Mandatory
Online
Open Enrollment
November 9-23, 2015
MVPOE16
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Enrollments not completed during Open
Enrollment will result in a loss of coverage.
If you waive your insurance benefits,
you must complete a waiver online.
If you want to keep your current
coverage, you must enroll online.
All enrollees eligible for
coverage must enroll.
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What is Open Enrollment?
Who is Eligible?
Medical Plan Options
Dental Plan Options
Steps to Enroll
Discussion Items
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The only time you can enroll or
drop in the medical and/or dental
plans without a qualifying event.
Open Enrollment is …
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Loss of medical and/or dental coverage due to: Divorce
Death
Spouse’s coverage ends with employer due to
termination or reduction of hours
COBRA benefits exhausted
Marriage
Adoption
Qualified Medical Child Support Order
Newborn – Special provisions allows enrollment within
60 days of the event
Please Note: You must enroll within 31 days of a qualifying event; otherwise, you will need to wait until the next Open Enrollment.
A Qualifying Event is…
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Dependent Eligibility
Who is Eligible?
Spouses and children up to age 26.
New: Dental Plan Eligibility Changes for 2016
• A dependent child may stay in the Dental Plan until the end of the month of their 26th birthday.
• The full-time student status requirement is removed.
You may add eligible dependents into the Dental Plan during Open Enrollment.
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Dependent Eligibility
Spouses for Medical Plan Only
Spouses who have access to group health coverage must take
that coverage on an individual basis as primary insurance in
order to be covered with Butler Health Plan as a secondary
insurance, unless they pay more that 55% of the single
premium.
This includes employed and retired spouses who have access
to group health plans or a group retiree health plan such as
STRS or SERS.
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Dependent Eligibility
Adding a Dependent for First Time? Legal Documentation must be provided to your
Treasurer or Personnel Department for
dependents at the time of enrollment.
You may upload documents during the online
enrollment.
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No Rate Increase
For Medical and Dental Plans!
Good News for 2016!
Get your premium rate share from your Treasurer
or Personnel Department or at online enrollment.
See your 2016 medical plan rates online or ask your Treasurer or Personnel Department.
Medical Plan Options - 2016
EPO PPO
Preventive Care Preventive services covered 100% for all plans
Annual Deductible*
This is the dollar amount you must pay first in a
year before the plans begin paying specified
benefits.
$650 /person
$1,300 /family
You do not have to meet the
deductible before copays apply.
$650 /person
$1,300 /family
You do not have to meet the deductible
before copays apply.
Annual Maximum Out-of-Pocket
Includes deductibles and copays. This is the
most you will pay toward your in-network
medical and prescription expenses.
$2,650 /person
$5,300 /family
$2,650 /person
$5,300 /family
Doctor Office Visit
Primary care includes family practice, internist,
pediatrician, OB/GYN, mental health and
chiropractor.
$15 for primary care
$30 for specialist
$30 for primary care
$50 for specialist
Urgent Care $40 copay $40 copay
Emergency Room $200 copay
(waived if admitted)
$200 copay
(waived if admitted)
Inpatient Hospital and Outpatient Surgery Ded, then Plan pays 80%
Tier 1 Network Tier 2 Network
Ded, then Plan
pays 80%
Ded, $300 copay,
then Plan pays 70%
Radiology
MRI, X-ray, CT, ultrasound Ded, then Plan pays 80%
Ded, then Plan
pays 80%
Ded, then Plan
pays 70%
Prescription Drugs ** Deductible does not apply
Retail
(Up to 30 day)
$15 generic
$35 preferred brand
$15 generic
$35 preferred brand
Mail Order
(Up to 90 day)
$35 generic
$85 preferred brand
$35 generic
$85 preferred brand
Specialty
(Up to 30 day) $75 $75
Pharmacy Network Express Scripts Prime Network
(More than 32,000 pharmacies nationwide including
CVS, Kmart, Kroger, Meijer, Sam’s Club, Target and Wal-Mart.)
HDHP Minimum Value Plan
Preventive services covered 100% for all plans
$2,600 /person
$5,000 /family
You must meet the deductible before
prescription copays apply
$6,550 /person
$13,100 /family
$5,000 /person
$10,000 /family
$6,550 /person
$13,100 /family
Ded, then Plan pays 80% Ded, then Plan pays 100%
Ded, then Plan pays 80% Ded, then Plan pays 100%
Ded, then Plan pays 80% Ded, then Plan pays 100%
Tier 1 Network Tier 2 Network Ded, then Plan pays 100%
Ded, then Plan
pays 80%
Ded, $300 copay,
then Plan pays 80% Ded, then Plan pays 100%
Ded, then Plan pays 80% Ded, then Plan pays 100%
After the deductible is reached Deductible does not apply
$15 generic
$35 preferred brand After medical deductible,
Plan pays at 100%
$35 generic
$85 preferred brand After medical deductible,
Plan pays at 100%
$75
Express Scripts Prime Network
(More than 32,000 pharmacies nationwide including
CVS, Kmart, Kroger, Meijer, Sam’s Club, Target and Wal-Mart.)
