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Trainee and Affiliate Benefits Program (TABP)

City of Hope. Trainee and Affiliate Benefits Program (TABP). Open Enrollment Plan Year 2014 October 21 - November 1. Effective January 1, 2014 Presented by Garnett-Powers & Associates, Inc. Agenda. The Role of Garnett-Powers & Associates (GPA) and the Insurance Carriers

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Trainee and Affiliate Benefits Program (TABP)

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  1. City of Hope Trainee and Affiliate Benefits Program (TABP) Open Enrollment Plan Year 2014 October 21 - November 1 Effective January 1, 2014 Presented by Garnett-Powers & Associates, Inc.

  2. Agenda • The Role of Garnett-Powers & Associates • (GPA) and the Insurance Carriers • Review of all Benefits, Rates and Plan • Designs • Explanation of the Patient Protection and • Affordable Care Act (ACA) • Explanation of Online Open Enrollment • Process • Q & A

  3. The Role of GPA and City of Hope • Garnett-Powers & Associates (GPA) is the • broker/administrator and customer service provider • for the TABP. • We design, market, implement and administer benefit • programs for Postdoctoral Scholars and Students at • many campuses throughout the U.S. • We act as the liaison between the insurance carriers • and you by providing assistance with understanding • and accessing your benefits.

  4. What is Open Enrollment? • Open Enrollment provides an annual • opportunity for you to change your benefit • choices and add or delete dependents. • If you are not making any changes, no action is • necessary. • If you previously waived benefits, you may enroll. • You are enrolling for the an entire year. You • may make changes to your elections during the • year only if you have a change in family status.

  5. What is Open Enrollment?(Continued) • Examples of qualifying life events are: • Marriage • Divorce • Birth of a child • Death of a dependent • Adoption or placement of adoption of a • child • Loss of coverage • Dependent arrival in the U.S. • Dependent loss of eligibility due to • attainment of age 26.

  6. Family Member Eligibility Eligible Family Members Include: • Legally married spouse, including same sex spouses if • married in a state that allows same sex marriage. Proof of • marriage is required. • Domestic Partner - You must submit an Affidavit of Spousal • Equivalency if you’d like to enroll your domestic partner. For • information on enrolling your domestic partner, please review the • Enrollment Instructions under ‘Enrollment’ as well as the • Enrollment Form. • Note: Spouses and domestic partners who are eligible • for group medical coverage through another • employer are not eligible for the TABP Plan. By • enrolling a spouse or DP you are attesting that they • meet the eligibility requirements • Natural or adopted children and children of a domestic partner to • age 26 regardless of student or marital status. • Stepchildren may be included if they live with the member and • are supported at more than 50% and claimed as a tax dependent.

  7. Benefits Offered Through the Trainee & Affiliate Benefits Program

  8. MEDICALINSURANCEProvided by and

  9. What is a POS Plan? • Under the Point of Service (POS) plan, the member • does not have to choose a Primary Care Physician • (PCP).You may use any provider. • There are both in-network and out-of-network • benefit levels. You will receive higher imbursement • if you use the network. • Each time you need service, you may obtain care • from any provider, without having to obtain a • referral from a PCP. • You will need to satisfy a deductible before many • services will be paid by the plan.

  10. YOUR OUT-OF-POCKET COSTSMedical BenefitsIn-NetworkOut-of-NetworkPhysician Office Visit $ 20 Copay 40%*Specialist Office Visit $ 30 Copay 40%*E-Visits to PCP$ 20 Copay 40%*Walk-in Clinics $ 20 Copay 40%*Hospitalization: Inpatient 20%* 40%* Outpatient 20%* 40%* Pregnancy 20%* 40%* Prescription Drugs: Generic $ 10 Copay Not covered Brand $ 30 Copay Not covered Non Brand $ 45 Copay Not coveredEmergency Room Visits $100 Copay $100 Copay Urgent Care $ 35 Copay $ 35 CopayRoutine Physical Exam $0 40%*Routine Gynecological Exam $0 40%*Routine Mammograms $0 40%*Mental Health: Outpatient $ 30 Copay 40%* Inpatient 20% * 40%*Annual Maximum Out-of-Pocket: $2,000 Individual $4,000 Individual $4,000 Family $8,000 FamilyDeductible: Individual $500 $1,000 Family $1,500 $3,000Lifetime Maximum Unlimited Unlimited *Coinsurance amounts after satisfaction of the deductibleFor more detailed plan design information go to: www.garnett-powers.com/coh Trainee & Affiliate Benefits ProgramAetna POS Medical Plan

