2014 health benefits open enrollment may 1 23 2014
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2014 Health Benefits Open Enrollment May 1 – 23, 2014 PowerPoint PPT Presentation

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Commonwealth of Virginia Health Benefits Program. 2014 Health Benefits Open Enrollment May 1 – 23, 2014. Highlights for July 1, 2014. April 2014. Customize based on your needs. Enroll, change or keep your health plan Consider buy-up options: COVA Care, COVA HealthAware & COVA HDHP.

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2014 Health Benefits Open Enrollment May 1 – 23, 2014

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2014 health benefits open enrollment may 1 23 2014

Commonwealth of Virginia Health Benefits Program

2014 Health Benefits Open EnrollmentMay 1 – 23, 2014

Highlights for July 1, 2014

April 2014

Customize based on your needs

Customize based on your needs

  • Enroll, change or keep your health plan

  • Consider buy-up options:

    • COVA Care,

    • COVA HealthAware &


  • Add or remove eligible family members

  • Waive coverage

  • Enroll in a Flexible Spending Account

Your health plan choices

Your Health Plan Choices

Cova care and cova hdhp


Administered by Anthem and Delta Dental

2014 health benefits open enrollment may 1 23 2014






DeltaDentalpartners withAnthem


2014 health benefits open enrollment may 1 23 2014


Behavioral Health

Change Effective 7/1/2014

  • Residential Treatment Centers

  • Approved in-network behavioral health services

2014 health benefits open enrollment may 1 23 2014


  • Workplaceissues

  • Finance/Legal

  • Health and Wellness

  • Mentalhealth

  • Parentingand childcare

  • Marriage&relationshipconcerns

2014 health benefits open enrollment may 1 23 2014

COVA Care – Prescription Drugs

  • Change for 7/1/2014

  • Drug copayments increase for tiers 2-4

    • $5 retail/$10 mail







Generic drugs(nochange)


$ 60


Lowercost preferred brands






Highercost brands





2014 health benefits open enrollment may 1 23 2014






or byphone



2014 health benefits open enrollment may 1 23 2014

Optional Buy-Ups

• ExpandedDental (Delta Dental)


ExpandedDental (Delta Dental)



2014 health benefits open enrollment may 1 23 2014

COVA Care – Vision and Hearing


  • Eyeexam

  • Eyeglassesandcontactlenses

  • Frames

  • Discountsonaccessories

  • Hearing

  • Routinehearingexam

  • Hearingaids

2014 health benefits open enrollment may 1 23 2014

Anthem Tips and Resources

Go tourgentcare centersinsteadof emergency


$25PCP/$40SpecialistcopayforUrgentCarevs.$150copay theER




  • Download the Mobile App on your smartphone

  • Find Doctor &Urgent Care Centers, View ID Card and Estimate Your Costs

Usethe“EstimateYour Cost” tool


Bookmark yourdedicatedwebsite for

Commonwealth employeesat anthem.com/cova

More on dental benefits

More on Dental Benefits

Administered by Delta Dental of Virginia

2014 health benefits open enrollment may 1 23 2014

  • Delta Dental of Virginia will continue to administer the dental benefits for COVA Care and COVA HDHP


  • Diagnostic & Preventive services are covered at 100% for all members when they see a participating provider.

2014 health benefits open enrollment may 1 23 2014

  • Expanded Dental optional buy-up includes

  • Primary Care – such as fillings, extractions, root canals

  • Complex Restorative - dentures, bridges and implants

  • Orthodontic services

Cova healthaware

COVA HealthAware

Administered by Aetna

Plan logo here

Comprehensive plan

Comprehensive Plan

  • Benefits and Coverage

    • Medical

    • Behavioral Health

    • Pharmacy

    • Basic Dental

    • Routine Vision Exam

    • Routine Hearing Exam

    • Includes a Health Reimbursement Account (HRA)

  • Expanded Dental and Vision benefits for an additional premium

Changes for 7 1 2014

Changes for 7/1/2014

  • Residential treatment centers added to behavioral health benefits.

  • More healthy activities to choose for “Do Right” contributions to the HRA.

  • What is a health reimbursement arrangement hra

    What is a Health Reimbursement Arrangement (HRA)?

    • Account that automatically pays eligible out-of-pocket expenses as long as funds are available

      • Medical

      • Behavioral health

      • Pharmacy

    • Funds paid automatically from HRA towards eligible expenses for any covered member

    • Unused HRA funds roll over into future plan years with no limit if enrollment in the plan continues

    Cova healthaware hra

    COVA HealthAware HRA

    • The initial HRA contribution for 7/1/2014:

      • Employee/Retiree$ 600

      • Employee/Retiree + Spouse$1,200

    • HRA contribution is prorated for new enrollments or QME changes during the plan year.

