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Join our conference call to learn about the changes to employee health benefits for 2014. Discover the new Health Account Plan (HAP) from Anthem and Kaiser, which includes resources for health screenings and tobacco testing. Learn how to earn health account credits, use your benefits, and access support through Provant for billing or coverage questions. Get important details on coverage rules for children, preventive services, and the role of health advocates. Ensure you are informed and ready to manage your health benefits effectively.
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2014 Benefit Changes Conference Call for ESC Represented Employees November 19, 2013
Agenda • New Medical Plan for 2014 • New Resources - where to get more information • What’s changing? • New Plan Design for 2014 • Question and Answer Period
New Resources Provant – Your One-Stop Shop for Health and Wellness Questions Talk to a health advocate for: • Billing Questions • New Health Account Plan questions • Dental or Vision Plan Questions • Questions about health screenings, health accounts • PROVANT • Phone support: • 866-271-8144, M-F, 5am-5pm. Pacific Time • Email support: • PGEsupport@provanthealth.com
New Resources • Details on the new Anthem and Kaiser HAP for 2014 • Accessed from any computer with internet access • What to expect at the doctor and pharmacy on your first visit in 2014 • How to use your different cards • Where to get more information as you use the plans New Website: www.mypgebenefits.com
What’s Changing? What Isn’t Changing? What Is?
What’s Changing? Rules for Covering Children • Children can be covered under your PG&E medical, dental and vision plan until their 26th Birthday • They no longer have to be • students • unmarried • your tax dependent • They can be employed and be offered benefits (New)
New Medical Plan for 2014 • The Health Account • All active employees enrolled in Anthem or Kaiser will have a Health Account • Both the Anthem and Kaiser PG&E plans for active employees will be called the Health Account Plan, or HAP
New Medical Plan for 2014 • The Health Account Health Account Deposits Single Coverage Family Coverage Remember: If you don’t use all your credits in one year, they roll over
New Medical Plan for 2014 • Earning Health Account Credits • Health Screening consists of four tests: • Weight/Height to get BMI • Blood Pressure • Glucose Level (non-fasting) • Cholesterol Level • Tobacco use test is optional anddone with an oral swab • Tobacco users can skip the tobacco use test and complete a tobacco cessation course with Provant to earn credits Employees with family coverage will earn credits for their entire family – their dependents do not need to do a screening to earn credits
New Medical Plan for 2014 • Health Screenings and Tobacco Use Test • Three ways to get a Health Screening/Tobacco Test • On-site event: enroll online at www.provantevents.com/pge or call Provant • Concierge: call Provant at 1-866-271-8144 to schedule at your home or office • Take a form to your doctor: doctor’s offices don’t do tobacco screenings; you’ll need to walk into any on-site screening – no appointment needed. Download the screening form from www.mypgebenefits.com • Check for your results at www.provantonline.com • Have until Sept. 30, 2014 to earn credits for 2014 plan year
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works • Using Health Account Credits • Pay for plan deductibles and other out-of-pocket expenses • Credits can be used for: • medical, dental and/or vision expenses • for you or your family members • unused credits roll over year after year and can be used for PG&E Retiree Medical Plan expenses • You can still contribute to a Health Care Flexible Spending Account (FSA)
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works • Using Health Care Flexible Spending Account • NEW! Can roll over $500 from one year to next, amounts above $500 left in account at end of year are still a “use-it-or-lose-it” • Will work with the Health Account • Administrators: • Your Spending Account (for Anthem Blue Cross members) • Kaiser (for Kaiser members) • Will automatically use the Health Care Flexible Spending Account first
How the Plan Works – Health Account Debit Cards YSA (Anthem HAP) • Use card to pay expenses for: • Medical • Mental health • Pharmacy • Dental • Vision Kaiser HAP • Use card to pay expenses for: • Kaiser pharmacy • Kaiser medical expenses and mental health expenses automatically taken out of your account after your visit to Kaiser • Submit claims to pay for • Dental • Vision
New Medical Plan for 2014 • 4 free primary care visits per year for every covered family member • First choice for everything from chronic disease management, physicals, everyday ailments • Choose a family doctor who knows you and cares about your “whole person” health • Primary Care Doctors • General or family practitioners (including nurses) • Internal Medicine doctors • Pediatricians • OB/GYNs • Urgent care • How the Health Account Plan (HAP) Works
New Medical Plan for 2014 • Other Free Services • Some free preventive screening services (e.g., mammograms, pap smears, colonoscopies, immunizations) • Some free prescription drugs for preventive care and chronic conditions (e.g., insulin for diabetes) • Free maternity and well-baby office visits to age two Go to www.mypgebenefits.com for lists of which preventive services and prescription drugs are free • Tip: free doctor visits may include additional tests or services performed during your visit – these are covered, but may not be free
New Medical Plan for 2014 • A few terms to understand … • Annual Deductible For services that aren’t free, amount you’re responsible to pay for first before the plan will start to pay Co-insurance You pay a percent of the cost of a medical service Out-of-Pocket Maximum The limit on the amount you have to pay every year for covered services
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works • Annual Deductible • If you have single coverage, annual deductible is $1,000 • If you have family coverage, annual deductible is $1,000 per person but no more than $2,000 for your entire family Remember: if you earn all your Health Account credits, you’ll have enough to pay your whole deductible from your Health Account
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works Coinsurance • You’ll be responsible for either 10% or 20% of the covered cost and the HAP will pay the other 90% or 80% respectively. • There are no copayments under the HAP, so instead of paying a flat $10 or $20 copayment at the time of service, you’ll pay 10% or 20% for services that are not free • But, your expense is limited by the Out of Pocket Maximum….
New Medical Plan for 2014 How the Health Account Plan (HAP) Works Out-of-Pocket Maximum • Limits how much you are responsible for paying every year • Once out-of-pocket maximum is reached, all covered services are free for the rest of the year • Includes all money you spend on covered medical services, prescription drugs and mental health services • Includes credits you used from your Health Account for medical expenses • Includes deductible and co-insurance
New Medical Plan for 2014 How the Health Account Plan (HAP) Works Out-of-Pocket Maximum • If you have single coverage, the annual out-of-pocket maximum is $2,400 • If you have family coverage, the annual out-of-pocket maximum is $2,400 per person but no more than $4,800 for your entire family All covered expenses paid at 100% for the rest of the calendar year
New Medical Plan for 2014 • Things to note about pharmacy • Express Scripts will continue to be the pharmacy provider for Anthem Blue Cross; Kaiser provides pharmacy benefits for its members • Free medications for Anthem HAP must be obtained from Express Scripts mail order • Free medication from Kaiser can be from any Kaiser pharmacy or mail order • Anthem HAP members will have mandatory mail order for many maintenance drugs – drugs you take on a long-term basis • In 2014, can get three fills at a retail pharmacy, then must get the drugs through Express Scripts mail order, or pay 100% of the cost • Can sign up now with Express Scripts mail order if currently enrolled in Anthem • Most narcotics, ADHD drugs and compound drugs are not included – you will continue to have coverage for these at a retail pharmacy
What do you need to do now? • Schedule a Health Screening to maximize your Health Account credits for 2014 • If you want a flexible spending account, enroll by November 21, 2013 • Review Health Account Plan User Guide that will be sent to you in late December • Visit www.mypgebenefits.com for more information on the new Health Account Plan • Contact Provant with detailed questions 866-271-8144, M-F, 5am-5pm, Pacific Time PGEsupport@provanthealth.com
Thank You Questions? Log onto www.mypgebenefits.com for more information Email PGEsupport@provanthealth.com Or call Provant at 1-866-271-8144 for medical plan questions