  11. What is a HMO Plan? • Under the HMO model, the member must choose a • Primary Care Physician (PCP). Each family member may • have a different PCP. • A PCP must be selected and indicated on the enrollment • form. Provider directory links are available on the GPA • website. • You are allowed to change your PCP once a month. • Your PCP becomes your healthcare “gatekeeper.” • If a member needs treatment from a Specialist or requires • an In-Patient or Out-Patient hospital procedure, s/he must • obtain a referral from their PCP prior to any type of • consultation or treatment. If the referral is not obtained, • no benefits will be paid. • There is no Out-of-Network benefit (except in the case of • an emergency).

  12. Trainee & Affiliate Benefits Program Aetna HMO Plan Medical BenefitsMember Pays Physician Office Visit$ 20 Copay Specialty Office Visit$ 30 CopayHospitalization:Inpatient $100 CopayOutpatient NonePregnancy $100 CopayPrescription Drugs:Generic$ 10 CopayBrandName$ 30 Copay NonFormulary $ 45 CopayEmergency Room Visits$100 Copay Urgent Care $ 35 Copay Routine Physical ExamNoneRoutine Gynecological Exam None Routine Mammograms None Mental Health:Outpatient $ 30 Copay Inpatient $100 CopayAnnual Maximum Out of Pocket:Individual $1,500Family $3,000Deductible:Individual NoneFamily NoneLifetime MaximumUnlimited • For more detailed plan design information go to: www.garnett-powers.com/coh

  13. Trainee & Affiliate Benefits Program Kaiser HMO Plan Medical BenefitsMember Pays Physician Office Visit$ 20 Copay Specialty Office Visit$ 30 CopayHospitalization:Inpatient $100 CopayOutpatient $ 30 CopayPregnancy $100 CopayPrescription Drugs:Generic$ 10 CopayBrandName$ 35 Copay Emergency Room Visits$100 Copay Urgent Care $ 20 Copay Routine Physical ExamNoneRoutine Gynecological Exam None Routine Mammograms None Mental Health:Outpatient $ 20 Copay Inpatient $100 CopayAnnual Maximum Out of Pocket:Individual $1,500Family $3,000Deductible:Individual NoneFamily NoneLifetime MaximumUnlimited • For more detailed plan design information go to: www.garnett-powers.com/coh

  14. Prescription Mail Order Pharmacy • You can order maintenance medications through • Aetna’s and Kaiser’s Rx home delivery service for • chronic conditions such as asthma, arthritis, • diabetes, high cholesterol and heart conditions. • The costs for the Aetna POS & HMO Plans are: $20 • generic, $60 brand-name and $90 for non-formulary • brand-name drugs up to a 90 day supply. • The costs for the Kaiser HMO Plan are: $20 generic • and $70 brand-name up to a 90 day supply. • It is a simple process and the mail order • information is posted on our website under • “Medical Plans”.

  15. Summaries of Benefits and Coverage • Legally required Summaries of Benefits and • Coverage for your medical plans will be available • on our website no later than October 21. • The Summaries of Benefits and Coverage follow the • recommended guidelines to show you your • benefits in a standardized format to assist you in • making your plan selections. • You may request a paper copy at no charge by • calling the toll-free number on your ID card. • You may also print a copy directly off of the GPA • website.

  16. Women’s Preventive Health Benefits • Certain women’s preventive health benefits are • available under the medical plans at no • out-of-pocket cost to you. • Routine gynecological care exams, routine adult • physical exams and mammograms are covered at • no cost. • Other services include but are not limited to: • Pre-natal maternity, screening for gestational • diabetes, HPV DNA testing, screening and • counseling for interpersonal and domestic • violence, contraceptive methods and counseling, • as well as breastfeeding support, supplies and • counseling. • FDA approved generic contraceptive drugs and • devices are also covered.

