PowerPoint Presentation · plans effective 7/1/2020. • EUTF 75/25 PPO drug plan calendar year...

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2020 Open Enrollment Informational Session

For Human Resource and County Personnel Officers

Hawaii Employer-Union Health Benefits Trust Fund

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Employer-Union Health Benefits Trust Fund

State of Hawaii

Money Saving Tips &

Wellness Programs Identify ways to reduce healthcare cost and

improve your health

Open EnrollmentImportant dates and form submission

deadlines

Plan ChangesImportant benefit changes

Health Plan SelectionKnow what to consider when

selecting a health plan

Enrollment FormCompleting and submitting forms for

open enrollment

Online ResourcesInformation on EUTF website

resources

OPEN ENROLLMENT ONLINE RESOURCES PLAN CHANGES HEALTH PLAN SELECTION ENROLLMENT FORMMoney Saving Tips & Wellness Programs


Open Enrollment

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State of Hawaii

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IMPORTANT DATES

APRIL MAY JUNE JULY JUNE

Election PeriodApril 1, 2020 - April 30, 2020

Submission Deadline April 30, 2020

Employees who wish to enroll or make changes must complete and submit an EC-1 or EC-1H enrollment form and any required proof documents to Human Resource Officers, County Personnel Officers or DOE-EBU on or before the submission deadline of April 30, 2020. For employees who do not want to make changes, no action is needed.




State of Hawaii

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IMPORTANT DATES




Submission DeadlineHRO/CPO/EBU

May 7, 2020

Submission deadline for enrollment forms and proof documents to EUTF by Human Resource Officers, County Personnel Officers and DOE-EBU is May 7, 2020 by mail or courier only. Faxes will not be accepted. (Non-OE enrollment forms may still be faxed)


OPEN ENROLLMENT


State of Hawaii

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IMPORTANT DATES


Processing PeriodMay – June 2020



Processing PeriodMay – June 2020

Enrollment forms received on or before the deadline will be processed during the months of May and June. Once the enrollment is processed, a confirmation notice will be mailed to the employee. If they do not receive a confirmation notice by the end of June, please have them contact the EUTF. If the employee is not enrolling or making changes during the election period, they will not receive a confirmation notice.

Confirmation NoticeReceived by end of June


OPEN ENROLLMENT


State of Hawaii

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IMPORTANT DATES


Processing PeriodMay – June 2020 July 1, 2020 – June 30, 2021

New Plan YearElection PeriodApril 1, 2020 - April 30, 2020


Processing PeriodMay – June 2020 July 1, 2020 – June 30, 2021

New Plan Year

New premiums deducted from paycheck

State EmployeesJuly 20, 2020 through July 5, 2021

County EmployeesJuly 15, 2020 through June 30, 2021

The New Plan Year for active employees begins July 1st and continues until June 30th of the following year. All changes made during open enrollment will take effect July 1st. Any health plan changes including new premiums and rate changes will also take effect July 1st.


OPEN ENROLLMENT

Online Resources

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Website: eutf.hawaii.gov

• Active Employee Tab

• Active Employee Reference Guide

• EC-1 (EC-1H) Enrollment Form

• Open Enrollment Checklist

(Forms & Documents)


State of Hawaii

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EUTF Online Resources



• EUTF Premium Plan Comparison

(Website Tools)


State of Hawaii

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ONLINE RESOURCES

EUTF Online Resources




• EUTF Plan Finder

EUTF Online Resources (Website Tools)


State of Hawaii

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ONLINE RESOURCES




• EUTF Plan Finder

• Learning Center

EUTF Online Resources (Website Tools)


State of Hawaii

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ONLINE RESOURCES

Plan Changes

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State of Hawaii

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Effective July 1, 2020*

*Unless otherwise noted.

MED

ICA

L P

LAN

For both EUTF and HSTA VB active plans

• Added coverage of 3D digital breast tomosynthesis screenings under the

mammography (screening) benefit.

• Added air ambulance coverage from Hawaii to the continental United States

for critical care treatment when commercial travel is not an option because of

the need for life supporting equipment and/or a medical support team.


PLAN CHANGES


State of Hawaii

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MED

ICA

L P

LAN






MED

ICA

L P

LAN

• Added 40% hearing aid coverage (60% member coinsurance) for one

hearing aid per ear every 36 months for EUTF active plans.

