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Welcome. Non-Represented Employees Employees Represented by Local 369. Agenda. Overview of 2013 Benefits Changes Medical Plan Options Dental and Vision Options Open Enrollment – What’s Next? Questions. Benefits Integration. Strategy and Guiding Principles One NU
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Welcome • Non-Represented Employees • Employees Represented by Local 369
Agenda • Overview of 2013 Benefits Changes • Medical Plan Options • Dental and Vision Options • Open Enrollment – What’s Next? • Questions
Benefits Integration Strategy and Guiding Principles • One NU • Offer market based benefits that attract and retain talent, and can be sustained into the future • Maintain choice of benefits to accommodate employees with differing needs • Promote wellness through preventive care and personal responsibility • Reduce impact of Health Care Reform
Expanded Dependent Coverage Introducing 4 Tiers of Coverage (Non-Rep EE only) Employee Only Employee + Spouse Employee + Child(ren) Family (Employee, Spouse, Child(ren) Dependents up to age 26 eligible for coverage regardless of student or dependent status Medical, Dental, Vision, Dependent Life
Glossary of Terms To understand the differences, you will need to understand some key terms • Copay – Your cost that is a fixed dollar amount. • Coinsurance – Your cost that is a percentage of the total billed amount subject to a limit. • Deductible – An amount you must pay before the plan begins to share the cost of some services. • Out-of-Pocket Maximum (OOPM) – The most you will pay in coinsurance, deductible, and some copays. Once you reach the OOPM, your plan will pay 100% of the cost for these services for the rest of the year.
New Medical Options for 2013 1. PPO 100 • Highest fixed out of paycheck cost and greatest stability in out-of-pocket variable costs • Employee cost for all services is a fixed copay - amount varies depending on service • Copays of $100 or more are limited to an out of pocket maximum each year 2. PPO 90 • Lower fixed out of paycheck cost, but greater variation in out-of-pocket cost when services are received • Employee cost for some services is a fixed copay but other services require employee satisfy an annual deductible and then pay coinsurance • Coinsurance and copays of $100 or more limited to an out-of-pocket maximum amount each year 3. Saver • Lowest fixed cost but greatest variability in out of pocket cost • Employee cost for all services is subject to annual deductible and coinsurance but all costs are limited to an out-of-pocket maximum each year • Opportunity to enroll in Health Savings Account (pre-tax contributions) with no “use it or lose it” rule All preventive care services in all options are at no cost to employees
Cigna National insurance company Over 90% of Blue Cross Blue Shield of MA providers currently participate in Cigna’s network—which also includes the Tufts network. Check to see if your medical provider is a participant. You should do this prior to January 1, 2013. Cigna has started the process of recruiting Blue Cross Blue Shield of MA providers who do not currently participate in the Cigna’s network. You can refer your physician to Cigna using the Provider Recruitment Form posted on “Working at NSTAR” Transition of Care for individuals who are receiving medical treatment from a non-participating provider
PPO 100 and PPO 90 Rx Coverage Prescription Drugs Administered by Express Scripts Retail (up to a 34 day) • $6 Generic • $25 Brand • 50% Non-Formulary (up to separate $1,000 annual OOPM/person) Mail Order (up to 90 day) • $12 Generic • $50 Brand • $97 Non-Formulary Retail Pharmacies include, but not limited to: • CVS, Rite-Aid, Wal-Mart • Mail order will be required for maintenance medications
PPO 100 & PPO 90 Rx Coverage If you have an active prescription on file at Medco as of January 1, 2013: Your prescription(s) will automatically transfer to Express Scripts You can continue to login to your Medco account Note: Medco and Express Scripts merged in 2012
PPO 100 Overview 1. PPO 100 • Highest fixed out of paycheck cost and greatest stability in out-of-pocket variable costs • Employee cost for all services is a fixed copay - amount varies depending on service • Copays of $100 or more are limited to an out-of-pocket maximum each year
PPO 100 Highlights Highest paycheck cost but most predictable out-of-pocket cost
PPO 100 Out-of-Pocket Maximum What is the In Network OOP Maximum? • $750 per person per year • $1,500 maximum per family What counts toward this limit? • Co-payments of $100 or more • ER, Outpatient Surgery, Hospitalization, Advanced Imaging What doesn’t? • Office visit copays (PCP & Specialist) • Rx copays (ESI) • Non-covered services When the total you pay out of your pocket for these services equals the OOPM, the plan will pay 100% of these services for the remainder of the year. You will continue to pay for services that are not subject to this limit (Rx and office visit copays) even after you have reached the OOPM.
PPO 90 Overview • PPO 90 • Lower fixed out of paycheck cost, but greater variation in out-of-pocket cost when services are received • Employee cost for some services is a fixed copay • Physician’s office visits • Urgent Care & Emergency Room • Prescription Drugs • Other services require employee satisfy an annual deductible and then pay coinsurance • Lab and Imaging • Outpatient Surgery • Hospitalization • Coinsurance and copays of $100 or more limited to an out-of-pocket maximum amount each year
PPO 90 Highlights Lower paycheck cost but less predictable out-of-pocket cost
PPO 90 Deductible • Applies to only certain services • Lab, Imaging, Outpatient Surgery, Hospitalization • $250 per person up to $500 per family • Example: 2 family members each pay $250 in deductible, no deductible for any other family member • After deductible is met – you pay 10% coinsurance • ER, Rx and In Network Office Visit copays are not subject to a deductible or coinsurance; subject to copayments only
PPO 90 Out-of-Pocket Maximum What is the In Network OOP Maximum? • $1,500 per person per year • $3,000 maximum per family What counts toward this limit? • Deductible • Coinsurance • Co-payments of $100+ (Emergency Room) What doesn’t? • Office visit copays (PCP & Specialist) • Rx copays (ESI) • Non-covered services When the total you pay out of your pocket for these services equals the OOPM, the plan will pay 100% of these services for the remainder of the year. You will continue to pay for services that are not subject to this limit (Rx and office visit copays) even after you have reached the OOPM.