  17. Aetna Wellness Programs • Aetna Navigator - This is an online member portal that allows • you to view your medical visits and claims status, print • temporary ID cards and gain access to a wealth of tools and • information. Access at www.aetna.com. Once you have your • member ID, you may register for access to this site. There will • be instructions on the website to assist you. • Beginning Right – Provides a pregnancy risk survey and a wealth • of information to assist you with when either you or your spouse • become pregnant. • Global Fit – Offers discounts to a nationwide network of fitness • clubs. • Health Connections – Discounts are offered through this • program for spas, health foods and fitness clothing. • Stress Management – Information available for better mental and • physical health.

  18. Kaiser Wellness Programs • Kaiser Website - This is an online member portal • that allows you to view your medical visits and • claims status, print temporary ID cards and gain • access to a wealth of tools and information. Access • at www.kp.org • Discounts – Kaiser offers a variety of health • discounts. See their website for more information. • Disease Management Programs – classes are • available for a variety of health conditions.

  19. EAP Program • City of Hope pays the cost of this benefit • The employee assistance program provides access • to confidential counseling for a variety of issues, • including: • Stress • Family issues • Bereavement • Relationship Issues • You are entitled to three visits per issue per year • and phone counseling. • The services are available by phone or online • 24/7/365 • Phone Number: (888)293-6948 • Website: www.horizoneap.com

  20. DENTALINSURANCEProvided by

  21. Trainee & Affiliate Benefit ProgramAetna Dental HMO Plan Annual Maximum: Unlimited In-NetworkMember Pays Calendar Year DeductibleNone Diagnostic and Preventive Care -Routine ExamsNo Charge -Teeth CleaningsNo Charge -X-Rays No Charge Basic Procedures -FillingsNo Charge -Endodontics $0- $225 Copay -Periodontics $10 - $140 Copay -OralSurgery $0- $60 Copay Major Procedures -Crowns$150 Copay -Bridgework $150 Copay -Dentures $200 Copay Orthodontia -Adolescent$1 845 Copay -Adult $1,845 Copay For more detailed plan design information go to: www.garnett-powers.com/coh

  22. Trainee & Affiliate Benefit ProgramAetna Dental PPO Plan Out-of-Network Member Pays $ 75 per individual $225 per family 20% 60% 70% 70% Annual Maximum $1,500 per person Calendar Year Deductible Diagnostic and Preventive Care -Routine Exams -Teeth Cleanings -X-Rays Basic Procedures -Fillings -Endodontics -Periodontics -Oral Surgery Major Procedures -Crowns -Bridgework -Dentures Orthodontia -$1,500 Lifetime Maximum PPO Network Member Pays $ 50 per individual $150 per family 0% (no deductible) 20% 50% 50% For more detailed plan design information go to: www.garnett-powers.com/coh

  23. VOLUNTARYVISIONINSURANCEProvided by

  24. Voluntary Vision Plan • This plan is voluntary, which means you are • responsible for the monthly cost for you and your • enrolled dependents. • The enrollment instructions and rates can be • found on the GPA website. • You will use your SSN and name to make an • appointment with a provider.

  25. Vision Benefits In-Network Out-of-NetworkMember PaysMember PaysEye Exam (every 12 months) $10 Copay up to $35 AllowanceFrames (every 24 months) $120 Allowance up to $60 Allowance (20% off remaining balance) Lenses (every 12 months) Single $10 Copay up to $35 Allowance Bifocal $10 Copay up to $49 Allowance Trifocal $10 Copay up to $74AllowanceContact Lenses (every 12 months) $135 Allowance up to $108 Allowance For more detailed plan design information go to: www.garnett-powers.com/coh Trainee & Affiliate Benefit Program Voluntary Vision Plan

  26. LIFE/AD&DINSURANCEProvided by

  27. Life and AD&D Insurance • Premiums are paid by the City of Hope. • The plan pays $50,000 in the event of your death. • The plan pays an additional $50,000 if your death is • due to a covered accident. • The AD&D feature pays a benefit in the event of a • loss of sight, limbs, hearing, etc. • Accelerated Benefit Provision – Allows eligible • members, who are terminally ill to receive a benefit • of up to 75% of their life insurance benefit if they • are diagnosed as terminally ill. • All J-1 Visa holders and their dependents will have • the required medical evacuation coverage of • $10,000 and repatriation of mortal remains coverage • of $7,500 included in this plan.

