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2012 Open Enrollment October 11th -November 10th New websitewww.myshbp.ga.gov Do NOT wait until the last minute You need to register every year. You can not use your password from last year
2012 SHBP Benefit and Plan Changes • PeachCare FOR KIDS® • TRICARE • Wellness vs. Standard Plans • HRA – prescription protocol • GaBreeze plan changes
2012 Benefit and Plan ChangesPeachCare FOR KIDS® Federal law has changed. SHBP members are now eligible to apply for the – PeachCare FOR KIDS®program
2012 Benefit and Plan ChangesPeachCare FOR KIDS® • a link to the PeachCare website that includes an eligibility calculator to determine if your children may qualify • Complete an application on-line or call and request a paper application • Information is available at 1-877-GA-PEACH (1-877-427-3224) and www.peachcare.org • Earliest an employee can apply is 10-03-2011
Frequently Asked Question Should an employee remove their child(ren) during Open Enrollment (O/E) in anticipation of PeachCare coverage acceptance? No! You should not remove your child(ren) during O/E unless the child(ren) has been approved for enrollment into PeachCare for Kids. Once approved, you have 60 to remove your child(ren) from your State Health plan.
2012 Benefit and Plan Changes New Tricare Supplement Is anyone eligible for TRICARE?
2012 Benefit and Plan Changes New Tricare Supplement • SHBP will again offer the TRICARE Supplemental Insurance to SHBP eligible individuals who are also eligible for TRICARE (which is the military health benefit program). • This coverage is an alternative to SHBP coverage. • This plan is voluntary and the member will pay all of the costs for the TRICARE Supplemental Coverage • Coverage ends at age 65 • Members must provide a Defense Enrollment Eligibility Report System (DEERS) number when enrolling
2012 Benefit and Plan Changes New Tricare Supplement (continued) • Eligibility for Children – NOT THE SAME AS SHBP -Must be single - Age 19 - 23 must be a full-time student or if under age 26 if enrolled in the TRICARE Young Adult Program • Loss of eligibility for Tricare Supplement while actively working - Is a qualifying event to select another option if you make the request within 31 days • COBRA - Members who lose eligibility for SHBP coverage while covered by Tricare supplement will not be offered COBRA For additional information call 866-637-9911 or on the website at www.asicorporation.com
2012 Benefit and Plan Changes New Tricare Supplement (continued) • At Age 65 and RETIRED • SHBP will roll your coverage into the MA PPO Standard Plan with your previous health care vendor prior to Tricare Supplement if we have your Medicare Part B information • If we do not have Medicare Part B information we will put all family members in the Standard Plan of your previous option prior to the Tricare Supplement and will pay 100% of the premiums for coverage
2012 Benefit and Plan ChangesNew Wellness/Standard Plans Wellness vs. Standard
2012 Benefit and Plan ChangesNew Wellness/Standard Plans Old Plans New Plans Wellness HDHP Wellness HRA Wellness HMO Standard HDHP Standard HRA Standard HMO • HDHP • HRA • HMO With these new Plan Options, all members will need to make a new election this year.
2012 Benefit and Plan ChangesNew Wellness/Standard Plans Wellness Plans Standard Plans No Wellness Promise No Biometric Screening Required Higher Premiums Less HRA credit Higher HMP copays • Wellness Promise • Biometric Screening Required • Lower Premiums • More HRA credit • Lower HMO copays
2012 Benefit and Plan ChangesNew Wellness/Standard Plans • Wellness Options are designed to help you (and your spouse, if covered) become a more active participant in your health and require you to take additional steps in engaging in better health. • If you do not wish to participate in the Wellness Options, the Standard Options are available to you.
2012 Benefit and Plan ChangesNew Wellness Plans Rewards received for Wellness Plan Options • Lower premiums (only 11% increase) • Lower out-of-pocket costs through co-payments, coinsurance, deductibles and out-of-pocket maximums
2012 Benefit and Plan ChangesNew Wellness Plans Includes the HRA, HMO and HDHP Plan Options • Wellness Plan Promise: - Members and Covered Spouses (not children) • Each MUST complete an Online Health Assessment • Each MUST Obtain biometric screening* between July 1, 2011 and June 30, 2012 (*Body Mass Index, Blood Pressure, Blood Glucose, Cholesterol – considered preventive and covered at 100%) • Biometric screening results MUST be received by your health care vendor by June 30, 2012
2012 Benefit and Plan ChangesNew Wellness Plans Includes the HRA, HMO and HDHP Plan Options • Wellness Plan Promise: If you or your spouse do not take the Health Assessment, complete and have your physician submit the results of the required screening that includes all four measurements by the June 30, 2012 deadline, you will not be eligible to enroll in any of the Wellness Plan Options the following year.
