Welcome to the 2006/2007 Annual Benefits Presentation • Paul Bogumill • Director of Benefits • (406) 444 – 0329 • Shelley Murphy • Benefits Specialists • (406) 444 – 0330 Montana University System'sFlexible Benefits Program
We Will Discuss • What Are We? • We ARE the Insurance Company • Who Are We? • How To Make Your Benefit CHOICES Work For You. • Plan Changes. • For most there is no increase to your out-of-pocket expense. • And some people will see a decrease in their out-of-pocket expense.
DATE TRANSACTION PAYMENT/ DEBIT (-) DEPOSIT/ CREDIT (+) BALANCE February 2006 Premiums & State Share & Investments $4.5 Million $4.5 Million Administrative Costs (6%) $245,000 $4.3 Million Medical Claims $3.2 Million $1.1 Million Dental Claims $250,000 $850,000 Prescription Claims $848,000 $2,000 Prescription Rebates $28,000 $30,000 Total going into next month: + $30,000 Our Self-Insured Checkbook
Who Are We? • A person employed by a unit of the University System, Office of the Commissioner of Higher Education, or other agency or organization affiliated with the University System or the Board of Regents of Higher Education is eligible to enroll themselves and their eligible dependents in the Employee Benefits Plan. • 17,849 Members • 6,200 employees • 1,200 Medicare Retirees • 350 Non-Medicare Retirees (pre 65) • Average Age = 42.04 40.53 • % Male/%Female = 53.20% / 46.80% 51.62% / 48.38% • Our Risk Mix = 1.019 normalized to national data base • All Of Us Have Plan Representation • Through IUBC
Medical Plan Differences • Familiarity with Insurance Lingo is a MUST to make a good PLAN CHOICE. • Copay * Coinsurance * Annual Coinsurance Maximum • In-Network * Out-Of-Network * Balance Billing • Traditional Plans – most services apply to deductible before plan starts cost sharing. Limited preventive services. • Managed Care Plans – for many services, cost sharing begins immediately without meeting the deductible. • Provider networks are key in maximizing benefit. • Separate Out-Of-Network deductibles and coinsurance maximums.
Traditional Plan Changes Preventative Services – Adult Exams, the $75 and $50 maximums have been removed and we will now allow 90% of UCR. Skilled Nursing – Lowered from 180 days to 70 days per benefit year. Rehabilitative Services – Outpatient services limited to $2000 per benefit year, with Up to $10,000 per benefit year for extended rehabilitative services - with Case Management prior authorization. Hospice – max of 180 days per benefit year. Organ Transplants – max of $500,000, with specific organ dollar limits. Chemical Dependency – Increase dollar cap up to $7000 per benefit year/$14000 lifetime. Increase outpatient dollar max to $2000 per benefit year.
Managed Care Plan Changes Do Not Need To List a PCP – for members enrolled in a Managed Care Plan. You are allowed to visit any network provider with out a referral. PLEASE, PLEASE, PLEASE – work closely with your Managed Care Plan for any elective procedures/services that may involve non-network providers. $15 Office Visit Copay – is for the office visit only, all lab and diagnostic services will apply to deductible and coinsurance. The $15 Preventive Office Visit copay DOES include various lab and diagnostic services, see your Schedule of Benefits for details. Retirees – can now choose a Managed Care Plan. Out of State Elective Services – please visit with your Managed Care Plan for details of accessing these services and having them applied to your In-Network benefit. New Managed Care Plan Offering – one new Managed Care Plan option called CHO Managed Care, is administered by Allegiance. Brings a Managed Care choice to more regions in Montana. MANAGED CARE PLAN INTRODUCTION
Optional Reimbursement Account Enhancements Debit Card – participants in the Medical Optional Reimbursement Account may now choose to use a debit card to pay for services at the “point of sale” – is called the Benny TM Card. There is a $10 setup fee for the card and a $1 per month processing fee – these charges are deducted directly from your flex account. KEEP ALL ITEMIZED BILLS / RECEIPTS!! On-Line Access – Flex account participants may access their account information by going to the EBR website at ebrworld.com. Because this access is available 24/7, employees will be receiving paper statements only twice a year (December 31 and June 30) rather than quarterly. Direct Deposit – employees can have their reimbursement deposited directly to their checking or savings accounts.
What is Long Term Care? andWhy Buy Long Term CareInsurance Now?Long term care is the type of care received either at home or in a facility, when someone needs assistance with activities of daily living, such as bathing and dressing, due to an accident, illness or advancing age. • Guarantee Issue • The younger you are when you sign up, the lower the premiums • Rates will not increase because of your age
Who Pays? National Average • Today, the average nursing home stay costs close to $56,000 a year, though in some areas of the country, it can easily reach twice that amount. • Bringing an aide into your home just three times a week (two to three hours per visit) to help with dressing, bathing, preparing meals, and similar household chores—can easily cost $1,000 each month, or $12,000 a year. • Medical Insurance doesn’t cover most long term care costs. • Medicare only covers short term, skilled nursing home care following hospitalization, and only pays for short term assistance for care at home. • Medicaid only pays after you have depleted your personal assets.
Thank You For Attending PLEASE turn in your CHOICES enrollment form to your campus Human Resource Office in a timely fashion. REVIEW more detail on your various benefit options on the CHOICES website at www.montana.edu/choices
Medicare Part D Coverage Prescription drug coverage from Medicare. Began January 1, 2006. Enrollment in Part D began in November of 2005 and runs through May of 2006. May 15th 2006 is a VERY important date.
MUS Plan Compared with Part D MUS Plan is a Creditable Plan MUS Plan Retail $100 Deductible. 10%, 20%, 30% coinsurance. No holes in coverage. MUS Plan Mail-Order No deductible $20/$40/$60 co-payments. Medicare Part D $250 Deductible. 25% coinsurance up to $2250. No coverage between $2250-5100.
If you enroll in Medicare Part D • No coordination between coverage's. • No subsidy. • May 15th 2006 is an important date
Thank You For Attending PLEASE turn in your CHOICES enrollment form to your campus Human Resource Office in a timely fashion. REVIEW more detail on your various benefit options on the CHOICES website at www.montana.edu/choices For Medicare Part D assistance call 1-800 – Medicare. 1-800-633-4227