savings AccountLimited-Use Medical Spending Account (MSA)

Limited-Use MSA• Must be employed for one year

• Only used for dental and vision care expenses

• $5,000 maximum contribution

• $3.50 monthly administrative fee

• “Use it or Lose it” account

MASC Orientation

Questions?