Transcription
2010 Open Enrollment Workshopfor RetireesAPRIL 9, 2010Presented byChristine Vo, Benefits ManagerAndRaul Herrera, UnitedHealthcare RepresentativeLoretta Chu, Kaiser Representative
Agenda Open Enrollment Information Plan Design Changes Mandatory Retiree Monthly Contribution Retiree Billing Medicare Changes for 2010 Healthcare Reform Surviving Spouse Benefits Program Dependent Verification Questions2
Open Enrollment Annual Open Enrollment–April 5 through 30–Changes are effective July 1, 2010Retirees may:–Reinstate previously waived coverage without proof of loss–Add eligible dependents without proof of loss–Remove dependents–Change medical plan–Waive benefits (evidence of other coverage is required by April 30) Benefits for Plan Year 09/10 (Medical/Rx, Dental, Vision, and MedicarePremium Part B reimbursement will end on June 30, 2010)3
Retiree Communications Newsletter mailed April 2:– Newsletter includes: Plan Comparisons 2010/11 Rates Dependent verification reminderForms–Available on website for download –For Employees/Retirees: http://hr.fhda.edu/benefits/Retirees will receive their Benefits Confirmation Statement for PY10/11 on May 20. A new Benefits Confirmation Statement is sent anytime there is a change,including premium changes.4
Rule Changes Dependent Coverage Michelle’s Law Healthcare Reform5
Retirees and Dependent Coverage Beginning July 1, 2010– Eligible retirees are required to have other comprehensive groupcoverage when removed from District-paid benefitsThe following have not changed:–Subscribers enrolling eligible dependents during a special openenrollment must provide proof of loss of other comprehensive groupcoverage–Subscribers enrolling eligible dependents during annual openenrollment are not required to provide proof of loss of othercomprehensive group coverage6
Michelle’s Law If a student enrolled in District coverage:–Becomes seriously ill, and–Requires a medically necessary leave of absence from attending schoolDistrict coverage may continue if the leave of absencequalifies under and is in accordance with the federalMichelle’s Law (Public Law 110-381)–Michelle’s Law allows a seriously ill or injured college student to takeup to one year of medical leave without losing health insurance7
Healthcare Reform Reconciliation Process Administrative Guidance, Notification, and Processes areneeded from the feds to ensure proper implementation ofvarious provisions Reconciliation Bill must passed before we know when changeswill become effective When Reform takes place: most likely July 1, 20118
Medicare Changes Possible Medicare eligibility changes in the coming years Part B Premium MAGI continues to climb Medicare Part D ?9
Benefit Changes
Premium Changes Monthly Retiree Contributions over 12 months periods: July2010 – June 2011PLAN OFCOVERAGERetiree OnlyRetiree OneDEPRetiree Twoof More DEPKAISER 48.00 96.00 144.00EPO 48.00 96.00 144.00PPO 120.00 240.00 360.00Note: Please be advised that the retiree contribution rates include 1/mo for Vision and 4/mo for Dental, and the remainder belong to Medical care.11
RETIREE PREMIUM PAYMENT INFORMATION All retirees are required to contribute towards the cost of healthcareregardless which plan you choose and the level of coverage.Everyone will be billed. Premium invoices will be issued by UnitedHealthcare BenefitServices. July 2010 premium will be mailed out on June 10. Premium is due no later than the last day of the month of coverage.i.e. July premium must be received by July 31. May elect to pay by check or via ACH (electronic fund transfer) All checks should be made payable to: UnitedHealthcare Customer Service Phone: (866) 747-004812
Cost Sharing All medical plans will cover the same benefits, but Some benefits will have higher costs at point-of-service Both self-funded plans and HMO increased:–Annual Deductible (except Kaiser)–Annual Out-of-Pocket Maximum–Copayment and Coinsurance13
KAISER HMO: What’s Changing Effective July 1, 2010:–Primary and Specialist Office Visits: increase from 10 to 20–Urgent Care Office Visits: increase from 10 to 20–Mental Health/Substance Abuse Outpatient Office Visit Co-pay: Increase from 10 to 20 for individual visit Increase from 5 to 10 for group visit–Outpatient Surgery Procedure: increase from 10 to 20–Chiropractic Care Co-pay: increase from 10 to 15–ROUTINE PREVENTATIVE CARE: Physical Exams Co-pay: reduce from 10 to 014
Kaiser Prescription Program - Effective July 1, 2010Tier 1 (Generics): pick up from Plan Pharmacy Old: 5/up to 100-day supplyNew: 5 Co-pay for 30-day supply 10 Co-pay for 31 to 60-day supply 15 Co-pay for 61 to 100-day supply‒‒Tier 2 (Brand-name drugs): pick up from Plan PharmacyOld: 5/up to 100-day supplyNew: 10 Co-pay for 30 days supplyNEW Prescription Mail Order:Tier 1(Generics): 5 Co-pay up to 30 days supply or 10 for 31 to 100-daysupply Tier 2 (Brand-name Drugs): 10 Co-pay up to 30 days supply or 20 for31 to 100-day supply 15