    • The HRA proration chart may be found on www.COVAHealthAware.com

    2014 health benefits open enrollment may 1 23 2014

    HRA Contribution

    Employee/ Retiree only


    Employee/Retiree + Spouse


    Do Right

    HRA Incentives

    Employee/ Retiree only

    earn up to $150

    Employee/Retiree + Spouse

    earn up to $300




    One person



    Two or more persons



    Out-of-pocket Max

    One person



    Two or more persons










    How the Plan Works

    COVA HealthAware is an open access, point-of-service (POS) plan with a large national network.

    Hra do rights

    HRA “Do Rights”

    • Employees/Retirees and enrolled spouses

      • Additional $50 HRA contribution for up to three “Do Rights”

        • Up to $150 per employee/retiree

        • Up to $150 per enrolled spouse

    • “Do Rights” include

      • Annual routine physical exam

      • Routine dental exam

      • Annual routine vision exam (new!)

      • Annual flu shot

      • Active Health Management Health Tracker

      • Active Health Management Coaching Module (new!)

    Pharmacy benefits

    Pharmacy Benefits

    • Integrated with the medical benefit

      • Combined deductible and out-of-pocket maximum

    • Mandatory Generic plan

    • Specialty pharmacy available

    • Members can compare drug costs in advance on their member website

    2014 health benefits open enrollment may 1 23 2014

    Dental Benefits

    • Diagnostic and preventive dental services

      • Included with the basic plan

      • Covered at 100% in-network

    • Expanded Dental: Optional Buy-Up

      • Primary procedures:

      • fillings, extractions, root canals

      • Complex restorative procedures:

      • crowns, dentures, bridges, implants

      • Orthodontia

    Vision benefits

    Vision Benefits

    • Routine annual vision exam included with basic plan and covered at 100%

    • Expanded Vision: Optional Buy-Up

      • Materials benefit for eyeglasses and contact lenses

      • Discounts for eyewear and accessories

      • Network includes private practice providers plus participating national chains

    Employee assistance program eap aetna resources for living sm

    Employee Assistance Program (EAP)Aetna Resources For LivingSM

    • Available to participants and members of their household

    • Confidential resource to address and resolve personal and workplace challenges

    • Provides up to 4 visits per incident per plan year at no cost

    • Additional legal and financial guidance

    Member tools and resources

    Member tools and resources

    Aetna Navigator

    • Secure member website for 24/7 plan access and answers to questions

      Member Payment Estimator

    • Provides real-time, personalized cost estimates for members based on their specific health plan and balances


    • Mobile app to help members make better healthcare decisions and improve healthcare delivery


    • Digital health and wellness tool to combine all leading health, wellness, and nutrition apps in one place

      Aetna Mobile

    • Access to Aetna Navigator from a smartphone

    Finding answers is easy

    Finding answers is easy!

    • Have a question about any COVA HealthAware Benefit?

      • One-stop, concierge-style service: 1-855-414-1901

      • Dedicated website: www.COVAHealthAware.com

    Myactivehealth total population health program

    MyActiveHealthTotal Population Health Program

    2014 health benefits open enrollment may 1 23 2014

    • ActiveHealth Management:

    • Provides coaching services as part of the COVA health management program

    • Partners with Anthem and Aetna to

    • deliver services promoting healthy lifestyles and chronic condition management.

    Posters, flyers, postcards and email communications provide program information.

    2014 health benefits open enrollment may 1 23 2014

    Customized Health Portal


    All eligible adult members may access their own customized portal

    Complete their health assessment

    Schedule biometric screening

    The portal is enhanced with online coaching and web tools

    Digital coaching

    Interactive trackers, games and more

    2014 health benefits open enrollment may 1 23 2014

    • Healthy Lifestyles - Lifestyle Coaching with Five Tracks

      • Smoking Cessation

      • Weight Management

      • Stress Management

      • Nutrition

      • Exercise

    • Healthy Insights - Disease and Chronic Condition Management for Conditions Such As:

      • Heart Disease

      • Diabetes

    • Healthy Beginnings - Maternity Care

    2014 health benefits open enrollment may 1 23 2014

    • Incentives - COVA Care and COVA HealthAware

      • Healthy Insights

        • Diabetes management

        • Hypertension (new July 1, 2014)

        • COPD & Asthma (new July 1, 2014)

        • Bariatric Surgery Coaching Program

      • Healthy Beginnings for expectant moms

    Kaiser permanente hmo

    Kaiser Permanente HMO

    Administered by Kaiser Permanente

    New for july 1 2014

    New for July 1, 2014

    • Pediatric Vision Eyewear up to age 19

      • No cost to members

      • One pair of frames per year from select group, and

      • Certain single vision or bifocal lenses, or

      • Up to three months supply of contact lenses from selected list

    The power of kp org

    The Power of kp.org

    Tricare supplement


    Administered by Association and Society

    Insurance Corporation (ASI)

    2014 health benefits open enrollment may 1 23 2014


    Voluntary supplemental health benefit option

    Available to employees and their dependents who are eligible for:

    TRICARE, the military health benefit program, and

    The State Health Benefits Program

    Eligible employees who enroll in the plan are responsible for 100% of the monthly premium amounts

    Monthly premium payments are made with pre-tax dollars through payroll deduction

    Premium reward

    Premium Reward

    • For employee, retiree and/or enrolled spouse

    • Employee/Retiree or spouse can save $17/month

    • Together can save $34/month

    Already earning a premium reward

    Already Earning a Premium Reward?