2012 Benefit and Plan ChangesNew Standard Plans Includes the HRA, HMO and HDHP Plan Covers the same services as the Wellness Plans EXCEPT: • No Promise (no biometric requirements) • Higher premiums (17% increase) • Less credit on the HRA plan • No preventive incentive for the HRA ($125 credit) • Higher Copays under the HMO plan
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans SHBP HRA Credit Comparison HRA Deductibles and Out of Pocket Maximums have not changed. They are the same for the Wellness and Standard options.
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans Prescription Drug Coverage • The Pharmacy benefit - the same under the Wellness and Standard HRA Plans • Pharmacy costs will NO longer apply to the HRA deductible or out-of-pocket limit no matter how you pay for them. • Starting day one member will pay a % (co-pay) amount • HRA dollar credits may be used for prescription drug • The benefit will change to a 3 Tier structure with a minimum and maximum out-of-pocket
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans Prescription Drug Coverageis the same for the Wellness and Standard Plans: A 3 tier structure with a minimum and maximum amount, you will pay as follows: • Tier 1 – 15% (min $20 – max $50) • Tier 2 – 25% (Min $50 – max $80) • Tier 3 – 25% (min $80 – max $125)
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans Prescription Drug Coverage - continued
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans Prescription Coverage Examples–Drug A is Tier 1 Cost of the drug is less than the minimum amount for Tier 1 drugs • For a 31-day supply the usual and customary price (contracted rate) is $15 • The minimum for Tier 1 is $20 • The SHBP Member pays only the $15 since the actual cost is less than $20. Cost of the drug when coinsurance applies for Tier 1 drugs • For a 31-day supply the contracted price is $100 • The Coinsurance is 15% and the minimum amount for Tier 1 is $20 • 15% of $100 is $15 • Since the actual cost is $100, The SHBP Member would pay the minimum amount of $20 Note:The $4 generics from $4 Generic Programs offered by some pharmacies will still be only $4
2012 Benefit and Plan ChangesHRA Wellness and Standard Prescription Coverage Examples – Drug B is Tier 2 Cost of the drug is less than the minimum amount for Tier 2 drugs • For a 31-day supply the usual and customary price is $35.79 • The minimum for Tier 2 is $50 • The SHBP Member would only pay $35.79 since the actual drug cost is less than the minimum. Cost of the drug when coinsurance applies for Tier 2 drugs • For a 31-day supply the contracted price is $350 • The Coinsurance is 25% and the maximum amount for Tier 2 is $80 • 25% of $350 is $87.50 • The SHBP Member pays $80
Frequently Ask Questions - FAQs What happens when I have used all of my HRA credit and I need to purchase prescriptions? The cost would be the same as in the previous examples you would just pay out of pocket instead of using HRA credits.
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans Prescription Drug Coverage • Please note: In addition to your insurance card, United Healthcare (UHC) members will need to provide a separate Pharmacy Health Care Spending Card (PHCSC) to access HRA dollar credits for their pharmacy expenses. (This additional card is not connected to the HCSA you may elect through GaBreeze.) • No separate card is required for CIGNA members at the pharmacy.
2012 Benefit and Plan ChangesHRA Wellness and Standard Plans United Healthcare Pharmacy Health Care Spending Card • How does it work and what happens at the pharmacy? • Activate your card as soon as you receive it by calling the number on the back of your card. • Your card must be activated 1 business day prior to use. • When you use your card, payment is transferred directly from your card to the pharmacy. • Once HRA funds are no longer available transactions will be denied. • This card can only be used for covered prescription expenses (not for medical or dental). • Unauthorized transactions will be denied.
2012 Benefit and Plan ChangesHMO Wellness and Standard HMO Plan Changes The $200 annual vision benefit for glasses and contacts will no longer be offered.