• Pre-exposure prophylaxis (PrEP) for the prevention of HIV infection

medication will be covered at $0 copayment for EUTF and HSTA VB active

plans, in accordance with federal law.


PLAN CHANGES


State of Hawaii

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MED

ICA

L P

LAN






MED

ICA

L P

LAN



• Added coverage of pre-exposure prophylaxis (PrEP) for the prevention of

HIV infection medication at $0 copayment in accordance with federal law

to EUTF and HSTA VB active plans.

PR

ESC

RIP

TIO

N D

RU

GS

PR

ESC

RIP

TIO

N D

RU

GS

• Pre-exposure prophylaxis (PrEP) for the prevention of HIV infection medication

will be covered at $0 copayment for EUTF and HSTA VB active plans, in

accordance with federal law.

• EUTF 75/25 PPO drug plan calendar year maximum out-of-pocket (MOOP) will

increase from $2,900/$5,800 (Individual/Family) to $3,150/$6,300 effective

1/1/2021.


PLAN CHANGES


State of Hawaii

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MED

ICA

L P

LAN






MED

ICA

L P

LAN






PR

ESC

RIP

TIO

N D

RU

GS

PR

ESC

RIP

TIO

N D

RU

GS

• Added coverage of pre-exposure prophylaxis (PrEP) for the prevention of HIV infection

medication at $0 copayment in accordance with federal law to EUTF and HSTA VB active

plans effective 7/1/2020.

• EUTF 75/25 PPO drug plan calendar year maximum out-of-pocket (MOOP) will increase from

$2,900/$5,800 (Individual/Family) to $3,150/$6,300 effective 1/1/2021.

PR

ESC

RIP

TIO

N D

RU

GS

DEN

TAL

PLA

N

• Added coverage of two additional teeth of Silver Diamine Fluoride (SDF) per date of service and coverage of restorations if placed after 30 days of SDF treatment (EUTF and HSTA VB 100% coverage and the HSTA VB supplemental 50% coverage).

• Added coverage of athletic/sport mouth guards for members ages 18 and under every 24 months (EUTF and HSTA VB 80% coverage and the HSTA VB supplemental 45% coverage).


PLAN CHANGES


State of Hawaii

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MED

ICA

L P

LAN






MED

ICA

L P

LAN






PR

ESC

RIP

TIO

N D

RU

GS

PR

ESC

RIP

TIO

N D

RU

GS


medication at $0 copayment in accordance with federal law to EUTF and HSTA VB active

plans effective 7/1/2020.



PR

ESC

RIP

TIO

N D

RU

GS

DEN

TAL

PLA

N

• Added coverage of two additional teeth of Silver Diamine Fluoride per date of service and allowance of coverage of restorations if placed after 30 days of Silver Diamine Fluoride (EUTF and HSTA VB 100% coverage and the HSTA VB supplemental 50% coverage).


PR

ESC

RIP

TIO

N D

RU

GS

VIS

ION

PLA

N

For both EUTF and HSTA VB active plans

• Increased the retail frame allowance from $120 to $150. Frame covered every other year.

• Increased the contact lens allowance from $120 to $130. Contacts covered every year in lieu of glasses.


PLAN CHANGES


State of Hawaii

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MED

ICA

L P

LAN






MED

ICA

L P

LAN






PR

ESC

RIP

TIO

N D

RU

GS

PR

ESC

RIP

TIO

N D

RU

GS


medication at $0 copayment in accordance with federal law to EUTF and HSTA VB active plans

effective 7/1/2020.



PR

ESC

RIP

TIO

N D

RU

GS

DEN

TAL

PLA

N

• Added coverage of two additional teeth of Silver Diamine Fluoride per date of service and allowance of coverage of restorations if placed after 30 days of Silver Diamine Fluoride (EUTF and HSTA VB 100% coverage and the HSTA VB supplemental 50% coverage).


PR

ESC

RIP

TIO

N D

RU

GS

VIS

ION

PLA

N

• Increased the retail frame allowance to $150 (from $120). Frame covered every other year.

• Increased the contact lens allowance to $130 (from $120). Contacts covered every year in lieu of glasses.