  28. DISABILITYINSURANCEProvided by

  29. Short-Term Disability Insurance (STD) • Premiums are paid by the City of Hope. • The plan pays up to 60% of the first $2,500 weekly • pre-disability earnings. • The maximum weekly benefit is $1,500 per week. • This benefit is offset by other disability income, • such as Worker’s Compensation and CA State • Disability. • The minimum benefit is $15.00 • The benefit waiting period is 0 days for disability • caused by an accidental injury and 7 days for • disability caused by sickness or pregnancy. • The maximum benefit period is 180 days.

  30. Long-Term Disability Insurance (LTD) • Premiums are paid by the City of Hope. • The Benefit Waiting Period is 180 days of • disability. This program starts when the Short • Term Disability ends. • The plan will pay up to 60% of the first $8,333 of • your monthly pre-disability earnings. • The maximum monthly benefit is $5,000. • This benefit is offset by other disability income, • such as Worker’s Compensation and CA State • Disability. • Once approved, benefits are payable each month • while you are disabled up to age 65.

  31. Health Care Exchange • The Patient Protection and Affordable Care Act (ACA) was • signed into law on March 23, 2010. • The ACA requires that most people that are either citizens or • legal residents must have health insurance coverage, or pay a • tax beginning in 2014 if they do not. • The intent of the ACA is make health care coverage available to • the millions that are uninsured in the U.S. • All states are required to offer a Health Care Exchange, also • known as an Exchange Marketplace, either through the federal • government, on their own or through a partnership between the • state and the federal government. • California’s Exchange will be provided by Covered California. • U.S. citizens and most legal residents are eligible for plans on • the exchange.

  32. Health Care Exchange(Continued) • There are differing levels of coverage and cost, as • well as several insurance carriers offering the plans. • In order to be eligible for the Premium Tax Credit, • also known as a subsidy, a person must meet certain • eligibility requirements: • Their employer offers coverage where the • plan design does not meet the coverage • requirements of the ACA. • Certain poverty-level income conditions are • met. • The cost of employee-only coverage • exceeds 9.5% of an employee’s wages.

  33. Health Care Exchange(Continued) • Important ACA Information Specifically for Enrollees in the City of Hope TABP • The Aetna and Kaiser plans meet or exceed the plan • requirements of the ACA. • To the best of our knowledge, in most cases, the cost of • single coverage for the plans does not exceed 9.5% of an • eligible Trainee’s wages/stipend. • It is highly unlikely that anyone enrolled in the City of • Hope TABP medical coverage will be eligible for a subsidy • through the exchange. • For more information, please visit California Healthcare • Marketplace at www.coverdca.com.

  34. The Open Enrollment Process • Go to the GPA website at • www.garnett-powers.com/cohand click on “Open • Enrollment”. • Next, click on the “OpenEnrollment Form • Instructions” link and print the instructions for • assistance with completing the open enrollment • form properly. • Once the instructions are in hand, go directly to • the “Open Enrollment Form Login” link. This will • take you to a login page where you will choose • “Returning User” and provide your City of Hope • ID number and previously created password.

  35. The Open Enrollment Process (Continued) • Once done, click “Submit” and you will be taken to • the Dashboard where you will be able to view your • current enrollment and also complete your Open • Enrollment form with any desired benefit changes. • Once complete, please click “Submit and Create • Printable Enrollment Form” which will send your • form to our secure database and also allow you to • print a copy of your enrollment form for your • records. • An e-mail will be sent no later than November 8, • 2013 confirming your new enrollment status. • ID cards for any new coverage will be mailed to • your home directly from the Insurance Carriers.

  36. Information Sources For general inquiries and customer service regarding enrollment, general benefit questions and confirmation, you should contact: Garnett-Powers & Associates, Inc. • Website: • www.garnett-powers.com/coh • Toll Free Phone: • 888-441-3719 • Fax #: • 949-583-2929 • Email Address: • COHBP@garnett-powers.com

  37. Thank you for joining us today! Questions?

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