Kaiser Senior Advantage Plan: 65 If you are Medicare-eligible and insured under Kaiser Plan, youmust enroll for Kaiser Senior Advantage Plan. This Plan isidentical to District Plan. Failure to sign up for Kaiser Senior Advantage Plan immediatelyupon Medicare-eligibility results disqualification from allDistrict-paid benefits for you and the dependent(s).16
Eligibility for Kaiser Coverage In order to select the Kaiser Plan you must reside within the Kaiser servicearea. Live-n-work rule is not applicable for retirees. If you reside outside of the Kaiser service area, you are not eligible to beinsured under the Kaiser Program. You may only select the PreferredProvider Organization (PPO) or the Exclusive Provider Organization (EPO)Medical Plan. If you are currently a Medicare recipient enrolled in the Kaiser SeniorAdvantage Program and wish to transfer your coverage to the District EPO orPPO Plan for the Plan Year 2010/2011, you must request a SeniorAdvantage Disenrollment Form and return to the District by April 30, 2010.17
Self-Funded Plan Changes
Medical Changes: EPO and PPO (In-Network only)90/10 plan In-Network Only: Starting July 1, 2010––Annual Calendar Year Deductible (EPO) Single – increase from 150/person to 350/person Family - increase from 400/family to 1,050/familyAnnual Calendar Year OOP Maximum (EPO) Single – increase from 600 to 1,000 Family - increase from 1,800 to 3,000–Co-Insurance: increase from ZERO to 10%–Co-Pays: OLD ( 20/office visit) NEW - Primary Care/Chiropractor/Acupuncturist Office Visit: 25 Co-Pay NEW - Specialist and Urgent Care Office Visit: 30 Co-pay19
Medical Changes: EPO and PPO (In-Network Only) continued . Inpatient Hospital Services:–EPO (OLD): 50 Co-pay, deductible applies–PPO (OLD – In-network only): 0 Emergency Services (level 1):–OLD: 50 Co-pay, if admitted waived, deductible applies New: increase to 100 Co-pay (waived if admitted), 10% after DeductibleNon-Emergency Services (not level 1):–OLD: 80% coverage if emergency criteria not met, deductible applies New: increase to 100 Co-pay, 10% after Deductible appliesNew: 100 Co-pay, 10% after DeductibleHearing Benefits: increase from 80% to 90% up to 1,000 max annually20
Medical Changes: EPO and PPO (In-network Only) continued . MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT–OLD: Restricted to 25 visits annually at 50% coverage (under EPO Plan),Deductible applies, 2,000 max coverage per year.–OLD: Restricted to 25 visits annually at 50% coverage (under PPO Plan), 100%of U&C, 2,000 max coverage per year. NEW: Effective July 1, 2010, district health plans that offer substanceabuse and mental health treatment benefits guarantee that the scope of thebenefits is equal to the plans coverage of medical and surgical benefits.PREVENTATIVE CARE:New Enhancements (restricted to In-Network Service Only)–Routine Health Screenings including Well Baby Care: 100% paid for by thePlan including Annual Physicals, Mammography, labs and x-rays services inaccordance to the US Preventative Services Task Force.–Immunization: removed age restrictions and 100% coverage21
Medical Changes: PPO (Out-of-Network)70/30 Plan Open Access – Starting July 1, 2010––Annual Calendar Year Deduc&ble (PPO‐In Network) Single – increase from 0/person to 350/person Family ‐ increase from 0/family to 1,050/familyAnnual Calendar Year Deduc&ble (PPO‐Out of Network) Single – increase from 0/person to 700/person Family ‐ increase from 0/family to 2,100/family ––Annual Calendar Year OOP Maximum (PPO In‐Network) Single – increase from 400 to 1,000 Family ‐ increase from 1,200 to 3,000Annual Calendar Year OOP Maximum (PPO Out‐Network) Single – increase from 2,000 to 3,000 Family ‐ increase from 6,000 to 9,00022
Medical Changes: PPO (Out-of-Network) Continued .70/30 Plan–Co-Insurance: OLD (80/20 plan/office visit subject to U&C charges) What is new? Plan pays 70% of U&C, aKer DeducNble, for thefollowing office visits‒Primary Care‒Specialist‒Urgent Care‒ChiropracNc Care‒Acupuncture Care‒PreventaNve Care‒OutpaNent Mental Health‒OutpaNent Substance Abuse23
Medical Changes: PPO (Out-of-Network) Continued .–Emergency Services: increase from 50 to 100 Co‐Pay (waived ifadmiFed) 10% coinsurance.–Non Emergency Room Services (Not Level 1) – Plan pays 70% of U&C,aKer DeducNble and 100 Co‐Pay24