*Unless otherwise indicated

Premium and Contribution amounts for 2020 to 2021 Plan Year Available:

• 2020 Active Employee Reference Guide Pages 16 and 17• EUTF Website (euft.hawaii.gov) under the “Active” tab• Printed on the 2020-2021 EC-1 & EC-1H form

PR

EMI R

IBU

TIO

NS

PR

EMIU

MS

& C

ON

TRIB

UTI

ON

S


PLAN CHANGES

Health Plan Selection

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State of Hawaii



Things to Consider

PREMIUMS

DEDUCTIBLE

The monthly amount paid for your health insurance shared between the employer and employee.

Deductibles do not apply to all plans or all services. They cannot be paid in advance and are renewed annually. Deductibles must be paid each calendar year on a claim-by-claim basis before benefits subject to the deductible become available.

CALENDAR YEAR PLAN YEAR

MAXIMUM

OUT-OF-POCKET

IN-NETWORKOUT-OF-NETWORK

COINSURANCECOPAYMENT

Calendar Year - January 1st to December 31st. Includes medical and prescription drug benefits.Plan Year – July 1st to June 30th. Includes dental and vision benefits.

The maximum amount in coinsurance, copayments and deductibles you will pay for covered medical and prescription drug cost within a calendar year.

Your out-of-pocket cost for covered services. • Coinsurance is based on a percentage.• Copayment is based on a fixed dollar amount.

In-network - Physicians, hospitals, pharmacies, and other providers contracted with your health insurance.Out-of-network - Providers are not contracted with your health insurance carrier.


State of Hawaii

Maximum Out-of-Pocket (MOOP)

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HEALTH PLAN SELECTION

• Financial protection• All covered coinsurance, copayments and deductibles apply towards MOOP• Insurance company keeps track of out-of-pocket• When MOOP is reached – 100% coverage• Member is still responsible for taxes• Resets every calendar year

EUTF 90/10 PPO Plan HMSA$2,000/$4,000 (medical)

$4,350/$8,700(CVS prescription drug)



EUTF HMO Comprehensive Kaiser$2,000/$6,000

(medical and prescription drug)



EUTF HMO Standard Kaiser$2,500/$7,500

(medical and prescription drug)

EUTF HMO HMSA$1,500/$3,000 (medical)


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HMSA 80/20HMSA 90/10 HMSA 75/25HMSA PPO Plan Comparison for Self-only

Total Estimated Annual Cost:

Annual Employee Premium Contribution* $4,634 $2,971

Rick anticipates 4 doctor visits during the calendar year. His doctors charge $100 per

visit before insurance pays. Total $400**

Coinsurance 10%$40

Coinsurance 20%$80

$0 $0$4,634 $2,971

Calendar Year Maximum Out-Of-Pocket (MOOP)

Coinsurance less than

$2,500 MOOP

Rick is considering enrolling in either the 90/10, 80/20 or 75/25 Self-only plan

(Low dollar example)

$767

Coinsurance 25%$100


$5,000 MOOP

$4,674 $3,051

$0$0Calendar Year Plan Deductible


$2,000 MOOP

$0$767$867

The HMSA 75/25 PPO Plan for Self-only offers Rick the most savings in this scenario

$300$300

*Based on employer contribution from July 1, 2020 through June 30, 2021** Examples do not include any out-of-network and non-covered services or any applicable taxes


State of Hawaii




State of Hawaii



HMSA 80/20HMSA 90/10 HMSA 75/25HMSA PPO Plan Comparison for Self-only


Annual Employee Premium Contribution* $4,634 $2,971

Rick anticipates $19,100 in covered in-network medical expenses (with $300

subject to the 75/25 deductible) from January 2021 - April 2021**

Coinsurance 10%$1,910


$0 $0$4,634 $2,971


Coinsurance exceeds

$2,500 MOOP

Rick is considering enrolling in either the 90/10, 80/20 or 75/25 Self-only plan

(High dollar example)

$767

Coinsurance 25%

Coinsurance + deductible reaches

$5,000 MOOP


$6,544 $6,791$5,471

$18,800X 25%$4,700


$0$0 $300Calendar Year Plan Deductible


$2,000 MOOP

$0$767$5,767

The HMSA 80/20 PPO Plan for Self-only offers Rick the most savings in this scenario



State of Hawaii



Standard PlanComprehensive PlanKaiser HMO Plans


Annual Employee Premium Contribution* $3,225 $810

Malia will undergo surgery and was told the cost before insurance could be $50,000 at an in-network Kaiser facility this year.**