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• With the PPO, you pay more out of your paycheck to
“buy” the coverage, and then less out of your pocket
because you pay flat copays for routine office visits and
prescriptions.
• The PPO has a lower deductible compared to the HDHP.
Preferred Provider Organization
PPO
Medical Plan Options
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• With the HDHP, you pay less out of your paycheck to “buy”
the coverage, and then more out of your pocket for
services.
• You can set up a health savings account (HSA) that lets you
build up tax-deductible money to pay medical expenses.
You pay a lower premium, but are subject to a higher
deductible and maximum out-of-pocket. Check with your
local bank or employer to see if they offer an HSA.
High Deductible Health Plan
HDHP
Medical Plan Options
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• If you use the Mercy Health System or don’t mind changing your
doctor, you may want to choose this plan. It can save you money!
• The Mercy Preferred Plan is an exclusive provider organization (EPO)
plan. It is a smaller network of doctors and hospitals.
• There is no out-of-network coverage except for emergencies.
Care coordination with a team of people who work with you and your
doctor.
Easier to make appointments and, in some cases, extended office hours.
Lower office visit copays.
Online access to your medical record and for emailing your doctor and care
team.
Mercy Preferred
EPO
Medical Plan Options
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• With the MVP, there is a higher deductible. Once the deductible
is met, the Plan pays at 100%.
• There are no copays.
• This plan offers basic coverage and has the following exclusions:
· No out-of-network coverage except for emergencies.
· No coverage for treatment of temporomandibular joint dysfunction (TMJ).
· No coverage for chiropractic care.
· No coverage for certain medications such as lifestyle medications.
Minimum Value Plan
MVP
Medical Plan Options
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Prescription Drug Coverage
Basic Standard Premium
Dental Networks
Delta Dental Provider Search
Delta Dental PPO Network
Delta Dental Premier Network
Annual Deductible $75 /person
$150 /family
$50 /person
$100 /family
$25 /person
$50 /family
Annual Maximum Benefit $1,000 /person $1,500 /person $2.500 /person
Lifetime Maximum Benefit
Orthodontia Not Covered $1,500 /person $1,800 /person
Preventative 80% Covered
Deductible Waived
100% Covered
Deductible Waived
100% Covered
Deductible Waived
Basic Care Covered at 80% Covered at 80% Covered at 80%
Major Care Covered at 50% Covered at 50% Covered at 60%
Orthodontia Care Not Covered 60% 60%
Adult Orthodontics Not Covered Yes Yes
Sealants Covered to age 16 Covered to age 16 Covered to age 16
Dental Plan Options - 2016
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See your 2016 dental plan rates online or ask your Treasurer or Personnel Department.
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The intent of the Butler Health Plan Wellness program is to
support employees to live healthier and more productive
lives by getting in front of potential health issues.
The free benefit allows you to have a convenient way of getting
your health screening at your work place in the spring of each
year. We all know that lifestyle choices have consequences and
making healthy choices helps employees and the Plan spend
less on health care.
*Watch for free health evaluation at your district.
BHP Wellness
Program
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Employees and spouses, enrolled in the Medical Plan
will have the opportunity to earn a $150 credit toward
next year’s medical plan deductible.
• Year 1 baseline: The first time you have a health screening
completed is considered the “baseline” year. You qualify for
the incentive simply by participating.
• Year 2 and beyond: In years two and later, your goals will
be set from the previous year (based on your baseline). You
must meet the goals in order to keep the incentive.
BHP Wellness
Program
*Watch for free health evaluation at your district.
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Open Enrollment Enrollment is Mandatory
For Everyone
(even if you are waiving coverage) !
The Butler Health Plan Open Enrollment will take place starting
November 9, 2015 through November 23, 2015.
ALL employees eligible for medical and dental benefits must enroll,
even if they are waiving coverage.
Before you enroll, you will need the following information about you and
your dependents:
- Social Security Number
- Date of Birth
- Information on other medical or dental coverage
that you and your dependents may have
Log on to https://butlerhealthplan.benelogic.com
Enter your UserID:
First Initial and Last Name with Last four of SSN
(For Example, John Doe would be: jdoe1234)
Your Password is your Date of Birth (MMDDYYYY).
Change your password (if you log into the website again, you
will need this new password).
Follow the instructions on the website and enroll in your 2016
benefits or waive coverage.
Click on the Finish button to save your elections.
Print your confirmation statement.
How to Enroll Online
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How to Enroll Online
You may make changes on the
enrollment website until 11:59 p.m. EST
on November 23, 2015.
The last elections that you save will be
your benefits beginning January 1, 2016.
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https://butlerhealthplan.benelogic.com
MARK YOUR CALENDAR
November 9-23
Open Enrollment is Mandatory For Everyone.
All employees eligible for medical and dental benefits
must enroll, even if they are waiving coverage.
Share your enrollment materials with your family.
Enroll before November 23 at 11:59 p.m.
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ID cards will be
mailed before
December 31 for
new BHP enrollees
and for employees
making Plan changes.
Everyone will receive
new Express Scripts
Prescription cards
with a new ID
number.
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Your
Open Enrollment
Changes for
Medical and Dental
Plan Begin
January 1, 2016
www.butlerhealthplan.org
Questions?