Saver Option Overview 3. Saver Option • Lowest fixed cost but greatest variability in out of pocket cost • Employee cost for all services is subject to annual deductible and coinsurance but all costs are limited to an out-of-pocket maximum each year • Opportunity to enroll in Health Savings Account (pre-tax contributions) with no “use it or lose it” rule
Saver Option is HSA Eligible The Company will contribute to your HSA • $500 if you elect Employee only coverage • $1,000 if you cover at least one dependent You can contribute additional funds through pretax payroll deductions: • $2,750 if you elect Employee only coverage • $5,450 if you cover at least one dependent • Another $1,000 if you are 55 or older at any time in 2013
Saver Option is HSA Eligible Saver is a tax qualified High Deductible Health Plan that allows you to participate in a Health Savings Account (HSA) • If you enroll in the Saver option, you will also be eligible for an HSA administered by Wells Fargo • Funds can be used for any qualified medical expenses including annual deductible, coinsurance, dental and vision expenses, etc. • Unlike the Health Care FSA, these funds rollover year after year if you do not spend them - no “use it or lose it” rule • Funds in excess of $2,000 can be invested and earnings are also tax free when withdrawn for qualified medical expenses
Saver Highlights Lowest paycheck cost but least predictable out-of-pocket cost
Saver Deductible • If election is for employee only coverage, deductible is $1,250 • For any other coverage tier, deductible is $2,500 which can be satisfied by any combination of family member claims • Example: Employee + Spouse coverage • Employee accumulates $2,000 in total cost and Spouse accumulates $500 • Deductible is satisfied for both • Applies for all services except preventive care – even prescription drugs
Saver Out-of-Pocket Maximum What is the In Network OOP Maximum? • $2,500 for employee only coverage • $5,000 for employee plus one or more dependents What counts toward this limit? • Deductible • Coinsurance • Drug copays What doesn’t? • Nothing except non-covered services When the total you pay out of your pocket for covered services equals the OOPM, the plan will pay 100% of all covered services for the remainder of the year.
Saver Option Rx Coverage Prescription Drugs Administered by Cigna Copays after annual deductible is met (subject to OOPM) Retail (34 day) • $0 Generic • $25 Brand • $50 Non-Formulary Mail Order (up to 90 day) • $12 Generic • $50 Brand • $97 Non-Formulary • Mail order for maintenance medications is optional
Saver Option is HSA Eligible Important considerations • Wells Fargo will provide debit card and other payment reimbursement options. • You will need to keep your receipts for your tax records, but Wells Fargo will not ask for validation as with the FSA. • Unlike the Healthcare FSA, these funds rollover year after year if you do not spend them – no “use it or lose it” rule. Save funds for future expenses such as in retirement. • Per IRS regulations, you can not have other medical coverage and you can not be Medicare eligible.
Selecting a Medical Plan Look at the cost of each plan and think about the services you typically use: • What services do you and your dependents typically use? • How are these services covered under each plan? • What is the weekly employee contribution cost? • Do you need a plan with more predictability or would you prefer to have greater control over your total spending?
Medical Waiver Allowance If you have other medical coverage and waive NSTAR’s coverage: $500 Lump Sum Payment Eligible if full-time employee with other health insurance (non-NSTAR plan) Allowance automatically provided to you if you waive medical coverage and are otherwise eligible Must complete HIRD Form (Mass requirement)
Vision Vision Coverage – Vision Services Plan (VSP) • $15 copay for annual eye exam • $25 copay for frames/lenses - every 24 months • $130 allowance then 20% discount over allowance • Contact lens allowance $335 in lieu of glasses (every 24 months)
Vision No Subscriber ID Card or Claim Forms: Locate a VSP Provider Go to www.vsp.com or call VSP at 800-877-7195 Choose the VSP “Choice” network Call the VSP Provider to schedule appointment Identify yourself as a VSP participant
Make an Active Choice for 2013 Some of your benefits will not roll over
Other Important Considerations • Health Flexible Spending Accounts • Contribution up to $2,500 pre-tax dollars to use for eligible pre-tax contributions • Use it or lost it • Non-represented employees have new life insurance benefits that may influence elections for voluntary coverage • A special enrollment brochure will be provided in your OE kit • New ID Cards will be issued – begin using these in January • Medical • Prescription Drug • Dental
Next Steps • Review your open enrollment materials carefully • Mailing in 3rd week of October • Other resources will be available • e-Learning • Carrier Web Sites • Cigna Pre-enrollment Line / Transition Benefits • Cigna Medical Modeling Tool • All employees need to make elections via Self Service – detailed instructions in your open enrollment materials