No ChargeCoinsurance 15%

$7,500

$0 $0$3,225 $810$3,310


$2,000Not met

$2,500Met

Malia is considering enrolling in the Kaiser Comprehensive or Standard plan

Total estimated annual savings under the Kaiser Comprehensive plan: $85



Enrollment Form

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State of Hawaii

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EC-1 Enrollment Form

• Please ensure you have the correct formthen complete all sections of the EC-1

• Attach any applicable proof documents

• Submit forms on or before the April 30th deadline to your:

o Human Resource Officeo County Personnel Officeo DOE-EBU Office o Enrollment Designee

Enrollment Form

(Except the Coverage Start Date section)



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Employee Data


State of Hawaii

Coverage Start Date

Plan Selection & Contribution



Leave this section blank

Employees must check the box of each plan they wish to enroll in. They may enroll in only one medical/prescription drug plan.

A spouse/partner and/or dependent child may enroll in the same plans as the employee, but may not enroll in health plans on their own.

Life insurance is 100% employer-paid and is available for the employee only.

All applicable fields must be completed.

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State of Hawaii

Dependent Information



List all eligible dependents (including spouse or partner) that will be enrolled in plans. If dependents are being enrolled in EUTF plans for the first time, please submit the following proof documents.


State of Hawaii

Proof Documents

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Enrollment Type Required Proof Documents

SELF PLANS No proof documents required

ADDING A SPOUSE/PARTNER Marriage certificate Domestic partnership documents

(available at eutf.hawaii.gov)

ADDING A DEPENDENT CHILD Birth Certificate Guardianship Decree (if legal guardian) Adoption Decree (if child is placed for adoption or

adopted)

DEPENDENT CHILDREN AGE 19 – 23 WHO ARE FULL-TIME STUDENTS AND ENROLLING IN DENTAL & VISION PLANS

Student Certification Letter(A letter from school’s registrar or verification certificate from the National Clearinghouse. Transcripts are not accepted)



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State of Hawaii

Other Insurance Information

Employee’s Signature

Form Submission



Employee must complete this section if they or any of their dependents are covered under a non-EUTF health plan.

Read the statement and if you agree, sign and date the form.

Enrollment forms must be submitted to human resource office, personnel office, DOE-EBU or open enrollment designee by April 30, 2020.

All proof documents must be received in order to process enrollment changes.



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State of Hawaii

Employer Form Submission

000000 Budget and Finance EUTF 13

4 18 2020 (808) 586-5555 (808) 586-9999

Ethan Smith 4 18 2020

Open Enrollment



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State of Hawaii

Submission deadline for enrollment forms and proof documents to the EUTF by Human Resource Officers, County Personnel Officers

and DOE-EBU is May 7, 2020 Submit forms to the EUTF by mail or courier only. (NO FAX)

EUTF201 Merchant Street, Suite 1700Honolulu, Hawaii 96813

All non-OE related enrollment forms maybe faxed to the EUTF.

Employer Form Submission


State of Hawaii

Confirmation Notice

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Employees who submit their completed form and proof documents on or before the enrollment deadline will have their forms processed during the months of May and June.

If employees do not receive a confirmation notice by the end of June, please have them contact the EUTF. If they are not enrolling or making changes during the election period, they will not receive a confirmation notice.

Employees will use the corrective action form provided with the confirmation notice to notify the EUTF of any EUTF errors.

Only employees who submit an enrollment form AND have made changes will receive a confirmation notice.



Money Saving Tips & Wellness Programs

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State of Hawaii

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Tips on How to Save Money

Choose a Plan That’s Right for You

Picking the Right Providers & Facilities

Use Mail Order for Maintenance Drugs

Choosing Generic When Available

•See In-Network Providers•Non-Network Cost More•Use ER for Emergencies

•Convenience•3 months for cost of 2•Contact CVS or Kaiser

•Same active ingredient•Costs 3 to 4 times less•Check with your doctor




State of Hawaii

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Wellness Programs

Annual Physical & Screenings

Tobacco Cessation Products & Programs Disease Management Programs

Health Coaching




State of Hawaii

Reminders

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Deadline for employees to submit EC-1/EC-1H forms is April 30, 2020.

All proof documents must be received in order to process enrollment changes.

Deadline for employers to submit forms to EUTF isMay 7, 2020.

Open enrollment forms and related proof documents must be mailed or couriered to the EUTF.


Mahalo

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