    • Remain in COVA Care or COVA HealthAware

    • Reward will continue through June 30, 2015

    • No additional actions required

    • New! Confirm your reward status on EmployeeDirect

    2014 health benefits open enrollment may 1 23 2014

    • Earn Premium Rewards –

    • COVA Care and COVA HealthAware

      • Eligible members enrolled from July 1, 2013–March 1, 2014

        • Health assessment and biometric screening must be completed and submitted by May 31, 2014.

      • Eligible members enrolled effective April 1–July 1, 2014

        • Health assessment and biometrics must be completed and submitted byAugust 31, 2014.

      • Health assessment and biometric registration are available atwww.MyActiveHealth.com/covaor by telephone at 1-866-938-0349

    Flexible spending accounts

    Flexible Spending Accounts

    Administered by Anthem

    2014 health benefits open enrollment may 1 23 2014

    Flexible SpendingAccounts


    Set asideupto $2,500per year,pre-tax, for eligible health expenses


    Set asideupto $5,000per year,pre-tax, for dependent day care expenses

    UsetheEliteBenefitCardforeligible Health FSA expenses

    2014 health benefits open enrollment may 1 23 2014

    FSA Change for 7/1/2014

    • You must file claims within the three months after your coverage period ends

      • Including any documentation required to validate an outstanding FSA card transaction.

      • For Example, if your coverage period ends on 4/30/15, you must file by July 31, 2015.

    2014 health benefits open enrollment may 1 23 2014

    All Participants Should Register Online:

    Account BalancesDirect Deposit

    Account Activity Statements Online Payments

    Important Information about your FSA:

    Participants must enroll each plan year in order to participate.

    If you enroll in COVA HealthAware, the HRA pays first.

    See Spotlight on Benefits for website and contact information.

    Alex is back

    ALEX is back!

    ALEX is your online interactive assistant. He can advise you on what plan may be best for you. The final decision is still yours. Take a look at www.alexforcova.com

    Get more details

    Get More Details

    • Find information:

      • Spotlight or Retiree notification booklet

      • www.dhrm.virginia.gov

      • Your agency Benefits Administrator

      • Contact the plans

    Make your election

    Make Your Election!

    • Visit http://edirect.virginia.gov

    • Login and select “Health Benefits Enrollment and Information”

    • Or submit an enrollment form to your agency benefits office

  • Final answer due May 23!

  • Remember it s your call

    Remember, It’s Your Call!

    • Consider what’s best for you and your family

    • Choose your health coverage

    • Premium reward

    • Employees - Flexible Spending Account

    Important dates

    Important Dates

    •Last day of Open Enrollment - May 23

    •Last Day to Key RC 56 – May 29

    •Last Day to Key RC 47 – June 30

    Premium rewards

    Premium Rewards

    Current Premium Rewards will continue until June 30, 2015

    as long as members remain in

    COVA Care or COVA HealthAware.

    No additional action required!

    Premium reward status

    • EmployeeDirect:

    • Health Benefits Enrollment and Information Bulletin Board

    • Confirm your premium rewards: Select “View Current Health Benefits Profile”, then look at Section 3: Health Care Coverage Election for “Reward Earned”.

    • PSBREW – New Premium Reward Activity Screen -

      • Check the status of the reward activities

      • Confirm the end date of the Premium Reward

      • Numbered Memo 14-01

    Premium Reward Status

    Employee mailing

    • The Spotlightnewsletter will be:

      • mailed to the employee’s home

      • providedelectronically to all employees with emails in BES

    • Summary of Benefits and Coverage(SBC)

      • required by the Affordable Care Act (ACA)

      • If currently enrolled, employees will receive a plan specific SBC

      • If not currently enrolled, a notice on how to obtain a copy of the SBCs.

    • Annual CHIP notice

      • required by the Department of Labor

    • HIPAA Special Enrollment Notice

    Employee Mailing

    2014 health benefits open enrollment may 1 23 2014

    Need Help?

    • EmployeeDirect login/password issues or HuRMan access:Email: [email protected]

      • General Open Enrollment questions:

      • Email: [email protected]

      • EmployeeDirect Health Benefits and Enrollment issues, keying BES, or content of a BES report:

      • Email: [email protected]

  • Policy and eligibility questions: Email: [email protected]

    • Fax: (804) 371-0231

  • Login