Three-Tier Prescription Drugs Plan – Advantage PDL–Starting July 1, 2010Tier 1: Preferred Generic Drugs (on the FORMULARY) - 10 Co-pay/30 days- Primarily made up of generic drugs.- May include some Brand-Name Drugs that have proven more effective, less costly and few sideeffects.- Lowest out-of-pocket expenseTier 2: Formulary Brand-Name Drugs - 25 Co-pay/30 days- Primarily made up of Brand-Name Drugs- May include generic drugs that the plan has determined to be more costly than their brand namealternativesTier 3: Non-Preferred (NON-FORMULARY) - 50 Co-pay/30 days- Made up of drugs that the plan has not included in Tier 1 or Tier 2.NOTE: Mail Order for 90-day supply provided through Medco cost 2 X 30days Co-pays25
Specialty Drugs – UnitedHealth Pharmaceutical Solutions–Starting July 1, 2010–Specialty medications are designed to address the most complex and lifethreatening diseases such as: Parkinson’s, Growth Hormone Deficiency,Hepatitis C, HIV/AIDS, Oral Oncology, Rheumatoid Arthritis, Transplant, CysticFibrosis, etc .Specialty medications broadly defines as having one or more of the following attributes: Unique distribution or administration (e.g., typically injectable or oral form) Market exclusivity to treat rare diseases (orphan drugs) Indication for chronic and life threatening diseases High cost (more than 250) Requires close monitoring by a pharmacist or physician–Restricted to 30 days supply via mail order provided by PharmaceuticalSolutions.26
DRUGS THAT WILL NOT BE COVERED EFFECTIVE JULY 1, 2010 NEXIUM COREG CR VERAMYST PREVACID DORYX CADUET ALLEGRA-D 24 HOUR ALLEGRA-D 12 HOUR TREXIMET REQUIP XL TRIAZ SOMA27
–Starting July 1, 2010–Maximum calendar year allowance for dental benefits through the Delta Dental’sPPO Incentive Plan is reduced to 1,700. –If you select a dentist from the Delta Dental PPO Network, you will pay fewer out-of-pocketexpensesPremier Delta Dental Plan’s maximum annual allowance is also reduced to 1,500. This plan allows you to select the dentist of your choiceTo Find a Participating Dentist, go to: http://www.deltadental.com28
Survivor Benefits
SELF-PAY BENEFITS–Survivors must notify the District within 31 days of life qualifying event torequest continuation of coverage under the district benefits program (NOEXCEPTIONS!)–Self-pay for benefits–Coverage may be continued for life–Must pre-paid for benefits quarterly–Premium will be billed by the District–Net 30 days due–May exercise changes in plan coverage through open enrollment–Qualify for Medicare Part B reimbursements–May qualify for COBRA if under age 65 (maximum coverage 36 months)30
SELF-PAYS MONTHLY PREMIUM FOR PY 10/11–KAISER MEDICAL/DENTAL/VISION (pre-65): 608.72 (est)–KAISER MEDICAL/DENTAL/VISION (65 ) 429.88 (est)–EPO/DENTAL/VISION 700.38–PPO/DENTAL/VISION 724.98–31
Dependent Verification
Dependent Verification Eligibility is being verified for dependent’s of all actives andretirees Letters will be mailed to all subscribers with dependents on theiraccount on May 17 by Secova, on-line benefits carrier Members should send copies of the documents used for proof,not originals (e.g., a copy of a 2009 Federal Tax Return)–Any financial information may be blacked out by the member–Information is private, as per the law–Hard copies will be shredded by Secova after 60 days33
ResourcesHR contacts:1.Patience McHenry, Benefits and Legal Compliance Assistant, phone:650-949-6224, email: [email protected] Robinson, Technical Specialist, phone: 650-949-6103, email:[email protected] Vo, Benefits Manager, phone: 650-949-6225, email:[email protected] Benefits Website:http://hr.fhda.edu/benefits/34
ResourcesInsurance contacts:Kaiser Permanente, group 857, customer service: g/UnitedHealthcare, group 708611, customer service: 1‐800‐510‐4846h]ps://www.myUHC.comDelta Dental of CA, group 603, customer service: ision Service Plan (VSP), group 12075742, customer service:1‐800‐877‐7195h]ps://www.vsp.com/35
What to expect after OE? By July 1, 2020, the following will be mailed to you home:– New ID cards will be issued to all UHC members– New Summary Plan Descriptions for EPO, PPO, Dental and Vision– HIPPA Certificates will be issued by Kaiser and UnitedHealthcare toall members who made changes during Open Enrollment, i.e. transferfrom PPO to EPO or Self-funded plan to KAISER and vice versa DO NOT PANIC!!! This Cert is required by law – please keep it in a safe place just in case theinsurance carriers request proof of prior coverage to give you credits toavoid pre-existing conditions exclusion.36
Closing Thank youQuestions and Answers37
– Maximum calendar year allowance for dental benefits through the Delta Dental’s PPO Incentive Plan is reduced to 1,700. If you select a dentist from the Delta Dental PPO Network, you will pay fewer out-of-pocket expenses – Premier Delta Dental P