2012 Benefit and Plan ChangesHMO Wellness and Standard HMO Plan Changes
2012 Benefit and Plan ChangesHigh Deductible Health Plan Wellness and Standard HDHP Deductible and Out-of-Pocket Comparison
2012 Benefit and Plan ChangesHigh Deductible Health Plan (HDHP) Wellness and Standard HDHP Co-Insurance and Pharmacy Comparison IN = In Network OON = Out of Network
2012 Benefit and Plan Changes All Plan Options • Certain Tobacco Cessation Medications • Covered when prescribed as part of a Tobacco Cessation Program • Contact each vendor for specifics • Bariatric Surgery • Bariatric (weight loss) surgery will no longer be covered under any plan options
Making Your 2012 Benefit Election - Considerations • Determine if healthcare provider is in-network • Carefully review the 2012 Decision Guide available at www.myshbp.ga.gov • Compare the benefits in relation to the premiums • Check the Preferred Drug Lists for each plan and healthcare vendor as the formulary varies between plans and vendors
Making Your 2012 Benefit Election – Did You? Remember to: Make sure you have selected the correct option Confirm you have added all eligible dependents you wish to be covered Confirm you have answered the surcharge questions correctly Click “Confirm” and always Print your Confirmation (this WILL include a confirmation number)
Making Your 2012 Benefit Election – If You Don’t If you don’t go online and make a 2012 election Your coverage will default to: Tothe Standard HRA, HMO or HDHP Option with your current vendor The tobacco and spousal surcharges (if you cover your spouse) will apply for the 2012 Plan Year
2012 Benefit and Plan Changes Eligibility Changes Surviving Spouse/Adding New Born 90 days to request to continue coverage/add newborn Election Error Reporting Active employees will have until December 31 to report an election error made during the Open Enrollment Period to their Payroll Location Office closure for the holidays will not extend the deadline Once coverage goes into effect, SHBP will not allow a change
2012 Benefit and Plan Changes Eligibility Changes Spousal Surcharge Verification it is important that you answer the Spousal Surcharge questions accurately to avoid disruption of coverage. SHBP will be requesting from you documentation or an affidavit from your spouse’s employer verifying the spouse is not eligible for health insurance. You do not need to take any additional action until documentation is requested.
Important Notice The information provided in this presentation is a summary of changes for the 2012 Plan Year. It is intended only to highlight principal benefits Please refer to the Active Employee Decision Guide for more details TTT, rates, decision guides and other information will be available soon at www.dch.georgia.gov/shbp and www.myshbp.ga.gov 37
Frequently Ask Questions - FAQs Q. If I complete my Health Assessment and obtain my biometric screening but my spouse doesn’t, will I be able to enroll in a Wellness Option in 2013? - A. No. Q. Can I still earn $125 for taking my online health assessment and obtaining my annual physical? A. Yes but only if you are enrolled in the Wellness HRA Plan. Q. If I smoke, will I be able to enroll in a Wellness Option? A. Yes
Frequently Ask Questions - FAQs Q. Can I submit my biometric screening results to my healthcare vendor? A. No. Your physician must fax to your vendor by June 30, 2012. (This physician fax form will be available January 1, 2012) Q. In year two, what happens if my biometric numbers don’t improve? A. You may continue in the Wellness Plan. You will need to show that you are taking steps to improve your health unless you have a medical condition that does not allow you to take steps to improve your biometric numbers.
Questions or Additional Information CIGNA -HMO, HRA, HDHP 800-633-8519 www.mycigna.com/shbp UnitedHealthcare- HMO, HDHP - 877-246-4189 HRA - 800-396-6515 www.welcometouhc.com/shbp Refer to www.myshbp.ga.gov to access additional information 36
Plan Design/Premium Changes for 2012 • Dental Plans • Regular and PPO Dental • Increase in premiums* • No changes to the plan design • DHMO – CIGNA • Increase in premiums* • No changes to the plan design *Premium amounts will be listed on the 2012 Rate Sheet
Plan Design/Premium Changes for 2012 • Employee, Spouse, Child Life and AD&D Plans – Minnesota Life • All life insurance options will deducted as after-tax options. • Plan Enhancements • Child Life • Removed the limitation for 0 - 6 months ($6,000 cap) • Child coverage can begin at live birth • Automatic coverage of $3,000 for a newborn child if the child dies within 30 days of birth but prior to the employee enrolling for child life coverage • Employee/Spouse Life • Legacy Planning Services: End-of-life planning and resources
Plan Design/Premium Changes for 2012 • Short-Term Disability Plans – • The Standard • 5% Rate decrease in STD premiums
Plan Design/Premium Changes for 2012 • Critical Illness Plan – CAIC • Plan enhancement • Additional covered illness: Coverage for Alzheimer’s disease (25% of the benefit amount) Also, if you have the critical/specified illness plan for this year, and went for your wellness check, don’t forget to send them a claim from to receive your $100. You can find the link to the claim form on our website.
Plan Design/Premium Changes for 2012 • Legal Plans – Hyatt • Plan enhancements • Additional covered services for Both plans (Select & Select Plus) • Elder law matters • Home equity loans assistance • Additional covered services for Select Plus plan • Civil litigation defense • Incompetency defense
Plan Design/Premium Changes for 2012 • No Plan Changes • Vision • Long Term Care (contact Unum directly to enroll) • Long Term Disability • Health Care/Dependent Care Spending Accounts
GaBreeze Enhancements for 2012 • GaBreeze Confirmation Number • Employees will receive a Confirmation Number upon successful completion of their online Annual Enrollment on the completed successfully page on the GaBreeze Website • Additional changes will be permitted online during the remainder of the Annual Enrollment period. • Employees will retain the same Confirmation Number • Date/Time Stamp will update to reflect the most recent completion • Employees should print a copy of the Confirmation Number page for their records